Should York County have its own health department?
York County officials are responding to the COVID-19 outbreak without the benefit of a county health department, and they're not alone in Pennsylvania.
Only six counties and four municipalities in the state have their own health departments: Allegheny, Bucks, Chester, Erie, Montgomery and Philadelphia counties and Allentown, Bethlehem, Wilkes-Barre and York City.
"When you are faced with a pandemic and you are trying to organize a response on a county level, this is really difficult when you don’t have that infrastructure behind it," said Dr. Matthew Howie, York City's medical director and York County's chief health strategist.
Howie is also executive director of the York Opioid Collaborative, which exists to combat the heroin epidemic in York County.
Howie said he's in daily contact with the York County Board of Commissioners and the county's incident command group at the Office of Emergency Management.
He's been working with the county group to create a dashboard showing the number of patients and the number of available beds at each York County hospital. He said having a wider lens at the county level helps decision-makers for the county and city to coordinate their next moves.
But Howie is only one person, he said, and he's no substitute for the resources of a dedicated health department team.
Not the right time: York County Commissioner Julie Wheeler said in an email Friday that now, in the midst of the coronavirus pandemic, is not the ideal time to consider such a big decision as the creation of a county health department.
"The existence of a county health department has certainly crossed our minds," she said. "But, our priority now is to continue collaborating with our two largest healthcare providers, WellSpan and UPMC to address the health and well-being of our York community."
It generally takes about a year and a half to get a new county or municipal health department up and running, said Nate Wardle, spokesman for the state Department of Health.
Of the counties that do have their own health departments, Chester County is most comparable to York County, which has a population of about 448,000 people, according to the U.S. Census Bureau.
The Chester County Health Department, established in 1968, serves a population of about 522,000 people with an annual budget of $11.4 million.
"Having a health department within the county allows us to respond to a pandemic such as this in a more direct way with the residents of the county, providing communication, education and prevention services for our many communities," Chester County spokeswoman Rebecca Brain said.
One of the resources available through Chester County's health department is an interactive dashboard and county map showing detailed information about coronavirus infections broken down by age, sex and municipality, as well the percentage of infections by population.
The York City Bureau of Health serves a population of about 44,000 people with an annual budget of $1.7 million.
On a day-to-day basis, the York City health bureau provides services for the treatment of sexually transmitted diseases and tuberculosis, operates a vaccine clinic and offers home visits for pregnant and parenting women through their child's second birthday, Howie said.
But when the coronavirus pandemic hit, the bureau had to switch gears, he said.
City officials set up an incident command structure to identify and trace infections, reach out to individuals who may have been exposed and try to contain the spread of the virus in York City.
Howie said the team meets twice a day, and he provides the medical expertise.
"My personal opinion is we would benefit, as a county, from having a county-level public health presence," he said. "I think this (COVID-19) just brings it into high relief."