Perhaps no organization in La Plata County gained more awareness of its work during the coronavirus pandemic than San Juan Basin Public Health.

From protective health orders to vaccines, the agency guided La Plata and Archuleta counties’ response to the crisis that upended the world. San Juan Basin Public Health became a household name in the two-county area, and at times it felt as though the agency was on the tip of everyone’s tongue.

But as COVID-19 cases continue to plummet, the future of the agency is less clear.

The pandemic presented SJBPH with two issues: limited funding and a growing workload. The agency weathered those strains by shifting employees, drawing them into the pandemic response and away from their usual duties, and shifting people and programs to local partners.

As SJBPH emerges from the pandemic, the agency plans a rebound for much of its work as it hopes to meet the needs of the La Plata and Archuleta communities, all while maintaining the awareness of the critical function public health serves.

“We’ve been able to reconfigure over the last eight months into this more normalized state where we’re rebuilding the programs that really did take a hit and creating a (COVID-19) response that has its own funding stream, its own leadership and its own elasticity to respond to the community,” said Liane Jollon, executive director of San Juan Basin Public Health.

Before the pandemic, SJBPH in many ways operated in the shadows.

The agency ran programs that helped those who live in La Plata and Archuleta counties, offering water quality testing, reproductive health access, long-term care coordination and school dental clinics. But those programs were largely invisible for those who did not use them.

As the pandemic took hold in 2020, SJBPH with its community testing sites and public information campaigns became a symbol of the response. Awareness grew among residents of La Plata and Archuleta counties, as they began to understand the important role the public health agency played in managing the highly communicable disease.

“(The pandemic) has been overall very positive as far as the community learning more about public health and getting involved and being a part of our response,” said Chandler Griffin, spokesman for SJBPH.

The medical reserve corps, a group of local public health volunteers, grew from about a dozen to more than 700 as San Juan Basin Public Health’s testing and eventually its vaccine clinics expanded.

But underlying this visibility amid its pandemic response, the agency was facing two crises that were existential and forcing a metamorphosis.

Decadeslong decline

The first crisis extended back more than a decade.

In 2008, the Great Recession rattled the United States’ economy. As the economy shrunk, so did budgets, leading to some of the highest recorded rates of unemployment since the Great Depression, according to the University of California, Berkeley’s Institute for Research on Labor and Employment.

About a fifth of all governmental public health workforce positions were slashed after the Great Recession, about 51,000 jobs in state, territorial and local public health departments, many of which were never replaced, according to STAT, which reports on health and medicine.

In 2000, public health workers already numbered 50,000 less than they did in 1980, according to a 2008 policy brief from the Association of Schools and Programs of Public Health.

Three years after the official end of the Great Recession, local public health agencies were still shedding jobs. In a 2013 report, the National Association of County and City Health Officials found that a third of all local health departments in Colorado lost staff members in 2012.

In addition to a depleted workforce, local public health agencies have seen eroding budgets over the last two decades.

A report by Trust for America’s Health released in 2018 found that state public health spending was lower in 2016-17 than it was during the Great Recession, with funding cuts from the Great Recession never fully restored. The report also cited stagnant federal funding, which accounts for about half of state public health spending, as another reason for lagging spending on public health.

In Colorado, staff challenges and insufficient funding accounted for about two-thirds of local public health agencies cutting at least one program and around one-third cutting three or more programs in 2012.

Amid this backdrop, San Juan Basin Public Health was both trying to respond to the pandemic while also facing further budget cuts as the state attempted to rein in its spending as the economy shuttered.

“We were in this really uncharted territory where we have these tremendous responsibilities to the community and we don’t have money flowing into the organization,” Jollon said. “When the (Colorado) Legislature finally reconvened late spring and early summer (2020) to pass a budget, they passed a budget for the next 12 months that had significant cuts to existing public health programs because the state was anticipating a fiscal crisis due to this pandemic.”

In April and May 2020, SJBPH was considering layoffs.

“Everything got flipped upside down,” Jollon said. “If we think about that, the need for public health couldn’t be greater than it was at this time, but … then we faced some huge cuts in our existing programs.”

The second crisis San Juan Basin Public Health faced was the wholesale reorganization of its staff to respond to the pandemic.

In February 2020, the agency’s leadership team began briefings about the coronavirus to stand up a local emergency response. The weekend of Feb. 29 leaders were asked to begin preparing a reshuffling of staff.

“Our whole team was assigned to go home that weekend and read all of our emergency management plans on communicable diseases, for a pandemic and for continuity of operations should you have to pull your staff from their day jobs into a response,” Jollon said.

Though SJBPH has its own communicable disease division, it soon became apparent to Jollon and others that much of the agency’s staff would have to be redirected to the pandemic response.

“We borrowed staff from every program in the organization starting in March of 2020,” she said. “We put them on the response and changed what their day jobs were.”

With many of its people and much of its resources dedicated to the pandemic, SJBPH had to limit its other programs and services. The agency had to sidestep the services it offered in schools, as well as substance abuse, suicide and environmental programs.

“Anything that involves kind of community building (or) collaboration was suspended,” Jollon said.

With a limited budget and a thin staff, SJBPH had to make the difficult decision to cut two programs and transition them to community partners.

Community Connections Inc., which serves people with disabilities in Southwest Colorado, absorbed the agency’s Single Entry Point case management services in July 2020.

The Single Entry Point program helps those in need of long-term care access services that range from behavioral health support to assisted living and personal care and homemaker services, said Tara Kiene, president and CEO of Community Connections.

“It was actually an interesting serendipity,” she said. “We had been already providing case management for Medicaid waivers for people with intellectual and developmental disabilities and there was a lot of overlap in those two programs and the kind of case management (they) provided.”

The state had already been looking at a model to combine the two programs for those with disabilities and those with long-term care needs, and SJBPH and Community Connections had been discussing a potential transition.

Both made the move of staff members and clients from SJBPH to Community Connections easier, Kiene said.

The second program SJBPH had to disband was its Title X reproductive health services, which it handed over to Axis Health System.

Title X is a federal family planning and reproductive health program that is known most for offering access to contraceptives for low income and at-risk women and men, but also provides pregnancy testing and counseling, STD screenings, Pap tests and breast exams.

Axis Health System had been working closely with SJBPH on testing and the agency’s COVID-19 response, when Tiffany Switzer, deputy director of operations for SJBPH, approached Axis Health System about taking over the program.

“Midway through (the pandemic), the health department, just due to staffing demands to try and get the COVID-19 response out the door, realized they were not going to be able to continue business as it had been operating,” said Dr. Luke Casias, chief medical officer for Axis Health System. “Their biggest concern happened to be a contract coming up with the Colorado Department of Public Health and Environment in regards to the Title X services.”

Late in 2020, with a state and federal grant deadline looming, Axis Health System agreed, submitting the necessary federal and state applications before beginning to offer the services in January 2021.

“We were committed to it and wanted to assist in our partnership with San Juan Basin, so we took it on our staff to pretty much roll out a program that usually takes six months to a year to get going and did it in roughly three months,” Casias said.

The moves of the Single Entry Point and the Title X programs were necessary with stretched staff and a limited budget, but both were still difficult for SJBPH.

“What’s really tricky about the experience that we’ve had for the last two years is that while so much focus has been on the pandemic, many local public health departments, ours included, have had borrow bandwidth from these (other) programs for the response,” Jollon said. “(It) makes very little sense because if people start out healthier, they’re more likely to have healthier outcomes in the face of a communicable disease, including COVID-19.”

On Tuesday, case rates in Archuleta County decreased to their lowest since June 2020. In La Plata County, they decreased to their lowest since September.

Declining case rates and a gradual shift to an endemic response to COVID-19 have allowed San Juan Basin Public Health to normalize operations and leadership to reassess the future of the agency.

In some ways, a new SJBPH is emerging. The agency has established a COVID-19 branch of its communicable disease division, and it is preparing to step into a larger advocacy role alongside other local public health departments in Colorado.

In 2019, local public health officials embarked on a study to better understand the essential functions and services of public health agencies statewide with the goal of working with policymakers and the Colorado Legislature in 2020 and 2021 to better fund and deliver public health across the state, Jollon said.

But in other ways, SJBPH is returning to its roots, to the public health efforts that added 25 of the 30 years American lives gained in the 20th century, according to the Centers for Disease Control and Prevention.

“What we really need to do as an organization is rededicate our resources to investing in steady state programs,” Jollon said.

SJBPH plans to expand water and air quality testing and return to schools for its dental and suicide prevention programs. Its early childhood intervention programs, which moved to virtual outreach during the pandemic, have begun returning to in-person care. The agency will continue tackling the issues of equity and access it previously worked on, but that were highlighted by the pandemic.

SJBPH is also looking to address behavioral health, which has been exacerbated by the pandemic.

“What we’ve seen during the pandemic is some of these non-COVID-19 public health outcomes in behavioral health have been negatively impacted by the pandemic,” Griffin said. “There’s stories out there about substance abuse (and) opioid abuse getting worse, and we’re really focused on some of the areas that need attention after two years of a pandemic.”

As the pandemic already begins to recede in the public’s collective memory, SJBPH will continue the communication and outreach central to its COVID-19 response. The agency’s aim is to sustain its programs and the awareness critical to public health.

“I do hope that this awareness and engagement continues,” Griffin said. “Public health relies so much on participation, awareness and engagement.”

ahannon@durangoherald.com