What is federal COVID relief money for anyway?

As daily news headlines detailing the spread of bird flu grow, so does Dr. Leonard Mermels’ anxiety.

An infectious disease expert who serves as medical director of Lifespans’ Department of Epidemiology and Infection Control, Mermel fears that the H5N1 bird flu outbreak now detected in cows and skunks in the United States will make the jump to humans .

The fatality rate of this virus in humans is as high as 30%, Mermel said in a recent interview. This is 10 times more deadly than SARS-CoV-2 [the name for virus causing COVID-19]. We want public health authorities to be prepared.

However, federal aid to Rhode Island state agencies to deal with public health emergencies, including the response to COVID-19, has barely been touched. And now, Gov. Dan McKee wants to repurpose more than half of that leftover funding into other non-health projects, like rebuilding Washington’s Interstate 195 bridge and the states’ unemployment insurance trust fund.

The funds must be obligated by December 31 of this year and spent by the end of 2026. according to the US Treasury Department.

The Pandemic Recovery Office, a subset of the Rhode Island Department of Administration (DOA), identified several buckets of federal COVID-19 funds as being at risk of significantly underspending, due to lack of use to date. With a December deadline to obligate the funds, state officials recommended returning $40 million in unspent state tax recovery funds (SFRF) to the state for other projects, according to a January report from the Office of Pandemic Recovery

The funds, part of the $1.1 billion share of American Rescue Plan Act aid, were originally intended to pay for COVID-19 testing, vaccines, contact tracing and other public health measures .

The state has not seen an increase in cases large enough to require its use, DOA spokesman Derek Gomes said in an email Friday.

Not so fast, countered Mermel.

Between the prospect of an even deadlier public health crisis if bird flu spreads to humans and the inevitable rise in COVID-19 cases as the virus continues to mutate, he wants the state to hold on to federal funds for health emergency preparedness and response. .

We don’t know what’s on the horizon, Mermel said. We must have a strong public health system to identify, manage and slow transmission.

Indeed, staff shortages and shortages of testing centers and vaccines in the initial outbreak of COVID-19 showed states’ lack of preparedness.

Dr. Michael Fine, a former state health director who serves as chief health strategist for the cities of Central Falls and Pawtucket, recalled asking the federal government for money to set up testing centers in the hardest-hit communities when COVID- 19 hit Rhode Island for the first time.

When federal aid became available, and state leaders developed a plan to spend it, passed along with the 2023 state budget, the sense of urgency surrounding the COVID crisis had subsided.

The Department of Health of the State reported 9,120 total cases of COVID-19 in June 2022, when the states’ long-term spending plan for federal pandemic aid was approved. At that time, there were 30.6 hospital admissions and 8.8 deaths per 100,000 residents. Cases, hospitalizations, and deaths reported in the state have continued to decline, with 408 total cases, and five hospitalizations and less than one death per 100,000 residents in April 2024.

As of January 2022, state health officials reported more than 101,000 cases with a hospitalization and death rate of 181 and 30.4, respectively, per 100,000 population.

McKees’ original pandemic spending plan, passed in fiscal year 2023, included $186.9 million for states’ COVID-19 response through fiscal year 2025. That was separate from money given to hospitals, nursing homes and community health centers.

A year later, as part of the 2024 budget, $110 million was moved to other projects. The remaining $73 million was split between the Department of Administration ($41.8 million) and the Department of Health ($34.9 million). None of the DOA money has been spent, while the health department has used $13.4 million of its COVID-related funding through March 2024, according to data from the Office of Pandemic Recovery.

McKee in its initial budget proposal for the 2025 financial year filed in January, proposed shifting $20 million of DOA’s COVID aid to other projects, including bridging budget shortfalls to the Rhode Island Department of Corrections and the Rhode Island Public Transportation Agency. On April 22, McKee proposed a budget amendment essentially draining the remaining money from the DOA COVID, leaving just $1.8 billion for fiscal 2025.

Instead, McKee proposed spending the money on housing and homelessness initiatives, state transportation projects including the state’s share of the cost to rebuild the Washington Bridge and bolster the unemployment insurance trust fund , among others, according to a separate budget. amendment note presented on the same day,

Sen. Sam Zurier, a Democrat from Providence, wasn’t sold.

I’m just wondering if this is the right time to take $20 million out of our COVID program and use it for the bridge, Zurier said during an April 23 State House hearing on the department’s budget of health

His comments came seconds after state health officials shared updated vaccination rates during the same Senate Finance Committee hearing, showing that 18 percent of Rhode Islanders have received the latest COVID-19 vaccine. 19.

Seema Dixit, RIDOH’s deputy director, blamed the apparently low turnout on vaccine fatigue, noting that Rhode Island is on par with regional and national averages. From April 1914% of children and 22.8% of adults nationwide had received the latest COVID vaccine, according to the Centers for Disease Control and Prevention.

Zurier was not satisfied.

That means five out of six people don’t get that vaccine, he said during the Senate Finance Committee hearing, noting that the health department’s own budget presentation acknowledges the risk of possible increases in COVID-19 in the future

In a later interview with the Rhode Island Current, Zurier explained.

The primary responsibility of this money is to give us resilience against this and future pandemics, he said. I just want to make sure we were doing everything we could before giving up that money.

Public Health Funding Wish List

Dixit seemed skeptical that more education and outreach could get more Rhode Islanders to roll up their sleeves for the latest bout of COVID-19. But other public health experts offered a host of ways to spend federal aid on public health care and preparation.

Among the top prescriptions: bolstering the states’ primary care workforce, which has suffered from shortages even before the COVID-19 pandemic hit town.

We know there is a critical shortage of primary care physicians, and they are one of the most reliable sources for encouraging vaccines in underserved communities, said Chris Gadbois, CEO of the nonprofit Carelink Inc. and former president of the board of the Rhode Island Public Health Association.

A group of bills being considered in the Rhode Island State House aim to address the primary care shortage. Among them: proposals to start a scholarship program encourage medical and nursing students to stay in the statei increase the number of clinical training centers where primary care professionals can hone their skills. The combined $3.5 million in funding required in fiscal year 2025 for both initiatives was originally proposed to come from state general revenue.

But perhaps that would be a better use of pandemic aid than a bridge, which while crucial, has little to do with the aftermath of the crisis that spurred the funding, Zurier said.

The Center for Budget and Policy Priorities based in DC a January 2023 report He specifically named state transportation projects and unemployment insurance trust funds as examples of federal pandemic aid spending that don’t actually address the human and health impacts of the crisis.

Federal guidelines allow states to spend relief from the American Rescue Plan Act to replace lost revenue, in addition to programs that address health, economic and human service gaps created by the pandemic. But just because they can, doesn’t mean they should, said Whitney Tucker, the centers’ director of state tax policy research.

Some of those initiatives, like a bridge or unemployment trust fund, fall outside the spirit of what the funding was intended for, Tucker said. I’m not saying there aren’t urgent needs, but they aren’t needs that should be financed with this money.

Rhode Island’s revised pandemic relief spending plan, adopted in the fiscal year 2024 budget, allocates $600 million more than half of its $1.1 billion windfall to the negative economy. The revenue recovery represents an additional $371 million in funds allocated by July 1, 2023, equivalent to one-third of total aid. Meanwhile, the $120.6 million allocated to public health represents just under 11% of federal funding.

McKees’ office deferred questions for comment to the state health department.

Joseph Wendelken, a health department spokesman, provided an email response highlighting the $32.2 million still available in the proposed fiscal 2025 budget for the prevention and control of COVID-19.

Combined with other non-SFRF funding sources, we have the resources we need to effectively do the work related to the prevention and control of COVID-19, Wendelken said.

According to Wendelken, the health department plans to spend the entire $32 million on surge needs related to COVID, technical assistance, data and analytics and communications in fiscal year 2025. A separate allocation in the proposed fiscal year 2025 budget, funded through a restricted receipts account for health insurer fees, would pay for the COVID-19 vaccines.