However public well being specialists say the character of the pandemic, which is available in waves of arduous to foretell magnitude, makes it tough to find out how ready New Hampshire is for future surges, particularly with legislative efforts within the Statehouse to curtail some key public well being instruments.

And as public well being leaders look forward, they fear New Hampshire is lacking a vital alternative to construct on the infrastructure developed over the course of the pandemic, to arrange for future public well being crises.

“Our query shouldn’t be: How can we get via the subsequent three months or six months or a yr?” mentioned Anne Sosin, a coverage fellow on the Nelson Rockefeller Heart for Public Coverage at Dartmouth Faculty, “However moderately: How can we make the investments to have a public well being infrastructure for the long run?”

From testing to therapy, right here’s the place New Hampshire stands on key COVID-19 infrastructure:

State managed testing and vaccination websites closed final month amidst a major drop in demand. On common, every of the 11 state-managed vaccination websites was administering round three photographs per day in March. Every of the seven testing websites averaged round 10 exams per day. Turnout was so low that workers working a number of the websites agreed it was time to shut them.

For Coos County Household Well being Providers, which covers round 12,000 sufferers within the area, the closure of a close-by state-managed vaccination website in Berlin made sense. Valerie Hart, the chief working officer and a nurse with the well being heart, mentioned to this point, workers have had no drawback shifting their vaccination and testing companies to satisfy swings in native demand this month. The well being heart has been holding extra vaccine clinics, with many North Nation residents newly eligible for a second booster.

However there may be some concern that the pullback of state-managed COVID companies may place a major burden on some well being suppliers, who’re already quick staffed, particularly within the occasion of one other massive surge. That’s precisely what occurred within the late fall and winter, when the state was concurrently experiencing its worst COVID-19 surge together with excessive demand for boosters and the vaccine for younger kids.

Sosin, of Dartmouth, mentioned basing the necessity for public COVID companies on demand isn’t the best method, particularly as important gaps in vaccination stay. A lull in COVID circumstances, such because the state is experiencing proper now, she mentioned, is one of the best time to give attention to closing these gaps with focused efforts.

“If we don’t shut the gaps in vaccination within the state, we’re going to see surge after surge that impacts our rural well being programs disproportionately,” Sosin mentioned.

Sosin mentioned rural areas have each decrease charges of vaccination than the remainder of the state, and still have much less capability to deal with surges. New Hampshire’s winter surge, she mentioned, was an instance of the actual pressure on rural hospitals, who struggled to switch sufferers in want of specialised care they usually would ship to bigger establishments.

However New Hampshire’s public well being staff, who’ve needed to put different vital priorities on the backburner for over two years now, don’t essentially have the bandwidth to ramp up their efforts to focus on the unvaccinated.

It’s a degree Sosin mentioned illustrates a bigger challenge: a scarcity of sustained funding for public well being. Extra sources, she mentioned, may enable for the rise of focused vaccination outreach and help different well being initiatives. Whereas a whole lot of hundreds of thousands of {dollars} in emergency federal pandemic support have poured into the state prior to now two years, it’s not a long run funding.

In the meantime, on the federal stage, funding for testing, therapy and vaccines for the uninsured has run out. The bipartisan invoice in Congress to supply extra COVID funding doesn’t embrace more cash to reimburse suppliers who deal with folks with out insurance coverage.

In New Hampshire, COVID care like testing stays obtainable without cost for the uninsured, however it might be harder to entry. The onus for a free take a look at or therapy can fall on people to join New Hampshire’s Medicaid COVID-19 profit.

The profit additionally covers pressing care visits and emergency room visits because of the virus, and the protection may be utilized retroactively, for 90 days after the appliance is submitted.

Some New Hampshire suppliers usually are not charging uninsured Granite Staters for companies like testing, however others are. Chain pharmacies like CVS and Ceremony Assist proceed to supply free exams and vaccines.

As infrastructure for vaccination and testing winds down, entry to COVID-19 remedies is rising throughout New Hampshire. Remedies at the moment are obtainable at almost 300 areas within the state, together with pharmacies, well being facilities and hospitals.

New Hampshire continues to obtain extra doses of extremely efficient remedies, just like the Paxlovid tablet, which may also help hold COVID constructive sufferers out of the hospital.

However accessing the treatment isn’t all the time easy. The antiviral is handiest early in sickness, and sufferers want a prescription for it. New Hampshire has solely six CVS areas with the potential to check and prescribe onsite. Some well being facilities that work with low earnings sufferers like Coos County Household Well being even have this potential.

For sufferers with no major care supplier or for many who might not know concerning the therapy, accessing it may be tough, mentioned Ed Laverty, the chief medical officer at Higher Valley Connecticut Hospital in Colebrook.

Demand for the therapy on the hospital is so low proper now that the hospital has widened its eligibility classes, Laverty mentioned.

Help for public well being

From masking to vaccines, public well being instruments are simpler the extra extensively they’re applied. Consequently, a part of New Hampshire’s COVID-19 infrastructure is tied to Granite Staters’ willingness and talent to observe public well being steering.

However New Hampshire residents have turn out to be more and more much less trusting of well being businesses just like the CDC because the pandemic has worn on, in response to polling by the College of New Hampshire Survey Heart. That may translate into native resistance to following state and federal tips on masking or social distancing.

Efforts on the Statehouse replicate the resistance, with a number of payments transferring ahead that public well being leaders fear would curtail their potential to combat future surges. One invoice would weaken the effectiveness of vaccine mandates and one other would prohibit masking necessities in colleges.

Public well being leaders have known as these efforts an assault on their work, and fear this legislative session can have implications that final properly past this pandemic. For instance, one invoice would make it tougher for the state Well being and Human Providers Division to mandate future vaccines for varsity attendance. The invoice requires the division to first get a supermajority vote from the Joint Legislative Oversight Committee on Well being and Human Providers.

Whereas there was important uncertainty as as to if or not the state would proceed its Public Well being Incident declaration on the finish of March, it was prolonged via June 30, 2022.

Which means New Hampshire’s regional public well being networks can proceed to carry vaccine clinics and the state may have a better time accessing some emergency funding. Emergency SNAP advantages, that are tied to the incident declaration, can even proceed.

On the federal stage, a public well being emergency declaration additionally stays in place, which suggests New Hampshire will proceed to obtain federal funding for pandemic initiatives like protected Medicaid protection.

However crisis-driven funding cycles make it tough to construct long-term public well being infrastructure. Thus far, the pandemic hasn’t modified that in New Hampshire.

In truth, specialists say New Hampshire entered the pandemic with an already underfunded and siloed public well being system.

The state has 13 regional public well being networks, with restricted workers. Whereas the mannequin may also help networks develop a robust understanding of native well being wants, it could additionally make a centralized response to a public well being disaster like a pandemic tough, mentioned Sosin.

She in contrast New Hampshire’s public well being system to some neighboring states, like Vermont, which has district stage public well being workplaces.

Due to the pandemic, hundreds of thousands of {dollars} for vaccination, testing, and momentary workers have poured into states, together with New Hampshire. However a lot of the funding was for particular COVID emergency response efforts, like vaccination campaigns, moderately than to help long run public well being infrastructure to reply to future massive scale public well being crises.

Scott Schuler, incident commander of the Seacoast COVID-19 complicated, mentioned they need a number of the new positions they’ve gotten funding for have been extra everlasting, to permit them to construct one thing extra long run. It additionally makes hiring difficult.

“How do you rent somebody for six months?” Schuler mentioned.

What Schuler desires to see is funding for a framework that can enable New Hampshire’s public well being networks to “flex up and flex down,” to satisfy not solely future surges of COVID-19 however future public well being emergencies.

“It’s like having your hearth division: They’re not busy on a regular basis, however you will get actually busy, actually quick, and overwhelmed in a second,” Schuler mentioned.

However funding for that sort of service isn’t all the time politically palatable. Traditionally, the urgency to fund public well being isn’t there, till the hearth is already burning.

Jane Goodman, public well being community strategist with the Nashua Division of Public Well being and Group Providers, was hopeful the pandemic may assist change the boom-or-bust manner public well being is funded.

“We have to construct our public well being infrastructure as a result of it’s horrendous throughout the nation,” mentioned Goodman.

However the so-called Construct Again Higher invoice, which included important public well being infrastructure funding and pandemic preparedness failed this previous winter within the U.S. Senate.

Nonetheless, Goodman says the Nashua division is making an attempt to do what it could to construct long run emergency preparedness for future outbreaks of communicable illness.

In its newest group enchancment plan, which outlines 5 priorities for the Nashua area, the division determined to make communicable illness a prime precedence.

Human infrastructure can be a priority for a lot of in New Hampshire’s public well being sector, the place staff have been stretched skinny after two years responding to the pandemic.

Earlier this yr, Ashley Desrochers left her job working in public well being. Desrochers helped lead the general public well being response in Strafford County, together with vaccination efforts throughout the area. Months of working 60 to 80 hour weeks responding to the disaster took a major toll on her well being. She mentioned it felt like making an attempt to place out a by no means ending hearth.

“I didn’t get to have the scared emotions,” she mentioned. “I used to be so busy working and making an attempt to repair it that I wasn’t allowed to really feel like a human. I sacrificed a lot of myself to try this work.”

In direction of the top of her time within the subject, Desrochers took medical go away.

“My mind was lifeless, I couldn’t suppose. Noise made it arduous to perform. I had seizures,” Desrochers mentioned. She’s in counseling now for PTSD.

Whereas Desrochers mentioned she received casual help from colleagues, she needs there have been extra official help constructions for each public well being staff and first responders throughout the state.

The dearth of a extra sturdy pre-existing public well being infrastructure meant many public well being staff have been compelled to tackle unmanageable workloads. The rising politicization of their work added new stress, as properly.

Greater than half of individuals working in public well being on the state, tribal, native and territorial ranges throughout the pandemic reported signs of not less than one critical psychological well being situation, in response to a 2021 large-scale survey performed by the CDC. The survey additionally discovered that public well being staff confronted greater charges of PTSD than different frontline healthcare staff.