Developing Local Epidemiology Services Capacity in the Wake of COVID-19

Rural areas often experience limited access to a full range of health care and public health services, suffer from higher rates of chronic disease, and experience greater health disparities when compared to their urban counterparts (CDC, 2019). Furthermore, in addition to these health disparities, rural communities historically lacked the adequate budget, staffing, and infrastructure to best support the many public health needs within their communities (Chillag et al., 2020; Huang et al., 2021; NACCHO, 2020a). The COVID-19 pandemic has only further exacerbated these unique public health challenges, widening the health disparity gaps present in rural areas (Li et al., 2021; Chillag et al., 2020). In particular, vulnerable populations living within rural areas continue to experience disproportionate rates of COVID-19 transmission, hospitalization, and mortality (Kaufman et al., 2020; Li et al., 2021; Tan et al., 2021).  Additionally, challenges in public health messaging and barriers to support or develop local surveillance platforms (often due to limited epidemiology capacity within some small, mid-size or rural health departments) has made transmission of COVID-19 in many communities difficult to track, manage and mitigate (Huang et al., 2021; Chillag et al., 2020).  

Cardno ChemRisk is uniquely positioned to support the needs of local health departments, municipalities, healthcare facilities or anywhere epidemiology services are needed. Our staff has extensive experience in exposure and health data analysis, disease surveillance and interpretation, epidemiologic research design and management, health risk communications, community health assessment and public health improvement planning and science-based decision-making guidance. We were recently hired by Inyo County, California to perform epidemiological analysis, interpretation, and evaluation of technical, medical, laboratory, demographic, and statistical data, with a focus on conducting analysis of communicable diseases (including COVID-19), suicides, drug and alcohol abuse, behavioral morbidity and mortality and related health concerns (link to the press release).

While many small, mid-size, and rural health departments have limited capacity to house full-time epidemiologists on staff, the COVID-19 pandemic has highlighted the importance of developing robust public health capacity in smaller jurisdictions (NACCHO, 2020b; Beck et al., 2017; Department of Treasury, 2021). With such recognition, several primary funding sources, including money appropriated to state and local governments under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and the American Rescue Plan Act (ARPA), are aiming to build epidemiology and public health response capacity and funding in small, mid-size, and rural health departments (Department of Treasury, 2021). 

In March of 2020, the CARES Act was passed via the Coronavirus Relief Fund and provided $150 billion for immediate financial assistance to health departments, including local health departments within rural areas (Department of Treasury, 2021; Figure 1). As the pandemic progressed and national needs evolved, ARPA was enacted in March 2021. ARPA appropriated $350 billion for state and local health departments to enhance their capabilities and ameliorate their pandemic-related financial burdens (Department of Treasury, 2021; Figure 1). These Coronavirus State and Local Fiscal Recovery Funds provide support for vaccination programs, testing and contact tracing, vulnerable populations to access medical or public health services, public health surveillance, enhanced capacity, and public health data systems and services to address mental health needs (Department of Treasury, 2021). These funds are particularly beneficial to rural health departments that can use them not only to reduce the gap in the response to COVID-19, but to help build or bolster sustainable epidemiology services capacity now and into the future.

To learn more about the ways Cardno ChemRisk can support your epidemiology and community health assessment needs, please contact Dr. Tony Cappello or visit our website at

Figure 1. Duration of CARES Act Coronavirus Relief Fund & the ARPA Coronavirus Fiscal Recovery Funds