From the director of the St. Francoise County (Missouri) Public Health Department (boldface mine):

We weren’t set up well to deal with this virus in Missouri. We have the worst funding in the country for public health, and a lot of the things we’ve needed to fight the spread of covid are things we should have had in place 10 years ago. We don’t have an emergency manager. We don’t have anyone to handle HR, public information, or IT, so that’s all been me. We didn’t get extra funding for covid until last month. I’m young and I’m motivated, and I took this job in January because public health is my absolute love. It doesn’t pay well, but would I rather be treating people who already have a disease or helping to prevent it? That’s what we do. We help take care of people. At one point this summer, I worked 90 days straight trying to hold this virus at bay, and my whole staff was basically like that.

Over four years ago, some asshole with a blog noted this about our public health ‘system’ when it came to Zika virus:

We don’t have a public health system: at best, we have 51 state* systems, but when we’re talking about mosquito control, it’s even more fragmented. And movie plots notwithstanding, the CDC has little or no control over these entities. To the extent it does, it’s largely the power of the purse (if CDC funds an initiative, it can call the shots). There’s no command-and-control here, only coordination at best.

Right now, luck is going to play a big role in whether Zika will become established in the continental U.S.–and that’s not a policy.

We got lucky with Zika (mostly). COVID-19… not so lucky.

You get the public health system you pay for, and since so much of it has been devolved to the states, there are many areas where we simply haven’t paid for what is needed.

In a manner of speaking, now we’re paying for it.