In and around Asheville, N.C., there are still visible signs of devastation that remain from the floods of Hurricane Helene six months ago: rusted debris in the yards of water-damaged residences in ruins.
But Helene, a federal disaster worker who coincidentally goes by the same name as the storm, also worries about this community's invisible problems that tend to persist, months later — like mold and financial and mental health aftereffects.
"That six-month mark is a really critical time," says Helene, who spoke to NPR on the condition of partial anonymity because she fears retaliation for talking to the media.
Until April 1, Helene worked at the National Center for Environmental Health at the Centers for Disease Control and Prevention. Her team parachutes in after storms, wildfires, factory explosions, or toxic spills to help state and local officials assess where to put emergency resources. Helene and her CDC colleagues lost their jobs in Elon Musk's DOGE-directed layoffs of about 10,000 staff at federal health agencies.
On April 1, Helene and about 55 other public health workers from the county and state government, as well as a local university, were set to go door to door, surveying 210 households about any enduring challenges facing residents of Asheville's Buncombe County.
They'd prepared detailed questionnaires about food insecurity, unsafe drinking water and toxic chemical exposure. The mission of Helene's CDC team was to collect and process that survey data and write up a report — all within 48 hours — so that local officials could solve residents' most pressing problems.
"The hardest phone calls"
Helene and other CDC colleagues were en route, or already on site in North Carolina, when they all received the "reduction-in-force" emails placing them on administrative leave. They had to abort the mission, and Helene had to deliver the news to their partners at the state and county level.
"It was really one of the hardest phone calls I've ever had to do in my career," says Helene.
The suspended Buncombe County survey is just one example of the many local and state efforts supported by federal health agencies caught up in the Trump administration's deep cuts to government staffing and spending.
Helene says she feels heartbroken. "I feel like I let down the community; I let down the health department; I let down North Carolina itself," she says. "I lost my job, but people have lost so much to these disasters and we're not out there … finding out what the community itself needed."
Federal cost-cutting rationale
The CDC is part of the federal Department of Health and Human Services. Neither CDC nor HHS responded to requests for comment on the specifics of this story.
In a fact sheet, HHS said CDC's workforce was being reduced by 2,400 people, and that the goal is to streamline divisions within the agency and get rid of redundancies.
On X, HHS Secretary Robert F. Kennedy Jr. expressed sympathy for those who lost their jobs. "But the reality is clear: what we've been doing isn't working. Despite spending $1.9 trillion in annual costs, Americans are getting sicker every year," Kennedy wrote in a post. "We must shift course. HHS needs to be recalibrated to emphasize prevention, not just sick care."
Overall, the HHS workforce is going from approximately 82,000 people to 62,000 people, the agency says, including staff who took offers of early retirement or DOGE's "fork in the road" offer. Overall, it's a reduction of 25% of the workforce. HHS is also cutting its contract spending by 35% across the board.
"Human-to-human interaction"
The impact of the cuts on the North Carolina project were immediate. But Helene — and others involved — wonder how the downsizing will affect both federal and local responses to any future disasters.
"I was really, really disappointed," says Ellis Matheson, Buncombe County's public health director, who was on the receiving end of one of Helene's phone calls April 1.
"We had publicized this to the community; they knew that we were going to be coming," Matheson says. That, too, had to be undone: "We had to notify the public that we would not be coming."
Matheson says it was a missed opportunity to address people's needs. "There would have been human-to-human interaction, and people could ask questions, say what resources they need," she says. "And right there in the moment, we could connect them with those resources."
Matheson says the county health department plans to eventually regroup, but without the CDC's help, her team could not carry out the project as planned. "That expertise of being able to help us with the analysis and develop a report was really vital; that subject matter expertise, we really rely on that," she says.
Devastating storms brought tornado damage and floods to a wide area in the South and Midwest the day after the CDC cut its team that responds to such disasters.
States rely on CDC expertise
Subject matter expertise at the federal level exists at the CDC precisely because it simply isn't possible or feasible for every state and locality to have its own disaster experts, says Dr. Zack Moore, an epidemiologist with North Carolina's Department of Health and Human Services. "That's the reason the CDC exists."
Moore says the Buncombe County survey is just one example of the ways states routinely rely on the CDC to keep residents safe from disease and disaster. "Beyond hurricanes, they do radiation preparedness, toxicology issues, surveillance for illnesses in Red Cross shelters after a disaster — anything from disease outbreaks to mental health needs," he says.
As in all other states, Moore says, North Carolina's health department is also extremely reliant on funding from the CDC — something that's also been slashed amid Trump's cuts to federal agencies. Moore, who oversees departments in infectious disease, vaccination and environmental disaster, says 90% of his budget comes from the CDC. Yet he says many people aren't aware how heavily states rely on federal funding for essential services like his: "We get very little funding from the state."
There are many worrying public health issues right now, Moore muses — "oh, gosh, hurricanes, measles, flu" — but one of the most pressing new concerns overarching all of them is the hollowing out of the CDC's environmental health division.
"Having them instantly disbanded is going to leave a big gap," Moore added.
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