It would be another long day, and Dr. Glennah Trochet, Sacramento County's chief public health officer, needed a moment to compose herself. Her eyes grew moist as she pressed her fingers to her lips, her usually cool demeanor suddenly melting under the strain.

She wanted to talk about her staff's dedication, their sense of public mission, she said, amid a week of fierce anxieties over a new form of influenza that has killed scores in Mexico, sickened dozens in the United States and was approaching a full-fledged global pandemic.

The swine flu outbreak has brought local health departments closer to their breaking points – whether emotionally or financially – as they attempt to stay ahead, or barely keep up with, an unfolding emergency.

"We have said for lots of years that we are much better prepared, and I think this is proving it. So far, so good," said Trochet. "But as it ratchets up and as it gets worse, we will have to see … whether we can rise to the occasion."

Over the years, budget cuts have left local health departments hemorrhaging staff and resources. As a result, public health offices are showing the strain.

It was just Friday a week ago when Trochet assembled her staff to deliver dispiriting news: In a few short months, she told them, many would be losing their jobs.

Two days later, the county's first cases of swine flu would emerge.

"On Sunday I called those same people into work, and they did. They've been working ever since, even though they know their positions may be eliminated," said Trochet, before losing her composure.

"I certainly hope the dedication of my staff will be rewarded," she said, "and they'll be able to keep their jobs."

In 2008, local health departments across the country lost $300 million and 7,000 staffers to budget cuts and could lose an equal number of workers this year, according to the National Association of County and City Health Officials.

"We're concerned that the worst is yet to come," said Donna Brown, a government affairs counsel for the association.

Health departments have responded to the challenge by shifting resources, including nurses, doctors and caseworkers. Routine duties, including some non-urgent visits with patients, are being delayed to free up staff.

"Should the outbreak intensify dramatically," Brown said, "we will then grow very concerned about our capacity to respond."

In just two years, Sacramento County's Division of Public Health could lose nearly half its budget from the county general fund – dropping from $9.8 million to $5.1 million – and pare more than a fourth of its work force. Last year, 57.4 full-time positions were shed; an additional 31 or more could be lost this summer, bringing staffing below 228 full-time-equivalent positions, according to the agency. Another day of reckoning will arrive this summer, when the county Board of Supervisors determines its spending priorities.

In the first five days of the local outbreak, county health workers devoted 1,200 hours, about a fourth of it in overtime, according to the division's tally.

"How are we going to pay for it? I just don't know," said Trochet.

The uncertainty of budgets has indeed taken its toll on local health departments, noted Dr. Richard Besser, the acting chief of the Centers for Disease Control and Prevention in Atlanta.

"We as a nation rely on public health personnel at the state and local levels to identify these outbreaks and identify them quickly," he said Tuesday. "We have an outstanding health system, but it is in a tough situation."

California's Department of Health reduced local grants to absorb the 10 percent spending cuts all state agencies were ordered to make under Gov. Arnold Schwarzenegger's plan to close a huge budget gap.

Local health departments are counting on the federal government to provide relief by authorizing supplemental funding.

The new strain of H1N1 virus does not appear to be as virulent as first thought, but local health agencies continue to act with urgency because so much remains unknown about the virus, said Dr. Joseph Iser, the director of Yolo County's Department of Health. On Friday, the county said it had two probable swine flu cases and expected more.

Call The Bee's Bobby Caina Calvan, (916) 321-1067.