Local public health officials were sometimes unsure about their direct role in following up with suspected ill patients and collecting and shipping clinical samples for laboratory testing. For example, there was frequently confusion around whether it was the responsibility of the local health department, the state health department, or the medical personnel at the hospital to collect laboratory samples. Once the samples were collected there was often confusion around whose responsibility it was to transport the samples, and in a few sites, local law enforcement were surprised to find out that they were the responsible party. A related issue was the ability of health departments to realistically generate enough surge capacity in their public health workforce to investigate or respond to a large event, especially one that encompassed multiple jurisdictions in the same state, thereby limiting the state health department's ability to shift manpower and resources from one jurisdiction to the next.