Since taking office, Missouri Department of Health and Senior Services director Margaret Donnelly has faced two major challenges:

H1N1 -- more commonly known as the "swine flu" -- and state budget cuts.

On Wednesday, Donnelly touched on both, along with the joys of her job, before an audience gathered at Webster University for the latest Pizza & Politics event hosted by the Holden Public Policy Forum.

Although she didn't say so, the audience's reaction indicated they were more worried about the budget cuts than the flu.

Even during her days as a state legislator from Richmond Heights, Donnelly said she'd never experienced a state income decline like Missouri and other states have experienced during the past two years.

"These are unprecedented times in terms of the lack of state revenue," she said.

Donnelly and her host, former Gov. Bob Holden, recalled how state officials thought things were bad during the first two years of his term (2001-2005), when state income dropped a couple percentage points.

This year, state income is running 12 percent below last year's, which ran about 7 percent below the year before -- meaning that the state income decline in less than two years is running close to 20 percent.

The state Health Department is weathering the downturn better than some other departments, she said, because almost three-quarters of its money comes directly from the federal government (the Centers for Disease Control and Medicaid in-home and community services for the elderly).

Even so, Donnelly said her department has cut about 120 jobs, and "used a scalpel" to make cuts of $13 million during the past fiscal year and $4 million so far this year.

Those feeling the brunt of the cuts are local public-health operations, and local agencies that serve the elderly with such services as Meals on Wheels, she said.

As for H1N1:

The Health Department suspects that most of the 25,548 cases of Type A flu reported by the state's doctors and emergency rooms since Oct. 1 were of the H1N1 variety, based on spot checks that showed 90 percent of the tests came back positive for H1N1.

Even so, the Health Department can document only a few hundred verifiable cases, with most of them in children age 14 and under.

As for H1N1 deaths, the state of Missouri is officially reporting only eight. But Donnelly suspects there were more, that were never documented.

At the moment, she said, even if most of the cases are H1N1, there is no inordinate upsurge of flu cases compared to previous years. Flu cases are making about 2.8 percent of all emergency visits at the moment, which is about average.

Which means Missouri is seeing a typical flu season. That's probably one piece of good news during un-typical bad economic times.