Thousands of employees across the vast Department of Health and Human Services (HHS) began receiving layoff notices as early as 5 a.m. on Tuesday. The purge comes on the heels of HHS

"Mass layoffs is not how you make America healthier," city and county health officials say in reaction to large-scale dismissals of federal health workers.

In a major overhaul, the U.S. Department of Health and Human Services will lay off 10,000 workers and shut down entire agencies, including ones that oversee billions of dollars in funds for addiction services and community health centers across the country.

CMS employees who got RIF notices were directed to send employment discrimination complaints to an official who died last November.

Federal health employees stood outside in line for hours Tuesday at the Department of Health and Human Service’s Public Health Division office in Rockville, Maryland, where people waited to scan their badge and learn if they still had a job.

Matt Cutler had been a longtime employee of the Administration for Community Living. But as of 5 a.m. Tuesday, he became one of thousands of Health and Human Services employees to lose their jobs in the latest sweeping round of cuts at the agency.

Layoff notices began arriving early Tuesday for thousands of employees of HHS and its subsidiary agencies, with as many 10,000 workers potentially expected to be hit by the cuts.

The Trump administration sent out the first round of reduction-in-force notices early Tuesday morning, telling employees the cuts are necessary to improve efficiency. “I’m in shock,” one worker said.

Significant layoffs across the FDA, CDC and NIH are ushering in a new era of public health under the Trump administration.