Public health officials under siege
The problem starts here. |
When
their vigilance gives us the green light to eat, drink, and recreate, we hardly
notice them waving us onto normal activities, barely knowing their names.
When
the light turns yellow for bacterial beach closures, stay-indoor smog alerts,
long-pants advisories for Lyme disease ticks and temporary restaurant closures
for rats and roaches, most people accept these measures from health
commissioners to assure safety, despite any grumbling over momentary
inconvenience.
Even
in instances when the light goes red, such as for citywide drinking water
contamination, most people are thankful for the guard waving the STOP! sign,
even if they have to trudge to the store for bottled water.
The
COVID-19 pandemic has put public health officials in a more perilous
place—alone in the middle of the intersection, with horns honking in
gridlock—caught between the common good and the often-toxic American drive for
so-called personal freedom.
Many
officials have figuratively been run over in rage by impatient Americans who
bolted out of line because they could no longer handle sacrificing their
personal desires to save lives.
The
National Association of County and City Health officials has tallied 28
officials across 14 states who have retired, resigned or been fired during the
crisis:
Nichole
Quick quit as the public
health officer for Orange County after she and her staff received multiple
threats over her order for residents to wear face coverings to help prevent the
spread of the virus;
Emily
Brown was fired as the public
health director of Rio Grande County in Colorado for resisting the pressure
from county commissioners to loosen restrictions. The tensions exploded into a
Facebook threat referring to "armed citizens" and "bodies
swinging from trees."
Amy
Acton resigned as Ohio's
state health director amid a backlash over the state's COVID lockdown that
included anti-Semitic slurs and
protesters outside her home with guns;
Chris
Dobbins resigned as health
director of Gaston County in North Carolina, amid turmoil when the chairman of
the county's board of commissioners pushed hard to
reopen businesses against state lockdown orders. Dobbins' colleagues in North
Carolina had named him state health director of the year in
2017.
Many
other public health officials are still on the job despite intense harassment.
The Colorado Association of Local Public Health Officials told the Associated
Press and Kaiser Health News that 80 percent of local health directors reported
that they had received personal or property threats and threats to have
department funding cut.
Barbara Ferrer, Los
Angeles County's public health director for 10 million people, and Lauri Jones, community
health director in Okanogan County in eastern Washington state, which has only
42,000 people, are just two of several public health directors to report having
received threats of being shot.
Jones told National Public Radio that, before the pandemic, she was known around the county for being the woman who issued permits for septic tanks, recorded births and investigated reports of food poisoning. She told the Washington Post, "We've been doing the same thing in public health on a daily basis forever. But we are now the villains."
The
ones who connect the dots of health
A
deeper reason that public health officials are often seen as villains, beyond
the momentary culture war over masks, is because they and their departments are
also the messengers of data that tells us how healthy or unhealthy our systems
are in America, connecting the dots from pollution to housing, from infant
mortality to homelessness, from asthma to tobacco and vaping control, and from
food deserts to diabetes and obesity.
The
understanding of systemic problems has grown to the point that several cities,
counties, and states have officially declared racism to
be a public health crisis. Undoing such systemic problems will take untold
billions of dollars of resources that federal, state and local governments and
the private sector have thus far been unwilling to spend.
Among
Dobbins' final acts before resigning was to write a Facebook post saying that
his department works to address "all factors that negatively affect health
and wellbeing in our community, including racism."
He
said his department recognizes that racism contributes to disparities in
"housing, employment, income, incarceration, education and access to
services—all of which impact physical, mental and emotional health." As he
added, "racism is an underlying cause of the disparities among those
suffering and dying from COVID-19."
The
loss of officials possessing that kind of systemic understanding deeply
troubles Oscar Alleyne, the
chief of programs and services for the National Association
of County and City Health Officials.
An
epidemiologist by training and past president of the board of directors for the
New York State Public Health Association, Alleyne said the attacks on his
colleagues reflect a culmination of several factors. Among them are governmental cuts in public health
funding, vigorous attacks on science and scientists by the
current administration and vocal anti-science movements on social media, such
as opposition to vaccinations.
"Public
health not a money-making venture," Alleyne said. "We really do have
an altruistic goal of trying to help people. We look ourselves as society's
safety net. When all else fails, especially for communities that are
marginalized, we try to be there for them. The concept that they are being
attacked because people need their individuality is perplexing and
discouraging."
Americans
get the importance of public health
It is discouraging because actually, most Americans do understand the need for strong public health measures to fight the coronavirus and were willing to put up with weeks of mask orders and closures to offices, schools, churches, sports evets, funerals, graduations and birthday parties.
The number of daily infections, as high as 36,738 on April 24, were mitigated down to a low of 17,618 on May 11. When Sunbelt states began to aggressively reopen their economies in mid-spring, several polls found that up to two-thirds of Americans thought it was too soon to reopen the economy for the many lives it put at risk.
We
now tragically see the consequences as the nation hit a new record of 56,567
daily infections on July 3 and now faces the prospect of at least 175,000
deaths by October according to at least two models kept on the Centers for Disease
Prevention and Control website. At least 21 states as of
Monday have paused reopening plans.
In
Texas, despite Governor Greg Abbott's boasting in June that the state had "abundant" hospital
capacity, mayors and health officials in Houston, San Antonio, Austin and Fort
Worth say their intensive care facilities are close to being overrun with
COVID-19 cases.
Abbott,
who, in April banned local
jurisdictions in Texas from mandating face coverings, reversed himself
last week and issued a statewide mask order.
In Florida, where the administration of Governor Ron DeSantis has been accused of firing coronavirus public health data scientist Rebekah Jones for her refusal to manipulate data to justify reopening, the number of daily cases hit 11,458 on July 4—nine times more infections than Florida's worst day in April.
In Florida, where the administration of Governor Ron DeSantis has been accused of firing coronavirus public health data scientist Rebekah Jones for her refusal to manipulate data to justify reopening, the number of daily cases hit 11,458 on July 4—nine times more infections than Florida's worst day in April.
Meanwhile,
the European Union, which was virtually tied with
the United States in the spring for also peaking at more than 30,000 daily
infections, is now down to 4,000 a day with
much stricter and consistent public health measures and political leadership.
As
hard as the COVID-19 crisis has been economically and socially, most Americans
would have accepted such leadership for tougher measures. Some 72 percent of
respondents told Gallup in late June
that it is better for people to stay home as much as possible to avoid the
virus rather than resume normal lives.
In
another late June poll by CNBC, the
top three reasons respondents gave for the resurgence of COVID-19
hospitalizations was President Trump, people not wearing masks, and states
re-opening too soon.
The
question now is whether the instinctive desire of Americans for public health,
which goes back to 1799 when Paul Revere was
named the nation's first public health officer in Boston to fight cholera, can
win the day without decisive federal and supportive gubernatorial leadership in
many states where the virus is now raging.
Confounding
this question is the immense amount of backbreaking work that needed to be done
to address systemic health and safety inequities, virus or no virus.
Work
deferred
"What we do is not new, but our job has grown so much," Alleyne said. "We deal with all the social determinants of health. We deal with diseases from chemicals—like asthma, from food—like diabetes, from stress of substandard housing and intergenerational poverty. All these things are happening concurrently and determine how long you live.
"To deal with COVID-19, our public health enterprise has had to shift away from opioids, heart disease, children's health and STDs. I'm worried what happens if these concerns accumulate much longer without our attention. Are we going to see a wave of chronic conditions hit us, with bigger wallop of behavior stemming from social isolation on top of poor health, on top of racism?"
And
also, on top of the new vilification of public health officials for being the
messengers for masks and lockdowns.
In Ohio, Governor Mike DeWine is keeping Amy Acton on board as a senior advisor. On her advice, his state was the first to shut down all schools and delay its presidential primary.
In Ohio, Governor Mike DeWine is keeping Amy Acton on board as a senior advisor. On her advice, his state was the first to shut down all schools and delay its presidential primary.
Even though concert promoters and restaurant owners sued her for not advising quicker re-openings, DeWine stood by her as Ohio, the 7th most populous state now ranks 37th in COVID-19 cases per 1,000,000 people and 20th in deaths per 1,000,000 people, according to tracking by the Kaiser Family Foundation.
"I
will always believe and know that many lives were saved because of her wise
advice," DeWine said of Acton.
Hopefully,
the rest of the nation will wake up in time to listen to the wisdom of the rest
of our public health officials to save many more lives. Few of us likely
remember the names of crossing guards at our schools.
They
are the ones who understand the green light of safety, the yellow light of
caution and the red light when we must put idle our individual pleasures and
privileges so the common good can cross the street.
Derrick Z. Jackson is
on the advisory board of Environmental
Health Sciences, publisher of Environmental Health News and
The Daily Climate. He's also a Union of Concerned Scientist Fellow in climate
and energy. His views do not necessarily represent those of Environmental
Health News, The Daily Climate or publisher, Environmental Health Sciences.
This
post originally ran on The Union of Concerned
Scientists blog and is republished here with permission.