Public health workers soldier on through unprecedented pandemic: Health Care Heroes 2021 | #healthcare | #elderly | #seniors
There are few lawn signs thanking your local health department for its help during the pandemic. No free meals to boost the morale of exhausted employees. No applause from high-rise balconies in their honor.
Yet like their hospital counterparts, the 153,000 employees of the nation’s nearly 3,000 local health departments have been tested, tried, and sometimes exhausted by the pandemic.
While they were rarely in immediate harm’s way, they, too, were thrust into an “all hands on deck” crisis. They, too, have worked round-the-clock on emotionally draining tasks, hoping to save lives. Not by curing COVID-19, but by preventing it.
“And they never get the limelight,” said Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials. “It’s always the doctors and the nurses and the ICUs.”
Over 200 public health directors have resigned, taken early retirement, or been fired during the pandemic, she said. “We have seen the consequence of stress and strain on the local health officials and their staff.”
Her group is helping the U.S. Centers for Disease Control and Prevention survey those workers about the toll their pandemic duties have taken on them. So far 27,000 responses have rolled in – and counting. “People were just waiting to be asked,” she said.
One unique burden they shoulder is that the regular threats to public health march on:
- Ticks and mosquitoes continue to spread diseases, with or without public health tracking.
- Opioid addiction continues to tear through communities, with clinics and outreach efforts severely restricted.
- Restaurants offering take-out meals still need to be inspected to prevent food poisoning.
- Pregnant woman still need to learn about nutrition, babies still need to get their shots, and families continue to be racked by domestic violence or child abuse.
“Health departments really had to find ways to continue to do that work, even during the height of the pandemic,” Freeman said. “They had to do it while still running a vaccine clinic.”
That challenge was evident in upstate New York, where the mid-sized city of Syracuse is home to a large university but is surrounded by scenic areas whose beauty belies the underlying strain of rural poverty. Tackling COVID-19 there meant addressing everything from partying college kids to senior citizens who couldn’t order groceries online because delivery websites don’t accept food stamps.
Onondaga County Executive Ryan McMahon’s solution was to turn nearly all of county government into one big public health department. The region got through the first wave of the virus by aggressively testing people even before the first case arrived. But McMahon realized the post-Thanksgiving second wave would be brutal.
“That first wave, there was the anxiety of the unknown,” he said. “The second wave was the opposite: the anxiety of what we knew was going to happen.”
The county went from having 60-70 new cases a day during the spring of 2020 to having almost 500 cases a day by December. “People weren’t ready for what the reality was,” he said of those who insisted on gathering for the holidays. “People didn’t listen. And it was complete hell for the next 60 days.”
By that second wave, county employees had been on pandemic overdrive for eight months. “My teams were already exhausted,” he said. “The raw emotions were just unbearable.”
After one particularly grim media update over a January weekend, he had to pull employees from every department – Parks, Roads, Taxation, Probation, IT – and put them on COVID-19 duty.
“I knew that if we didn’t get it under control, our hospitals would be overwhelmed, and the economy would have to be shut down again,” he said. “And if the economy shut down again, the government would lose complete credibility with the people.”
One employee he turned to was Maria Mahar, RD, a certified dietician who normally runs Meals on Wheels and other nutrition services for seniors. With each stage of the pandemic, she’s had to quickly don a new, unfamiliar hat.
Her first task was to make sure her seniors would be able to get by without having to go to a grocery store. Workers throughout county government stepped up, from librarians to landscapers, delivering everything from meals to adult diapers.
One unexpected benefit of all those home visits was workers got to see what she knew was out there: isolated seniors who needed help. In one case, a volunteer who delivered food noticed an elderly woman’s porch and front door badly needed repairs. She contacted her church, which sent volunteers to fix things.
When the first wave subsided in June, Mahar went back to her regular job, only to be reassigned to setting up a system for contract tracing. Next, she was tapped to switch duties again, this time getting a 5 p.m. phone call from a county commissioner telling her, “Guess what? You’re going to be running our biggest test site.” Now that the vaccine is here, she is staffing the county’s vaccination center as well.
In neighboring Oswego County, which covers the farmland north from Syracuse to the shores of Lake Ontario, Public Health Director Dr. Jiancheng Huang first heard about COVID-19 from news accounts coming out of his native China.
“When I read this news, two things came to mind: It’s SARS, or the movie “Contagion,” he recalled. Both the infectious disease that hit Asia in 2002 and the pandemic sci-fi movie convinced him that Oswego County, as seemingly remote as it was, needed to get on a wartime footing.
Huang quickly discovered a mammoth roadblock to his department’s pandemic response: 90 percent of senior citizens either lived in rural areas with no high-speed internet or weren’t internet-savvy enough to use it.
They wouldn’t be able to order groceries online. They wouldn’t be able to get their medicines delivered. In short, it would be next to impossible for them to “shelter in place” when the first wave hit.
His solution was a hotline, also manned by reassigned employees. “We’d ask, ‘Do you need any supplies or food to help you stay in your home,’” he said. They spent those early weeks delivering food, detergent, thermometers and the like directly to the homes of seniors.
Most of his employees were yanked from their regular duties and thrown into COVID-19 tasks, whether it was designing a case-reporting database or doing contact tracing. “No one gave me any difficulty,” he said with obvious appreciation. “No one refused.”
“I remember when the hammer fell here. Everything changed, said Trish Eggleton, BSN, RN. She went from running programs for maternal and child health to manning the help line to triage patients and authorize testing. “You couldn’t do that by the internet; you had to talk to a nurse,” she said.
It was vital work, and rewarding in its own way, but not really what attracted her to the field of nursing.
“With COVID, you miss being out with people, because that’s the biggest part of the job I love. You’re dealing with people who are sad, who are really sick,” she said. “You check in with them – not every day – but track them to see how they’re doing.”
Sometimes those check-in calls would reveal that the patient had died. Although she and her co-workers were removed from hands-on medical care, hearing about those deaths still took an emotional toll on them. It was hard to avoid burnout.
“It’s been a really long year of seven-day weeks. You think, ‘Oh my goodness, how long can we do this?’,” she said.
Gnawing away at her is the realization that the issues she had been addressing – maternal health, child abuse, childhood vaccinations, lead poisoning in children – have all been shoved to the back burner.
“We were making headway on that, then Wham! COVID,” she said.
That’s a common dilemma. Most of the nation’s public health departments employ fewer than 50 workers; about a third have fewer than 10 employees. They could only be stretched so far.
Once the pandemic passes, public health workers expect to see the cost of having been forced to neglect those problems: big jumps in opioid addiction, child abuse, low birth weights, unimmunized children, HIV, diabetes and smoking.
Freeman, of the public health department lobbying group, said the employees who switched from, say, restaurant inspections to contact tracing, are anxious to get back to their areas of expertise.
“They were happy to do it, but that reassignment has gone on a bit too much,” she said. “They want to return to their normal jobs they were hired for.”
Kathleen O’Brien is a veteran journalist focusing on health care. She can be reached at firstname.lastname@example.org