Stateline: Politicians Shunt Aside Public Health Officials

Read Stateline coverage of the latest state action on coronavirus.

By: Christine Vestal & Michael Ollove, Stateline, Pew Trusts

Four months into the pandemic, some governors and local officials are sidelining public health professionals in a rush to reboot their state economies, even as infections and hospitalizations increase in many areas of the country.

Photo: Becker1999 from Grove City, OH; Wikimedia

Shunted to the background, and often ignored, public health professionals at the state and local levels who have been working long hours with few breaks are starting to burn out and lose momentum. Many have left office; a number of them were pushed out, either by their bosses or in the face of vehement public opposition.

A recent analysis from Kaiser Health News and the Associated Press found that at least 27 state or local public health leaders across 13 states had resigned, retired or been fired since April.

For at least a century, state and local public health agencies in the United States have been charged with protecting residents’ health and safety by monitoring infectious diseases and other health hazards, informing the public and taking action in an outbreak.

That includes testing, disease surveillance, data gathering, contact tracing and education. It also entails support for the local medical community, including ensuring an adequate supply of personal protective equipment and other essential resources.

But in this pandemic, top federal, state and local elected officials have taken the lead in performing those functions, not public health agencies.

“It’s been a bit of an uncoordinated disaster,” said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials. “Now that we’re at the point of reopening communities — businesses, pools, summer camps — local health departments are back in the ballgame and left to enforce the governors’ [restrictive] orders, which basically villainizes them.

“It’s really hard to be a partner in that work when you haven’t been allowed into the group that informed the decision,” she said.

From the beginning of the pandemic, Freeman and other experts say, the White House set the tone for this unprecedented circumvention of public health agencies.

anagement leaders and health experts from other agencies, diluting the historic leadership role of the nation’s primary public health authority, the Centers for Disease Control and Prevention.

Later, as the nation grew weary of quarantine, Trump flagrantly dismissed even his own health experts’ precautions in favor of jumpstarting the stalled economy.

Similarly, governors, mayors and county executives in many parts of the country took the lead in the beginning of the crisis, setting up COVID-19 surveillance websites, outsourcing testing and contact tracing, and buying masks and other medical supplies from manufacturers.

When governors and local elected leaders decided to reopen, often encouraged by vehement residents and business owners demanding an end to shutdown orders, many complied despite warnings from public health officials that infections were still rising.

“We would agree on the metrics, a 14-day decline in infections, and then they would choose to ignore them,” said Freeman, the public health association CEO.

Governors who relaxed some restrictions early insisted that keeping businesses closed for a prolonged time would cause too much economic suffering. Republican Georgia Gov. Brian Kemp was one of the first to begin allowing businesses to reopen in his state in April, without a 14-day decline in infections. At the time, he insisted the state could safely ease its lockdown, dismissing computer modeling showing that the peak had not yet arrived.

While local public health officials in Georgia have objected to quickly reopening some businesses, Kemp’s public health director, Dr. Kathleen Toomey, has backed his decisions. Media reports said Toomey’s department released confusing and sometimes misleading data in support of relaxing restrictions. The number of coronavirus cases now is rising in Georgia, according to state data.

“Georgia — go to the beach, lake or a state park!” Tim Fleming, Kemp’s chief of staff, wrote in a Facebook post after the governor lifted restrictions. “They are all open and despite what the media is reporting there have been no issues on Georgia beaches or lakes today.”

COVID-19 Is Crushing Black Communities. Some States Are Paying Attention.

Arizona also was quick to ease restrictions; it now is seeing its highest increases in cases since the pandemic began, and hospitals are nearing capacity.

Republican Gov. Doug Ducey attributed that rise to increased testing, although Dr. Cara Christ, the state health director, conceded she didn’t know whether the rising numbers were the result of more testing or community spread of the disease.

Danger Ahead

Freeman’s group and the Big Cities Health Coalition this week issued a sharp warning that attacks on public health officials were compromising American safety.

Noting that public health officials have been “physically threatened and scapegoated” and some forced out of their positions, the groups said, “We are losing expertise, experience, and most importantly, leadership, at a time when we need it most.”

The groups said it is not individual attacks that are most damaging, but the sidelining of public health expertise in the midst of the most dangerous health crisis in more than a century.

“At the federal, state, and local health levels,” the groups said, “new task forces have been created to guide COVID-19 decision-making, which lack the critical input of the public health brain trust and ignore that this virus has been and continues to be the most difficult and costly public health challenge of our lifetime.”

While turnover of top health officials in federal and state government is normal, especially when administrations change, said Dr. Georges Benjamin, head of the American Public Health Association, “we’re seeing it happen at the local level, now.”

“It’s a manifestation of the politicization of public health that many of us have been concerned about.”

The divide between elected and public health officials has been further illustrated this week as Trump continued to insist on holding a maskless, indoor campaign rally in Tulsa this weekend, overruling the cautions of his own health advisers, including Dr. Anthony Fauci, who heads the National Institute of Allergy and Infectious Diseases, and the director of the Tulsa health department, Dr. Bruce Dart.

Trump dismissed the request, and his campaign is requiring attendees to sign waivers that they won’t sue should they become infected while at the rally.

Officials Quit, Fired

In Ohio, the state’s health director, Dr. Amy Acton, resigned from her post last week. Early in the pandemic, she was hailed in many quarters for her plainspoken explanations of state safety measures. As time went on, she drew vociferous attacks over the restrictions.

Businesses such as gyms and concert venues sued her, lawmakers pushed to limit her authority, and protesters, some of them conspicuously armed, demonstrated outside her Columbus home.

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