It is one of the toughest, and most important jobs in the nation right now. Never before have public health officials featured so prominently in the news, and their daily briefings been so anxiously awaited. But as many directors of public health departments have found out recently, it is not a job for the faint of heart.
Dr. Sonia Angell, Director of California’s Public Health department, resigned this week amid news that the state disease data-tracking system had suffered a technical issue resulting in the loss of almost 300,000 records. Those records were a part of the California Reportable Disease Information Exchange (CalREDIE) and were not all related to COVID-19, officials say. Though the backlog has been processed and the issue resolved, it is an embarrassing blow to the accuracy of the state’s coronavirus response nonetheless.
Dr Angell’s resignation comes two-months after Orange County public health officer Dr. Nichole Quick gave her notice, though for very different reasons. Quick faced threats to her safety over her public health order making it mandatory for Orange County residents to wear masks. Reports say that security was needed at her home to ensure her safety. NBC reported that an Orange County Board of Supervisors meeting included protestors carrying a poster of Quick represented as Hitler.
Board Supervisor Doug Chaffee noted that Dr. Quick has ‘done her best to give her medical opinion and it’s not popular so she has resigned.’ He added that for every one letter he received condemning the mask order, there were 10 in support of it. However, those against it were more vocal. “It was too much for her,” said Chaffee. “She has three young children and she’s been severely criticized by people who came out demanding her resignation, demonstrations in front of her home.”
The backlash Dr. Quick received is not unprecedented. There was resistance to mask ordinances during the influenza pandemic of 1918 too. While public health departments now have a greater range of tools at their disposal, masks are still seen as one the most effective, albeit controversial measures available. Dr. Jon Hallberg is the medical director at the University of Minnesota. “I think it’s hard for us to wrap our heads around the fact that something we did 102 years ago is still relevant today,” Dr. Hallberg said recently. “We’ve really learned that masks actually work, and they work because the viruses are not just spreading around by themselves, they’re hitching rides to droplets. And if we can contain droplets by wearing a mask, we can reduce spread.”
Getting that message through to the public has proven difficult. There are undoubtedly numerous reasons for this, though underfunded public health departments have likely contributed. A Kaiser Health News (KHN) and Associated Press investigation takes a deep dive into the history of public health and describes state and public health staffing levels as ‘skeletal,’ and the system as underfunded and under threat.
“The U.S. public health system has been starved for decades and lacks the resources necessary to confront the worst health crisis in a century,” the article begins. At least 38,000 jobs have been eliminated since 2008, according to KHN and AP. State public health department spending is 16% lower per capita than it was in 2010 while local health department spending has dropped 18%.
Burnout and fewer people doing more work is also a contributor to an unhealthy public health system, as well as to recent public health resignations. “Many health officers are working 90, 100 hours a week, and doing all they can to fight this,” said Kat DeBurgh, the executive director of the California Health Officers Association in an interview with NPR. “I’m afraid with the way that health officers are currently being portrayed, we’re not inspiring the next generation to want to take on this role.”