For many, public health was a relatively vague concept before the COVID-19 pandemic. Health departments or health districts were perhaps best known for inspecting restaurants, but few people outside these organizations had a deep understanding of the many roles that public health can play, including tracking and preventing the spread of diseases.
But public health officials, thrust into the spotlight as they worked to educate the public on rapidly changing information about the virus, quickly received backlash as they enforced rules to slow the spread in an effort to prevent the outbreak from reaching pandemic status. With states closing down businesses and banning gatherings, and health officials ordering people to stay home, stay distanced, mask up, get tested and quarantine if they got the virus, people's patience for changing guidance rapidly waned.
Tracking the virus in those early days, as it went from an international concern to a local one, was "chaotic," says Dr. Bob Lutz, who was the health officer at Spokane Regional Health District when the pandemic started.
"We were getting information from just a lot of different sources. You know, you were hearing about what was happening in China, you were getting regular updates from the CDC," Lutz says. "Washington state DOH [Department of Health] mobilized its internal resources pretty quickly such that we were having daily calls to try to understand the complexity of this."
Much of the early public health guidance was based on how officials thought the virus would act, i.e., like the flu, Lutz says. But that was not how it behaved. Plus, many of the things that local health officials took the blame for were actually requirements coming down from the state level.
"Local health can be more restrictive but not less restrictive than what DOH and the Governor's Office requires," Lutz says. "We were doing what we had to do based upon what we were told to do, and based upon the science that we had at the time."
In the early fall of 2020, after months of extremely restricted activity, people did not like it when Lutz, as the health officer, shared that Spokane County was not heading in the right direction to hit the metrics laid out in former Gov. Jay Inslee's four-phase reopening plan, he says.
"At the end of the day we really believed that we had everybody's health foremost as a priority, and yes, there were economic challenges," Lutz says.
But even if some choices could have been made differently — "we're not infallible" — Lutz gives Inslee credit for truly wanting as many people to survive as possible, despite the criticism that he was being overzealous and destroying livelihoods.
"He really cared about the lives of Washingtonians," Lutz says. "If you're not alive, you're not going to have a job."
LESSONS LEARNED
The pandemic required public health to get really good at displaying massive amounts of data — think thousands of COVID results, from positive tests to hospitalizations to deaths — so Spokane Regional Health District's epidemiology team improved its work on "informatics," explains Mark Springer, who oversees the district's "epi" team and communicable disease specialists.
"You know, a large outbreak prior to the pandemic might be 150 people," Springer says. "But we were dealing with data sets with COVID of 30,000 to 40,000 unique patients."
So the district and the state worked to build dashboards to quickly and clearly communicate that information with the community and health care providers, Springer says.
Since the pandemic, there have been two major outbreaks of communicable diseases in the Spokane area, with Shigella among the homeless population and pertussis, or whooping cough, among the broader community. Because of that data work during COVID, the team was more easily able to pull reports on those outbreaks, Springer says.
Spokane Health Officer Dr. Francisco Velázquez says the district has also maintained many of the relationships with community partners that were built and strengthened during the pandemic.
"If you think about it, for a large percentage of the population, public health was in the background and became front and center in the pandemic, which is actually a good thing," Velázquez says. "I think a lot of people now have a better understanding of the significant presence of public health in many aspects of the community."
The pandemic required the district to work closely with groups like the chamber of commerce, event planners and schools, Velázquez says.
"We enhanced the collaboration and relationships that were there to a level that is useful and practical today," he says.
BECOMING POLITICAL
Still, public pushback on everything from business restrictions to masks and vaccines resulted in public health landing in the political crosshairs in recent years.
Some communities fired their public health officials, as Spokane did with Lutz in October 2020. (Lutz has an ongoing wrongful termination lawsuit against the health district.)
"Public health became politicized," Lutz says. "That's why you saw so many high level officials, public health officials, either step away or resign or retire, or in my case, get fired. I think it's a challenging time for public health going forward."
Skeptics of well-established science have made their way to the highest levels of our health system. Robert F. Kennedy Jr., an outspoken skeptic of the measles vaccine, is now the U.S. secretary of Health and Human Services; meanwhile, a measles outbreak is currently affecting hundreds of people in Texas.
Simultaneously, states across the country are taking power away from local public health officials, and health offices at the local, state and federal level have largely returned to a fragmented, decentralized approach, where there's little coordination, Lutz says.
"We saw some coordination during the pandemic response, but lessons learned have become lessons forgotten," Lutz says. "I truly hope at the end of the day that there will be some lessons that we learned that will make us stronger when we face another pandemic." ♦
