In the mid-1800’s, John Snow traced a local cholera outbreak in Soho, London back to the community water pump. Local officials dismissed him. They refused to adopt his recommendations and called his report nonsense. In the face of derision and disbelief, he still moved forward. He convinced local officials—whether they believed the evidence or not—to try removing the Broad Street pump handle. He ended one of the worst cholera epidemics in local history, and modern-day epidemiology was born.
Disbelief and harsh words are nothing new to public health officials, nor even threats of violence. It wasn’t unheard of for AIDS epidemiologists in the 80s, or for reproductive health practitioners today, to wear bulletproof vests on their way to work. But in this moment, our local public health officials face a double challenge: responsibility for managing the deadly COVID-19 pandemic, and a politicization of their work that puts their own lives and the health of their communities at risk.
We stand with our local public health officials. It is imperative that as a nation we stand with science and public health.
Orange County’s public health officer, Dr. Nichole Quick, was simply following best-practices in late May when she required that county residents wear face coverings to protect against COVID-19 transmission. To have failed to do so would have neglected her legal and ethical responsibility to the county’s residents. The response—from protests at her house to death threats—prompted her resignation two weeks ago.
Dr. Barbara Ferrer, Director of the Los Angeles County Public Health Department, is also receiving death threats. All told, a half a dozen local public health officials in California have stepped down in the last two months.
Across the country, NACCHO officials estimate that more than twenty health officials have left office — through resignations, retirements or being fired. These high-level resignations and retirements come as local jurisdictions and their public health officials have had to shoulder the burden of COVID-19 policy decisions and responsibility, along with the resultant blame and anger.
This is wrong, and it needs to stop now.
Advising (or telling) people of the best way to protect their health, and the health of their children, and of their parents and communities, shouldn’t result in death threats. It saves lives. In Los Angeles County alone, an estimated 45,762 lives were saved and 436,656 hospitalizations were avoided thanks to early, courageous action from local health officials on COVID-19.
Although there is a violent and vociferous minority– the truth is that majority of people support the public health orders.
According to the California Health Care Foundation’s COVID-19 Tracking Poll, nearly 7 in 10 Californians have confidence in the California Department of Public Health and in their county public health department. Polls from the CDC and The California Endowment also report high levels of support.
No local public health official expects to win a popularity contest. They are appointed to their positions based on their knowledge and expertise, and hold a statutory responsibility and authority to protect their residents’ health. Their decisions are not about winning votes; they decide, recommend—and at times mandate—based on science, evidence and best-practices. They also sit at the table with elected officials who may have other agendas, differing viewpoints, or answer to various constituents, industries and donors.
Make no mistake: elected officials who subtly undermine, shift responsibility, or publicly mock their public health officials aren’t just dumbing down the discourse. They are costing lives. This past weekend, approximately, two weeks after Dr. Quick relinquished her post, Orange County saw its largest two-day surge in COVID-19 cases, according to county data. COVID-19 cases arecontinuing to rise across the state and the nation at an alarming rate.
We’ve seen it before. From climate change to vaccinations, feelings about what is expedient, convenient, and serves narrow private interests or a political agenda have trumped hard recommendations based on science and what is good for the community as a whole.
Instead of bulletproof vests and security details, our local public health officials deserve the protection and support of those who appointed them, and of those they serve. We owe a debt of gratitude to all the public health officials and staff that have worked tirelessly and selflessly throughout the COVID-19 pandemic—even while understaffed and under-resourced. What we need now—from state leadership, from local and state elected officials, from healthcare and from the public—is a clarion call of solidarity, cooperation and concrete support of public health policy.
Here’s how you can support your public health officials:
We can sit at the same table, and even disagree. But we need civil discourse and support for the safety of public health officials as they perform their responsibilities: to provide scientific and data-driven responses to protect the health and lives of all in their community.
John Snow knew the risk of an unpopular stance. And history shows how efforts like his can control, and sometimes even wipe out, an epidemic–when we support our public health officials and civic-minded community leaders stay the course.
Especially in the midst of a pandemic, no one of us can do this alone.
Tracy Delaney, PhD, Executive Director of the Public Health Alliance of Southern California, a coalition of local health departments responsible for the public health of 50% of the state’s population.
Jonathan E Fielding, MD, is a Distinguished Professor of Health Policy and Management at the UCLA Fielding School of Public Health and served for sixteen years as Los Angeles County’s Health Officer.
Mary A. Pittman, DrPH, President and CEO of the Public Health Institute, one of the largest non-profit public health organizations in the United States.