POST 231. January 24, 202. CORONAVIRUS. “Florida’s top public health official in Orlando has been placed on administrative leave after sending an email to his employees noting their lackluster coronavirus vaccination rates and urging them to get the shots.”

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Florida’s top public health official in Orlando has been placed on administrative leave after sending an email to his employees noting their lackluster coronavirus vaccination rates and urging them to get the shots.

The official — Dr. Raul Pino, the administrator for the Florida Department of Health’s office in Orange County — sent the email on Jan. 4, in the thick of a surge in cases caused by the Omicron variant.

In the email, Dr. Pino said that he had asked a staff member to pull out the vaccination rates for the office, and that the figures were alarming: Of the office’s 568 employees, only 219 — fewer than half — had completed a full vaccination series, and just 77 of them had received a booster shot, a number he called “SUPER LOW.”

“I am sorry, but in the absence of reasonable and real reasons, it is irresponsible not to be vaccinated,” Dr. Pino wrote in the email, which was first reported by WFTV, the local ABC News affiliate. He called the office’s vaccination rate “pathetic.” (A)

“Pino, 58, declined to discuss the Health Department’s action, but an agency spokesperson confirmed his status.

“As the decision to get vaccinated is a personal medical choice that should be made free from coercion and mandates from employers, the employee in question has been placed on administrative leave, and the Florida Department of Health is conducting an inquiry to determine if any laws were broken in this case,” spokesperson Weesam Khoury said in an email Tuesday. “The Department is committed to upholding all laws, including the ban on vaccine mandates for government employees and will take appropriate action once additional information is known.”..

Since March 2020, when the pandemic erupted in Central Florida, Pino has been a fixture on more than 150 press briefings, appearing beside Orange County Mayor Jerry Demings to discuss COVID-19, best practices, safety protocols, coronavirus infection, testing and vaccination rates, and deaths…

Pino also formerly served as commissioner of the Connecticut Department of Public Health.

While Florida Gov. Ron DeSantis, a Republican, and Demings, a Democrat, have often sparred over vaccination and face-masking mandates, Pino has tread a thin line between the two elected officials, usually offering raw data and opinions based on his medical experience and research…” (B)

“A measure Gov. Ron DeSantis signed into law last fall prohibits government agencies from mandating vaccinations and restricts private businesses from requiring vaccinations unless they allow workers to opt out for medical reasons, religious beliefs, immunity based on previous infections, regular testing or agreements to wear protective gear.” (C)

Aug 10, 2020

“Vilified, threatened with violence and in some cases suffering from burnout, dozens of state and local public health officials around the U.S. have resigned or have been fired amid the coronavirus outbreak, a testament to how politically combustible masks, lockdowns and infection data have become…

A review by the Kaiser Health News service and The Associated Press finds at least 49 state and local public health leaders have resigned, retired or been fired since April across 23 states. The list has grown by more than 20 people since the AP and KHN started keeping track in June.

The departures are making a bad situation worse, at a time when the U.S. needs good public health leadership the most, said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.

“We’re moving at breakneck speed here to stop a pandemic, and you can’t afford to hit the pause button and say, ‘We’re going to change the leadership around here and we’ll get back to you after we hire somebody,’” Freeman said…

Many of the firings and resignations have to do with conflicts over mask orders or social distancing shutdowns, Freeman said. Many politicians and ordinary Americans have argued that such measures are not needed, contrary to the scientific evidence and the advice of health experts.

“It’s not a health divide; it’s a political divide,” Freeman said…

West Virginia Gov. Jim Justice forced the resignation of Public Health Commissioner Dr. Cathy Slemp in June over what he said were discrepancies in the data. Slemp said the department’s work had been hurt by outdated technology like fax machines and slow computer networks.

“We are driving a great aunt’s Pinto when what you need is to be driving a Ferrari,” Slemp said.

Tom Inglesby, director of the Center for Health Security at Johns Hopkins, was critical of Slemp’s firing and said it was deeply concerning that public health officials who told “uncomfortable truths” to political leaders had been removed.

“That’s terrible for the national response because what we need for getting through this, first of all, is the truth. We need data and we need people to interpret the data and help political leaders make good judgments,” Inglesby said.”  (D)

Dec 14, 2020

“The backlash has moved beyond the angry fringe. In the courts, public health powers are being undermined. Lawmakers in at least 24 states have crafted legislation to weaken public health powers, which could make it more difficult for communities to respond to other health emergencies in the future.

“What we’ve taken for granted for 100 years in public health is now very much in doubt,” said Lawrence Gostin, an expert in public health law at Georgetown University in Washington, D.C…

The departures accelerate problems that had already weakened the nation’s public health system. AP and KHN reported that per capita spending for state public health departments had dropped by 16%, and for local health departments by 18%, since 2010. At least 38,000 state and local public health jobs have disappeared since the 2008 recession.

Those diminishing resources were already prompting high turnover. Before the pandemic, nearly half of public health workers said in a survey they planned to retire or leave in the next five years. The top reason given was low pay.

Such reduced staffing in departments that have the power and responsibility to manage everything from water inspections to childhood immunizations left public health workforces ill-equipped when COVID-19 arrived. Then, when pandemic shutdowns reduced tax revenues, some state and local governments cut their public health workforces further.

“Now we’re at this moment where we need this knowledge and leadership the most, everything has come together to cause that brain drain,” said Chrissie Juliano, executive director of the Big Cities Health Coalition, which represents leaders of more than two dozen public health departments…

The politicization has put some local governments at odds with their own health officials.

In California, near Lake Tahoe, the Placer County Board of Supervisors voted to end a local health emergency and declared support for a widely discredited “herd immunity” strategy, which would let the virus spread. The idea is endorsed by many conservatives, including former Trump adviser Dr. Scott Atlas, as a way to keep the economy running, but it has been denounced by public health experts who say millions more people will unnecessarily suffer and die. The supervisors also endorsed a false conspiracy theory claiming many COVID-19 deaths are not actually from COVID-19.

The meeting occurred just days after the county public health officer, Dr. Aimee Sisson, explained to the board the rigorous standards used for counting COVID-19 deaths. Sisson quit the next day…

As public health officials depart, the question of who takes their places has plagued Dr. Oxiris Barbot, who left her job as commissioner of New York City’s health department in August amid a clash with Democratic Mayor Bill de Blasio. During the height of the pandemic, the mayor empowered the city’s hospital system to lead the fight against COVID-19, passing over her highly regarded department.

“I’m concerned about the degree to which they will have the fortitude to tell elected officials what they need to hear instead of what they want to hear,” Barbot said.”  (E)

May 23, 2021

Riverside County, California, was one of the first counties in the country to face Covid-19, when repatriated US citizens were quarantined at March Air Reserve Base on January 29, 2020. Seeing how quickly things moved in China, then Riverside County Health Officer Dr. Cameron Kaiser knew he had to act fast.

“From what we saw was going on in China at the time, it potentially, it could be very big,” he said.

On April 4, 2020, Kaiser took actions more protective than the state’s health orders, including prohibiting gatherings of people from different households in his county, as well as an order for people to mask in public.

He knew none of this would be easy, but he didn’t expect the backlash.

“We never really dealt with a situation where people simply told us to go jump in a lake when we had to make those necessary orders to protect society,” Kaiser said.

A month later, dozens of citizens came before the Riverside County Board of Supervisors — many of them saying that their personal liberties had been infringed upon.

“You are trampling on the Constitution by agreeing to extend Dr. Kaiser’s recommendations,” declared one resident.

Another said: “When we are inside, locked up because of health orders by Dr. Kaiser, we are weak. The American people are a free people.”

A fake Twitter account was created with Kaiser’s picture and a Hitler mustache, calling him Führer Cameron Kaiser.

What’s the science behind CDC’s decision to say fully vaccinated people don’t need masks?

Kaiser says there were many people in the community who supported him, and he did try to acknowledge their concerns. But there were also those who were very vocal and angry. “Listening to the anger, the vitriol, again, they were coming from people who had legitimate concerns, but some of them were also, frankly, simply ways to get at me directly. And that was really hard to listen to. That’s the kind of thing you never want to go through again in your life,” he said.

On May 8, 2020, the Riverside County Board of Supervisors directed Kaiser to rescind his orders, so that the county would be more in line with the state. He said in the months that followed, the threats continued, and he was given fewer and fewer responsibilities at work.

Two months ago, Kaiser received a call from the Riverside County CEO telling him that his services were no longer needed. Kaiser says since his appointment as the county health officer in 2011, he’s had no issues or complaints about his work.

CNN asked the Riverside County Board of Supervisors about Kaiser’s position and they replied by thanking Kaiser for his service and noting the decision to terminate Kaiser’s position had been made by the County CEO, Jeff Van Wagenen. They added that the Board of Supervisors had appointed a new health officer and said they would provide no additional information.”  (F)

DEC. 9, 2021

“Lori Tremmel Freeman, the CEO of the National Association of County and City Health Officials, said more than 500 public health officials have been pushed out or have left their jobs since the early days of the pandemic.

“For us to see this level of turnover is just really tough — tough for the community and tough for our response,” Freeman said. “We don’t have a lot of people in line to take the positions, because they’re difficult. And, of course, the more we talk about how they’re a target, with threats and intimidation and other things, the less appealing those positions sound.”..

The exodus of public health officials is raising concerns with experts like Freeman about the country’s ability to respond to the highly transmissible omicron variant, which is putting further strain on the nation’s health system.

“Our public health workforce has lost over 20 percent of its workers in the last decade due to disinvestment, so these losses are coming on top of losses to the field,” Freeman said. “And as we head into omicron and we’re hearing more and more about the seriousness of transmission, we worry about the capacity of our local health departments to continue to respond.”

Still, some advocates say, the pandemic has presented an opportunity for officials to reconnect with their communities and teach people about their roles.

“We need to make sure people understand what we do and how we protect them,” Dr. Georges Benjamin, the executive director of the American Public Health Association, said in a phone interview.

At the same time, he said, “anyone who thinks we’re suddenly going to wake up two months from now and things are going to be the way they were two years ago is fooling themselves.”

For some public health officials, the backlash to their Covid recommendations can be confounding.

Lisa Macon, a local health director for Granville and Vance counties in North Carolina, said that even though “we are used to having good dialogue across political lines most of the time” in a state with a Democratic governor and a Republican legislature, “it’s still really challenging.”

“It’s hard to understand how people are against the things that are intended to make people safe and save lives and keep people out of the hospital and prevent disease and death,” said Macon, who is also president of the National Association of County and City Health Officials. “I just struggle to understand it other than we know we’re having political and cultural wars right now.”” (G)

“In June, a study published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report found that nearly 24% of more than 26,100 state, tribal, local and territorial public health workers surveyed this spring were feeling bullied, threatened or harassed due to work. Almost 12% had received job-related threats.

The problem not only endangers the safety and mental well-being of public health workers; it is pushing out leaders when public health needs them most. It could also make it harder to recruit new workers into governmental public health. According to an analysis from Kaiser Health News and The Associated Press, published in December, at least 181 state and local public health leaders in 38 states had resigned, retired or been fired since April 1.

In August 2020, Joshua Sharfstein, MD, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health, coauthored an article in the Journal of the American Medical Association highlighting attacks on public health workers. He urged local officials to step up protections, including investigating credible threats, providing security detail when needed and prosecuting those who break the law. A year later, the backlash against local health officials seems to be getting worse, he said, egged on by legislative attempts in more than a dozen states to restrict and undermine the authority of health agencies to act in emergencies.

Sharfstein said many of the factors contributing to the backlash were entrenched well before COVID-19, such as political polarization and social media sites that make it easy to spread misinformation and extremist views. But he said elected officials and community leaders can help by speaking up in support of public health authorities and making sure workers are protected from threats…

Georges Benjamin, MD, executive director of APHA, also urged elected officials to speak out in support of local health authorities and condemn harassment. A former health official in Maryland and Washington, D.C., Benjamin said he has spoken at contentious public hearings during his career, but never experienced the “vitriol and anger” public health workers are now facing.

“People forget that when you run out your local epidemiologist because you’re mad about masking advice, you’re also running out the person protecting you from all kinds of other diseases,” he said. “Elected officials need to control these public meetings and be clear that attacks on public health officials will be prosecuted.”  (H)

“A large-scale survey conducted by the federal Centers for Disease Control and Prevention released last month found that more than half of people working in public health at the state, tribal, local and territorial levels during the pandemic reported symptoms of at least one serious mental health condition…

Unless the well-being of these workers is addressed, said Amber Williams, a senior vice president of the Association of State and Territorial Health Officials, “we will continue to get what we are getting now, which is a burned-out workforce and less robust response to a pandemic.”

She noted that the system’s capacity to address the problem is questionable. “There’s very little bandwidth to make the changes that are needed,” she said. It remains an all-hands-on-deck situation that requires long hours and workers assuming unfamiliar roles.

Rao said that while the top-level findings of the report weren’t unexpected, some incident details were.

Nearly 12% of the 26,174 public health workers surveyed said they had received job-related threats since the start of the pandemic. Nearly a quarter said they had felt bullied, threatened or harassed as a result of their work.

“Given the length of the response of pandemic, we had a feeling that public health workers were under immense amount of stress,” said Rao. “The amount of threats, harassment and bullying, that was the surprise.”..

While clinicians treat one patient at a time, the job of public health workers is to protect the health of populations. That means promoting healthy lifestyles and prevention of disease and injury, and detecting and responding to communicable diseases…

Many workers had to shift away from usual jobs and schedules during the pandemic’s early days, and then had to scramble to find personal protective gear, ramp up contact tracing of people infected with the virus or help those experiencing homelessness quarantine after testing positive.”  (I)

“Billions of dollars have been made available to public health by the federal government, but most of it has been geared toward stemming the emergency, rather than hiring permanent staff or building long-term capability. Most of the departments that responded to The Times’s survey said they were worried about their funding levels, which in most cases had been decreasing or flat before the pandemic. About three dozen departments said their budgets were the same or smaller than they were at the beginning of the pandemic.

At least 32 states have enacted legislation restricting state or local authority over health and emergency decisions.

There are already signs that the growing shortfalls in public health could have lasting impacts beyond the pandemic.

More than 220 departments told The Times they had to temporarily or permanently abandon other public health functions to respond to the pandemic, leading to a spike in drug overdoses and a disturbing drop in reports of child abuse. Several health officials pointed to runaway infections of sexually transmitted diseases, with gonorrhea cases doubling and syphilis on pace to triple in one county in Pennsylvania. Oswego County, N.Y., recorded a surge in lead poisoning. In Texas, requests for exemptions to the usual suite of required childhood immunizations have risen sharply…

The Times spoke with dozens of lawmakers who have introduced such legislation, most of whom shared a concern that health officials had overstepped their authority and required a check on that power.

“It’s a very dangerous situation when you decide to take away anybody’s rights,” said Bob Rommel, a Republican lawmaker in Florida. He drafted a bill, whose main provisions were incorporated into a law that took effect this summer, allowing the governor to squelch local health orders deemed too restrictive.

Citing that law, Gov. Ron DeSantis’s government, which has been aggressive in slapping down local restrictions, fined Leon County $3.5 million this month for mandating Covid-19 vaccinations for its employees — $5,000 for each person required to get a shot. The state has threatened to levy millions of dollars more in fines for similar county mandates.”  (J)

“This has been a major, unprecedented loss in public health leadership across the nation,” Dr. Richard Besser, former acting director of the Centers for Disease Control and Prevention and president and CEO of the Robert Wood Johnson Foundation, told ABC News.

While prepared to handle the relentless strain that comes with managing the COVID-19 crisis, officials told ABC they had not anticipated the cross purposes of scientific response and political backlash — in both red and blue states — that hamstrung the offices in which they’d been tasked to serve — and where some said they found little support from their leadership.

“This past year, you saw public health as a science and as a field being berated and belittled,” Besser said. We saw it being lifted up as the enemy of economic recovery — rather than the path to sustained economic recovery.”

The contentious atmosphere between political and public health risks eroding trust and morale in the system, experts say; that only gets exacerbated as science becomes the target of public ire — and physical threats.”” (K)

“Mr. Biden and his team have gotten much right, including getting at least one dose of a vaccine into nearly 85 percent of Americans 12 and older and rolling out life-saving treatments. Those achievements have put the United States in a far better place to combat the virus than it was a year ago, with most schools and businesses open and the death rate lower because the vaccine significantly reduces the chance of illness or death, even from the highly contagious Omicron variant.

But an examination of Mr. Biden’s first year of fighting the virus — based on interviews with scores of current and former administration officials, public health experts and governors — shows how his effort to confront “one of the most formidable enemies America has ever faced,” as he recently described it, has been marked by setbacks in three key areas:

The White House bet the pandemic would follow a straight line, and was unprepared for the sharp turns it took. The administration did not anticipate the nature and severity of variants, even after clear warning signals from the rest of the world. And it continued to focus almost single-mindedly on vaccinations even after it became clear that the shots could not always prevent the spread of disease.

The administration lacked a sustained focus on testing, not moving to sharply increase the supply of at-home Covid tests until the fall, with Delta tearing through the country and Omicron on its way. The lack of foresight left Americans struggling to find tests that could quickly determine if they were infected.

The president tiptoed around an organized Republican revolt over masks, mandates, vaccine passports and even the vaccine itself, as he worried that pushing certain containment measures would only worsen an already intractable cultural and political divide in the country. The nation’s precarious economic health, and the political blowback that Mr. Biden and members of his party could face if it worsened, made him all the more cautious. So rather than forcing Americans to get shots, he spent months struggling to accomplish it through persuasion….

The episode laid bare a fundamental problem. Some of the administration’s most difficult public health decisions are essentially hammered out by a handful of senior health officials who hold roughly the same status, none of whom are in charge. They are overseen by Mr. Zients, a former economic policy adviser to President Barack Obama who is known for his logistical and planning skills but has no public health expertise. No single public health expert has the role of guiding the response, running interference between various players or standing up to the White House when necessary.

“There is no formal decision-making process,” one senior federal official said, speaking on the condition of anonymity. “Who is in charge of all this?”” (L)


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