It was late June 2020. COVID-19 cases were starting to double in Nevada County, Californians had been ordered to stay home, and protests against community health measures were growing more strident.
Amid the alarm bells, County Public Health Department Director Jill Blake received a letter.
“Thank you,” the sender wrote.
Nevada County public health nurse & immunization coordinator
– Nevada County immunization coordinator
– Nevada County Recognition Coin recipient
– Associate Degree in nursing, University of Hawaii, Lihue, Kauai campus
– Bachelor of Science in nursing, Western Governors University
– Public Health Nurse certification
– Basic Life Support/CPR certification
– Advanced Cardiovascular Life Support certification
– Neonatal Advanced Life Support certification
The sender was a local woman whose husband had been hospitalized in late March 2020, sickened by the novel coronavirus. One of Blake’s employees, Public Health Nurse Laura Zieman, had been in daily contact with the woman during her quarantine. First, Zieman had traced the couple’s movements since the time they had been potentially contagious, and she contacted people they had been near; that included many relatives who had gathered at a family celebration. During the quarantine, Zieman had monitored the woman’s health, part of the time-tested routine for curbing the spread of contagious disease. After two weeks, the woman had developed no symptoms of COVID-19, so her quarantine ended. Yet, Zieman continued her frequent telephone calls for another seven weeks of moral support, until the woman’s husband returned home.
During those weeks, several of the husband’s relatives who had been at the celebration also grew sick with COVID-19. Two of his siblings died. Through it all, Zieman listened to the woman’s fears and family stories, explained the unfolding details of her husband’s medical situation, and even made the woman laugh.
“My ability to be here (and be sane!) I credit in a large part to Laura’s calm, empathetic and supportive role in my life during the horrific time when I did not know if my husband would survive,” the woman wrote. “She is an amazing nurse, but an even more amazing human being.
“Nevada County Public Health and the citizens of Nevada County are lucky to have such a dedicated public servant.”
At Christmas, the couple sent Zieman a card. At the one-year-anniversary of the man’s illness, Zieman mailed them a note.
“It’s still a powerful thing for me,” Zieman said recently.
Relationships form the foundation for much of what Zieman does at the county Public Health Department. She has called on those relationships again and again as the department continues its work of protecting residents from COVID-19. The results show how public health services have impacted people’s daily lives as they live through this pandemic.
‘Track shoes’ to run the pandemic race
Zieman was living in Hawai’i, where she was a 100-ton-certified, licensed captain in the United States Coast Guard and a Professional Association of Diving Instructors-certified scuba teacher, when she met the man who would marry her and bring her home to Nevada County.
Here, she worked many years for Dr. Robert Lowe, a Grass Valley internist who specializes in infectious diseases. She also worked with special education students at Nevada Union High School, and was a back-up to campus nurse Karen Harris. She spent time as a nurse for the county Behavioral Health Department, then went to Western Sierra Medical Clinic, where she started their substance abuse program for heroin and opioid use, she said.
So when Zieman hired on at the Public Health Department in March 2019, she brought all those connections and all that experience with her.
“I have some good shoes on, if you will, to run the track race, because there’s a lot of people out there I know,” Zieman said. “We can work together to accomplish what we all want to see, which is for this be over.”
When there’s not a pandemic raging, Zieman coordinates the five routine immunization clinics the county runs each year, plus drive-through influenza vaccination clinics each fall. Many of her clients are families that have young children, no doctor, little or no insurance coverage, and scanty resources to get or pay for medical care; she also sees adults in similar straits. “Primarily, we look at our communicable diseases and how we can prevent them, utilizing vaccines,” she explained.
With that background, Zieman was part of the team planning the nuts and bolts of the county-run COVID-19 vaccination clinics.
Concern about vaccine equity
Early on in the planning, Zieman saw that many people would have trouble getting the COVID-19 vaccines.
“One of the main charges of public health is to serve the entire community and to attempt to achieve equity for everyone,” Zieman said. But even during good times, many county residents face challenges getting the usual vaccines due to their income or education level, where they live, whether they have a vehicle, whether they have a telephone or access to the internet, their language, their use of addictive substances and their mental state. She calls such folks her “beleaguered population.”
So to get the COVID-19 vaccines to as many people as possible, Zieman drew on her relationships.
The department has taken COVID-19 vaccinations to the food pantry in North San Juan, to the Washington fire station, to senior mobile home parks around the county, to nursing homes and to low-income apartment complexes. Staff at Tahoe Forest Hospital are reaching out to people at homeless shelters in the Truckee area. Zieman tapped Spanish-speaking health promoters at the county’s Truckee clinics to contact Latino families.
“We might call the mom of the daughter who goes there, and six family members show up,” Zieman said.
The mental health piece of this puzzle — usually attended by the county Behavioral Health Department — has been key to reaching some residents, Zieman added.
“We’ve seen our alcohol use go up and drug use go up through all of this, as well as lack of sleep, too much food, not enough food — all of those things people use as stress coping mechanisms,” Zieman observed. So, her work has included finding ways to keep people engaged with her programs despite mental conditions, such as paranoia, that might compromise their thinking about getting vaccinated, she said.
All these efforts “attempt to reach people that are unreachable or don’t have the ability to make a decision, based on the information they’ve gotten,” Zieman said. “It’s powerful, very powerful.”
Pandemic experience may ease future vaccine hesitancy
Zieman has worked with school nurses to reach out to parents, promoting routine childhood vaccinations. “When the schools closed, there was a great concern for an outbreak of children’s diseases, because (parents) were not following through on the vaccines that (their children) needed,” she recalled.
That part of her job brings Zieman into regular contact with parents who were reluctant to vaccinate their children, even before COVID-19 and social media-fueled fears about the vaccines’ safety. Nevada County already has the lowest childhood vaccination rate in California: In 2015, about 77 percent of local children entering kindergarten had all their required vaccinations, compared to nearly 93 percent of children statewide, according to the county Health Assessment Report.
“So that makes trying to sell the COVID vaccine harder, but you do build confidence with folks … by being straightforward with them and answering their questions and being available,” Zieman said. She gives parents “the insurance talk,” she says, weighing out the very small risks of the vaccines against the more likely and more serious risks of illness.
“I have kids that come in, I’ll see them 20 times (for routine vaccinations) instead of nine times, because parents don’t feel comfortable with more than one shot at a time… But, you continue to educate them, and for the most part, they continue to bring their kids back.”
Zieman is counting on her relationships with her partners and her clients to help people be safe and move the COVID-19 full-vaccination rate beyond the current level of 54.6 percent for adults and 33.4 percent for children 12 to 17 years old. Those figures compare to statewide full-vaccination rates of 59.6 percent for adults and 32.4 percent for children 12 to 17, according to data from the state of California and the CDC, as of July 6.
“This is a balance,” Zieman said. “Nevada County, with the constraints we have and the vaccination attitudes that we have, we’ve done really well with COVID.”
The pandemic experience, she added, “might give a different spin on vaccines to people, and I hope it’s a positive one, when we’re done with it and science wins out.”