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As Nevada County and the world ground into our second pandemic year, YubaNet reached out to people working with the county Public Health Department to ask for their insights into their front-lines fight to keep this community as safe as they can from the novel coronavirus.
“It’s been a transformative year,” said Nevada County Public Health Director Jill Blake.
This project began with interviews of eight women in the department. These women — and the department is almost all women — counted at least 185 spouses, children, siblings, parents, cousins, in-laws, faith community members and dear friends they have seen little in the past 16 months. Among those dear ones are some who became sick or died of COVID-19, alone and not properly mourned. Also among those dear ones are people who disagree with the measures the department has promoted to safeguard public health, people who refused to wear masks, refrain from gathering or get vaccinated.
“Some of my family, we just don’t talk about it. We can’t have that conversation,” one of the women said.
Most of these women have been working 14-hour days, seven days a week, for 16 months. Together, they, other county employees and temporary staff pulled into the pandemic response clocked 22,000 hours for the effort from March 2020 to mid-February 2021, according to a county report. They made telephone calls, took reports, held virtual meetings and vaccinated people — alongside their regular public health duties — during birthdays, anniversaries and holy days. Only recently have they started to take some time off, as daily new cases have declined amid growing vaccinations.
“We have a joke at work: how to position the cot if one of us snores,” laughed Public Health Nurse Laura Zieman.
Most of these women are salaried. That means they have received no additional compensation for the hours they work beyond their regular 8-to-5. That is just one small part of the decades-long pattern of not valuing public health at a national and international level, many experts have said.
“Public health has been such a neglected field for so long. It has been underfunded for so long,” Blake added.
As bare-bones state and local public health departments scrambled to respond to the pandemic, their employees became the targets of fear, anger, threats and attacks. At Nevada County Board of Supervisors meetings every two weeks for more than a year, people opposed to public health mandates and guidelines — which would keep them and others safe from the worst effects of COVID-19 — continue to stage protests, shout, wave flags and make claims largely unsupported by scientific evidence to press their arguments. They have pounded on windows and doors at the county’s Eric Rood Administrative Center during public meetings. They refused to cooperate with efforts to limit COVID’s spread by wearing masks, keeping physical distance at gatherings and keeping businesses closed.
While the women of Nevada County Public Health have worked to keep people alive and minimize suffering and death, they and other county employees have received communications threatening violence against them and their families. Some of the communications describe very personal violence in graphic detail. These women have been confronted by hostile residents pushing cell phones in their faces with the cameras turned on, video-recording their movements and posting images of their vehicles’ license plates. For the first time in their lives, these women have to think about how late they stay at work and whether anyone will be around to accompany them to their vehicles when they leave in the dark after a 14-hour shift. Some have installed security systems at their homes.
Nationally, 53 percent of public health workers reported their mental health has suffered amid the pandemic, according to a study released June 25 by the U.S. Centers for Disease Control and Prevention. In a survey of more than 26,000 people taken this spring, public health workers at state and local levels reported feeling recent symptoms of post traumatic stress disorder, depression and anxiety, or feeling they would be better off dead. Mental health symptoms worsened for people working more than 41 hours weekly, who had been unable to take time off, and who had spent more of their time focused on COVID-19 response, the researchers found.
Pressure from the outside and pressure from the inside have added to the professional anguish of Nevada County’s public health team, as local COVID-19 cases soared, intensive-care beds at the local hospital filled and deaths spiked. To date, nearly 5,000 Nevada County residents have gotten sick with COVID-19, and 75 have died.
Despite those pressures and anguish, not one of them has quit. They hang in there, they said, because they believe in the mission of caring for the health of their community. They are part of a tradition that goes back more than 200 years in the United States of America, a tradition that has grown Americans’ average life expectancy from about 39 years in the mid-1800s to nearly 79 years before the pandemic struck.
“Public health people are do-gooders,” Deputy Public Health Director Dr. Glennah Trochet said.
In more than 12 hours of interviews, Nevada County Public Health Department and other county employees described what it was like to watch the pandemic unfold as they battled against it. YubaNet will publish those interviews and related stories in coming weeks. Throughout these interviews, certain themes came up again and again:
Passion for public health.
All the women interviewed expressed a passion for helping people and a commitment to their community. Many studied nursing, but they chose public health because they care about people, even though it pays much lower than most other health fields.
“Most young nurses want to get out and work in the hospitals. They would look at public health as a retirement job,” said Public Health Nurse Charlene Weiss-Wenzl. “I always wanted to work as a public health nurse.”
This word came up again and again in interviews as Nevada County’s Public Health employees discussed their experience of the pandemic, especially in the early days. It was surreal for these women to watch the pandemic unfold, to drive through empty streets, to swim amid the chaos of the federal response, and to watch opposition develop to science-backed public health guidelines.
Most of all, they said, it was surreal to know that people are going to die, no matter what they did to prevent it.
“Nothing prepared us for this.”
Nevada County Public Health employees, along with fire, law enforcement and other emergency response agencies, plan and prepare and drill every year to hone their response to public health emergencies.
The novel coronavirus brought a reality unlike anything they had imagined.
Yet, they thought on their feet, rolled with the punches, and adapted as the science evolved and led to new guidelines that changed — sometimes daily.
“I’m tired of the word ‘pivoting,’” quipped Director of Public Health Nursing Cynthia Wilson.
“It was overwhelming.”
The sense of surreality gave way to feeling overwhelmed, which accelerated in fall 2020 as COVID-19 cases and deaths rose quickly in Nevada County and across the nation.
“We tried to constantly evolve and be accessible to the community, but to still be able to do our job was a challenge, and it still is,” said Health Technician Lisa Richardson.
Many recalled a roller-coaster of emotions over the course of the pandemic. “Fear, trepidation, joy, excitement. Seriously, it can be moment-to-moment when you’re in it,” Zieman said.
They responded to the challenges by working together, hashing out problems, seeking consensus, bringing in help, and trying new approaches as problems arose or overwhelmed their plans and preparations. “It can be very difficult and very hard, but I have seen all the people around me rise to meet the moment, to meet the situation that we are in,” said Jennifer Tamo, an analyst with the county Office of Emergency Services brought in to organize county-run vaccination clinics.
Chaos and politics at the national level slowed local response.
Lack of leadership, organization and clear information at the federal level slowed the ability of Nevada County Public Health to respond quickly, according to the women interviewed. Most also noted how the politicization of public health measures by the nation’s executive branch created conflict and confusion.
“I thought (this pandemic) was going to be the one thing that would bring everyone together, and we would all work together,” Public Health Nurse Charlene Weiss-Wenzl said. “That didn’t happen.”
Startled by the public spotlight.
People in public health are accustomed to flying under the radar. It’s the kind of profession that no one notices until you need it, some said.
“Most of the time, if you’re in nursing and healthcare, you’re just doing the job,” Weiss-Wenzl said. “We’re just thinking about what needs to get done to keep people healthy.”
The pandemic has thrust public health employees across the nation into a spotlight that they never expected.
Surprised by the rejection of evolving coronavirus research.
Many public health workers have nursing backgrounds. “I’m a science nerd!” Weiss-Wenzl said with a self-deprecating laugh.
People immersed in scientific fields are used to seeing the twists and turns, the missteps and course-corrections that are part of the scientific process. Most of the rest of us, however, are not. The early days of the pandemic put science’s journey toward discovery on public display. That view stirred confusion, especially when federal policy was inconsistent with science-based guidance, and leadership was lacking. As a consequence, many Americans rejected the public health guidelines that evolved according to the unfolding understanding of the new coronavirus.
Americans’ rejection of those evolving health guidelines increased suffering and death, the women interviewed said.
“We were really naïve to think everyone else would listen to the epidemiologists… to the people who have dedicated their lives to the study of disease and disease transmission,” Blake added. “It was startling to see that the evolution of the science was something that people found suspicious. This was a virus that was so new. As we learn the lessons, we incorporate the lessons from the research into our response. That was frustrating for people, and (their frustration was) surprising to us.”
Angered by the “dismissal” of deaths.
From the earliest days of the pandemic, a line of argument emerged both nationally and locally that portrayed suffering and death due to COVID-19 as an acceptable sacrifice to avoid economic losses. Several of the women interviewed expressed pain and outrage at what they considered a false balance of values.
“When we started having the outbreaks in the assisted living and skilled nursing facilities, that was the worst part of the pandemic for me, because we had people discounting the deaths of elderly people as if they didn’t matter, publicly, while the folks in these facilities were crying and upset, and the families weren’t able to come in to see them,” said Deputy Public Health Officer Dr. Glennah Trochet, who monitored the spread of disease in group living facilities. “Once COVID entered one of these facilities, the outbreak would go on for weeks. It was awful. It was a terrible experience for everybody.”
Economic loss and disruption was the result of the pandemic itself, not the public health measures enacted to slow the pandemic and save lives, several of the women argued.
Before the vaccine and after.
Nearly every woman divided this pandemic time into two parts: Before the vaccine and after. The arrival of the first vaccines in Nevada County in late December marked a turning point in the department’s battle against the pandemic, coming just after the peak in the fall surge of cases and deaths.
Zieman, who is the county vaccination coordinator, gave the first shot to county Behavioral Health Nurse Jessica Ferrer, both in the first group to receive vaccines as front-line workers, on the Tuesday after Christmas 2020. “It was monumental,” Zieman said. Recalling that moment “makes my hair stand up.”
“We have stuck together.”
Across America, at least 181 local and state public health leaders in 38 states resigned, retired or were fired between April 1 and Dec. 15, 2020, according to an investigation by The Associated Press and Kaiser Health Network.
Before the pandemic started, Nevada County Public Health Officer Dr. Ken Cutler already had planned to retire, and he did so in July 2020. The health officer is an independent contract position within the Public Health Department.
Within the department’s core employees, however, not one person has left.
Every woman interviewed praised her co-workers, using phrases such as “amazing leadership,” “completely committed” and “brilliant women” to describe them.
“There’s immense amounts to learn from this experience, but am I proud to live in this community, and proud to work amongst the people that I do?” said Kimberly Blix, the public health emergency preparedness coordinator. “Absolutely. Every day. All day long.”
Pattern of neglect in public health funding.
The pandemic has underscored the pattern in public health funding of neglect-crisis-fund-repeat on a state, national and global level, most of the women said. Decades of declining resources left public health departments across America ill-equipped to deal with a disease that quickly overwhelmed our ability to confront it, according to health experts at the local, state and national levels.
“I would hope this would be a wake-up call to our state, to our country,” Wilson said. Public health “is a place where our infrastructure needs to be permanently maintained.”
The future: Economy reopens while new variant spreads
The pandemic’s landscape has continued to evolve. In late May, the nation’s rate of new COVID-19 cases and deaths for the first time dipped lower than the rate in March 2020, according to Reuters news service. On June 15, California’s economy fully reopened, and most mandates to wear masks and keep physical distance ended, under an order by Gov. Gavin Newsom.
By June 23, more than 58 percent of Californians were fully vaccinated, according to the state’s vaccination progress data. In Nevada County, about 52 percent of people 18 and older were fully vaccinated, according to the county Public Health Department.
Local schools are set to reopen with in-person instruction in August. The Pfizer-BioNTech vaccine has been authorized for emergency use for people as young as 12 years old. Clinical trials are now underway for a vaccine for children as young as six months old.
On the horizon, a new variant of the novel coronavirus is spreading around the world and in the United States. The delta variant was first detected in India in December 2020. Mutations in the virus that scientists still don’t fully understand make it easier for the virus to enter human cells and possibly to evade the infected person’s immune system. It is spreading much faster and making people much sicker in comparison to the original virus. Some early studies suggest people sick with the delta variant are twice as likely to be hospitalized compared to those infected with the original virus, researchers said.
And, children and people younger than 50 are 2.5 times more likely to become infected, compared to the infection rate of the original coronavirus strain, researchers have found.
On June 25, the World Health Organization recommended that all people continue to use face masks and take other precautions, regardless of having antibodies or having been vaccinated, to slow the spread of the delta variant.
“Our fear is that people will start getting too complacent and stop doing the right things, and we’ll have another surge of illness,” Trochet said. “I’m hoping that won’t happen, but that’s the concern.”
Editor’s note: The series is about local women working in Public Health during this pandemic. Their stories offer a glimpse behind the scenes of Nevada County’s small but definitely mighty PH department. Our thanks to all who talked to us, answered questions, provided background and explanations. Special thanks to Trina for working with us on this project. Your talent and kindness made this possible. -Pascale