The Daily - The Public Health Officials Under Siege

Episode Date: November 11, 2021

This episode contains strong language.When the coronavirus hit the United States, the nation’s public health officials were in the front line, monitoring cases and calibrating rules to combat the spread.From the start, however, there has been resistance. A Times investigation found that 100 new laws have since been passed that wrest power from public health officials.What is the effect of those laws, and how might they affect the response to a future pandemic?Guest: Mike Baker, the Seattle bureau chief for The New York Times. Sign up here to get The Daily in your inbox each morning. And for an exclusive look at how the biggest stories on our show come together, subscribe to our newsletter. Background reading: State and local public health departments have endured not only the public’s fury, but also widespread staff defections, burnout, firings, unpredictable funding and a significant erosion in their authority to impose the health orders that were critical to America’s early response to the pandemic.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. 

From The New York Times, I'm Michael Barbaro. This is The Daily. Today. In their efforts to fight the pandemic, local public health officials have become the target of protest. We will give no more ground. We will not comply. Anger.

The governing body should fear the people. We are pissed off. Threats. You, doctor, are going to be arrested for crimes against humanity. There's a lot of good guys out there ready to do bad things soon. And increasingly, laws intended to limit their power. Increasingly, laws intended to limit their power. My colleagues have been investigating how all of that is impacting the ability of public health workers to do their jobs, and whether it's left the country less prepared than ever for the next public health crisis.

I spoke with my colleague, Mike Baker, about what they found. It's Thursday, November 11th. Mike, tell us how this investigation into the state of our public health agencies got started. Well, I've been covering the pandemic since basically the beginning when the first cases arrived in Seattle. And what was clear even early on in those days was how critical public health departments were going to be to confronting the virus, to stopping the pandemic. Public health is really a patchwork system of agencies, both at the state and local level, that work together across the country. And so when COVID hits, these public health agencies are responsible for monitoring the cases that arise in their

community to figure out quarantine protocols, to recommending or instituting or implementing mask mandates and establishing the kinds of rules and protocols that businesses and schools and everyone's going to be following for the course of the pandemic. Right. But almost from the start of the pandemic, I think we all saw this resistance to the notion of public health mandates and how public health operates. notion of public health mandates and how public health operates. And what we've increasingly seen over the course of this year is that a lot of that resistance is actually starting to become policy. So earlier this year, I teamed up with my colleague, Danielle Ivory, and she has been leading a COVID data team throughout much of the pandemic. So we started combing through all the states looking for new laws and proposals on the table that would undermine public health.

We began reaching out to every health department to see what kinds of changes they were seeing in their departments. And what we found was a pretty bleak picture for them. At least 14 states have introduced or passed bills that would limit the power of state officials. Iowa's Republican governor signed a bill into law that bans local jurisdictions from implementing mask mandates. In North Dakota, that's a ban on mask mandates. I mean, it was more than 100 new laws.

The measure Governor Ron DeSantis signed into law banning businesses, government agencies, and educational institutions from requiring proof of vaccination status from... That had passed, that limited the power of public health departments, and largely turned over that power to political leaders in their states.

In Ohio, the legislature could overturn any order issued by the governor or state health department in a public health emergency. And in the end, it was a picture of public health in this country that was in a very precarious state. So the main strategy for us was just trying to talk to as many of these public health officials as we could to better understand the circumstances they were facing, what they were dealing with. And where did you end up going? Whose experience seemed to stand out to you?

One of the states that stood out as we were compiling these laws was Kansas. They had some really impactful new legislation and also these interesting political dynamics with a Democratic governor and a Republican legislature. these interesting political dynamics with a Democratic governor and a Republican legislature. And so there was clearly a battle going on in the state over what the role of public health should be. Yeah. Hi, doctor. How are you? Yeah. Nice to meet you too. And one of the people in the middle of that battle that I found to be really interesting was Dr. Jennifer Bakani McKinney. She's the health officer in Wilson County down in southern Kansas,

and it seemed like a good place to go visit. I don't know if we're shaking hands anymore these days. Oh, I thought we were hand sanitizing the shit out of our hands. So I met Dr. McKinney outside the Wilson County Health Department. It's a one-story building surrounded by small local businesses. It's such a lovely area. Isn't it? It's not bad. It's really lovely.

I do want to know what's in the Horseshoes and More store, though. It's mostly more. I know. It's a small community of about 9,000, and she's one of those people who knows everybody in town. I would show you our bar scene, but it's one bar. All right. It's called Alky's, like legitimately

the name of the bar is Alky's. You know, she grew up in Fredonia, Kansas, in Wilson County. She went off to college to get her degrees, but came back and, you know, became a family physician and also works at the hospital and also on the school board. So on top of being a doctor and on the school board, she also runs the public health department? Yeah, she's got a lot of duties.

Do you mind if I see the sites in here? So I want to talk to her about like, you know, how are things going now? What's the future? And we really started with sort of a journey through her time in the pandemic as someone who was a trusted voice in the community, someone who was admired and known by all, to someone who's dealing with just constant skepticism and this sense of almost being a pariah. And what was that journey?

So March of 2020, I remember on a Friday... So she started back at the very beginning when the first few cases are coming into the United States and she starts to rally the community. And so I got all the schools, business owners, churches, government leaders, hospitals, clinics, just, I mean, we had about 60 people like smushed into a room the first meeting when we were like, oh, we didn't realize we're not supposed to do that. But, um, and people in the community are really looking to her for guidance. They're trusting her as, you know, the family physician they know her to be. Because they were like, we don't know who to listen to,

but we see you guys and we know you, so we trust you, you know. And she carries out the governor's statewide lockdown in March of 2020. And Kansas does not really see any early wave of cases. In fact, there are almost no cases in Dr. McKinney's county. Things are going pretty well. So when did you say things start to change? We all did the lockdown. That's what we were supposed to do. And I think people started feeling like we did all of this for nothing. It was overreaction. We're isolated. So we don't have to worry. Look, we've made it this far and everything's fine.

Dr. McKinney starts to get a sense of change by May of 2020 when there is this effort to start reopening. And once we started, like, opening back up, that's when we started seeing kind of the disagreements. Like, the county commissioners were like, no, we just open everything up. Because at that point then... And that resistance that Dr. McKinney is seeing is also happening at the state level, too. I mean, you have Republican lawmakers at the Capitol who want to open up the economy again.

They want to prevent the governor and public health departments like hers from implementing lockdowns like they had just done. So Governor Kelly could issue whatever mandate she wanted, but thanks to Republicans in the legislature stripping her powers, her public health orders didn't mean anything statewide. And so they go after the governor through these laws that I mentioned earlier. There's 105 counties in Kansas. After Governor Kelly issued her mask mandate, more than 80 of the 105 counties

in the state opted out of it. To limit the powers she would have to call us for a state of emergency. What it does is it puts some checks and balances in place. So if the governor wanted to declare another disaster related to COVID, then it has to run through a legislative body in this case. And they want to really empower the political leaders at the local level, the county commissioners that Dr. McKinney deals with, empower those people to control more of what the county health departments do. And so what do these new laws and rulings at the state level, giving these local leaders more power over a department mean for Dr. McKinney?

There was a little power struggle in there, you know, because after the reopening, that's when they started saying, you know, we've looked into it and you're you're appointed by us. And like like we could fire you if we wanted, know or you have to do what we we tell you even so far as like one of the commissioners saying you can't post things on facebook without talking to us and i'm like that's my personal account like that's not even so she feels like this is really a slap in the face this is the kind of thing that prioritizes political decision making over health decision making and she starts to see in her community a shift in sentiment of how people are viewing public health and how people are viewing her. County commissioners who were not medically trained or didn't know how to read research or do

anything, they're trying to do what I do. You had school board members who were making decisions for the kids who also had no medical knowledge. And even if you have a doctor on your board like ours, they don't listen to you, you know. And so she's seeing people in her community suddenly becoming distrustful of what she's asking for. Her county commissioners are calling her a liar. They're disagreeing with the facts she's trying to present to them. So I remember bringing in the whole idea that young people could get cardiomyopathy, you know, myocarditis after COVID.

So we need to clear them for sports before they started playing. And I remember distinctly one of the commissioners said, that was the first time he said, that's bullshit. And I said, I'm sorry, what? And he said, you think you know everything? And I said, well, I do about this. I know about this. Well, this is bullshit.

They don't need to be cleared. You can't do that. And he said, well, I'm just trying to protect the kids and make sure they're okay. And that's where he said something like, well, you and your 10-page resume think you can, I don't know, it's a weird thing. And part of that in this tension that's growing, the commissioner's mocking her, saying something along the lines of like, well, yeah, you and your 10-page resume, as sort of a jab at her expertise. That was the first time I remember it being not just disagreement, but like hostile, you know? So in her mind, the laws that have been passed at the state level that seem to challenge

public health rules related to the pandemic, those seem to be encouraging this kind of behavior, this commissioner turning to her and basically saying, I don't trust you, even though she's quite skilled. Yeah, that's right. I mean, it really was just basically them saying, thanks, but no thanks. We don't need you anymore. And by the time COVID really does come for Kansas by the fall of last year, you know, the sentiment in the community is creating problems for Dr. McKinney.

How so? She had been pushing for quite some time for a mask mandate as case numbers were rising. And the county commissioners, sort of seeing the dire numbers, agreed to have a discussion about whether to do one. And so that sets up this really tense town meeting where community members are outraged at the idea. And she's there left trying to convince all these people who have grown skeptical of her, trying to convince them of the need to make this happen. So, this guy invited all of his constituents, all anti-mask. I'm against the mandate. We are in the process of losing our freedoms. We're in the process of losing free speech. If you do mandate to take a stamp, are you then going to mandate that everyone has to take the vaccine?

Fear, intimidation, insecurity, and control have done more damage to our people than the virus. But what are they going to come next? After our guns? After our kids? After everything everything we've ever known in our lives. Is this America? Thank you. And then at the end of the meeting, the commissioners said, well, this is the mask mandate that we want to pass. We're going to read you a resolution that is made for us that we have not voted on. So you already had this resolution?

No, we have not voted on it. They had me read it. So people started getting up and yelling, you brought us here for nothing, like, this is, like, we wasted our time and all this. It's a tense meeting and it really illustrated how much the community was in many ways turning against her. So by the end of the meeting, there's security there that wants to escort her out. For her own safety.

Yeah, that's right. Like, that was a weird moment for me when the sheriff's deputy was like, no, we'll just walk you out. I mean, there's some angry people here. no we'll just walk you out i mean there's some angry people here and as she's leaving the meeting she gets a text from someone she knows like one one of my old classmates stood up at that mass meeting and he's he's like we shouldn't have masks freedom rights and he sent me a text that was like this wasn't personal personal. And I'm like, no, it is personal.

Like, this is my life's work, you know, so what's not personal about it, you know? So it feels like this community, her community, seems to be turning on her. And so where does all of this leave Dr. McKinney and the people who work with her at the Department of Health in the middle of this dark period in the pandemic. I mean, they're feeling pretty demoralized. They're seeing the lack of support in the community. They're frustrated by all the misinformation that they're dealing with, exhausted by how much the community is ignoring them

or rejecting them. And they're not in a great spot. I mean, it's just, it is really sad because it's a small town. I don't know how we're supposed to move forward or like forgive and forget because it's not, it wasn't just one episode. It's like throughout this last 18 months. I mean, how much do you feel like you are? We'll be right back.

Mike, I'm curious, in all your reporting, in communities around the country, in your conversations with people in public health, how usual or unusual is Dr. McKinney's experience? Well, I think throughout the investigation, the more people that we talked to, the more it became clear that the experience that Dr. McKinney had and was having

was a really common one, that the public health officials around the country in dozens of states were seeing their public trust eroded. And the powers that they had that had allowed them to do the job during the pandemic, those were eroding as well. And so we really found sort of three main reasons why these public health agencies were in a very bleak situation. And what were those three reasons? bleak situation. And what were those three reasons? Well, the first thing, and I think the foundational one, is that these new laws are cropping up everywhere. As I said, we found more than 100 new laws that have passed, and many of them are so potent in their reach that they extend potentially

here beyond the pandemic. For example, some laws place a limit on quarantines that is so broad that it could disrupt quarantine protocols even for diseases like measles. Other laws are targeting vaccine mandates, but some of those restrictions are now stretching beyond just COVID vaccines. In Montana, for example, the hospitals there are worried that they can no longer require the annual flu shot for their employees, which is something that's become pretty common practice in healthcare settings. And Mike, what is the stated rationale for these laws? Well, for a lot of conservative lawmakers, there was this response that public health overstepped its authority and essentially took away people's rights in the middle of this pandemic. to control people's lives, to shut down restaurants, to order masks.

And they weren't keen on that power being there, that they wanted to put some more restraints on public health agencies and to prioritize personal liberties and the rights of people to go out their day as normal. So what they have been awakened to is just how much power people in the world of public health have. And they fear that after having used it during COVID, public health officials could keep using it in ways post-COVID that might continue in their mind to infringe on people's rights. That's right, yeah. Okay, and what is the second reason why people in public health

are feeling so frustrated and undermined? Well, one big thing we found was there's just been a mass exodus of people leaving public health jobs. That's been firings, that's been resignations. But around the country, we heard from people who are just burnt out. They've been dealing with direct threats on their safety. They're struggling to break through misinformation. And there's protests sometimes right outside their homes. And so there's a lot of people who have resigned and left the job.

So we actually found some agencies who say they have the same or fewer staff than when they began the pandemic, despite all the investments in trying to build up a response. Right. And despite the enormous need of the pandemic. Absolutely. Yeah. Did you get a sense for just how many people have left the public health industry? It's hard to tell because there's no central tracking system, but we found more than 500 top public health officials who have left their jobs since the pandemic began. Hmm, at the level of someone like Dr. McKinney.

Right, exactly. Okay, just to recap, local politicians are shifting power away from health experts who in turn are leaving their jobs, which brings us to the third reason there's a crisis in our public health system right now, which is what? Well, the third reason there's a crisis in our public health system right now which is what well the third kind of builds off the second which is that with these vacancies opening up and

the need to appoint new leadership some of those that are getting appointed have a lot less experience and expertise than those who are there before them and in fact some of them are being appointed specifically because they run counter and have different ideas than those who were there before them. And in fact, some of them are being appointed specifically because they run counter and have different ideas than those who have been in public health before. What do you mean by that? I mean, the people being put in these jobs sometimes don't have backgrounds in public health

and in some cases actually openly oppose the science of COVID. One of the cases we looked at was in Idaho. I went to Boise to watch some interviews take place for a new position on the regional health board. One of the candidates for the job was someone who is an epidemiologist who is specialized in infectious disease. He had support from all the hospitals in the area. But the commissioners decided he wasn't the one for the job. The person they chose was a doctor who had, in recent months, been advocating against getting the vaccine, who had called the vaccine needle rape,

and basically positioned himself as someone who thinks that the public health world has this all wrong. So they chose someone who was anti-vaccine? Yeah, the commissioners basically said, this is someone who's going to bring an alternative perspective to the job. And you're saying that is the kind of decision that would leave everyone working for this person very disillusioned? Well, it changes the whole dynamic of public health and what it has meant for decades now and what it's going to become. So yeah, there's some great angst about what this is

going to mean for the future. So Mike, where does all of this, these three factors you just cited and the experience of what someone like Dr. McKinney went through, Where does all of this leave the country's public health system at this moment, these frontline workers in protecting all of our health? Yeah, I mean, there's a deep worry that the public has turned against public health agencies where lawmakers got this window into what public health does and they don't want any more of it. And so there's this fear that right now, public health agencies are constrained in responding to this pandemic, but also what happens with the next one?

What happens when the next virus comes, when the next disease is going through a community? Are we now hamstrung to respond to the next virus comes, when the next disease is going through a community, are we now hamstrung to respond to the next pandemic? Right. What you're describing seems to be a sense that instead of the public health system in this country becoming stronger and more robust, having lived through the trauma of COVID, that it's more the opposite case, that the system seems weaker and more vulnerable. Is that right?

Yeah, I think this could have been an opportunity to rebuild public health after years of budget cuts, after a chance to build up staffing to make these departments better and stronger to fight the pandemic. And instead, we're dealing with the opposite. And the communities are more vulnerable too. Well, Mike, thank you very much. We appreciate it.

Thank you. We'll be right back. Here's what else you need to know today. On Wednesday, the Biden administration said that consumer prices on everything from groceries to cars rose more than 6% in October compared to a year ago, the largest annual increase in 30 years. year ago, the largest annual increase in 30 years. The increases defied predictions from U.S. policymakers. And in a statement, President Biden said, quote, reversing this trend is a top priority. And describe what happened. I look over my shoulder and Mr. Rosenbaum, Mr. Rosenbaum was now running from my right side. Um, and I was cornered from in front of me with Mr. Zeminski. And there were... and there were...

In at-times emotional testimony on Wednesday, Kyle Rittenhouse took to the stand to defend himself against murder charges, testifying that he shot and killed two people and injured a third in Kenosha, Wisconsin, only after feeling that his life was in danger. But in their cross-examination, prosecutors suggested that it was Rittenhouse who had made the situation more dangerous by going to Kenosha with a gun. Why do you need the gun when you go out there?

I need the gun because if I had to protect myself because somebody attacked me Why would you think anybody would do that? I don't know But you clearly planned on it That's the whole reason you brought the gun Isn't it? I brought the gun to protect myself

Exactly Today's episode was produced by Sydney Harper, Stella Tan and Rachel Quester It was edited by MJ Davis, Stella Tan, and Rachel Quester. It was edited by M.J. Davis-Lynn and Patricia Willans, contains original music from Marion Lozano, and was engineered by Chris Wood. Our theme music is by Jim Brunberg and Ben Landsberg of Wonderly. That's it for The Daily.

I'm Michael Bilbaro. See you tomorrow.