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Public Health Struggles With Pandemic and Politics

Health departments are battling not only rising COVID-19 caseloads but restrictions, complaints and second-guessing from politicians and the public.

A protestor with a megaphone wearing a t-shirt that says "masks are slavery" and holding a homemade sign that says "cancel masks!"
An anti-mask mandate protest underway in Florida earlier this year. The state now has a mask mandate ban.
Arkansas Gov. Asa Hutchinson recently did something that’s unusual for a politician: He admitted he’d made a mistake.

Back in April, Hutchinson signed a bill blocking state and local mask mandates. With his state suffering due to the delta variant of the coronavirus, Hutchinson has expressed his regret. “In hindsight, I wish that it had not become law,” he said.

The Republican governor called a special session to overturn the law. Legislators ignored his wish. Last week, however, a judge temporarily blocked the law’s enforcement.

Legal battles involving the ability of cities, counties and school districts to impose mask mandates are currently playing out in Florida and Texas. Texas Gov. Greg Abbott announced Tuesday that he tested positive for COVID-19, although he is asymptomatic.

All told, more than a dozen states have blocked local governments from imposing mask mandates, or stripped them of authority involving measures such as quarantines or vaccine requirements.

Health officials in those states are now strictly time-limited in imposing emergency orders, or have been left with diminished authority to respond to changes in local conditions, including outbreaks of measles or sexually transmitted diseases, or even weather-related catastrophes.

“It’s going to make it harder to respond to the delta variant,” says Joshua Sharfstein, vice dean of the Bloomberg School of Public Health at Johns Hopkins University. “More broadly, it’s going to make it harder to respond to any major crisis.”

Along with other Americans, many health officials hoped that vaccines could end the coronavirus pandemic, or at least bring it in for a smooth landing in this country. Those hopes have been dashed.

Instead, health departments — traditionally underfunded and understaffed — find themselves caught between caseloads climbing back toward the million-a-week level and politicians in many places hampering their ability to respond.

More than 250 health officials have quit or been shown the door over the course of the pandemic. Those who remain on the job, including front-line workers, frequently find themselves harassed by angry members of the public and, sometimes, by politicians. “When you have looser guidance at the state and federal level, people put the blame on the local level, if they feel you are limiting their lives or their freedom,” says Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.

Faisal Khan, the acting director of the St. Louis County Department of Public Health, testified last month before the county council in favor of a mask mandate. “My time before the council began with a dog-whistle question from Councilman Tim Fitch, who said he wanted to emphasize for the assembled crowd that I was not from this country,” wrote Khan, who has worked in numerous international settings. “In all that time and in all those places, I have never been subjected to the racist, xenophobic and threatening behavior that greeted me in the county council meeting.”

Health officials have been working at full tilt, plus overtime, for a year and a half now. They recognize that the politics of the pandemic aren’t getting any easier even as COVID-19 is once again spiking.

“Our local health department staff are exhausted. They are demoralized,” Freeman says. “They don’t really have any reason to look forward to things changing any time soon.”

It’s All Politics

Occasionally, drinking water becomes contaminated. A health department might issue an advisory warning people they’ll need to boil their water. “How many people are going to look at this and think, ‘This is politics — you shouldn’t be telling me I need to boil water,’” Freeman wonders.

In terms of the coronavirus, health advice has clearly become a battle line dividing red and blue. An Axios/Ipsos poll released Tuesday found that two-thirds of Americans favor mask requirements in schools, but that share included only 44 percent of Republicans. Just a third of Americans favor state laws, such as those in Florida and Texas, pre-empting mask mandates, but a majority of Republicans — 57 percent — favor such laws.

At the state level, health officials have learned to navigate treacherous political waters, suggests Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials. With the exception of Michelle Fiscus, the vaccine expert fired from Tennessee’s health department last month, there haven’t been the kinds of high-profile clashes seen last year between state health officials and elected leaders.

Nevertheless, state health officials share a “palpable frustration,” Plescia says. “The ones having the hardest time are those in states where the governors or legislatures are not willing any more to take the kind of actions needed in this pandemic.”

Trouble at the Local Level

The frustration may be even greater at the local level, due to the decline in their authority. “The burnout level is high,” says Georges Benjamin, executive director of the American Public Health Association. “People are very stressed. They’re still receiving threats from the public.”

Some legislatures have moved to give themselves unilateral veto power over local health decision-making. It’s become a common talking point that health decisions shouldn’t be made by “unelected bureaucrats.”

On Tuesday, a joint subcommittee of the Kentucky Legislature voted that school mask mandates issued by the state departments of education and public health were “deficient.” Several legislators referred to officials from those departments as unelected bureaucrats.

Legislatures putting themselves in charge of health response are making a mistake, Benjamin argues, because you can’t run emergencies by committee. “They’re already underfunding public health; now they’re defanging it,” he says. “If they did this for crime and police departments, crime would soar and buildings would burn down. They’re creating the same risk for health in this country.”

Public health officials know they face a daunting task in trying to convince politicians to look at their efforts as a health practice, not something always viewed through a political lens. That’s the long-term challenge.

More immediately, the pandemic is now at one of its choppiest points. At the same time, political and legal tensions have grown, if anything, only greater.

“It’s been a really trying time for local health departments,” says NACCHO’s Freeman. “They are apolitical and they have struggled in having their messages twisted around politics.”
Alan Greenblatt is the editor of Governing. He can be found on Twitter at @AlanGreenblatt.
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