Pandemic strife put Michigan health departments on life support. Can it heal while COVID surges? – MLive.com

Public health departments in Michigan are on life support.

Health officials across the state worry their departments are on the edge of becoming another casualty of the pandemic. A prolonged battle with the coronavirus, misinformation and efforts to undermine emergency orders has left public health weaker. The consequences could last years.

Nearly two years since the initial outbreak, multiple waves of infections and vaccine-resistant variants signal that COVID-19 isnt just going away. The coronavirus will likely become another permanent community health problem to grapple with. More than 26,375 Michigan residents have died from the virus.

Marcia Mansaray, deputy health officer for Ottawa County, said the pandemic added tremendous strain to a system that was already struggling to make do with limited resources. Now many departments are dealing with widespread burnout, unprecedented staff shortages and the publics fury.

There were lots of things were weak in, but we had strong staff, Mansaray said. Lots of expertise and leadership within the health system. That is what has been compromised now.

Congress appropriated $275 billion in emergency dollars to help Michigan health departments secure equipment and hire short-term staff. As the pandemic drags on, and the one-time funds dry up in 2022, those resources arent expected to make a long-term impact.

I think its fair to say we were not structurally prepared going into this, said Kevin Hughes, health officer of the District Health Department No. 10 in Northwest Michigan. We didnt have the appropriate staffing levels to be able to address something of this magnitude for this length of time ... When those funds run out, were still in this same place. Were gonna be right back where we were before.

Perhaps most harmful is the strain created by misinformation and politics. An erosion of the publics trust doesnt just undermine efforts to keep communities safe, it could bring controversy to mundane duties that were quietly carried out for decades.

Public health is being just seen through this narrow lens of this little slice of our role in enforcement and authority, when the majority of work we do is not that, said Lisa Peacock, director of the Health Department of Northwest Michigan. Public health has increased the longevity of our population in so many ways.

Norm Hess, executive director for the Michigan Association for Local Public Health, said people dont become acquainted with their health department until something goes wrong. The pandemic pushed health officials into the spotlight, for better and for worse.

People are more aware of how important public health is, but at the same time they have very strong emotional opinions on how public health has performed during this, Hess said. I think rebuilding public trust in local health departments and local health officials is going to be a primary task, and it will take years.

Protecting public health isnt just a job, its required by law. Health departments have a mandate to inspect restaurants, keep a handle on preventable diseases, monitor toxic exposure and respond to other threats.

Weve seen PFAS, weve seen Legionella, weve seen lead in water, those are all public health issues, said Ingham County Health Director Linda Vail. I dealt with a million gallons of oil spilled into the Kalamazoo River. You either need us to handle those things or you dont, and I think you do.

Genesee County Health Director Pamela Hackett said people in her field want to protect their neighbors. Public health policy is driven by scientific evidence, but the pandemic -- seemingly like everything else these days -- quickly became political.

Attitudes and behavior became divided along party lines. A growing body of research found Republicans are generally less likely to wear masks, get vaccinated and support policy interventions like closing businesses.

New activist groups sprung up across Michigan during the pandemic. Some worked hand-in-hand with lawmakers and party officials.

These very loud and active groups in the community are still the same ones were going to want to reach out to when we have a preventable outbreak such as measles or chickenpox, Hackett said. This deliberate politicization of COVID has made it, potentially, so we have a society thats more vulnerable to other types of outbreaks that weve already had control over.

Expressions of intense anger over health rules pit school boards and county commissions against health officials who saw the outrage derail efforts to protect their communities. Health officials were also targets of harassment, death threats and accusations of treason and child abuse.

Hackett was one of many who faced pressure to resign after requiring protective face masks in public schools. She also received a death threat from a woman who allegedly told Hackett to leave our children alone or I am going to kill you.

The threat still makes Hackett uneasy in her own home. She doesnt take walks alone anymore. Hackett shared other precautions that became part of her routine, which MLive will not publish due to safety concerns.

I will jump at a branch falling from a tree now, Hackett said.

The Genesee health director said she didnt expect politics to affect the response so disastrously. She had been working as a clinician at Henry Ford Hospital before coming to the county in 2019 and said she may not have taken the health director job had she known what was coming.

Internet trolls published addresses and cell phone numbers of health officials on social media. Mansaray said pictures of Ottawa County health department staff were posted online encouraging people to go get them. Police departments are monitoring social media for threats and keeping a watch on her home.

Vail installed a security system after someone mailed a threatening message to her house. Sometimes she wears a hat and sunglasses to avoid being recognized in public. Vail said the shadow of harassment hung over a visit to the county fair with her granddaughters.

Its this environment thats been created, where even if youre not being attacked youre preparing yourself, she said. Most of my colleagues are wondering at which point is something really bad going to happen to one of us?

Each health officer that spoke with MLive has considered how much they can endure. Its tempting to cut losses and leave, but they worry their community would be worse off.

I am concerned about what the future will hold for public health, Mansaray said.

Im a person of faith, and so I put part of it there. I feel called to do what Im doing. I have a community that I want to take care of and is depending on me.

Power struggles

Two color-coded folders sit on Peacocks desk. A red folder houses printouts of all the voicemails, texts and emails from people who disagree with her decision to require masks in public schools. Next to it sits a green folder containing messages of support.

Peacock estimates positive messages outnumber the negative pile five to one. But while the red folder is physically smaller, its contents extracted a heavy toll from Peacock.

Peacock filed a complaint with the Michigan Attorney General alleging local officials on the board of health encouraged people to bully her. In the complaint, Peacock describes a four-hour planned ambush at a September board of health meeting. The meeting was centered on a motion to rescind her order, something the board cant legally do.

Attendees called for Peacock to be arrested. The meetings Zoom broadcast was disrupted by racial slurs and a pornographic video. Hecklers intimidated health department staff. Peacocks said the crowd seemed on the verge of rioting.

Peacock was escorted out of the building through an alternate exit to avoid a group of people who were waiting in the parking lot. Health department staff continued to face harassment days after the meeting. One facility was put on lockdown for two days after police found threatening messages on social media.

The health director said shes seen flyers calling to pluck the Peacock with an image of an injured bird.

The Health Department of Northwest Michigan relies on a 90-year-old partnership between four counties. The board of health is filled by elected commissioners from around Northern Michigan.

Peacock said those relationships have deteriorated. She and Medical Director Joshua Meyerson narrowly survived an attempt to fire them in November when a board ended in a tie.

Otsego County residents asked their commissioners to sever ties with the health department, block its funding or sue Peacock. Commissioners asked county administrators to look into what it would take to abandon the health department.

A district health department is a great option in rural areas where you have counties with smaller populations, Peacock said. When were facing all these different threats, it could take away something really good.

Supporters have rallied behind Peacock. More than 300 people signed a letter thanking the health department for protecting the community. The board of health received 497 comments in support of the health department and 66 in opposition before voting on whether to fire Peacock.

Peacock says she stands behind the orders she issued. They were based on overwhelming medical evidence. Some residents accused Peacock of being on a power trip, but she says epidemic orders are reserved as a last resort for when other measures arent working.

Issuing orders is a tiny fraction of what we do for the public, Peacock said. Its one tool that we dont even like to use.

Michigans Public Health Code empowers health directors to set emergency procedures during an epidemic. But lawmakers and local politicians have worked to peel back this authority and give control to other groups.

Republicans added language in the 2022 budget threatening to withhold funding from health departments with mask orders. The governor said the budget language is unconstitutional and departments received their usual allocation of state funds, but several smaller counties pulled back school mask orders to avoid a potential lawsuit.

An activist group is also gathering signatures to shift power from nonpartisan health departments to elected officials. A ballot initiative seeks to end epidemic orders after 28 days unless extended by legislators or county commissions.

Hess said state law puts authority in the hands of unelected officials for a reason: Health departments have to make tough, sometimes unpopular, decisions that shouldnt be influenced by politics.

There are very few public health emergencies in the area of epidemics that come and go in 28 days, Hess said. I believe that it could make it even more difficult to make hard decisions if people are worried about whether or not they will be reelected.

Hess said taking power from experts would have a long-standing impact on the ability to deal with health emergencies.

People are basing their opinions on what is happening with COVID, but that could really limit the ability of health departments to respond to public health emergencies that we havent even thought of yet, Hess said.

Loss of knowledge and funding

Linda Vail has worked to exhaustion nearly every day since March 2020.

This is like being full-on, adrenaline push every day, all day, the Ingham County health director said. Youve got to be ready to respond. Having that level of readiness constantly is not really good for your body.

Sometimes the stress builds to a point where it cant be held in any longer. Vail said it can feel like the world is crashing around her. She probably would have retired already if she didnt feel supported by local officials.

I refer to them as my meltdown moments, Vail said. " Ive had my meltdowns where Im crying and Im beside myself. Im depressed and Im anxious.

Health officials say burnout and the stress of public scrutiny are driving people out of the field. They reported early retirements, unprecedented turnover and low rates of retention among new staff. Its resulted in a large loss of institutional knowledge and leadership.

People who face the public are getting yelled at every day. People are just treating them with such disregard for their expertise, Peacock said. Its getting harder and harder to conduct trace investigations and contact tracing, which are important tools to keep this from getting worse, because people dont want to talk to us.

Hughes said hes had staff leave because theyre fed up with getting abused when trying to trace contacts of people infected with COVID-19. Quitting has crossed Hughes mind too, but the 27-year veteran of public health said hes committed to staying.

I think many of them feel an ethical responsibility to hang in there for now, but when this crisis is over we could see people exiting the workforce to find meaningful work in other areas, Hess said.

Berrien County lost its health director over what she called the politicization of public health during the pandemic. Interim Health Officer Courtney Davis resigned, saying she can no longer effectively do her job in this climate. The health departments communications manager also resigned.

Its hard to find replacements at a time when people in the public eye and (are worried) the job would maybe endanger their children or their spouse and expose them to a lot of intimidation and threats, Mansaray said.

Whats next?

Fully staffing health departments would only solve one problem. Hess said a bigger issue is chronic underfunding since the 1990s. Long-term investments are needed to get health departments back on track.

A 2019 report from the Michigan Department of Health and Human Services noted that failing to adequately support local health departments puts residents at risk. The report found that state appropriations actually decreased by $658,000 from 2003 to 2018.

The state is supposed to evenly split the cost of administering health services with local governments, but this isnt happening. In 2019, the state was only reimbursing 25% to 30% of the cost. Hess estimated that the state is likely still about $30 million short of meeting its obligation.

The Michigan Association for Local Public Health requested a $5 million to $8 million increase in the state health departments budget to meet the need. That request did not make it into the final 2022 budget.

Weve had an influx of COVID funding and some staff resources which has helped greatly, but the problems were created by years of neglect are going to remain, Hess said. When these COVID emergency funds dry up, I think we are going to be in a more difficult position than we were to start with.

Thats what makes threats to revoke funding so concerning. Health departments are already struggling to get by with what they have.

One thing does seem sure: COVID-19 is here to stay.

While some viruses can be considered extinct -- like SARS-CoV, a coronavirus responsible for the SARS pandemic in 2003 -- virologists believe COVID-19 will become an endemic disease. Thats because its highly transmissible and could continue to find new hosts to infect.

The next wave of infections is already here. The Omicron variant quickly became the dominant strain in the U.S.

Michigan cases and deaths began to rise again in the winter, filling hospital beds and ICU wings. The federal government sent medical teams to support four overburdened hospitals across the state.

Peacock said health departments need more resources to survive the current emergency and be prepared for whatever challenges lie ahead. Health departments have had to shift resources to COVID, resulting in scaled-back nutrition assistance for low-income mothers, testing for sexually transmitted diseases and other health monitoring programs.

Reflecting on the last year, several health officials said there was a lot of appreciation and trust for public health until the situation became politicized. Trust is difficult to repair once broken.

I wish that our culture hasnt lost the civility that I thought we had, Mansaray said.

Health officials arent sure if the highly-charged environment is the new normal; they havent had much chance to take a breath and think about it.

There is a segment of the population that distrusts public health, because its seen as the government, and theres a lack of trust in the government, Hughes said. Theres still a fair segment of the population that appreciates what it is that we do, but theres also now that that segment that that doesnt. The longer this goes on, I think the potential is there for that segment to get a little larger.

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Pandemic strife put Michigan health departments on life support. Can it heal while COVID surges? – MLive.com

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