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How pandemic politicization undermines public health

Jefferson County’s termination of its public health officer’s contract is the latest example of the rift between county authorities, health officers, and the public.

When Joan Van Duynhoven read the Boulder Monitor’s story about her termination as public health officer for Jefferson County, the county’s explanation — Van Duynhoven’s failure to approve the Northern Rodeo Association rodeo and a “misleading” statement about canceling non-conference high school sporting events — came as news to her.

“They didn’t give me any reason,” said Van Duynhoven, who after serving in the part-time role for 14 years was notified by email on Aug. 24 that her contract would not be renewed, ending her employment effective Sept. 1.

Because she was a contract employee, Jefferson County didn’t have to provide a reason, but she said she never had conflicts with local elected officials during her time in the job until the arrival of COVID-19.

“From the beginning [of the pandemic], I had received so much resistance from the county hierarchy that I felt in a lot of ways I wasn’t supported,” she told Montana Free Press.

First, she said, it was local law enforcement asking for addresses of all positive cases so they could take special precautions during interactions. Van Duynhoven balked at that idea, knowing that when a highly transmissible disease is present in a community, it’s best to treat everyone as if they have the disease, rather than just selective populations. She eventually decided to give law enforcement a daily list of active cases and take back the previous list each day so recovered patients wouldn’t continue to be seen in the county’s small communities as having “cooties.”

Then came the rodeo. She approved the local Jefferson County Rodeo, a small event featuring local participants, but declined to approve the Northern Rodeo Association’s late-August event, which could have drawn hundreds of participants and attendees from other states. Van Duynhoven also decided to cancel non-conference high school sporting events in order to limit team travel and potential exposure to the coronavirus in hot-spot areas around the state.

Increasingly, people questioned her judgment and kept asking for her reasoning, she said. She said county commissioners weren’t taking the pandemic seriously, and sometimes didn’t wear masks at public gatherings.

“People are dying. There’s outbreaks of COVID, and we have a governor’s directive limiting large gatherings,” she said. “I didn’t understand why I had to repeat that again.”

Montana is in the midst of its largest COVID-19 outbreak to date. The state currently has about 2,000 active cases and 150 active hospitalizations. As of Thursday, 111 Montanans have died of the disease. And as students return to schools, case counts are expected to increase.

Public health officials know the disease is spread by close contact between an infected person and others, which is why masks are required. Large gatherings have the potential to spark larger outbreaks, which is why there are limits on gathering size. Once an outbreak takes hold in a community, it’s difficult to prevent the disease from spreading through schools, nursing homes, and other locations where people are gathered in close quarters.

But public health responses to the pandemic, from mask requirements to limits on large gatherings, are becoming increasingly politicized, public health officials told Montana Free Press.

The politicization of the pandemic has created strife for health officials across Montana. In addition to Van Duynhoven’s dismissal, public health officials in PowellCarter and Ravalli counties have resigned after receiving political pushback. In Big Horn County, the health officer’s mask requirement was challenged by the county attorney, Jay Harris. In Cascade County, a judge criticized county officials for a “cavalier” attitude toward the virus that led to a large outbreak at the jail in Great Falls.

The latest battleground is sporting events, from rodeos to high school football games. Particularly at issue is whether to allow spectators at such events.

Republican Sen. Steve Daines, who is being challenged by Gov. Steve Bullock, recently posted a video on Facebook calling for Bullock to allow spectators at high school sporting events. A recent petition to Bullock’s office to allow spectators at high school sports events currently has more than 33,000 signatures.

Bullock, who responded to the petition by saying he also wants to watch his children play sports, told the Association of Montana Public Health Officials that a statewide limitation on events for more than 50 people does not apply to school-related events, but allowed local health officials to make decisions about limiting sports or disallowing spectators.

Drenda Niemann, Lewis and Clark County Health Officer and chair of AMPHO, said Bullock’s  delegation of decision-making creates a challenge for county health officials. Niemann said local control can be beneficial, but a lack of cohesive direction from the state and federal governments makes it difficult to know whether recommendations are based on public health best practices or political calculation.

“It makes it hard on a local public health department,” Niemann said. “Public opinion is not how we make decisions. We make decisions based on good public health processes and science.”

Niemann said Lewis and Clark County decided to allow high school sports, but disallow spectators, because such gatherings increase the risk of COVID-19 transmission. After that decision, the department was flooded with feedback from upset parents.

“The last week, it’s just been a flood of calls and emails and very, very angry parents that insisted we reconsider, and it’s not always been very respectfully done,” Niemann said. “People have called and left disrespectful and belligerent voicemails toward us. Our role is to protect our community from the spread of this virus.”

Niemann said the local health board is meeting Thursday to discuss whether to change that decision after the outcry. Niemann said many of the people criticizing public health officials are doing so based on inaccurate information, and stressed the importance of relying on authoritative information sources such as the Centers for Disease Control, the Montana Department of Health and Human Services and local health officials.

Matt Kelley, of the Gallatin City-County Health Department, said high school sports are emblematic of many decisions health officers have had to make since the beginning of the pandemic, from restaurant re-openings to mask requirements. He said it’s clear that sporting events with spectators is a risk. Kelley is recommending that local schools allow two spectators per student athlete, and that competing teams from the same county be allowed two spectators per athlete as well. But he wants to limit crowd sizes.

“If every Friday night we have hundreds or thousands of people gather in close proximity, we’re more likely to see transmission of the disease and we’re more likely to see outbreaks,” Kelley said. “We’re trying to strike a balance between the public health risk and being practical.”

Kelley said that while the job can be difficult, the majority of his interactions with the public are positive.

The state is working on a high school sports plan, said Dr. Laurel Desnick, Park County health officer, who said she was on a call with state officials Wednesday afternoon discussing options.

Though children who contract COVID-19 appear to become less ill than adults, Desnick pointed to an August 28 letter from the Montana Chapter of the American Academy of Pediatrics that recommended all student athletes who become even mildly sick with COVID get an EKG to check for heart conditions that can be caused by the virus.

“It’s a matter of life and death,” Desnick said. “There should be no politics involved, and it’s unfortunate that some people would like to make it a political issue. It’s very basic: what’s going to keep people safe? Keep kids in school? Keep businesses open?”

Desnick recommends that schools in Park County, which currently has two active cases, not compete against teams from counties with confirmed community spread. (Individual schools have the authority to follow or ignore those recommendations.) Desnick said spectators add another level of risk to the events, and increased risk puts the academic school year in jeopardy.

“If this is about kids, spectators add another level of risk,” Desnick said.

The politicization of public health recommendations is not unique to Montana. Health officials, for instance, have raised concerns that President Donald Trump is rushing a pre-election vaccine to boost his re-election chances against former Vice President Joe Biden. But the issue can create special difficulties in rural communities, where part-time health officials have smaller staffs and work with sometimes less-informed officials, Van Duynhoven said. In small communities, health officials also frequently run into neighbors who don’t agree with their decisions.

“I’ve been to birthday parties and Christmas gatherings with the same people who are now calling me a dictator. I’ve invited them out for dinner. It surprises me that they don’t know my heart — that they think of me as some distant oppressor,” Powell County Public Health Officer Lori Drumm wrote in an op-ed published Tuesday in the Washington Post, explaining her decision to resign from the post after protesters upset about her cancellation of the Tri-County Fair Rodeo showed up at the hospital where she works and blocked patients from getting care.

Even though her contract wasn’t renewed, Van Duynhoven maintains that she made the right call cancelling the Northern Rodeo Association rodeo. She pointed to Phillips County, where an “adult sports activity” in August led to an outbreak that eventually topped 100 cases.

“Oh definitely. It’s common sense,” she said. “In today’s political craziness, doing a health officer’s job is really difficult. I guess the beauty now [is], the whole event/rodeo season is over.”

The Article was originally published on How pandemic politicization undermines public health

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