Emily Brown was stretched thin.
As director of the Rio Grande County Public Health Department in rural Colorado, she was working 14-hour days, struggling to respond to the coronavirus pandemic with only five full-time employees for 11,000 residents. Case counts were rising.
She was at odds with county commissioners, who were pushing to loosen public health restrictions in late May, against her advice. But she reasoned standing up for public health principles was worth it, even if she risked losing the job that allowed her to live close to her hometown.
Then came the Facebook post: a photo of her and other health officials with comments about “armed citizens” and “bodies swinging from trees.”
The commissioners had asked her to meet with them the next day. She intended to ask them for more support. Instead, she was fired.
“They finally were tired of me not going along the line they wanted me to go along,” she said.
In the battle against COVID-19, public health workers spread across states, cities and small towns make up an invisible army on the front lines. But that army is under assault when it’s needed most.
Officials who usually work behind the scenes managing immunizations and water quality inspections have found themselves center stage. Elected officials and members of the public frustrated with lockdowns and safety restrictions have turned public health workers into politicized punching bags, battering them with angry calls and physical threats.
On Thursday, Ohio’s health director, who had armed protesters go to her house, resigned. The health officer for Orange County, California, quit Monday after weeks of criticism and personal threats from residents and other public officials over an order requiring face coverings in public.
As pressure rises, many more health officials have chosen to leave or been pushed out of their jobs. A review by Kaiser Health News and The Associated Press finds at least 27 state and local health leaders have resigned, retired or been fired since April across 13 states.
From North Carolina to California, they’ve left their posts due to a mix of backlash and stressful working conditions, all while dealing with chronic staffing and funding shortages. Some health officials haven’t been up to the job during the biggest health crisis in a century. Others previously had plans to leave or cited their own health issues.
But Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials, said most of the exodus resulted from increasing pressure as states reopen. Three of those 27 were members of her board and well known in the public health community — Rio Grande County’s Brown; Detroit’s senior public health adviser, Dr. Kanzoni Asabigi; and the head of North Carolina’s Gaston County Department of Health and Human Services, Chris Dobbins. Asabigi and Dobbins did not reply to requests for comment.
Freeman warned more departures could be expected as political pressure trickles down from the federal to the state to the local level.
Since the pandemic began, federal public health officials have complained of being sidelined or politicized. The Centers for Disease Control and Prevention has been marginalized; a government whistleblower said he faced retaliation because he opposed a White House directive to allow widespread access to the malaria drug hydroxychloroquine as a COVID-19 treatment.
In Hawaii, Democratic U.S. Rep. Tulsi Gabbard called on the governor to fire his top public health officials, saying they were too slow on testing, contact tracing and travel restrictions. In Wisconsin, several Republican lawmakers demanded the state’s health services secretary resign, and the state’s conservative Supreme Court ruled that she’d exceeded her authority by extending a stay-at-home order.
With the increased public scrutiny, security details — like those seen on a federal level for Dr. Anthony Fauci, the top infectious-disease expert — have been assigned to state health leaders, including Georgia’s Dr. Kathleen Toomey after she was threatened. Ohio’s Dr. Amy Acton, who resigned Thursday, had a security detail assigned after armed protesters went to her home.
In Orange County, in late May, nearly 100 people attended a county supervisors meeting, waiting hours to speak against an order requiring face coverings. One person invoked Second Amendment rights to bear arms; another read aloud the home address of the order’s author — the county’s chief health officer, Dr. Nichole Quick.
After another public meeting that included criticism from members of the board of supervisors Monday, Quick resigned. She couldn’t be reached for comment.
Many local health leaders, accustomed to relative anonymity as they work to protect public health, have been shocked by the threats, said Theresa Anselmo, executive director of the Colorado Association of Local Public Health Officials.
After polling local health directors across the state at a May meeting, Anselmo found about 80% said they or their personal property had been threatened since the pandemic began. About 80% also said they’d encountered threats to pull funding from their department or other political pressure.
In Colorado, the Tri-County Health Department, serving Adams, Arapahoe and Douglas counties near Denver, has received hundreds of calls and emails from frustrated citizens, deputy director Jennifer Ludwig said. Some were angry their businesses couldn’t open. Others were furious with neighbors who weren’t wearing masks outside.
Then rocks were thrown at an office window — three times. The department also received an email calling its members “tyrants,” adding “you’re about to start a hot-shooting … civil war.” Health department workers decamped to another office.
“It does wear on you, but at the same time we know what we need to do to keep moving to keep our community safe,” Ludwig said.
Back in Colorado’s Rio Grande County, COVID-19 case counts jumped from 14 to 49 as of Wednesday.
Brown grapples with what she should do next: dive back into another strenuous public health job in a pandemic or take a moment to recoup?
When she told her 6-year-old son she no longer had a job, he responded: “Good — now you can spend more time with us.”
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This story is a collaboration between The Associated Press and Kaiser Health News.
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AP writer Audrey McAvoy in Honolulu and KHN correspondent Angela Hart in Sacramento contributed to this report.