Baker: Has public health lost our trust?


By Evander Baker

First off, I would like to remind that most face coverings do not protect the wearer from the novel coronavirus. I am sure you’ve heard this before.

The mechanism by which the virus tends to spread to other humans is through water droplets expelled directly from the nose (please wear your face covering over your nose when around other people you don’t live with) and mouth. The microscopic virus particles are active within symptomatic and asymptomatic carriers, but a face covering prevents those water droplets from passing into the air and projecting or floating to others.

Any incoming water droplets containing the virus from those not wearing face coverings are not stopped from projecting or floating. So it could get to a person wearing a mask, fall onto the outside of the mask, and be inhaled by the person wearing the mask, because the droplets containing the virus are so close to the inhaling nose and mouth.

That is relevant to why public health has not been trustworthy and why I feel the need to apologize and rectify that in the small ways I can. I’ll come back to that.

Back when the coronavirus pandemic was only just becoming known to be widespread in the United States, employees in my office began wearing non-N95 masks in the midst of a client who entered the health department with symptoms consistently with what we then knew of COVID-19 illness. In response, the district office sent specific orders to not wear masks, because it would cause patients to panic.

As the pandemic progressed, the district office began to offer hazard pay to district employees for working during the public health emergency. That hazard pay was only granted if employees took less than four hours of leave during a semimonthly pay period. The sentiment was nice but poorly conceived.

A little further up, Georgia’s state Department of Public Health came under scrutiny for presenting a graph that appeared to show a downward trend in COVID-19 cases over time. Governor Kemp was a countrywide laughingstock for his response and lack of response to the pandemic for not knowing the basics of the virus.

Of course, President Trump has often contradicted his own Coronavirus task force opting to listen to and promote those outside of his administration in efforts to downplay the virus (you can inform the American public of the severity of an issue without panicking them), and his messaging was pivotal in creating the politicized nature of the response to the pandemic.

And Robert Redfield, current director of the CDC, made a well-replayed quote: “I might even go so far as to say that this face mask is more guaranteed to protect me against COVID than when I take a COVID vaccine.”

No, Mr. Director. A vaccine of any decent level of effectiveness will serve to protect you more than a basic face covering. You’re a virologist. You know that. Communicate that.

Now I am a critical person. I am critical of myself and others. But I tend to be the most critical of the powerful and most influential of people and entities in government. These are the people with the massive salaries and most secure resources. They are appointed and hired for their unmatched expertise to be trusted to protect citizens.

These people cannot fail.

You cannot fail at that basic of a level.

It is understandable to not immediately know the effects of a novel virus when it becomes a pandemic. It is understandable to not have resources for contact tracing or testing for that virus immediately.

But you must have a better conceived policy for the most immediate public health workers for each community when a pandemic is beginning to sicken the people you serve.

You cannot take a bar graph appearing to show a trend over time that does not show that perceived trend.

My specific degree in Public Health was focused on biostatistics which is akin to epidemiology. I would never present a graph such as that to a population unless they were also biostatisticians or epidemiologists. Apologies from the governor’s office go far. But it’s such a basic error, I doubt your ability to navigate the more complicated aspects of disseminating data to the public regardless of your intentions.

And that is where we are. There is a missing trust in public health. Among ineptitude, poor planning, or political pressure, Americans cannot trust our key public health programs and centers, and I understand why they can't. I don't trust our public health institutions, and I work for one.

Actually, it is because I work for the Department of Public Health, I do not trust it. We know how contagious illnesses spread, how easily they spread, how long they take to incubate, how others can spread the illness, what symptoms they induce, when and for how long those symptoms persist, when those symptoms subside, and when a person who is sick is no longer contagious. All of those factors fall within a range, and we base our regulations on those illnesses to prevent illness and promote and protect the health of the public.

But the trick is to not impractically implement these regulations to prevent illness. It is important to not implement and enforce these preventative measures without knowing the population you serve and knowing the buy-in of that population.

Maybe you shouldn’t leave enforcement of a public health Executive Order to the police, Governor Kemp. They're busy. They're not trained to implement public health measures.

Taking enforcement of public health measures from those who are trained to help businesses in their communities be as safe as possible while still operating in a pandemic and giving it to already overburdened law enforcement entities is probably intentional.

In practice, law enforcement isn't going to stop what they're doing to address face covering complaints. Georgia State Patrol isn't going to a restaurant to ensure social distancing is enforced. It was forced on law enforcement, and they have other more immediate concerns to address even outside of a time of heightened awareness social injustice and police brutality.

And I think that was the point. There is an impractical Executive Order that cannot be questioned and will not be enforced.

Along that same vein, our current state testing and quarantine inadequacies are probably intentional at this point.

As we have seen in events with large groups of people in close proximity, the virus spreads very efficiently. So with people not abiding by measures with a very contagious virus that spreads by just being around people, testing as many people as we should means a lot more of people will be found with the virus. They would have to isolate until they (ideally) had multiple negative tests. If you contact traced properly, all of those exposed would have to quarantine and (ideally) test.

That takes out a lot of otherwise healthy, able-bodied people out of the workforce for weeks at a time. And small businesses may not be able to operate if they're missing just five employees.

A de facto shutdown.

That is likely why the quarantine period lowered from 14 days to 10 days (but that is inconsistent.) That is likely why people who have been exposed to someone who tests positive for the virus are allowed to work as long as they consistently wear a face covering.

That is likely why our health department originally offered hazard pay but only if you didn't take more than half of a day off. You drastically increase our pay but only if we don't do things that would take up more than half of a day. Such as staying home because you feel ill. Or staying home and quarantining because you know someone in your family is sick, but you could really use that massive bump in pay.

When you don't get paid much to begin with, it's hard to turn down hundreds of dollars per month when you feel fine even if you believe you might be exposing your coworkers and the community to the virus.

It's a bit coercive.

Fortunately, the health district adjusted the hazard pay policy to be distributed by day instead of by pay period. We have a mask requirement so that we must wear face coverings when around clients, patients, or other employees.

I feel like trust would come from better messaging and more workers in public health being bolder even at risk of their jobs. But to end, I would like to state how I go about my days in terms of being cautious but not "living in fear" (I hate that phrase.)

I pick and choose whether I need to go out.

Taking out my recycling is a safe activity. Jogging in a park is relatively safe, and I can give everyone I come across plenty of space. I take fewer trips to the store. I buy more in bulk and get more frozen and canned foods. I always wear my mask, but I hardly even think about it, because it’s not for me. I don’t go anywhere near anyone not wearing a mask indoors. I will turn around mid-aisle and walk around to get something on the other end of the aisle to avoid someone with a mask. It’s your right to not wear a mask for whatever reason. Don’t mind if I take a minute to avoid you. I give people wearing masks 6 ft. of distance anyway. But if I have to walk by, I turn my head and walk by quickly. I stopped going to the gym and the movies. They’re not so terribly important to me.

I feel like public health should have realized what our circumstances were and focused on how to live with the pandemic. We should have known that certain aspects of life are too important for some people to give up, but many would be willing to give up other activities.

Shaming people for living life in ways that normally bring them joy will not get them to stop it.

If you want to date, then date in one-on-one settings. Treat it as if you have multiple sexual partners: Consider quarantining and/or testing for COVID-19 before you meet up the first time. If your partner gets sick, you get tested and quarantine. If you get sick, let your partner know so they can get tested and quarantine.

If you really love the movies and get depressed about not seeing films on the big screen, then wear a mask. Social distance: sacrifice the row you love to sit in most to give yourself plenty of room from others. Don’t be afraid to go by yourself. Keep a small bottle of hand sanitizer on you. Use it when you get your ticket, get your food, exchange money, before you eat your food, etc. Wash your hands, and use a paper towel to open the door.

If you go to bars, go with fewer friends. Find a bar with better social distancing and rooftop access. Don’t drink after your friend or people you meet. Be a little more selective with strangers you don’t know and might not see again.

It’s my opinion that not doing everything to prevent spread is ultimately still going to get some people sick and some people will die. That will always be awful. But I don’t believe a strict adherence to the gold standard is sustainable when it comes to us. Don’t let perfect be the enemy of the good.

I feel as if American public health entities failed on many fronts, and American politics only made it worse. Trust is earned, but trust can be and should be lost. But fortunately, how this virus spreads isn’t difficult to understand. We can take our own precautions.

So as public health gets back to being as creative and resourceful as it has been, people may have to take public health into their own hands until public health earns the trust back it lost.

Evander Baker is a public health official and a resident of Athens


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