Fresh faces, fewer tools: Meet the new public health leaders fighting COVID

VIRGINIA CITY, Mont. — Emilie Sayler’s roots run deep in southwestern Montana. She serves on a nearby town council and the board of the local Little League. She went to college in a neighboring county and regularly volunteers in the schools of her three kids.

Just a few months into her new job as public health director for Madison County, she had hoped that those local connections might make a difference, that the fewer than 10,000 residents spread out across this agricultural region would see her familiar face and support her efforts to curtail the COVID-19 pandemic raging here.

That largely hasn’t happened. School boards have rebuffed even minor measures to prevent outbreaks, vaccination rates languish and the Centers for Disease Control and Prevention categorizes infection levels in the rural county as high. Parents, Sayler said, are sending sick kids to school.

On top of that, a resident phoned her office and told a member of her staff, “I wish that you would get COVID and die.”

“People have used the term ‘free-for-all,’ and I really hate to admit that that’s what it kind of feels like,” Sayler said.

Nationally, KHN and The Associated Press have documented that more than 300 public health leaders, weary of abuse and of their expertise being questioned, have resigned or retired as the country struggles to recover from the worst pandemic in a century. They have been replaced by people like Sayler, often inexperienced yet tasked with repairing the trust of a polarized and fatigued public.

At least 26 states have passed laws or regulations limiting the powers of public health officers this year, meaning these replacements have fewer tools and less authority than their predecessors to enforce their orders and recommendations.

Montana passed laws considered some of the most restrictive. This year, the state legislature curbed the powers of health officers to, among other things, quarantine infected citizens or isolate those in close contact with them. Lawmakers also prevented public and private employers from requiring workers to be vaccinated and gave local elected officials the ability to overturn public health orders.

Now Montana is at or near the bottom of many national statistics charting the COVID surge — rates of new cases, hospitalizations and deaths — that is happening in counties big and small.

Lori Christenson is the new health officer for Gallatin County, Madison County’s neighbor to the east and home of the city of Bozeman and Montana State University. In June, she replaced Matt Kelley, who before resigning had become a political punching bag as the county mandated masks in public places and restricted business hours and the size of crowds. Protesters on social media demanded his ouster; a few picketed outside his home. Christenson had served in the health department for seven years before her promotion and worked closely with Kelley.

While her office still hears daily from frustrated citizens “on both sides,” she said the vitriol is not quite as malicious as in the past. That’s in large part, she believes, because the new laws that gutted her department’s power shifted criticism to other entities like local school boards that still have the authority to mandate measures such as wearing masks.

“Sometimes it can be pretty frustrating not having the ability to make some immediate changes that previously helped to slow transmission,” Christenson said. “We just don’t have the tools at our disposal in the same way that we did before.”

That reality, she said, has been “morally challenging.”

“I have a duty to protect the community. You want to do what is right, but you also want to do what is lawful. In this situation, it didn’t mesh.”

Joe Russell does not envy health officers new to their positions. He retired as head of the Flathead City-County Health Department in 2017 but returned in December after the interim director resigned over what she called a “toxic environment” inflamed by the “ideological biases” of local politicians.

“Think about going into a brand-new profession, in a leadership role that you’ve never held, in a crisis like COVID-19,” Russell said. “It would be miserable.”

He said his experience — 30 years in the Flathead health department, including 20 as its leader — has eased navigating through the pandemic in one of the state’s most populous and conservative counties, although the rate of cases there remains high and its vaccination rate low.

His tenure, he said, has given him the credibility to confront officials who question the seriousness of COVID or the safety and effectiveness of vaccines.

“When someone spouts this nonsense, who better to stand up and give them the science-based evidence and tell them that they are full of crap?” Russell said. “I love it when that happens at a public meeting.”

Although Montana laws essentially prevent public health officials from following many CDC guidelines, Christenson said they still have useful tools available to combat the virus: testing, contact tracing, vaccination, communicating with the public.

“That is what I focus on,” she said. “That is what we can do.”

Christenson believes she has the community’s support. She noted that while a few people protested outside of Kelley’s home, crowds countered that criticism by lining Bozeman’s Main Street, offering cheers of support on his drive home.

“Not to say that every day is rosy,” she said. “That would be naive. But you can feel the staff here continue to try to move forward, and that to me is a success.”

In Madison County, Sayler said she is taking an “olive branch” approach to turning things around, advancing recommendations rather than orders, as her staff works to nudge vaccination rates up from the current 48%. She’s doubtful that will quickly reduce COVID.

In September, the county saw approximately 200 new cases — roughly 20% of all its infections since the pandemic began — and had more residents hospitalized with the virus than ever before.

While the pandemic has filled Sayler’s first months on the job, she said she looks forward to focusing on other ways the health department can restore the public’s faith and help Madison County, such as offering car seats for babies or nutrition advice for expectant mothers.

“There is a lot of rebuilding to do here, because this whole office has been consumed by COVID for so long,” she said. “I can still see long-term goals for us and what we can do for this community. That’s not just a goal. That’s a need.”

Her office has on occasion persuaded those sick with COVID, even those who insisted the virus is not serious, to seek medical help. “Tell your story,” Sayler said she advises those COVID survivors. “Make sure everybody knows how sick you were.”

But then there are more difficult encounters, such as when a mother cursed her out over the phone about the recommendation that her child be quarantined. A week later, she saw the woman at her daughter’s volleyball game.

“She was sitting there and looked directly at me and then looked away,” Sayler said. “That made me feel better. You truly don’t feel that way. You were just expressing frustration in that moment.”

That experience left her with cautious optimism about the difficult task she has ahead with the pandemic set to enter its second winter.

“It is reassuring that there is potential here. We can still work with these people,” she said. “We just really don’t want to be a punching bag, either.”

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.