State, local public health veterinarians work long hours to protect the public

Dr. Betsy Schroeder, Pennsylvania state public health veterinarian, feels like she’s sprinting a marathon.

She and the members of her public health teams are trying to find a sustainable pace in their work to protect people from COVID-19.

“We’ve all already put in at least a year’s worth of what would be regular working hours in a little over six months,” Dr. Schroeder said.

She is the operations section chief for Pennsylvania’s pandemic response, supervising epidemiology, laboratory, and community nurse teams. They interact with health care providers and people exposed or potentially exposed to the COVID-19 virus.

Dr. Schroeder said Pennsylvania has a smart, dedicated corps of health officials but not the deep bench of the federal workforce. Friends at the Centers for Disease Control and Prevention told her about times rotating on and off pandemic-related duties.

She’s working to add staff members, though, using funding from the CDC.

Public health veterinarians describe shifting this year from protecting against familiar local threats to managing broad health care and education efforts during a pandemic that, at press time, was killing about 1,000 Americans each day. Some in state government have been aiding national control efforts since the start of the year.

For example, veterinarians in the California Department of Public Health Veterinary Public Health Section began work in January to screen and monitor people arriving in their state from other countries, according to a CDC Morbidity and Mortality Weekly Report published May 15. Their duties since have included analyzing demographic data of people infected, collaborating with other agencies on testing in animals, and educating people who work with animals, according to CDPH officials.

In February, CDC officials created the 17-agency One Health Federal Interagency COVID-19 Coordination Group to share information and coordinate messages to the public. The agency also leads weekly federal and state one-health calls among about 165 partners, including state public health veterinarians, wildlife officials, animal health officials, and local partners.

Other outbreaks continue

Dr. Joann Lindenmayer is an elected volunteer on the Board of Health for Uxbridge, Massachusetts, a 14,000-person town on the state’s southern edge. Early in the pandemic, she, a fellow board member, and the town health director worked 60-hour weeks for two months.

She is a public health expert, epidemiologist, and former professor who has worked for a variety of institutions, including the CDC, Tufts University, Brown University, and health departments in three states.

Dr. Lindenmayer led a coalition of community service organizations that bought and delivered food, cleaning products, baby diapers, and masks to unemployed people as well as offered to call people who needed daily check-ins, give rides to and from health care providers, and walk dogs. She and colleagues also put up signs encouraging practices such as washing hands and keeping safe distances and distributed information on COVID-19 through the town’s website, the town’s cable TV station, newsletters, and educational materials left on doorknobs of homes for people who are elderly or who have disabilities. And she supervised nine master’s-level Harvard University School of Public Health students who were participating in the COVID-19 Academic Public Health Volunteer Corps.

Pennsylvania and Massachusetts both endured spikes in COVID-19–related deaths in April and drop-offs through summer, although confirmed infections rose in Pennsylvania in mid-to-late July, according to data from both states. As of Aug. 3, Pennsylvania had more than 7,000 deaths from 114,000 infections and Massachusetts had almost 9,000 deaths from 118,000 infections, according to the CDC.

Dr. Schroeder said her office is still investigating animal bites, and her enteric disease experts split their time among diseases.

At one time, they could be working on Salmonella outbreaks and trying to coordinate an investigation on COVID-19 exposures in a restaurant, she said.

Dr. Schroeder enjoys the familiarity of rabies consultations; she’s good at them and able to give people definitive answers. Salmonella has a playbook, and the work is routine yet important, she said.

But public health authorities are still learning about COVID-19, including whether people can become reinfected.

Dr. Catherine Brown is Massachusetts’s public health veterinarian and state epidemiologist. Much of her work involves capturing and analyzing data to find the people vulnerable to SARS-CoV-2, the virus that causes COVID-19; finding patterns among clinical outcomes; and using those results to shape policy.

“It’s fine for the Department of Public Health—at the state level—to collect information,” she said. “But if we’re not turning that around and making actionable items out of it, and then helping people understand what those action items are that they should be involved in, then what’s the point?”

With COVID-19, Dr. Brown is dealing with the unusual task of analyzing tens of thousands of negative laboratory results daily, in addition to looking at emergency departments’ data streams on COVID-19–like symptoms. She also is working with other agencies to coordinate information on infections in pets, whether pets should be tested, and how often human-to-pet transmission occurs.

Urging community responsibility

This spring, Dr. Kristen Obbink helped plan how to test Iowa State University students for COVID-19 when they returned this fall. In July, she became the university’s COVID-19 public health coordinator.

Normally, she’s a veterinary specialist at the Center for Food Security and Public Health at Iowa State. “In this new role, I’ll be full-time serving as the public health coordinator for COVID-19 response through the end of the fall semester,” Dr. Obbink said.

She is coordinating efforts to mitigate risk of COVID-19 among 35,000 students and university employees. She is part of a university team using contact tracing, quarantine, isolation, and symptom tracking as well as working with ISU statisticians and the university’s communications team. On campus and in the surrounding community, the university’s Cyclones Care campaign encourages physical distancing, masks, hand washing, and—when people get sick—isolation in their apartments or in residence halls set aside for them.

About 9,000 of ISU’s students will live on campus this fall. On Aug. 3, Iowa State officials announced they had started testing all students as they moved into residence halls and on-campus apartments ahead of classes that started Aug. 17.

ISU was processing those samples through the university’s Veterinary Diagnostic Laboratory. Dr. Obbink said the laboratory intended to deliver test results within 24 hours—a goal she acknowledges is unmet in much of the country.

The school planned to offer a mix of classes in person and at a distance. For those that require in-person attendance, the university cut attendance by half and rearranged seating.

“We all have the same goal, although we have a different part to play in it,” Dr. Obbink said. “We want our students and our faculty and our staff to have the best experience possible. We’d prefer that to be as it used to be, and, of course, that’s not possible right now.”

Saving lives, often unnoticed

Dr. Lindenmayer said signs in her town thank first responders and essential workers but not public health workers. She said the public, historically, knows little about public health work and why it should be funded.

“The real dilemma with public health is that we don’t have a constituency,” she said. “When public health succeeds, that means that nothing happens.”

Data published March 23 by the Association of State and Territorial Health Officials indicate that, from 2010-19, employment at state health agencies dropped by about 15% and spending by those agencies was almost the same in fiscal years 2010 and 2018—equal to a 13% budget cut after adjusting for inflation.

The ASTHO also warned in February against the Trump administration’s fiscal year 2021 proposal to cut funding for public health agencies and consolidate public health programs.

“Now more than ever, Congress and the Administration must prioritize funding for the entire public health system,” the announcement states.

Public health veterinarians described boom-and-bust cycles tied to disease events, citing crises involving West Nile virus, anthrax, Zika, and Ebola.

Dr. Schroeder said public health agencies go unnoticed when they do their jobs well, and few people get into public health work for personal glory. It’s hard to take credit for someone not developing polio, she said.

Dr. Brown likewise said, “One of the things we say in public health is, ‘It’s very difficult to measure the diseases you prevent.’”

“What I hope COVID is teaching all of us is that there’s always going to be the next thing,” she said. “And so, we need to not just invest in disease-specific public health responses; we need to invest in public health infrastructure.”

Dr. Lindenmayer also wants to see more veterinarians apply their population health training in local government. They can make life better for people and animals, and many communities are desperate for volunteers, she said.

Dr. Brown also thinks veterinarians can impact public health by, say, building relationships with local human health care providers and offering expertise in case of disease outbreaks.

Dr. Schroeder said everyone can help during this pandemic by wearing masks and washing their hands.

“Those really are the best things we can do to help take care of all of us, together,” Dr. Schroeder said. “The only way we’re going to get through this is by looking out for each other.”