Public Health Review

Remembering humanity within the tragedy

Keelia Silvis, MPH Student in Public Health Administration and Policy Program at the University of Minnesota School of Public Health

Submitted: November 18, 2020

Every positive COVID-19 case is its own unique tragedy. As a COVID-19 case investigator (CI) with the Minnesota Department of Health (MDH) during the summer of 2020, I was part of an interdisciplinary team that called and interviewed Minnesotans with confirmed positive COVID-19 test results. CIs determine likely sources of infection, identify contacts that need to quarantine, provide up-to-date information, and offer assistance with basic necessities. 

And, when needed, we do our best to comfort frightened people as they cry and cry.

Over the course of my time making calls as a CI, I served an incredibly diverse set of Minnesotans. I interacted with people from a spectrum of ages, racial and ethnic identities, preferred languages, health needs, family structures, and socioeconomic statuses. Often the person I talked to was in a good situation with secure access to housing, food, and medical care for their entire isolation period. But too many times this was not the case. 

In partnership with local public health departments, MDH offers assistance to people in quarantine or isolation who need basic necessities. You don't want someone with confirmed COVID-19 leaving isolation to get groceries, just as you don't want people in quarantine facing the threat of eviction. I was happy and proud to offer this support at the end of every CI interview, but it wrenched my heart to hear the need from some of our community members. A father saying, "I hate having to ask, but my kids are growing. They need food." A college sophomore admitting, "My savings are gone. I don't know how I’m going to make rent." As a part of the CI team, I could help MDH get them those basic necessities in the short term, but the broader disparities to food and housing still remain.  

Sometimes the resources MDH provided weren't enough. I will never forget the night a woman sobbed helplessly for thirty minutes on the phone with me. She was supposed to have back surgery in three days, but because of that positive COVID-19 test result she would have to postpone the procedure. She had no idea when she would be able to reschedule the surgery, and she didn't know how she could keep running her business without it. Overwhelmed by pain, anxiety, and helplessness, she just kept saying, "I was so careful. I don't know how this could have happened." And all I could say was, "It's not your fault. You're not alone. I'm still here with you."

When COVID-19 is over, I wonder how we will remember this period. Will it feel like a strange fever dream? Or a period of intense, painful clarity? Will it be the start of a new, bolder era of public health prevention and intervention? Or will it mark the brutal beginning of a long period of economic and civil instability?

If nothing else, I hope we remember the humanity within the tragedy. Each person who contracts COVID-19 has their own unique story. We can't forget that. The COVID-19 pandemic isn't just statistics or case counts, it's worried fathers, exhausted college students, sobbing businesswomen, and so much more. The people behind the cases are what matter, and we need to center them now and as we move forward.

Post-Pandemic Mental Health: Navigating Individual & Collective Trauma

Teale Greylord, MPH

Submitted: September 21, 2020

I was diagnosed with PTSD when I was ten years old, after surviving an F-5 tornado that destroyed my hometown. Although we rebuilt, the mark of the storm never really faded. The trees and houses that had stood for generations were gone. It took years to rebuild and shape the community into something new. During all that time, life continued moving forward. 

Although the nightmares and flashbacks eventually subsided, deep down, I never felt entirely comfortable being left alone again. You never know when something bad might happen.

As an adult, I thought I had totally overcome that experience. That mixture of fear, uncertainty, and loss of control were something I hoped to never feel again. But when Minnesota declared an emergency shelter-in-place order and the University of Minnesota School of Public Health shifted to on-line classes in March, it all came flooding back. My brain thought I was ten years old again, home alone and huddled under a blanket in the basement, as the weight of a storm crushed the house around me, a freight train of sound and broken glass. I knew in that moment that I was going to die. Then all of a sudden it was 2020 and although the circumstances were different, it was happening all over again. I was alone and afraid for my life.

Only it wasn’t just me who was experiencing the shock and disruption of COVID-19. All around me, I watched people struggle with what was happening to us. Businesses were closing, people were losing their jobs, there was panic at grocery stores to buy essentials, concern for how to pay rent, fear of evictions. And it was happening on a global scale that had never been seen before. Our instincts to survive were kicking in and no one knew what was about to hit us. 

I was so shook up by it all, that it took a moment for me to realize that I was safe. My basic needs were still being met. There was a roof over my head, running water and electricity, and a grocery store down the road. I was still a graduate student with schoolwork and project deadlines to complete. I had responsibilities. People were relying on me to get things done. In the earliest days of the pandemic, that was what kept me going. 

Six months have passed since then. It is easy to say that a lot has changed, but also… it hasn’t? I am still sheltering in place here in the Twin Cities. I haven’t seen (or hugged) anyone outside of my home during this time. The feelings of isolation run deep. I have developed new routines and coping mechanisms to help me get through each new day. The early feelings of shock and utter discombobulation have changed into a quiet murmur of grief and constant discomfort. I am ready and waiting for the news that more of my loved ones have fallen ill or died from the virus. Or for the chance that it might be me next. 

I didn’t expect public health to be like this. Or for life – and my vision of the future – to have changed as drastically as it has. But I am slowly coming to accept that the world has changed, and that we have changed with it. Life goes on and it’s up to us to choose what we’re going to do after this experience. I am hoping to learn from it and use that knowledge to rebuild, yet again.  

The Blame Game: Navigating the Public Health Response to a Political Problem

Jennifer Mandelbaum, MPH is a PhD student in Health Promotion, Education, and Behavior at the University of South Carolina.

Submitted: July 25, 2020

As I’ve watched responsibility for the virus shift away from the federal government, I’ve wondered: Are we gaslighting the public health profession? I see my colleagues at my university and the state health department being blamed for there not being stricter lockdowns or mask-wearing mandates. My coworkers are some of the most selfless people I know, yet some people act as if our motivations are anything less than pure. No one I know gets into public health for the fame or fortune. In fact, despite the high return on investment from public health interventions, many state and local public health professionals qualify for public aid. We don’t blame environmental health scientists for climate change; why are people targeting public health professionals for an inadequate federal response to the pandemic? There seems to be a misunderstanding about how science works. We do what we can with the best evidence available to us, and that sometimes means our recommendations change. Ultimately, it’s not up to us whether those with the political capital to enact change use our knowledge when developing guidelines.

And as we’re blamed for worsening case rates, insults like “arrogant” are slung at us for speaking out against mis/disinformation. This pervasive anti-science rhetoric is only eroding the general public’s trust in public health experts. Whatever privileges come with our education and workplaces should not discredit the science we do. Simply because the word “public” is in our profession, our jobs are treated as though anyone can do them and that the general public knows more about this than we do (see “armchair epidemiology”). It isn’t “self-centered” to assert our roles as public health professionals; it’s our job.

If this sounds personal, it’s because it feels that way to me. It’s difficult for me to ignore the parallels between COVID-19 and the virus which killed my dad a year before this pandemic struck. While I don’t intend to center my experience over those who have lost loved ones to COVID-19, I empathize with the frustration that more isn’t being done to prevent this virus’s spread. I have a hard time believing that such apathy would exist if a new form of cancer killed more than 100,000 Americans in three months. What about a novel virus spreading throughout the world sounds anything other than urgent? What will it take for people to stop calling COVID-19 a “hoax” or downplay its severity? We can acknowledge there might be some silver linings to quarantine for the privileged among us (myself included) without normalizing the lives and livelihoods lost from this virus.

To be clear, I don’t blame individuals; doing so ignores the context in which behaviors take place and lets political actors off the hook. And call me naïve, but I think most people mean well. I do think that we, as a field, need to be clearer about how the scientific process works and how it intersects with our political system. It’s important the general public understand that even though the news narrative centers on the “public health response” to the pandemic, this response is ultimately a political one. While I applaud all of the people wearing masks and adhering to physical distancing guidelines, goodwill will not be enough to get us through this. Through it all, my colleagues and I will continue to work every day to research and implement measures that protect the public’s health.

My experience with COVID-19 public hotline duty at the Minnesota Department of Health

Diksha Srishyla, MPH 

Submitted: May 30, 2020

During my master’s in public health studies at the University of Minnesota, I started a position as a student worker at the Minnesota Department of Health (MDH). I was in the Infectious Diseases Epidemiology, Prevention and Control division (IDEPC). In the first week of March, employees in IDEPC, including all the student workers, started getting trained to staff hotlines; to be prepared to answer health and precautions-related questions regarding COVID-19 from the general public with reference to MDH recommendations.

The hotlines were initially set up in small conference rooms able to seat 6 people at a time. I went into my first shift in apprehension of what was to come; some of my usual work involved making phone calls to clinics and laboratories to enquire about testing results and, being an introvert, I did not especially enjoy that. It just so happened that my first day on the hotline shift, March 6th, was also the day when the first case of COVID-19 in Minnesota was detected. Sometime after this was announced in the news, landlines began ringing off their hooks and it was also my turn to answer some calls. People mostly wanted to know where the positively diagnosed person resided and where they had been in the past few days, and we had instructions to not reveal this information to protect personal identity. Many callers were not pleased to hear that. 

Over the next few days, the public hotline transitioned from this conference room of 6 people per shift to a classroom with about 20 people per shift. I made sure to read the news, CDC and MDH guidelines everyday to ensure I gave callers the correct information and recommendations in response to their specific queries. Elderly people who lived alone asked if it was ok to meet up with their friends to play cards, parents of college students returning from other states asked about where to put them in quarantine, people who had recently returned from travel abroad asked what symptoms to look out for, conscientious factory workers complained about their administration not taking cleaning and disinfecting guidelines seriously. There are a few calls I shall never forget. A father who had to send his daughter for a custody hearing to another state called to ask if it was alright for her to travel there, and took down my name at the end of the call, probably so that he could cite me for the recommendation I provided in the name of MDH. Such were the calls which reminded me that I wasn’t just representing and relaying MDH recommendations to these people, but that I was also accountable for the information I gave them based on their specific situation so that they could make a sound decision. I was on another call for 45 minutes with another person who reported that she had depression and was very upset that one of her favorite museums had shut down; I could see here the challenge in our roles as hotline responders; to strike a balance between listening, empathizing with the caller and providing her with referrals and resources for her mental health while making sure we weren’t spending so much time with them that we couldn’t attend to other callers’ concerns. 

Initially, I would find myself feeling drained at the end of these shifts, as would other employees new to hotline work. Thanks to supportive colleagues and supervisors, my parents and friends who let me vent and a regular workout schedule, I would go back to my next shift with a renewed sense of purpose. Gradually, the feeling of being drained became more of satisfaction and answering these calls became a practiced skill. After a month working on the COVID-19 hotline, I developed not only a useful new skill but also a new appreciation for the work done by hotline employees.