We Can’t Forget the Health and Well-Being of Our Front-Line Public Health Workforce as the COVID-19 Pandemic Continues

By BCHC Staff

We thank our membership for discussing this difficult and shared challenge with us. Their anecdotes from the front lines help us tell this important story.

As the coronavirus pandemic continues, we have begun to hear more about the mental health impacts of the public at large, as well as among health care workers. While there is nightly applause or flyovers in support of doctors, nurses, and other front-line medical staff- public health department staff, who have also been working tirelessly for months to manage the response, track cases, and control the spread of COVID-19, receive less recognition.

In most large metropolitan areas, public health departments lead the response to crises like this one. They draft data-driven guidance for decision-makers; collect and analyze data; conduct contact tracing, community education, and outreach; and factual information in communicating with the public. All of this is on top of routine activities that support healthy communities, such as environmental health inspections, violence prevention, and immunizations.

While public health departments prepare to respond to outbreaks like COVID-19, the scope and scale coupled with a long-term lack of resources across the field, has led to a particularly difficult environment for the workforce. Staff that includes those front-line workers in the community to epidemiologists, and also, health officials, are experiencing not just exhaustion and low morale, but real and significant mental health challenges that cannot be ignored.

Below we highlight stories from BCHC health department leadership which demonstrate the real concern for their staff and the toll the response is taking on them. Now more than ever, we must ensure public health staff have support from their peers as well as their leadership and have access to necessary resources and services to address their mental health and prevent additional distress.

• Responding to a pandemic is an all-encompassing task with incredibly high stakes that impact both the community’s health and wellness and the public health workforce. Dedicated public health staff have often been working around the clock for months without a full day off since the pandemic began. The community, media, and policymakers are all looking to health departments for guidance in uncertain times, adding a significant amount of urgency, stress, and visibility to their work. Pressure continues to increase as departments are looked to as a source, or allocator, of scarce resources, such as personal protective equipment (PPE) and tests.
  
  While health department staff are professionals, they are also human. They are experiencing personal and professional loss coupled with a great deal of uncertainty, just like the folks in the communities. Giving public health professionals an outlet is critically important to their mental health. For example, one member health department shares a moment of silence each day and leaves time for group reflection during their incident command meetings. Dr. Barbot, Commissioner of the New York City Department of Health and Mental Hygiene, mentioned in a recent webinar  that she makes sure to “show up as ‘just’ Oxiris,” not the Commissioner at key times.
  
  Many public health department staff have been in crisis response mode since February. The demanding hours, ever-changing responsibilities, and burden of ensuring continuity of other public health services has increased stress and the risk of behavioral health issues. Health department staff, like the rest of us, are juggling work duties with personal obligations and challenges, but also have a heightened responsibility to be “on the job.” Many governmental public health professionals have also lost more than one colleague at their department, as well as suffering vicarious trauma, or the indirect trauma that can occur as experiences of the losses or trauma they are attending to in the community. In a webinar, Patty Hayes, Director of Public Health-Seattle-King County, described many of her employees as exhibiting symptoms of Post-Traumatic Stress Disorder (PTSD).
  
• BCHC health department staff are experiencing low morale and burnout related to the COVID-19 response, with little relief in sight. Due to funding shortfalls and restrictive policies and procedures such as hiring freezes and, in a few parts of the country, layoffs, health departments have shared administrative challenges related to increasing staffing or compensating staff appropriately for increased hours. In at least one case, where dedicated, additional dollars were available to support the department’s response, a hiring freeze at the city level stopped any further discussion of hiring. Many health departments are using creative approaches by working with temporary staff, students, or volunteers. While these approaches are helpful, staff still need to dedicate time to onboard and manage new volunteers, and some have raised valid concerns around the ability of individuals who may have little experience or training to effectively carry out work that experienced, trained department employees typically undertake.
  
  Finally, many health departments are involved in the next phases of planning for and implementing re-opening activities, including the development of aggressive contact tracing programs. Increasing workloads will continue and exacerbate the challenges the current workforce is already experiencing. 
• Health departments recognize this is a growing concern and have been proactively implementing measures to support their staff. Several departments have been able to implement a specific mental well-being unit within the incident management structure to offer support, resources, and encouragement to staff.Others make sure to remind staff to take wellness or mental health breaks at some point in the day – which in “normal times,” might be someone’s commute to or from the office, which is many cases isn’t happening right now. Others are working with elected leaders and/or Boards of Health on straightforward tactics to revise administrative policies to allow staff to keep, or rollover, their vacation time.
  

Overall, we need to work together to do more across all big cities, as well as encourage others at local and state health departments across the country to develop “out-of-the-box” initiatives that support the well-being of our public health workforce. We can start with the simple recognition that public health staff are integral, front-line essential workers in this pandemic response just like doctors, nurses, and paramedics. We want them to receive the same kind of encouragement, support, resources, and services that are being made available to other first responders.

While certainly not a cure-all, sustained public health funding will help narrow existing gaps between the public health workload and its workforce. Large metropolitan health departments need federal and state funding to support surge staffing and training for staff as the COVID-19 response continues and evolves. Local governments must work with their health departments to provide flexible policies to support public health staff in times of need and hiring freezes should not apply to those who are responding to the crisis, especially when funding is available to support additional positions. Finally, federal resources and guidance should specifically highlight the public health workforce in the CDC’s COVID-related resources which includes information for families and children, people at higher risk for serious illness, and first responders.