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SAN JOSE — Maybe there’s no winning for Dr. Sara Cody.
From the moment Santa Clara County’s public health officer led the Bay Area’s first-in-the-nation coronavirus lockdown 14 weeks ago, she has endured the wrath of a vociferous public taking aim at every damned-if-she-does, damned-if-she-doesn’t-do-it-fast-enough decision. In these last three months, to many of her critics, she has turned from public hero to public enemy No. 1.
“I’m the face of everything that people might be upset about,” Cody said in an interview with the Bay Area News Group this week. “It’s a very odd position, a very odd position.”
The hot seat for Cody and other public health officers has only intensified in recent weeks as the pain of our epic economic collapse continued to grow alongside the threat of the deadly, invisible virus.
Protesters showed up at the home of Contra Costa Public Health Officer Chris Farnitano last Sunday, chalking the sidewalk and waving signs that said “Open Contra Costa” and “No Masks.” Tesla founder Elon Musk called Alameda County interim health officer Erica Pan “unelected and ignorant” and threatened to move his company out of state unless she allowed him to reopen his Fremont factory. A Sunnyvale woman called Cody a “renegade doctor” in a letter to the editor, and a Cupertino woman purchased a full-page newspaper ad accusing the doctor of personally “cratering our economy.” This week, the sheriff’s department acknowledged it is investigating threats against Cody.
It’s too early to know how history will judge Santa Clara County’s public health officer. But it’s clear that this unelected public servant with extraordinary authority is trying to maintain her singular focus — to end the pandemic before it ends us.
“I keep thinking about what is my job, what is it that I’m here to do, who can I work with and how can I work to make the best decision possible for the people living in Santa Clara County,” Cody said. “It’s very helpful to stay focused on the mission and not get distracted. There’s a lot of noise, a lot of noise.”
In normal times — remember those? — public health officers are effectively invisible, keeping track of flu bugs and meningitis outbreaks.
Since the onset of coronavirus, seven public health officials across California have resigned over a combination of burnout and backlash. Orange County’s health officer resigned after critics, upset about her order requiring people to wear masks, protested in front of her house. Marty Fenstersheib, Cody’s predecessor, recently resigned from a similar role in San Benito County after a particularly withering supervisors meeting. Cody hired him back to help track COVID cases.
“Health officers are working 80 hours a week to stop the spread of the disease — working hard since February. Many haven’t had a single day off,” said Kat DeBurgh, executive director of the Health Officers Association of California. “But add on top of that the angry public comments that become personal attacks and that’s a very hard position to be in.”
In mid-March, when the lockdown was ordered, Santa Clara County was considered one of a few national “hot spots” of coronavirus outbreaks. Since then, the county has kept its numbers in check, with 151 deaths. Across the country, there have been 36 deaths per 100,000 residents, while Santa Clara County has had 7.7 — or about one-fifth the U.S. death rate. Los Angeles is at 28.8. California’s death rate is 13. The rate for Alameda County, which has had a spike in the number of overall cases in recent weeks, is 6.9. The number of hospitalizations in Santa Clara County is down from a high of 264 in early April to 48 on Tuesday.
“I attribute it directly to her efforts and the whole county health department that sits behind her,” said Dr. George Rutherford, a UCSF professor of epidemiology and public health. “In many ways, they’ve led the world in how to handle this epidemic, and the fact that the rest of the United States doesn’t seem to be paying attention — it’s not their fault. Just look at what’s happening in Phoenix. They’ll have their ICUs overrun.”
Arizona, which lifted its stay-at-home orders more than a month ago, is seeing its highest cases ever, with 83% of its ICU beds full earlier this week.
Cody says she understands the toll the lockdown is taking, the restlessness and angst to return to normal lives. “I would lie if I told you I didn’t feel that way, too,” she said.
And as a public health officer, she is schooled in the fact that being employed and living a normal life is important for health and well-being. But the virus is tricky, she said, spreads easily and is deadly.
“You can never bring someone back if they died. But if you can find money, you can help someone who lost a business or a job,” she said. “It’s extraordinarily difficult, but there is a way forward. Once you’re dead, there is no way forward. There’s no way to bring your family member back.”
And her strict rules are working, she said.
“So we’ve been able to open a number of different sectors — we’re going a little more slowly than other areas, but what we don’t want to do is have to go backward, because then all the progress that was made would be lost.”
Shopping malls are open, outdoor dining is allowed and summer camps, with tight restrictions, are welcoming children. Santa Clara County allowed indoor retail in early June, before San Francisco. But unlike other counties with higher infection rates, Santa Clara County still won’t allow nail salons to operate or indoor dining.
As much as the lockdown is being blamed for crippling the economy, Cody said, businesses still would be devastated if the virus went unchecked and people afraid of getting sick stayed home.
“It’s a very, very challenging environment in which we are trying to make decisions,” she said. “I feel like I’ve made 80,000” of them.
The county’s impressive progress against the disease, however, is chiefly why critics say that Cody should have started reopening sooner.
In an “open letter” on May 23 titled “Dr. CODY, YOU OWE US ANSWERS,” former Cisco vice president and philanthropist Paulette Altmaier demanded in a full-page newspaper ad to know why Santa Clara County wasn’t following Gov. Gavin Newsom’s own guidelines for reopening — criteria that Cody had told reporters would be reopening “too fast.”
“Gov. Newsom has laid out an opening plan and what we need to meet it. We meet it by a mile,” Atlmaier said in an interview. “Our county isn’t following it. We are creating hardship, distress and despair.”
In the letter, she demanded that Cody justify her slow approach, and explain why she hasn’t met her own goals on testing for the disease and tracking contacts of infected people — benchmarks Cody had said were needed as part of a reopening plan.
County Supervisor Susan Ellenberg has asked some of the same questions but has been careful to point them to Cody’s boss, County Executive Jeff Smith.
“It seems unfair to herald her as a hero in early March when she put the shelter-in-place order in place, then question her expertise now because it’s gone on for such an extended period of time,” Ellenberg said. “In my view, the question is not whether Dr. Cody is dragging her feet, but whether the county administration is moving fast enough to get us to a place where shelter-in-place can be lifted.”
Testing in Santa Clara County has lagged behind others, but it is targeted to more vulnerable areas and six new testing sites were added this week. And while Cody had set an “audacious goal” of recruiting 700 people to trace the contacts of people infected with coronavirus, far fewer are actually needed right now, she said. The 285 tracers the county has recruited are just shy of the 300 benchmark set by the state.
When Cody relaxed some of the rules in early June, she said she would be waiting another few weeks to monitor the impact. If the numbers don’t spike, she would continue the reopening process.
But don’t expect life to go back to normal anytime soon.
“The next challenge for us,” Cody said, “is to try to come to terms with the fact that we cannot go back to the way we were living in 2019.”