Public Health a guiding light in dark times

Uinta County Public Health employees give a message of hope while the COVID-19 pandemic was raging last year. Picutred are Susan Dasher, Salena Dorner, Merrillee Francom, Kristin Nicholls, JoAnna Roybal and Kim Proffit. (COURTESY PHOTO)

EVANSTON — It was late February 2020 when Salena Dorner, registered nurse with Uinta County Public Health, first “got a little weak in the knees” about the COVID-19 pandemic. It happened when healthcare workers in Uinta County were dealing with a potential exposure to someone possibly ill with the virus. At the time, the World Health Organization had not yet declared the situation a pandemic and the first Wyoming case wouldn’t be confirmed for another couple of weeks.

Although the February 2020 incident would ultimately turn out to be a false alarm — the first positive case in Uinta County wouldn’t be confirmed until more than a month later, on April 1 — the concerns that rippled through the public health office were a sign of things to come in a year that has been almost impossible to describe for public health staff.

In a sit-down with Dorner, RN Merrillee Francom and public health nurse manager Kim Proffit — who was also designated as county coronavirus response co-commander with county public health officer Dr. Mike Adams — the three struggled to detail what the past year has been like for those working essentially nonstop to educate, coordinate, communicate and keep residents safe and healthy in a situation unlike any other.

Francom explained, “Before the pandemic, our full-time job was to prevent avoidable disease, protect community health and promote wellness. This included offering vaccine clinics and health fairs; case management, testing and treatment for some diseases; working with moms and babies and families; finding resources for those in need; promoting wellness through classes and events; being on multitudes of community coalitions and so much more.” In other words, public health staff were busy and had many responsibilities prior to COVID-19.

In the past year, however, public health staff have continued to try to fulfill their prior responsibilities while taking on more duties that at times seemed to grow exponentially almost overnight. In the early weeks, those duties were focused heavily on education, meaning educating themselves about the new virus and then sharing that knowledge with the community, in a rapidly changing situation, with knowledge evolving almost daily. Dorner described it as being “flooded” with responsibility for educating the public — a responsibility that has continued nonstop through to the present. In addition, public health staff took the lead on coordinating the distribution of personal protective equipment (PPE) to ensure local healthcare providers of all types were prepared and had enough supplies on hand.

Ensuring adequate and affordable testing for COVID-19 was another early concern. At first, there were very strict requirements regarding who was able to be tested due to shortages of testing materials. Public health worked diligently with local providers to overcome the obstacles surrounding limited testing and reach a point where testing was readily available to anyone with symptoms — a process that took sustained collaborative effort.

The three explained their office has been overwhelmed with phone calls over the past year and counting. Other healthcare providers, school districts, governmental and public agencies, businesses and individuals have consistently called public health looking for answers and guidance on best practices. The volume of phone calls literally overwhelmed their phone system, necessitating an upgrade in an attempt to keep up.

As cases were confirmed last spring, staff then had to add contact tracing to their list of duties, calling confirmed cases to explain isolation protocols and to obtain a history to contact those who were exposed to explain quarantine protocols. At the time, the confirmation of positive cases was a trickle, during what they described as the “good old days” when they had time to “cross the T’s and dot the I’s.”

That all changed abruptly in early June when the trickle of cases became a flood with the county’s first case spike. It suddenly became impossible for existing staff to keep up with contact tracing, education and prevention efforts, keeping the community informed about statewide health orders and more. Hiring additional staff became a necessity, which then required training and further expansion of the public health office, including installing new computers and even more phone lines, and eventually utilizing more building space by expanding into areas once occupied by LUCDA.

As the pandemic continued, concerns then shifted to getting students back into schools in person in the fall. Public health staff worked extensively with school districts to develop plans for a return to classrooms in a way that maximized safety of students and staff — a plan that has been more successful than anyone thought possible at the time.

Other responsibilities have included the distribution of more than 20,000 masks made and donated by community members, calls to check on those who have been sick with COVID-19, helping businesses reopen safely after periods of closure, assisting with the planning of local events and even picking up groceries or taking supplies to those who were sick and homebound. The receipt of government funds to help respond to the pandemic has been helpful and necessary; however, tracking the expenditures requires extensive paperwork that has also added to the public health workload.

The latest responsibilities added to the pile have included vaccine distribution and organizing massive vaccination clinics to get vaccine out as quickly and efficiently as possible. Proffit explained the four hours often spent actually getting the vaccine into arms at mass clinics are the most visible but in many ways the smallest part of what is required to pull off such clinics. For every four hours at a mass clinic vaccinating hundreds of people — the largest one to date delivered more than 700 shots — there are extensive hours behind the scenes organizing the staffing, scheduling times for people to come, getting all supplies in place, doing data entry to keep track of who has been vaccinated and when they will need to return for a second dose, and even maintaining first doses of vaccine separate from second doses in inventory received from the state.

Throughout it all, staff said they have managed to keep working and striving to do the best work they can for the community. Upon reflection, Francom shared a personal story.

“During the 1918 influenza pandemic, my 26-year-old grandfather’s job was to drive his horse-drawn wagon around his small rural community to gather the bodies of those who died. Over 100 years later, my job as a public health nurse is to work with my community to help prevent the spread of disease and death from the current COVID-19 pandemic.”

Dorner, Francom and Proffit said they have practiced and prepared for years to deal with a pandemic, and that preparation has proven invaluable as they have dealt with the realities.

There are some aspects, however, that took them by surprise.

“I never really anticipated the challenges involved with the disbelief that this is real,” said Proffit. “I always envisioned if something like this happened, everyone would come together, like you hear about with World War II efforts. That’s not what has happened.”

Explained Francom, “There have been times when it has been very difficult to deal with the hostility toward us. People have vented their anger at us for asking them to isolate or quarantine to avoid spreading the disease. Others have posted extremely negative comments against us. At times some local leaders in the community have seemed to suggest there is no need to follow public health precautions.”

“Some people have mocked our work, telling us the disease isn’t real,” she continued. “But, we have talked to many, many persons who have been very ill, families with loved ones in critical condition in the hospital, and we have mourned with those who have lost beloved family and friends to COVID-19.”

All three described going through periods of anger, especially when fatalities occurred, and struggling with burnout and exhaustion. They regularly talk with community members who are still struggling with the effects of having COVID-19, even months later, with some continuing to require supplemental oxygen.

Though they have encouraged one another to take days off, the reality is that’s often impossible simply because there is so much work to be done. Their workdays have continued to grow longer and weekends and holidays have been sacrificed. They said even when they are away from work, they have become so focused on work demands it’s difficult to stop thinking about what needs to be done, meaning they never really do take a break. “It’s really all we think about,” said Proffit. “There’s been a high level of imperative to everything we’ve done and there’s no ability to finally say, ‘We’re done for the day.’”

In spite of the challenges they’ve faced and continue to face, all three did continue to focus on the positives, sharing stories of community members buying them meals, bringing hot chocolate to outdoor vaccination clinics, and more. They said the vast majority of people they spoke with who were confirmed to have COVID-19 wanted to protect their loved ones and fellow citizens and were very willing to isolate to keep others safe.

Proffit directly referenced the invaluable help of Uinta County staff members who ensured phone system upgrades, computer additions and office expansions took place as quickly as possible, as well as UCSD No. 1 Transportation Director George Dickerson who reached out to suggest the bus barn as a location for drive-through vaccine clinics. Drive-through clinics at the bus barn and the Mountain View fire station have enabled thousands of county residents to receive vaccines efficiently.

Proffit also thanked staff at Frontier Psychological, who reached out to offer assistance in helping her office staff cope with their own stress. “We’re so busy it’s easy to get tunnel vision and not think about our own self-care,” she said, “so that was super helpful and thoughtful.”

She also thanked Dr. Adams for his work as county health officer. “He has been a good leader and his strength and courage have shone through,” she said. “I have lots of respect for him. He has a compassionate heart and cares a lot about this community. He tries to see all sides of an issue and has been committed to finding ways to allow things to happen, schools to open and events to take place as safely as possible through all of this.”

With more mass vaccine clinics scheduled throughout April, public health staff anticipate another shift in their focus in the coming months — that of working to reach out to those hesitant to be vaccinated to encourage them to do so, as most of those eager to be vaccinated will have already received two doses by the end of this month. In addition, they’re asking parents of teens ages 16-17 to reach out if they’re interested in having them vaccinated; they may be able to secure doses of Pfizer vaccine (the only vaccine currently authorized for use in those 16 and over) for that age group if there is enough interest.  They also expect to continue to stress the importance of prevention, physical distancing, mask usage, hand hygiene, staying home when sick, etc., until such time as herd immunity is reached — a goal that is complicated by a reluctance by some to get vaccinated.

“Some people may think we’re being negative to continue stressing that,” said Proffit. “We know everybody is anxious to reach the end of this pandemic, but I don’t think anybody is as anxious as we are. We’re stressing continued prevention because we don’t want numbers to just decrease or even level off. We want it to be really, finally over.”

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