The Invisible Shield

I think most of us, when we talk about progress, have a bias towards dramatic leaps forward...

Technological innovations, scientific breakthroughs, feats of exploration, military victories, lone geniuses, factories, skyscrapers, rockets, computers.

But there's another, more complicated history of civilization.

And what's complicated about it is that the driving force, in many cases of positive change, is immense catastrophe.

Viruses, pathogens, and microorganisms... at times, threaten to bring us to our knees as a society.

In Europe, 60% of all children would have smallpox.

It's so much worse than you can imagine.

Because of new trade routes, suddenly Black Death comes along, killing 2/3 of the population at a time.

Cholera rampaged throughout the globe.

It kills 50% of the people who get it.

With industrial capitalism, we saw people dragged into factories from countrysides.

The world was turned upside down, and with it, went health status.

The way we were organizing society was causing people to die at an alarming rate.

It was plausible to look at all that and say, this isn't going to work.

And so it's not an accident that public health emerged.

We don't have monuments to public health the way that we have monuments to the great military battles.

And yet the battles that have been fought in the realm of health are so much more consequential.

Fight back!

Fight AIDS!

Act up!

Imagine a world where no vaccines existed, where a third of your children died before reaching adulthood.

This was the reality of all human life until just about a hundred years ago.

We don't really recognize what is sustaining civilization.

And so I've come to think of the role of public health as a kind of invisible shield that has been quietly protecting us, extending our lives, keeping our children safe.

And the work that it does is almost always underappreciated, almost by definition.

Because when it's working well, you don't get sick.

And in fact, you live longer lives.

One of the things that pandemics do is that they make that shield visible.

Public health saved your life today but you didn't even know it.

And to a little extent, that's been a point of pride in public health.

You can walk around the community knowing that you've made it safer, even if nobody knows your name.

When prevention works, nothing happens.

That is definitely part of the challenge, right?

I mean, if you're a firefighter, you can explain to your grandma what you do.

Your house is on fire, I come in, I save you.

I know who you are!

You're Anthony!

- That's right, yeah.

- Yeah, that's right.

Public health is like, do you have five minutes?

I can explain to you.

We regulate restaurants.

We regulate septics.

We regulate wells.

By the way, then we do maternal child health.

And by the way, you know, when there's a food outbreak or a TB outbreak, we deal with it.

When I was state public health director, we had a laboratory technician who said, "I've seen two cases of Salmonella Agona, "the last week.

And I normally see maybe one a month."

"Something might be going on here."

That's when the public health epidemiologists went out and they interviewed the individuals who had this positive.

They asked them what they ate.

They asked them where they ate.

And the stories began to line up.

And it pointed to a single breakfast cereal.

This led to a recall of literally millions of pounds of this breakfast cereal that was causing disease across seven states in the country.

That's the public health system.

I think that, like, I take care of 905,000 people.

One of the things we have to remember is that basically until the 1700s, the entire medical profession was probably a net negative in terms of health.

If you were sick in 1650, you were better off not seeing a physician.

Because the physician would be like, "Oh, you do seem ill. "Here, take some of this deadly poison mercury.

Or would you like some leeches?"

Two centuries ago, 30% of children died before they became adults.

A third of your kids were likely to die in childhood.

But it was also hard to live to 80 or 90.

When my grandfather was born in 1900, he was expected to live to 48 years of age.

He actually lived to 84.

So in the last century, we gained 30 years of life expectancy, but only five of those years were due to everything I learned in medical school.

All the really intensive, expensive sick care things that, you know, you want to have when you have that one rare disease.

But 25 of the years that we gained in that last century were due to things that we can only solve collectively.

To me, that is the most impressive thing that we have ever done as a species.

I think public health goes deep into our history as a way of mitigating the risk of living socially.

How do you limit infectious disease and deaths?

It comes down to prevention.

These are ideas that led to a kind of an attention to the environment: the water supply, the sewage systems, housing reforms, the creation of sanitation departments.

It wasn't that long ago that you went to work and you might not come home.

Workplace mortality was very high.

We fixed that, not through medicine, we fixed it through policy.

There's just so many things in public health that work every day that we don't know are happening.

It begins with prenatal care.

It begins with what we serve our children for their school lunches.

Public health asks the question, "How can we prevent tragedy?"

It's what we as a society do collectively to improve our health.

That's the definition of public health from the Institute of Medicine.

And what I like about it is the what we as a society do collectively.

No one person does public health.

We do it together.

I was looking at the data.

Life expectancy, which is usually one of the key measures of the well-being of a society.

We began falling as compared to other wealthy nations.

What happened?

As public health saved many, many, many lives, people took it for granted.

We don't think about the fact that we are drinking safe water, eating safe food, inhaling safe air.

But all of that is what makes us healthy.

Public health is undervalued and underappreciated.

And so it's a difficult moment because many health problems really can only be improved through public policy.

About 40 years ago, we started really significantly underinvesting in public health in ways that became real challenges.

In 1980, Ronald Reagan became president of the United States.

And his presidency really represented an important ideological shift.

In this present crisis, government is not the solution to our problem.

Government is the problem.

We adopted this idea that all we are is a collection of families.

It's parents who are responsible for children.

It's each adult who's responsible for his or her health.

And the market is the place where we figure out the most efficient options.

Now, this is just so wrong.

We know that we can take people who have been severely injured or have significant diseases, and that we can cure them, and that's very good.

But it's very expensive.

In this country, we spend, what, $3.6 trillion on health.

And less than 3% of those expenditures are focused on prevention.

The erosion of government investment in the tools that we need to keep people healthy, the disease monitoring, the public health labs, the disease detectives.

Some 50,000 frontline health workers were lost, beginning with the decline in 1980.

We have to ask ourselves, "What happens when you put profit in the mix of guaranteeing people's health?"

Compared to other high-income countries, we are not a healthy country.

Compared to other high-income countries, we have a life expectancy about three to five years less.

And the way to think about that is we, as Americans, are choosing to live five years less.

Now when I say that to people, people often say, well, wait a second.

I'm not choosing to live five years.

But we are, right?

We are because we allow the policies to happen that create a world where we live shorter, sicker lives.

Between 2016 and 2018, life expectancy in the United States stagnated and declined.

This was the first three-year decline in life expectancy in a century since the time of World War I and the Great Influenza.

One of the tragic facts about the recent decline in life expectancy in the United States is that it actually wasn't entirely driven by COVID.

The escalating obesity epidemic and the rise of diabetes as a leading cause of death, the continued impact of heart disease, stroke, and, of course, the many common cancers.

There's opioid overdoses, suicides, gun-related homicides, problems that involve the overall health of the fabric of society.

People are dying when they don't need to die.

We're the wealthiest country in the world.

So, what exactly is happening here?

Public health is like the foundation of your house.

It's not something you talk a whole lot about until it's cracked.

And let me tell you, ours is cracked.

This is a moment to really tell the story of public health as to why it matters, what it does, and how much is fundamentally at stake for whether people can live the lives they want to live.

If you think about the great heroes of history of health and medicine, we often evoke people who invented specific interventions...

So Edward Jenner and the smallpox vaccine, and Salk and the polio vaccine, Alexander Fleming and penicillin.

But there are other pioneers in that history who have saved, I would argue, just as many lives.

But they didn't do it by creating a thing, an object, or a pill.

They did it by thinking about data in new ways.

Human societies have had a long history of registering births and deaths.

That's basically as old as the census, which is thousands of years old.

But what we didn't have until around 400 years ago was one crucial element of data, which was what they died of.

This first began to become a practice in the development in what were called bills of mortality that were collected on a parish-by-parish level in England.

The diseases and casualties this week, you have things like cough.

Five people died of cough.

47 people died of fever, nine people died of rickets, four died of scurvy, two died of spotted fever, and then apparently, 27 died of teeth.

What you see here is an attempt, in a very elemental way, to detect patterns in a series of lives and deaths.

The idea that perhaps you could learn from those patterns was pioneered by a guy named John Graunt in the 1660s.

Graunt hit upon the idea of collecting data across all the different parishes, and then wrote a pamphlet using that data to sketch out, really for the first time, a general sense of how long people were living, how often children were dying in London, what the overall prevalence of certain diseases were.

For the first time, you could start to think about not just individual cases, but trends, trends happening over time.

The rising and falling of outbreaks, clusters of death that were associated with some kind of pollutant, all of these things became visible for the first time.

The collection of the data and the belief that those patterns would ultimately reveal insights that could actually improve our health, in some ways, this is the beginning of public health.

The science base for public health is epidemiology.

Semmelweis was using epidemiology when he found that the reason women were dying in childbirth was that they were getting infections from the doctors who were doing autopsies and then delivering babies without washing hands.

Can you believe we did not have a department of epidemiology in this country till a little over 100 years ago?

The U.S. Public Health Service started the first department of epidemiology at the Johns Hopkins School.

It was founded in 1916 right before the Spanish flu pandemic that circulated and killed millions of people around the world.

And it trained a group of practitioners that would be able to fight that pandemic.

It's gone on to make extraordinary contributions to public health.

There are epidemiologists and clinicians, public health practitioners all over the world who are looking to see what's happening in their communities and raising the alarm when something unusual happens.

It's often doctors or nurses who report that a patient has different symptoms than they might expect.

And by gathering that data in aggregate, we, as epidemiologists, can see what viruses are emerging.

In late December of 2019, I got the original reports of cases of severe respiratory disease in atypical pneumonia in Wuhan, China.

The concern I heard in the voices of trusted international colleagues of mine that have been part of our community for a long time suggested to me this was something that we really needed to pay attention to.

Health care worker deaths are a red flags.

People that are treating the cases coming in, if they're getting sick and dying and how quickly that's happening, tells you a lot about the nature of what the pathogen may be.

Early in an outbreak, speed is of essence.

Days can matter, hours can matter.

And so the quicker that you can make your insights widely available, the faster other people can use that to help to protect their own communities.

Day after day, I saw that case counts were increasing.

So the number of people with this infection were growing really quickly, and it really made me nervous.

I could see that this was not coming under control quickly, and that it was likely a problem that was going to spread beyond China.

In January of 2020, when the epidemic was growing exponentially, there were rumors that the Chinese would begin closing down Wuhan and then all of Hubei province, cutting off the transportation infrastructure.

We had made the decision that there was enough seriousness to the nature of what was going on and concern and fear that we would go into our playbook for setting up an international arrival screening program at our airports to look for cases.

We did not know fully what we were dealing with or the extent of exposure or contagion.

Without really understanding or knowing the threat, how do you protect against introduction and spread in the United States?

So in that setting, there were a lot of conversations about resurrecting 14th-century toolboxes.

Public health has been protecting us since medieval times, since the Black Death.

It was spread by fleas who carried Yersinia pestis, which causes the bubonic plague.

And when it reached Europe through trade and travel, largely carried by rats, but could also be on fabrics, wool, other items that were traded.

It caused terror, utter terror-- one in ten of a city is dying up to sort of 2/3 of the city.

It must have seemed like the end of the world.

That kind of destruction is hard to imagine.

In the late 1300s, in the Adriatic, in a town we now know as Dubrovnik, whose fortunes were built on trading with the East, they couldn't afford to lose the trade.

But you can't have 2/3 of your population dying.

What to do?

And so the city elders of Dubrovnik came up with a solution that they thought would let them have their cake and eat it too, basically, which was quarantine.

Make the ships stop at an island offshore and wait.

And if anyone did fall ill, well, that's great, don't let them in.

And if they didn't, well, great, it's safe.

Quarantine was a public health tool.

It was the city making visible its fight against this terrifying, invisible plague that no one really understood.

In Wuhan, China, the size of that quarantine was pretty unprecedented.

Obviously, it did escape.

Many people left the city before the quarantine could be enacted.

So it didn't ultimately have an impact on preventing the pandemic.

The first case of the coronavirus has been reported here in the U.S.

According to the CDC, the patient traveled in November to Wuhan, China.

He's currently quarantined at a hospital just north of Seattle.

911, what's the emergency?

I can't breathe.

You're having difficulty breathing?

Yeah, I've got my oxygen on, but it's not-- it's not doing too well.

She's feeling clammy and having chest pain, and she's getting shaky.

It feels like there's something on my chest.

My arms and my hands are really tingly and cold.

I cannot catch a breath.

I can't...

I can't catch my breath.

I understand.

Are you alone right now?

Yes.

Thank you all for being here.

I'm Dr. Anthony Chen.

I'm director of health at the Tacoma-Pierce County Health Department.

What I'd like to announce today is that we have our first COVID-19 case in Pierce County.

We might not have any magic bullets.

We might not have a vaccine yet.

But we do have a playbook.

It might be an old playbook that has gone back for centuries, but it is a playbook that we know works.

When there is no cure, when there is no vaccine, public health knows what to do.

Today, I've come to talk about our nation's efforts to address this vital issue... to the health and the safety of all Americans.

I'm here to discuss our strategy to prevent and protect the American people from a possible outbreak.

After SARS in 2003, the Bush administration was very much gearing up for this concept of the potential of a new pandemic of influenza akin to the veracity of the 1918 pandemic.

And there was, both at a global level and at a national level, a desire to have a really robust pandemic response plan.

The 1918 pandemic killed over 1/2 million Americans and more than 20 million people across the globe.

One-third of the U.S. population was infected.

And life expectancy in our country was reduced by 13 years.

We wanted to chart the epidemic curve of deaths over a six-month period during that 1918 wave in the fall, and then plot every day what every city did to mitigate that pandemic.

We wanted time on one axis, the death count on another, and along that continuum, what were the interventions.

First thing we noticed as we got the death curves together is that they looked fundamentally different.

There were huge spikes, like Philadelphia, and there were sort of rolling hills, like St. Louis.

When we looked at all the interventions, we could see that the shape of those curves were profoundly affected by the non-pharmaceutical interventions-- mask use, isolation, quarantine, business closures, school closures.

We wanted to reduce the area under the curve, which is the cumulative number of deaths.

And the delay was to buy time until we understood the virus better and until we could rapidly develop treatments and vaccines.

What we saw in 1918 was no one thing in the NBI arena of non-pharmaceutical interventions was sufficient to give you the kind of protection that was needed.

Multiple layers were beyond additive.

They were actually synergistic.

And that's essentially the Swiss cheese strategy.

No one slice alone is sufficient.

But as long as you had multiple slices of Swiss cheese and the holes weren't perfectly aligned, you create a redundancy of protection.

COVID has the ultimate invisibility cloak.

People won't even know they're infected.

They won't know when they became infected after exposure.

And the only way to really curtail person-to-person spread and get ahead of what exponential growth would look like is to have a contact quarantine program.

But I think the reality of implementing large-scale mass quarantine and isolation for a highly-contagious respiratory pathogen that had reproductive rates with exponential growth and the potential of asymptomatic transmission, in many ways, that completely blew away even the best-laid plans.

Tonight, elected officials taking unprecedented measures to keep people safe.

The nation's biggest states ordering all non-essential workers to stay at home.

Closing down bars and restaurants-- Social distancing-- That includes shutting down things nationwide if the numbers start accelerating.

We had our playbook.

But before the pandemic, we never had to implement it.

You know, it is quite unusual.

We are a little bit further apart than we normally are, and that is intentional.

I mean, things like social distancing and stuff, we were talking theoretically that, you know, yeah, that would be weird.

Kids would have to sit six feet apart.

We never did that before, but we had talked about it.

So I think we were ready.

But, are we ready for the full scope of it?

No.

The infrastructure has been just kind of hollowed out.

Everybody loves public health, but we don't seem to like to fund it.

Due to local budget restrictions, we were forced to close our clinic.

We don't have any communicable disease staff.

We have a problem in public health.

We only fund when there's an emergency.

The investigators at the FBI are very carefully exploring all the information they have about the anthrax attack on the country.

After an incident, whether it's the anthrax attacks in 2001, SARS in 2003, H1N1, Ebola, Zika on and on, there is a surge of interest, and sometimes funding in bolstering public health.

And then very quickly, that energy and investment fades.

This is part of the panic-neglect cycle, that in the middle of a crisis, attention and care and investment flood into addressing the problem.

And at some point, all of that starts fading.

We start shifting towards this kind of cultural amnesia.

And it returns us to the same state of unpreparedness.

That is not how we manage national security.

It's not how we manage the weather service.

The Hurricane Center does not shut down when there is not a hurricane.

I was in the government after the anthrax attacks and H1N1.

We had gone through planning for a pandemic flu.

But those government responses sat on a shelf.

They had not been funded to be maintained, enhanced, reimagined.

My hardest day, it was 2009, 2010.

And all of a sudden, we couldn't connect the dollars.

And we as a department had to make a very difficult decision to lay off 56 people.

During that economic recession, we lost tens of thousands of public health personnel across the country.

Tens of thousands.

And they're gone.

When you lose an epidemiologist or you lose a public health nurse, it's a specialized skill set.

Those people move on.

And so now with COVID, you've got to build public health systems in the middle of a crisis.

We're building a plane while we're flying it.

We've had this workforce that has been underfunded and understaffed for a long time.

And when we needed to actually pull that pandemic playbook out, we found that a lot of the players weren't there.

And those folks who were still there, those who were on the field, they threw everything they had at COVID.

We just didn't give them enough to throw.

The public health professionals in our communities are truly the first line of defense.

They are trying to prevent the community from ever needing to encounter.

Emergency departments, hospitals, those are the systems that are under strain right now and under stress right now.

Can I get an attending out to the front waiting room for a rapid triage?

Let's get a stretcher, restraints, meds.

Because of COVID, we found out just instantly how one entire city or state or wherever could be overwhelmed.

Gentleman who fell 50 feet off of a ladder.

About 60% of our work is focused on patients who are having direct impacts from COVID.

But 40% is for people who have a heart attack or get a bad infection, get sepsis, but who can't get access to the care that they need without somebody blocking in front of them.

America's health care system is fundamentally designed to meet the needs of diseases when they happen.

And yet if you peel back the layers, you realize, "Oh, my, "the public health infrastructure in our country "has really been one of the key reasons why America has been allowed to flourish," I think.

They are the ones who really are focused on preventing disease and mitigating disease before it gets to the point of needing to be in the hospital.

When I was in a hospital or a clinic as an ER doc, I was super-focused on the individual in front of me, my patient.

My patient's blood pressure, my patient's immunization status.

So many patients would come in multiple times.

And it was particularly around chronic health, diabetes, high blood pressure, salt-related for heart failure.

And they would come back and I would treat it.

And they would come back, I would treat, they'd come back, I'd treat, they'd come back.

I felt powerless as a physician to care for them because I didn't have time.

I had to go to the next patient.

In public health, the community is our patient.

The health and well-being, the safety and security of that overall patient, that's what we focus on.

I remember driving to work one day, it's your normal busy, crazy day, knowing that I was going to have to say something to people to explain that these highways would be empty just like we had seen, you know, around the world.

And what are the words you use?

You know, what are the things you're going to say?

There's no playbook for that.

You do feel 11.7 million people, and the feeling I had was how do I get every single one of them up on this life raft?

And nothing I would do orders-wise was going to do that.

What we really knew was it was behavior.

It was what we were all going to do collectively.

We were teaching Ohioans what to do.

We taught the metaphors, you know, the Swiss cheese analogy.

If we did nothing, again, I'll refer you to the UK study by Ferguson.

We would see that more scary, sharp, steep climb.

We have these things like social distancing and mask wearing and washing your hands, that when you layer them, what you got was almost near vaccine-like effect.

And people rallied.

And it was a beautiful thing to see.

I pledge allegiance to the flag of the United States of America, under God, indivisible-- I think it brings the neighborhood together.

It brings us together safely from a distance.

This is no small thing that we are doing together.

It is so incredibly hard to have shut down our lives the way we have.

I am absolutely certain... you will look back and know that you helped save each other.

There was probably a good six weeks of folks rowing together before things became overtly, overtly political.

We are special!

We are special!

We are special!

We are special!

It is getting increasingly hard to give you numbers that are accurate because it's pouring in so quickly.

We are looking at what the scientists know, what we're seeing happening in other countries, what the best data and studies are, and we're predicting.

One of the most common kinds of activities that we do in outbreak science is forecasting.

So we can actually look ahead and say, "What do we think will happen with this outbreak "in two weeks or three weeks?

"And what do we need to do now to be prepared for that eventuality?"

And that's important for decisionmakers.

It is important that we minimize our physical connectivity.

COVID has turned me into a data addict.

There's this sort of routine, which is that every afternoon, I get the number of infections in my state, the number of hospitalizations, the number of deaths in each individual county.

But we also look for national data to see if there's any breakthrough viruses appearing anywhere.

And it has guided our decision-making.

And I think it's one of the reasons we've been successful.

Tonight, I am extending our state's Stay Home, Stay Healthy initiative for an additional month.

When you make decisions on data and respond to the changes in data, that creates some frustration for citizens.

I'm defying the governor's order.

All business is essential to someone.

I don't think our governor thinks that.

From a public health or scientific perspective, the reasons that policies change or recommendations change, it's usually because we have new data coming in.

And we see that as science or progress.

The public does not see that as science or progress.

They see that as, "The public health entity doesn't know what they're doing."

Looking back on that period, I remember thinking that the entire population is getting a kind of a real-time, firsthand experience of watching the scientific method in practice.

How long can COVID-19 survive on a surface?

The CDC, NIH, UCLA, and Princeton released a study that said the virus can live for hours on copper and cardboard and up to two to three days on plastic and stainless steel.

One of the things you do learn if you spend some time around the scientific method is it's messy.

The CDC now says the coronavirus does not easily spread by touching surfaces.

Early statements were later brought out as evidence that the public health authorities, you know, had conflicting messages.

And it's like, well, they did have conflicting messages on some level because they were learning on the fly.

You are the 18th director of the Center for Disease Control and Prevention-- should people be afraid?

No.

Should you wear a mask if you're healthy?

No.

I did become frustrated with the fact that the White House was dictating not only what CDC would say, but what was on the CDC website.

We now know from recent studies that a significant portion of individuals with coronavirus lack symptoms.

In light of this new evidence, CDC recommends, and the task force recommends wearing cloth face coverings in public settings.

This is voluntary.

I don't think I'm going to be doing it.

You couldn't even end a press conference knowing what the truth was.

They were not protecting the population.

They were not helping public health.

They were giving public health a bad name.

You didn't know who to believe.

The whole idea of trying to improve on what you've learned in the past-- well, in the past, this always would have been approached with some sort of a national plan.

There was no national plan.

It was, OK, states, you're in this alone.

Compete with each other.

There were many messaging challenges throughout COVID.

A lack of consistency, a lack of clarity.

But what really hurt was that the president of the United States framed this whole response as lives versus livelihood.

And that ended it.

All of a sudden now, any public health intervention, masks or vaccination, it was about taking away your freedom.

One of the things that came up a lot in the early days of COVID-19 was the fear that medical professionals were sort of intervening in everyday life and trying to shape the things that we could or could not do.

You couldn't go shopping.

You had to go to grocery stores at certain times of day.

The government is making sure you were wearing a mask or making sure that you stayed at home.

People had a fear that these kinds of things were just a harbinger of something worse yet to come.

Essentially, every school district across the state is starting out this fall with distance learning.

But in Pierce County, it's not a choice.

It is the only county where local health officials are actually making an online start mandatory.

We were flabbergasted.

We did not think that the Tacoma-Pierce County Health Department had the right to do that.

They've acted on their frustration and filed a lawsuit against the Tacoma-Pierce County Health Department.

Here we had a health department come down and say, "No, we're going to make the decision for everyone."

And they cannot legally do that.

But Pierce's health department says Dr. Chen does have the authority to make that call, and did so using the state's guidance.

We've had to make all kinds of difficult decisions.

I've got a great crew of folks here.

And now, you know, people are tired.

And you can't just run on adrenaline anymore.

Pierce county's rates are up dramatically.

No one thing appears to be driving up the numbers.

We're just seeing more cases, any place that people are, where they're not wearing masks, maintaining physical distance.

You know, I worry about my mother.

She's been hospitalized three times this year already.

And my father's in his mid-90s, and a COVID-19 infection would kill them.

With this third surge, we must recommit to wear masks, limit travel and gatherings, and keep physically distanced so that we can make progress and keep what's important for us.

We've seen COVID fatigue.

I mean, even for me, it's like...

I connect with our county exec every day, give him the numbers.

It's like, "Oh, yeah, another 300 cases."

"Heck, back in June, we were 15, ten cases a day."

300 cases a day now, it's like, shrug our shoulders, right?

Even we are getting numb to it.

But we've got to keep the conversations going.

We need to find the right message.

But is the public willing to listen if they're confused about public health?

It's really hard to describe the public health system.

Who's in charge?

It's not the CDC, no matter how much people might want to think it.

They don't have authority to go into a state and tell that state what to do.

The CDC gathers data from all of the state health departments.

And they will bring that data together into reports.

They also turn that data into guidance.

But public health authority actually lies at the state level.

This is one that the founding fathers got wrong.

They put the control of the public health system with the states.

And that means we don't have one public health system, we have 50.

If you count localities, it's now in the thousands.

Some states have a secretary of health, and some states have very specific departments which interact with local health departments.

Each local health department has its own code.

Often, it's funded differently.

So you could say, "I would like to have a public health system."

Not every state has its own army or its own navy.

Could you imagine?

We would have already been taken over by a foreign nation if that was the case.

But when it comes to public health, everyone's doing it themselves.

One state is trying to hire contact tracers while another state is opening up bars and restaurants.

It's an orchestra with a lot of conductors and very few instruments.

This has been a tough week, and we are seeing a lot of deaths here in Ohio.

We also are seeing a lot of confusing messages out in the media.

And I want to say to you, Ohioans, stay strong, keep doing the right thing.

I don't know if you can hear through the television, but there are people protesting right now outside the statehouse.

And people are worried.

Open Ohio now!

USA!

USA!

I have people in my family who have businesses.

Like, people were facing tremendous hardships.

So there were people legitimately protesting and worried and concerned.

My first instinct always is to go talk to people.

But I couldn't go out of doors because they had guns.

This has been a very difficult time for people in the field of public health, who suddenly have been in the harsh glare of a spotlight that they did not ask for and that has been, unfortunately, skewed by the polarizing politics that we have in this country.

That speaks to the other question I asked last night.

I know it's like 1:30, 2:00 in the morning.

Sorry about that.

It was a little bit of insomnia going on.

Those politics will affect the response to the pandemic.

And we're already seeing, unfortunately, in some states that the lesson people are drawing from COVID-19 is we need to have a weaker public health system with fewer powers to protect people in the case of an emergency.

It's a huge mistake.

Ohioans did such an amazing job collectively of helping flatten the curve that we didn't see the worst of the impact that we might have seen on our hospitals.

Unfortunately, that also led to people saying that it's not true.

Eventually, the legislature was doing acts to impeach my ability to do work.

You almost had the feeling that there was an intentional attempt to discredit public health leaders.

This week, Dr. Acton told me that she feels it is time for her to step down as our director of health.

Her wise advice and counsel have truly been invaluable.

The hard part of my job is that when I knock it out of the park, you don't see what I've done.

I've prevented something.

You actually can't see what it is we prevented.

There's a real science to this.

We are actually professionals.

We train to know what to do when there are outbreaks, and we should listen to those people.

Today, I'm issuing an executive order, an executive order that outlines how we go about opening the Texas economy.

To guide this effort, I have formed a statewide strike force to open Texas.

You don't want a politician in your clinic telling you what to do with your health.

If you had cancer, you're not turning to a congressperson to figure out how to treat it.

That's a decision between you and your doctor.

But when it comes to public health, everyone seems to know how to do it.

And we debate it instead of following what the science tells us.

Now within the last hour, as you had mentioned, Texas Governor Greg Abbott announced the state will now pause its additional reopening phases after health officials in his state reported over 4,300 new hospitalizations of COVID patients yesterday, a record high for the 13th straight day.

We were in a political environment that, frankly, I think, cost lives.

Now, those decisions cannot be considered in just a four-year term.

It's the legacy of decades of underinvestment which led to where we are today as a nation.

And we should have done better.

But we didn't.

And that's something we're going to always have to live with.

It looks like now we definitely have an increasing trend in deaths.

In, you know, early September, we were kind of around five deaths being reported per day.

Now we're closer to probably having 12 deaths reported per day.

I'm basically working seven days.

Sunday evening, 8:00 p.m., and I'm working the phones.

The CEOs of the hospitals, the chief medical officers, the mayor.

Do you anticipate that our numbers could go right back up tomorrow?

We've caught up to the lag in results?

Yeah, so right now, it's not clear to me the numbers are actually down.

I'm helping them make decisions.

They're consulting with me.

And at the same time, I'm trying to do my regular job.

But my staff, they say to me, "You need to take some time off over the holidays," right?

I took ten days off.

I was in the car.

You know, my wife was driving towards Buckley and Enumclaw to go to a waterfall out there.

I was on my laptop trying to wrap up something that I needed to do.

And I saw the email pop up from one of our board members that said, "I just heard the council chair's "going to drop this bill, which, you know, dissolves the health department."

And this was time just so that they could vote on it in the last meeting of the year, which would be the last meeting that there would be a Republican majority.

Because the elections had shown that the council was going to flip.

And so come January, they would lose the majority.

Under the system of the county council, being the board, every citizen will have equal access.

It's much better for open government, which is something I have fostered over the last 30 years.

Science is subjugated to a political agenda in this nation.

And until we can separate those, then we're always going to have politicians who are going to run for re-election, prioritizing their winning over the lives of their constituents.

The Pierce County Council is set to address this at their next meeting on the 7th.

I did ask both council member Roach and Doctor Chen if they've had a chance to speak with each other since this news came out, to which both of them said no.

We believe in the strength and value of an independent health department.

I've been here over a decade.

I knew I could get fired any time.

But I didn't care.

I was trying to do what I thought was right in a public health way and took a harder line than some of my peers throughout the state.

It is just unfair to be doing something where my staff, who are working incredibly hard, are wondering are they going to have a job tomorrow because the county council is going to disband the health department.

We knew that people have thought about this.

It was a real surprise to us that people would want to bring it up in the middle of a pandemic.

I mean, it just boggled my mind.

I mean-- but that's politics, right?

Case counts show we are likely heading into the darkest hours of this pandemic.

But the Pierce County Council member behind the move apparently wants the county to have more say in how public health is handled, and want to make that change right now.

It means, in fact, we have a different governing body.

And I think that's a good thing.

There's not a single suggestion of how it would improve health outcomes for the people that live in Pierce County.

Right now is not the time to change.

We need to be focusing on saving lives.

Now is not the time!

Now is not the time!

Now is not the time!

Now is not the time!

At this time of the great unveiling of the weaknesses in our system, in this very moment when we see that things aren't working... is the exact moment we have a tremendous opportunity.

We could do so much better in this country.

If the county council passes the ordinance, the current health agency would be dissolved by the end of next year.

If one person dies because of this decision, you will have blood on your hands.

We now have seen real time what happens when you ignore public health.

A lot of people are going to die.

We currently do not have the ability to properly report COVID-19 data.

If you're missing data, then you miss whether or not there are pockets of illness that need special attention.

The most important point in public health history was 1854.

Something was killing people.

Cholera, it's horrifying.

It was the first time an actual intervention had been made based on data.

The promise of better information is what can unlock our health.

I just can't ever accept body bags for our people.