The Battle in Our Backyard: Our Local Health Department Works to Defeat COVID-19

Bauman: There's so many different challenges in this pandemic. It's really a situation where we all have to work together. I've been co-chair for running outbreaks in Washtenaw County for over 20 years now, and we've had big outbreaks before and I've worked with teams of people, but this is by far the biggest response we've ever had. We have so many different people working on different aspects of it because so many different parts are so important: isolation and quarantine housing for people who can’t be housed, we’ve had lots of challenges with testing and labs, we've got a whole case investigation team, and a whole contact racing team. We've got just so many different people working on this, and it's just so important that we're all working together and coordinating what we're doing, not only internally at the health department, but with so many of our community partners.

Speaker 1: There's no shortage of statistics these days when it comes to the novel coronavirus pandemic. Real-time updated websites show numbers of cases of COVID-19 in states and countries around the world. We can see these stagger numbers, but what we may miss is the immense amount of work happening on the ground as local health departments take on this international challenge. In this episode, we’re exploring the work happening in our own communities to find out more about what local public health professionals have been doing to fight this fight on our behalf.

Hello and welcome to Population Healthy, a podcast from the University of Michigan School of Public Health. This episode is part of a series of special editions of our podcast focusing on the ongoing coronavirus pandemic. Laura Bauman is the Epidemiology Program Manager at the Washtenaw County Health Department. Ann Arbor and the University of Michigan are in Washtenaw County. She is also a graduate of the University of Michigan School of Public Health. She worked as a public health nurse for six years before joining the County Health Department. She's been there now for over 20 years. We asked her first to give us an idea of the health departments work during normal times when there isn't a pandemic.

Bauman: Really, the core of what we do is prevention and trying to support optimal health for the whole community. So that's everything from trying to make sure food and water is safe, to investigating 80 different communicable diseases to try to prevent those diseases from spreading in the community, to screening kids for hearing and vision to...I mean, we do so many things that the health department.

I spend much of my time in the communicable disease or infectious disease realm, but I also work with a team of two other epidemiologist and they also, in addition to communicable disease, our Epidemiology team is working on maternal child epidemiology, looking at the difference in birth outcomes across our community, looking at the opioid epidemic, suicide, depression. So we look at a number of different health outcomes always with an equity lens and looking at who in our community is doing better and who isn’t, who's having more challenges, and what can we do to try to make a difference.

Speaker 1: Bauman is uniquely situated to give us a front line view of what she and her health department colleagues have been going through during the pandemic.

Bauman: We started watching the situation closely in January only because that was when we had a number of University students returning from China and from Chinese New Year Celebrations to our community. And so we actually were already starting to test for COVID back in January and early February and putting individuals into isolation and quarantine at that point. And what was interesting at that time and challenging as well, is that the only place that you could get a COVID test back at that time was in Atlanta, Georgia, down at the CDC. And so we had to coordinate getting samples from individuals here in Washtenaw County, and typically they would go from the clinician office here, we'd send them up to the state health department, and then the state health department would send them down to the CDC. That whole process takes a while to get the sample along and then to get the results back. So typically, we weren't getting a result back for a week or so as we were waiting to see what was going on.

Those early cases, we did not have any positive results, but we continued to work very closely with our state and federal public health partners. In February, if you'll remember, boarders started closing and we started having to track all the international travelers, particularly from China, South Korea, Japan and then Europe. So that was where a lot of the health department activity happened in February as we were tracking all these international travelers because that certainly is where we think that COVID entered the US and also to Washtenaw County.

Our introduction of COVID into the county, probably in early March, happened from individuals returning mostly from Europe. And so again, we were working closely with the state health department, with our local universities, with international travelers as everybody was returning back and coming into quarantine, but then it was in early March that we detected our first cases here in Washtenaw County. 

It's been a really intense situation. I sit on the core team responding to COVID-19 and especially in March, as we were trying to get a handle on this, we were working seven days a week. Our job at the health department, we're not providing care for the individuals with COVID, but we are coordinating all of the kind of response out in the community. Plus early on, again in March, state health department got testing for COVID, but the local health departments, we were the gatekeepers of the testing, so every doctor in Washtenaw County had to call us to get permission to test their patient. We had a whole system as all of that testing pass through us. You had to be very sick. You had to meet very strict criteria to get access to a test because we didn't have that many tests available in the whole state of Michigan, and again, the only place to get a test was the state health department. The County, our job was keeping track of every single case, keeping track of who they were in contact with, making sure their contacts were quarantined, answering lots of questions. People were really scared early on, and not that they're not scared now, but it was so new to everyone. Our cases, our folks with COVID, we call them every few days to check in on them and make sure they're doing okay, and sometimes our nurses had to call 911 because they were talking to the individual and they could tell the person was not able to breathe very well, and so they just said, look, it's time for you to go to the hospital.

We have a whole team that's available to bring food to people if they can't get food while they're in quarantine. We've had to put some people in housing when they couldn't isolate safely in the housing that they have. It's been a whole process to really support folks who are having to deal with this disease.

Our first peak was in early April, and at that point we were running at 30 to 40 cases per day. In early April, we had multiple hospitalizations. At that point, folks were a lot sicker because the folks who were getting tested were a lot sicker. We're worried that we're headed again there now, because our hospitalizations have started picking up again in the past couple of weeks, but at the height, kind of in early April, we had over 80 hospitalizations in one week from COVID, which is just an extraordinary number.

We were lucky though, here in Washtenaw County that our hospital beds never filled up. We were able to actually provide some extra capacity for some of our surrounding communities like Wayne County and Detroit that needed more hospital beds. And so we had some of the folks from there coming over to get care in our hospitals.

We are now seeing again, 20 to 25 new cases per day here in Washtenaw County. The difference between now and April is that because we do have a lot more testing available, people who are more mildly symptomatic are able to get tests, which is great, and that we can more quickly get people isolated and their contacts quarantined, so that's good. The goal is to try to keep this virus away from the most vulnerable folks who then do require hospitalization. So keeping it away from older people, individuals with underlying health conditions, trying to keep the virus from running rampage across the community again.

We reached out to the School of Public Health to see if they could provide some support to both our case investigation and contact tracing teams this summer, just because it's been a challenge with fluctuating case numbers and we knew once things opened back up, when everybody wasn't staying at home, the contacts would increase. And that has definitely been true. It was much easier to do case investigation when everybody was at home because usually they had their household contacts, maybe they were someone who was an essential worker and went out to work, but now people are everywhere. And so as we try to figure out and do contact tracing, we just need a lot more folks really helping out with that, and we knew that it'd be great to have some graduate students helping back us up this summer as we kinda figure out a longer term solution, because we know we're gonna be doing this for probably another year or so, and they've really been doing a great job.

Speaker 1: Nicholas Dolnicek is a masters student at Michigan Public Health studying Epidemiology. This summer, he's worked alongside public health students and public health professionals at the Washtenaw County Health Department taking on important roles in the ongoing fight against the spread of COVID. We asked him what it's been like working as an epidemiology case investigator.

Dolnicek: So anyone that goes ahead and gets a COVID test, the positive test results, those will come into the case investigators, and what we do is we go ahead and we call them. I talk to the people with the case and I keep in communication with the whole household. We’re the ones that typically ask them to isolate themselves, stay away from other people until we feel like the person is not contagious anymore and safe enough to leave the isolation. We also collect the contact information so that we can send that to the contact tracing team to make sure that no one else is either infected or goes out while they could have COVID.

We do also provide isolation resources. We do have a hotel that is set up for people who don't think they can isolate safely. That's where people can typically go. Sometimes it is hard to get in contact with homeless people or other people that might not have a phone number, but we try to do the best we can whether it be contacting other family members or having somebody else contact them. We do what we can and it’s been working out pretty well.

For the most part, almost everybody I’ve spoken to in the last month and a half here has been really helpful. I feel like most people are pretty willing to talk. I think there's some hesitancy at first because there was an unknown number and you have somebody asking them health questions, you don't know what it is, but especially if you've gotten tested recently, make sure you have your phone, just kinda be ready to answer questions about what you've been. That really helps us get a gauge of this whole COVID situation and stop the spread.

Another thing that I think people don't do enough when they do get tested, especially people that might have been feeling sick or having a few symptoms, people do sometimes go back to work even though they're waiting for test results. And unfortunately, with the state of testing right now, it does take a little bit of time for some people’s test to come back and if people’s tests come back positive a week later but they've been going on public, well, then we have to contact trace and entire list of people that you would have been in contact with versus just saying at home while you’re waiting for the test results. As painful as it is sometimes we ask that people do wait at home to wait for their test results, even if it does take a little bit of time.

When this whole COVID pandemic happened, I was really interested in trying to help and get involved in any way I could. A lot of counties right now don't have enough case investigators and contact racers. So I thought, yeah, what could I do? And that's kind of how we got here.

Bauman: I think the biggest thing is that we are all in this together. We're all so tired of this virus and the pandemic, but we're gonna get through it. And we're gonna get through it together, and we just have to keep working on it.

Speaker 1: This has been a special edition of Population Healthy, a podcast from the University of Michigan School of Public Health. During the ongoing coronavirus pandemic, we’ll work to bring you analysis from our community of experts to help you understand what this public health crisis means for you. To stay up-to-date in between special edition episodes, be sure to check out our website publichealth.umich.edu, subscribe to our Population Healthy newsletter at publichealth.umich.edu/news/newsletter and follow us on Twitter, Instagram, and Facebook @umichsph.