EYE OF THE STORM:
Arkoosh became face of public health guidance
NORRISTOWN >> As the new coronavirus was bearing down on Montgomery County last March, Dr. Valerie Arkoosh was thrust into the spotlight, becoming the face of the local public health response to the outbreak.
It was a challenge unlike any she had faced before in her medical career but one she took on with unflinching determination.
“It is an enormous responsibility and I continue to see it that way. It was particularly challenging, because I, like everyone else, did not know much about this virus,” Arkoosh, chair of the Montgomery County commissioners, said during a recent interview as the one-year anniversary of the virus’s appearance in the county approached.
“So, I felt it was part of my responsibility to read everything that I could to learn and understand all the new information that was coming out, practically on a daily basis at the beginning, and then try to convey that as accurately and simply as possible to members of the public who were just hungry for reliable, trustworthy information,” Arkoosh added.
A graduate of the University of Nebraska College of Medicine who also
holds a master’s degree in public health from the Johns Hopkins Bloomberg School of Public Health and an undergraduate degree in economics from Northwestern University, Arkoosh, 60, concedes the battle against COVID-19 has been the greatest challenge of her career.
“I’ve been through some big challenges in my professional career and none of them hold a candle to this,” said Arkoosh, who also briefly chaired the county Board of Health for eight months between 2012 and 2013 and served a brief stint as medical director for the health department.
Arkoosh, appointed a commissioner to fill a vacancy in 2015 and later elected and re-elected in 2019, also made an unsuccessful bid for Congress in 2013.
“I have used every skill that I have. I was an economics major as an undergrad, I have used those skills. I have used my skills as a physician, as a public health professional. I have used my skills in leadership … I’ve used what political skills I have. Every skill, it’s taken them all,” Arkoosh said about her preparation for the battle against the virus.
‘Hang in there’
What sustained her during this difficult year has been outreach from residents who offered support in emails, text messages and cards, total strangers expressing appreciation for the county workers tirelessly working to keep people safe and encouraging her to “hang in there.”
“Those are the quieter voices. There have been some loud voices over this past year and many of those loud voices have been very much in opposition to many of the policies and procedures that our Office of Public Health has put forth based on the best data, evidence and science we have,” Arkoosh said.
“But I have truly believed that those voices are shouting over a much bigger group of people who have just been doing their best to get through this, to be safe, to look out for their neighbors, to buy groceries for someone who can’t safely go to the grocery store, to help their parents. The extraordinary outpouring of volunteers and just true sense of community — that has been the thing that has sustained me and has been the most incredible thing I have seen, that people could come together in such supportive ways over such a long period of time,” she added.
“From the bottom of my heart,” Arkoosh thanked all those who reached out to a neighbor or someone they know who needed help.
“Those are the people who have kept me going and those are far and away the vast majority of people in our community. I am so grateful for them and so proud of this community for how it’s pulled together to get us through this,” Arkoosh said.
Virus gains attention: Preparedness
It was sometime in midto late-January 2020, after the virus was confirmed in the Chinese city of Wuhan, that it caught Arkoosh’s attention.
“I’d been reading about it over December and early January, but when Wuhan went into lockdown, I looked at that and I said to myself, ‘This must be way worse than they are letting on to the public,’ because a government doesn’t just do that. It was just so completely locked down and that is what made me really, really concerned because you just don’t see that, it’s unprecedented,” Arkoosh recalled.
About three or four weeks before the first cases surfaced in the Philadelphia suburbs, Arkoosh convened a meeting of all of departments in the county that would be involved in a virus response and reviewed emergency preparedness plans.
“We had that meeting and so it really got people focused and every department was doing planning. I also called the Montgomery County Intermediate Unit and asked if a couple of people from our health department could meet with all the superintendents because we just wanted to talk to them about this in case we started seeing cases. They all understood the potential gravity of the situation,” Arkoosh said.
Montgomery County becomes epicenter
On March 7, 2020, the county recorded its first two cases of the virus.
At the time, Arkoosh described it as “a rapidly evolving situation,” and within a week the number of those infected swelled to 20 and the county had the most presumptive positive cases of any county in the state, which recorded a total of 47 cases at the time, according to the Pennsylvania Department of Health.
“We were the biggest county to have the first cases. We also were really quite unlucky,” Arkoosh recalled.
Several county residents who attended a medical conference in Boston returned home with the virus and several local people who had gone on cruises on the Nile River were part of spreading events. Additionally, an Upper Merion cardiologist who had traveled out of the country was believed to have exposed multiple patients when he returned.
“There were people here, before anyone really understood this disease, who were going about their business due to no fault of their own, spreading this disease. So, we had this very rapid escalation of spread in our county and it was just frankly bad luck,” Arkoosh said.
Arkoosh and her fellow commissioners began holding daily news briefings to inform the public about virus cases and deaths.
“The situation was changing so rapidly that we felt it was necessary. We just wanted to make sure people understood how serious this was, make sure that they understood whatever we were able to convey to them at that point. People had so many questions. People were terrified,” Arkoosh said.
Transparency was important
“I think particularly in a situation that is uncharted territory, which this virus was, you have to be 100% clear with the public about what you know and what you don’t know and you had to be honest about both,” Arkoosh said.
County health officials didn’t publicly identify positive individuals by name or address but did make the public aware of the municipalities in which the individuals resided. Emergency medical responders also were made aware if they were responding to a residence where there was a positive individual so they could wear personal protective equipment.
“We just tried to do everything we could to keep the whole community safe,” Arkoosh said.
Within days, Gov. Tom Wolf ordered schools, community centers, childcare centers licensed by the state, gyms, entertainment venues and nonessential businesses in the county of
“It is an enormous responsibility and I continue to see it that way. It was particularly challenging, because I, like everyone else, did not know much about this virus.”
— Montgomery County Commissioner Dr. Valerie Arkoosh
more than 820,000 people to close for two weeks, through March 27. Then, court operations were reduced and efforts were made to reduce the inmate population at the county jail.
“Our schools closed very quickly and then a few days after that, businesses closed and we wanted to make sure that people would comply and understood why they were being asked to take these really extreme sacrifices,” Arkoosh explained.
On March 21, officials reported the first COVID-19 death in the county, a 72-year-old Abington man.
Early challenges and the evolving science
During the early days of the pandemic, health officials just didn’t know very much about the virus.
“So, those early days where the science was still uncertain and almost on a daily basis we were getting new information, and some of it contradictory to what we had been given the week before. That was really, really difficult,” Arkoosh explained.
For example, early on, the Centers for Disease Control and Prevention and the World Health Organization suggested face coverings were not necessary, that the virus was not primarily spread by respiratory droplets, and there was more concern about surface contacts.
“That didn’t make sense entirely with what we were seeing with our contact tracing. We had these social events where the only thing that made sense at that event, to get the amount of spread that we saw, was that there was some respiratory spread,” Arkoosh said, adding there was also conflicting information from experts regarding contagiousness of asymptomatic people.
“So we went through a period of about a month where it was just very difficult for us because we were seeing one thing but experts were saying something else and of course we were trying not to confuse the public and we were trying to be as clear as we could in our communications,” Arkoosh said.
A shift came in April when a state mask mandate took effect for customers at businesses.
“Then it was just another level of confusion. We had been telling people for weeks that they didn’t need to get masks, masks were scarce. I remember the day the mask mandate went into effect, we all looked at each other, none of us had masks. We didn’t even know how we were going to get masks,” Arkoosh recalled.
As cases surged, testing became the first challenge. On March 20, the county’s first testing site opened in Upper Dublin and a month later it moved to Whitpain. Eventually, six testing sites were up and running in Pottstown, Norristown, Lansdale, Willow Grove, Ardmore and Green Lane.
The county recorded its first peak of positive coronavirus cases during a spring surge in April and in June the first signs emerged to indicate the county was beginning to control the spread of the virus. However, positive cases of the virus began to rise again in October as weather turned colder and holiday gatherings increased and the seven-day average of positive cases hit its highest point on Dec. 7.
“On top of that, an overall arching theme is there never was a coordinated federal response to this virus. As a consequence, there were so many different messages coming at the public,” Arkoosh said.
“So, however you felt about this virus, if you wanted to wear a mask and stay home and be super cautious you could easily find somebody who was telling you that was exactly the right thing to do. And if you did not want to wear a mask and you wanted to go to parties with your friends and hang out in bars, you could find someone who would tell you that was exactly the right thing to do,” Arkoosh added.
During daily and later weekly news briefings, Arkoosh and health officials repeatedly urged residents to wear masks, to wash hands and to practice social distancing.
But coronavirus fatigue appeared to set in.
“It’s very frustrating, but I know from years of practicing medicine that this is human nature and when people don’t get consistent messages this is what happens. People find the messenger that they want to listen to. That was tough,” Arkoosh said.
“People have made enormous sacrifices over this year in their personal lives, in their professional lives, and they’re exhausted from it. And we needed a single, consistent factbased message from the public and they got that from Montgomery County but there were plenty of other voices that were saying different things,” Arkoosh continued. “It was frustrating but it was also heartbreaking because the cost in human lives is huge and I believe did not have to be so high.”
Schools presented the most difficult situation.
“I think it’s been with schools that the data has been the hardest to interpret and in some ways has been conflicting over time. I’m a parent. I have twins who graduated from
“I’m a physician and my whole life has been spent trying to help people heal and it just kills me that we have so many people who really do need to be vaccinated and we are nowhere close to having enough vaccine for them.”
— Dr. Valerie Arkoosh
high school last year in the spring, so they didn’t have a prom or a graduation. I’ve been living this with a lot of parents,” said Arkoosh, adding schools had some of the most formidable tasks of all during the pandemic with decisions about virtual or hybrid learning models.
Controversy and protests
In November, the fivemember county Board of Health voted unanimously for a two-week pause, from Nov. 23 to Dec. 6, on in-person instruction and extracurricular activities at all public and private schools to help thwart the spread of COVID-19 around the Thanksgiving holiday.
Concerned about large, family holiday gatherings, health officials said the implementation of virtual schools during the period of peak contagion was essential to ensure the protection of children, teachers, school staff, as well as those in the general community.
The decision to go allvirtual for two weeks also came on the advice of the Children’s Hospital of Philadelphia Policy Lab.
Arkoosh supported the health board’s decision, prompting disgruntled parents to take their complaints directly to her front door where protests were held outside her Springfield Township home on multiple days over the course of several weeks.
“Of course you feel it. You’d have to be inhuman not to feel it,” Arkoosh reacted to the personal attacks.
“I think what’s hardest for me, is that in some of these situations, not all of them, but in some of them, I was accused of making political decisions. And never in this pandemic have I made a decision based on politics … that’s just not how I operate,” Arkoosh added.
“That was hard for me because I could refute it but they would never believe me. That’s how it feels. It makes me feel that no matter what I said or did they would never believe that I was trying to make these decisions as best as I can with the knowledge that I have,” Arkoosh continued. “Every decision has been based on the data as I have it, the data as we know it on that particular day or week.”
Arkoosh is empathetic to the parents’ concerns.
“I completely understood how much and why they wanted their children to be back in school in person. I understood why they were so upset,” Arkoosh said. “But there was no easy answer for them and it is a combination of being about the children but also about all the adults who have to be in the building in order for the school door to open, the teachers, the custodians, and the school bus drivers.”
Several outbreaks and deaths were reported among school bus drivers during the pandemic.
“It’s been a very, very complicated situation and a lot of frustration on all sides. Not only are students bearing costs from this but so are parents, and particularly moms. So many women have left the workforce. The data is skewed heavily toward working women who have had to step out of the workforce because their children are not in school,” Arkoosh said.
“The toll is impacting the entire family, the children with their learning, as well as parents and their ability to go to work and provide for their families. It has been the most difficult situation of this entire pandemic, from my perspective,” Arkoosh said.
Forming new collaborations
Throughout the pandemic, there have been some more promising developments, most notably the many collaborations that formed between health officials and various institutions, collaborations that weren’t always front and center in the past.
“There will be some really lasting and wonderful things that come out of this. One is with the (public) schools. I meet with the schools still once or twice a week and I feel wonderful relationships have come from that,” said Arkoosh, referring to meetings with 21 school superintendents, adding she has also met with administrators at in
dependent schools. “So, all of those relationships have been built.”
Weekly meetings with administrators of the county’s nine hospitals and collaborations with faith leaders were also important to health officials.
“The faith community calls have been really important. In the early months we had a faith community call every week for a while and that was critical because they were struggling as to whether or not to have in-person services and they’re also extremely trusted messengers to their congregations,” Arkoosh said. “Making sure they had the most up-to-date accurate information that they could share with their congregations was extremely important in getting our community engaged in this response.”
Collaborations were strengthened even among the county’s government agencies.
“We have departments working closely together now that had maybe spent a couple of hours together during a drill but never really had to work in a kind of integrated fashion that we are now. So, there will absolutely be some very positive things that come out of this,” Arkoosh added.
Message of hope
The current challenge is getting vaccines in arms of residents at a time when the supply of vaccine is limited.
“People send me heartbreaking stories every day about themselves, about their parents and there’s nothing I can do. It’s really tough. It makes me die inside a little bit every single day,” Arkoosh said.
“I’m a physician and my whole life has been spent trying to help people heal and it just kills me that we have so many people who really do need to be vaccinated and we are nowhere close to having enough vaccine for them,” Arkoosh added.
Health officials are hopeful that in another six to eight weeks there will be enough vaccine to make it easier for people to be vaccinated.
“I know it’s coming and I try to help people remain hopeful. But it’s tough,” Arkoosh admits.
As vaccine production ramps up and more vaccine is administered, as positivity rates continue the current downward trend and the nation gets closer to reaching herd immunity, Arkoosh remains optimistic for a return to “something that feels much more normal.”
“My message is, the end is in sight but we’re not quite there yet,” Arkoosh said.
“Until we get enough people vaccinated, we do have to continue to make these sacrifices like wearing a mask and watching our distance and avoiding social gatherings in private homes and things like that. We have to continue to do that until we have enough vaccine to get a very substantial percentage of our population, 75% or so, vaccinated,” Arkoosh explained.
Diseases liked COVID-19 with a high reproduction rate need a large percentage of the population to be vaccinated against the virus to reach herd immunity. Once a large percentage of society is protected, the virus has fewer people to infect and is circulating less in the community.
“And then at that point, I think we’ll be able to go back to something that feels much more normal,” Arkoosh said. “I can see it in the distance but we still have a little way to go and we can’t forget that there’s still plenty of virus out there and I just don’t want anybody else to die. We have had too many people die and people still need to be careful or we are going to continue to have people die. We’ve had enough of that.”
The virus, Arkoosh said, “will likely be with us in some way, probably something that looks more like the flu, but hopefully, if enough people get vaccinated it will be relatively minor.”
“I am hopeful. I believe we are going to get through this,” Arkoosh said.