Health officers reflect on their role
Bay Area contingent ‘had to make decisions that affected millions’
California’s reopening today bookends the remarkable emergence of what was, until the coronavirus pandemic, a relatively obscure profession: the public health officer.
While Dr. Anthony Fauci has become a household name, local public health officials in Northern California — particularly the group of 13 county and city appointees known as the Association of Bay Area Health Officials — exert even more influence over local residents’ day-to-day lives. With statutory authority to take whatever
“measures as may be necessary to prevent the spread of” communicable diseases, the Bay Area’s unelected local health officers have wielded extraordinary power since the onset of
COVID-19, issuing the nation’s first stay-in-place orders, shutting down whole economies, ordering residents to wear masks, and recommending nearly uni
versal vaccination for adults.
Earlier this month, the Bay Area health officers again displayed their influence over public life as they gathered together unmasked for the first time in more than a year to recommend that the region’s schools should reopen this fall.
In a series of interviews with the Bay Area News Group, members of the group, known colloquially as ABAHO, reflected on their historic role in managing pandemic responses.
“We had to make decisions that affected millions, and the choices that we had before us were between a bad decision, a worse decision and a farworse decision,” San Mateo County Health Officer Dr. Scott Morrow said. “But we tried to use, to the best of our ability, cost-benefit analysis to make these decisions, and sometimes it was not terribly clear — the costs and the benefits.”
Those costs and benefits weighed by the health officers association continue to emerge: More than 63,000 statewide deaths have been attributed to COVID-19 and 15 months of shuttered businesses, schools and other public spaces have taken a steep toll on Californians’ physical, mental and economic health. California, however, is also recovering far faster than many states, posting employment gains; a historic budget surplus due, in part, to its booming technology sector; and a vaccination rate surpassing 63% statewide and 76% across the Bay Area.
Even as some state legislators pressure the governor to end his COVID-19 emergency order, public health officers retain extraordinary statutory powers to reimpose shutdown orders if they deem it necessary.
“The law gives public health officers incredibly broad authority regarding communicable disease,” said Santa Clara County Health Officer Dr. Sara Cody, who played a leading role as the Bay Area issued the nation’s first shelter-inplace order in March 2020. “I never, ever, ever, ever in a million years imagined that I would have to exercise that authority and that I would continue to exercise it for over a year.”
In the face of sparse or contradictory guidance from the federal government and state, San Benito County Health Officer Dr. David Ghilarducci said the Bay Area network members relied on each other’s expertise as they forged into unprecedented policy terrain. “We health officers were taking on a lot of risk, so it was really important to have this collective organization, personally and professionally, to bounce the science off of each other and make sure that things we did made sense,” Ghilarducci
said.
California has a total of 61 health officers, many of whom are included in often overlapping regional organizations, including the Rural Association of Northern California, the San Joaquin Valley Public Health Consortium and the statewide Health Officers Association of California.
Of these, the Bay Area network — representing the cities of San Francisco and Berkeley and the counties of Santa Clara, San Mateo, Alameda, Contra Costa, Marin, Napa, San Benito, Santa Cruz, Sonoma, Monterey and Solano — is among the oldest, having formed in the 1980s to coordinate responses to the HIV epidemic. In the middle of the pandemic, Gov. Gavin Newsom tapped two of its members for statewide posts — former San Francisco Public Health Officer Dr. Tomás Aragón was appointed in December to lead the state Department of Public Health, and former Alameda County
Health Officer Dr. Erica Pan was sworn in as the state epidemiologist in July 2020.
“I think we influenced a lot of the state’s decisions,” said Santa Cruz County Health Officer Dr. Gail Newel. “Our early shelterin-place orders definitely pushed the governor to move forward on the statewide shelter-in-place order, and that was our intention.”
During weekly planning calls the Bay Area group often found itself in uncharted terrain, said Newel, who acknowledged struggling to balance constituents’ health risks with economic hardships imposed by her emergency orders. Along with the intense pressure, she and other Bay Area health officers endured personal threats trying to intimidate them into ending shutdown orders.
“I had these voices saying: ‘Open the boardwalk! Open our businesses! Open our restaurants! We’re dying out here! You’re costing our lives, our businesses.’ And that’s really hard to completely dismiss because that’s putting food in their families’ mouths,” said Newel. “It’s certainly given me a better understanding of the impact of poverty and all the social determinants of health on people’s health outcomes in a way that’s really become real to me, not just theoretical.”
Pan, the former Alameda County health officer who is now charged with marshalling health data to prevent communicable disease outbreaks across the state, said her relationships with Bay Area health officers continue to inform her work and has helped California play a significant role nationally as well.
“Certainly, the Bay Area counties have a lot of things in common, but there are also a lot of different aspects for San Francisco versus Sonoma County,” she said. “Being able to share our best thinking and our best practices has really been valuable.”