101: Recalling COVID-19's First Case Part 1

Dr. John Wiesman, the former Secretary of Health in Washington state, reflects on the moment the first case of COVID-19 was confirmed in his state and thus the U.S.; Dr. Alexis Travis, Michigan’s State Health Officer, says it’s never too late to...

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Dr. John Wiesman, the former Secretary of Health in Washington state, reflects on the moment the first case of COVID-19 was confirmed in his state and thus the U.S.; Dr. Alexis Travis, Michigan’s State Health Officer, says it’s never too late to review and revise crisis standards of care to reflect input from vulnerable groups, including people living with disabilities; and ASTHO and NACCHO team up to report on state and local health departments who’ve implemented a “health in all policies” approach to their COVID-19 response.

CDC Webpage: CDC Museum COVID-19 Timeline

ASTHO Webpage: Public Health Review Podcast

ASTHO Blog Article: HiAP Strategy Works in States, Locally to Meet Equity Challenges in COVID-19 Response

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This is Public Health Review Morning Edition for Thursday, January 20th, 2022. I'm Robert Johnson. 
Now, today's news from the Association of State and Territorial Health Officials. 

Two years ago today, the CDC announced the first laboratory-confirmed case of COVID-19. It was recorded in Washington state; Dr. John Wiesman was secretary of health when the virus arrived on U.S. soil. From his office at the University of North Carolina at Chapel Hill, we talk with him about the early days of the pandemic in the first of a two-part morning conversation. 
It's the second anniversary of the arrival of the COVID-19 virus in the U.S., particularly—or, more specifically—in Washington state. You were the state health official at the time. What are you thinking right now about that moment and what it became two years later? 
So at that moment—and I'm thinking right now just how proud I am and was back then, still am today, of our initial response. People came together—the federal government, Centers for Disease Control and Prevention, state, government, local, our healthcare providers—they just all came together to really address the immediate issue. And incredibly proud with how quickly people responded and how everybody came together sort of in a single message and unified, and the teamwork that that took, right? I'm really proud of that. 
I will say, you know, it's hard to imagine that this would have happened—that two years into this, we would have over 800,000 deaths and the impact on the economy that we did. So just hard to imagine, I think from a public health perspective, just how much impact we have on the behavioral health of people, the economic health of our folks, obviously the physical health, and how big this became—so, just the enormity of it all. 
There was a report on NPR on January 22nd, 2020, quoting the governor, Jay Inslee, saying there was no indication that the public was at risk at that point. In fact, really none of us believed this was going to be a problem—did we? 
I would say that I'd frame that a bit differently, I think. 
I think at the beginning we felt like at the very moment there wasn't this immediate threat to the general public, Yes. If you had been traveling internationally—especially in China—that was the immediate risk; and that we were certainly concerned about that group of individuals. 
But at the time of the first cases, we were basically saying, look, you know, we would still be fine going out to grocery stores and carrying on with our normal everyday life.
Now that said, we were very worried that this could grow. I mean, we were, for a couple of weeks, working with hospitals and medical societies and others to say, "You need to get your contingency plans in place. You need to refresh your pandemic flu plans." We were briefing the governor around pandemic flu plans, having watched the numbers, you know, grow in China and just sort of thinking, "You know, this could become big."
Now, would have I imagine it was quite this big? No. But we were putting in motion those sort of pre-planning to try and respond if this got large. 
Fast forward—now, here we are in 2022, and you're teaching health policy at the University of North Carolina. The pandemic must be part of every class. 
So, it is in a number of ways.
I think, one, just the impact it's having on people's everyday life. And behavioral health: for example, how challenged people are feeling in their everyday lives to manage; in this case, students manage their coursework, manage the sort of social interactions that they're having, and just how managing the sort of length of this in terms of just the mini-milestones they've missed along the way—whether it was a graduation, whether it was some important event in their lives—and how they're processing that is a big focus right now. 
And yes, you know, in those classes, you can talk about leadership, and you can talk about disease control, and sort of what has gone well in this response, what has gone not well, and take it from that academic point of view. So, it's both the academic piece, I think, as well as the human piece that we're talking about. 
From a policy perspective, there must be a great deal of interest among the students given the fact that you were essentially at ground zero for this whole thing.
There is. And you know, this real honest sense of how proud we are to work in this profession. 
You know, I was really pleased that I wasn't a brand new health official when this happened, that I had had six years under my belt of experience to be able to draw upon was really helpful. So yeah, those conversations about the difficult decisions: how do you decide what you're going to close down, not close down; how do you engage with communities that have been disproportionately affected by this and recognizing that there is so much injustice you wanted to cure but, like, you can't in one day undo the injustices of, you know, decades of time; and how as an individual, that was a real struggle for me to know what is the right thing to do and want to make it happen, but not necessarily have the resources or the place to be able to make that happen. 
We'll have part two of our conversation with Dr. John Wiesman tomorrow.
Also, if you're curious about the two-year history of the pandemic, you can find a COVID-19 timeline curated by the CDC Museum in Atlanta using the link in today's show notes.

The announcement that a state will allow its hospitals to invoke crisis standards of care can be upsetting to everyone impacted by the news, but that concern is nothing compared to the anxiety felt by people living with disabilities. 
Dr. Alexis Travis has worked hard as Michigan state health officer to support a committee that keeps the guidelines up to date and key communities informed. 
Even if your existing crisis standards of care guidelines have not previously received info from members of the disability community—or, indeed, other diverse members of the community—it's never too late to seek input, advice, and feedback. 
Dr. Travis discusses the impact of crisis standards of care on disability communities during a new episode of the Public Health Review Podcast, now available everywhere you stream audio. 

Finally this morning, ASTHO has a new blog article that examines the way state and local health departments have implemented a health-in-all-policies approach to their COVID 19 response. It reviews the experiences of Maryland and Virginia, as well as Allegheny County, Pennsylvania, and the city of Santa Cruz, California. 
ASTHO teamed with the National Association of County and City Health Officials to write the article. Read it using the link in the show notes. 

That'll do it for today's report. 

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Be sure to join us again tomorrow morning for more ASTHO news and information. 
I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day. 

John Wiesman DrPH MPH

Professor of the Practice & Director, Executive Doctoral Program in Health Leadership, University of North Carolina

Alexis Travis PhD

Senior Deputy Director at the Michigan Department of Health and Human Services