New study shows threats were more personal in nature and calls for more support for workers
While doctors and nurses were hailed as the frontline heroes of the COVID-19 pandemic, their public health counterparts were facing threats. During the pandemic, threats against public health workers reached an all-time high. After the vaccine rollout, those threats increased and changed in nature, according to a longitudinal study conducted during the first year of the pandemic by Jennifer Horney, founder of the Epidemiology Program at the University of Delaware School of Health Sciences.
The results, recently published in an open-access commentary in Public Health in Practice , show a strong need to expand legal protections for all frontline workers, but also illustrate the need for a more resilient public health workforce.
While public health workers have always faced threats, including during the SARS and Zika outbreaks, the threats of the COVID-19 pandemic were different. "These threats were more personal in nature," Horney said. “Due to the proliferation of social media and the politicization of the pandemic, for the first time, public health leaders found protesters at their doors.”
Horney and his team surveyed staff at state and local health departments in 23 states, most of them epidemiology or communicable disease staff.
The initial online survey found that 25% of respondents said someone at their public health agency had received personal threats. That percentage nearly doubled to 41% in a follow-up survey. Of those, respondents said almost all personal threats were made by members of the public. Nearly 40% reported receiving political threats.
Threats reported by public health workers who responded to the survey ranged from death threats to blaming COVID-19 deaths due to incompetence. One respondent reported that a member of the public slapped her hand while she administered a vaccine, while another said that an unmasked person coughed on her before swearing at her.
"The threats were much more intense across the board," Horney said. "But personal attacks of this nature were something we hadn’t seen before."
The study found that public health leaders were particularly affected. During the pandemic they felt internal and external pressure to alter data and support easing COVID-19 restrictions. More than half of local health directors reported harassment of themselves or their staff between March 2020 and January 2021. As a result, more than one in three public health leaders retired, resigned, or were fired .
“Nearly every state lost a public health leader during COVID-19, and half of those losses were related to some type of threat,” Horney said. "Leadership turnover during a response to a public health emergency can have significant negative impacts on effectiveness."
During the COVID-19 pandemic, public trust in the Centers for Disease Control (CDC) plummeted. State legislatures also introduced 1,531 bills during the pandemic that sought to alter public health emergency authorities. Of them, 191 were enacted in 43 states. Only 17 laws expanded public health authorities, while 65 laws contracted emergency authorities.
“The COVID-19 pandemic also marked the first time that dozens of state lawmakers introduced new laws to take away public health powers,” Horney said. “It was very short-sighted because vaccination powers are critical to preventing outbreaks of deadly diseases.”
The severity of the threats and their impact on the workforce is concerning, Horney said.
“These threats led to mental and emotional health issues that impacted this incredibly dedicated and already understaffed workforce,” Horney said. "Workforce recovery could take years." The study illustrates the need for stronger support for public health workers, including training, coping, protective services and media management.
“Public health has become more politicized with vaccine and COVID hesitancy, so leaders need more education and training to be more politically astute,” Horney said. "Public health workers who are governed by political factors must understand how the power structures operate in their state and their ability to operate within those structures."
In response to this study and others showing the toll of the pandemic on the public health workforce, in October the CDC released new burnout prevention training . The free online training aims to help managers and supervisors prevent burnout in their employees and themselves.
Even as public health workers have become more visible during the pandemic, that visibility has come at a cost. Horney said public health must find a better way to tell its success stories.
“The big argument has always been that when public health works well, it is invisible . We don’t count how often you ate at a restaurant and didn’t get sick,” Horney said.“Public health must be more proactive and take more credit for successes. If what you do is invisible unless there is a major emergency, it will be difficult for the public to understand.”
