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The Big Picture: Being A County Health Officer in a Pandemic

Nilesh Kalyanaraman, MD and Neda Frayha, MD
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The covid pandemic has been challenging for all front-line clinicians. Can you imagine if you were in charge of the public health of an entire county? In this very special conversation, Neda sits down with Dr. Nilesh Kalyanaraman, Anne Arundel County Health Officer in Maryland, to learn about his public health goals and personal challenges in the pandemic, and what we can learn from them.

Pearls:

  • Dr. Kalyanaraman takes us through some of his lessons learned as a county health officer during the COVID pandemic that include managing competing priorities, communicating with the public and dealing with personal attacks.

  • Public health is a broad tool. The job of the clinician is to individualize it.

 

  • What is it like to be a county health officer?

    • Job is to monitor and address the health of the community: what is going on with communicable disease, environmental health, food safety, chronic disease

    • The entire county population is like your patient panel

  • When you knew COVID was coming, how did you prepare?

    • Relied heavily on emergency preparedness work

    • Twitter, Facebook, blogs, newspapers were important sources of information because of the speed of information flow and also places where information was disseminated

    • Established an incident command structure to focus communication and establish a group of people tasked with those responsibilities

    • Scaled up testing capacity, contact tracing, phone line support and communications team

  • How did you prioritize preparation?

    • Distinguishing the roles of the county and state health departments was important

    • The county focused on communications and contact tracing of county pockets where larger campaigns could not reach

    • Testing became the focus of the state health department and hospitals

  • What was a typical day at the beginning of the pandemic?

    • Start at 5am to start responding to 20-30 emails that came in the night before

    • Meetings start at 7am

      • Many meetings around coordination of the activity in the state

    • Triaging certain activities and groups (ie: nursing homes over sports)

    • Town halls (3-4 times per week)

    • Call it a day at 9pm

    • 7 days a week!

  • How did you balance reassurance with maintaining a high level of alertness?

    • Art of communication to convey risk/danger but give them tools to manage their risk

    • If you raise a particular risk you have to raise a countermeasure for it

  • How do you deal with the personal backlash?

    • Very difficult

    • Important to maintain a focus on the goal

    • Be vigilant about what you may be missing

    • Allow yourself to tune out of channels that aren’t productive for you while still maintaining an openness to feedback that may actually be helpful

  • Lessons learned that may be applicable to frontline clinicians?

    • Public health is a broad tool. The job of the clinician is to individualize it.

    • Keep your eye on advancing the health of everybody on your panel

    • Deepen your relationship with public health



References:

  1. Mello MM, Greene JA, Sharfstein JM. Attacks on Public Health Officials During COVID-19. JAMA. 2020;324(8):741–742. PMID: 32777019

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Hippo Primary Care Written Summary September 2021 751 KB - PDF

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