It’s been a difficult two years and counting for local public health officers tasked to enforce sometimes unpopular policies across Maryland communities during the coronavirus pandemic. And the struggle isn’t over yet, health officers and advocates say.

Local health officers were shocked about the level of vitriol from residents, said Ruth Maiorana, executive director of the Maryland Association of County Health Officers, otherwise known as MACHO.

“Before, we were basically invisible in our communities,” Maiorana said. “As long as something wasn't happening, nobody was paying attention to what a local health department did.”

Maiorana oversees the nonprofit association which represents 24 local health officers across the state.

Those officers have been thrust into the spotlight since the pandemic began. And while there has been a lot of progress in mitigating the severity of COVID-19, the challenges they faced still loom large.

That includes intense harassment by the public.

Anne Arundel County Health Officer Dr. Nilesh Kalyanaraman noticed that the harassment stems from a vocal minority of residents.

But he said that harassment is “more than anybody should ever be asked to bear.”

“It does take its toll,” said Kalyanaraman, who also serves as president of MACHO.

While on the job, he said health officers experienced “threats of violence, threatening language, racist language, homophobic language, threats against family.”

Over the course of the pandemic, eight local health officers statewide left their jobs.

Maiorana said two of those officers were already planning on retiring. But she wonders if the pandemic accelerated their departure.

“I think the stress of the job certainly did not help some of the others,” she said.

Such as former health officer Dr. Travis Gayles, who worked for Montgomery County until he resigned in September 2021. As of Monday, Gayles’ position remains vacant.

Gayles faced backlash for COVID safety measures. It included a challenge in federal court brought by a group of private school parents who were against postponing in-person classes in 2020.

“It also set off a torrent of personal threats to me, my family and my staff,” Gayles said during a joint senate and house committee hearing in March.

Gayles said he sought guidance from the Maryland Department of Health on implementing guidelines on reopening schools to no avail.

“We received none,” he said.

Likewise, he felt unsupported by the state health officials to help enforce the state’s pandemic guidelines, something he did not expect.

Maiorana said it became “very clear” in the last legislative session that some members of the public, including elected officials, think local health officers make policy decisions related to COVID.

“That’s a huge misperception,” she said.

The harassment local officers face, she said, may stem from this misunderstanding. And while local health officers have some flexibility with COVID guidelines, such as masking, the decisions they make are based on guidance or orders from the state and the Centers for Disease Control and Prevention.

Ed Singer, who served Carroll County and was president of MACHO, resigned in October 2021, shortly after Gayles. He said it felt like local officers were “on our own” when trying to implement state and federal pandemic guidelines.

“I really felt like the secretary of health of Maryland [Dennis Schrader] didn’t essentially have the health officers’ backs. I felt like he was not supportive,” Singer said. “And really, I felt like he was somebody I didn't want to work for.”

Singer said he personally had a good relationship with his own elected officials during the pandemic, but that this was not the case for all of his colleagues.

“When things got politically difficult, it seemed to me that the Secretary of Health wasn't willing to stand behind those other health officers,” he said. “Some people lost their jobs, really through no fault of their own.”

The same month Singer resigned, Dr. David Bishai was terminated from his position as Harford County Health Officer.

Leading up to his termination, Bishai said he was harassed by county residents upset with COVID restrictions, who targeted him in a Twitter campaign.

“They would cite pseudoscience,” Bishai said. “They would say, ‘why would the health department promote masking?’ They would promote untried treatments, there was this ivermectin moment, there was spreading of false claims about vaccines.”

Somerset and Garrett counties had the lowest vaccination adoption with 50 percent and 51 percent respectively for residents who are fully vaccinated against COVID, according to state health records. Montgomery County had the highest percentage of residents who are fully vaccinated with nearly 88 percent who got the job. In Baltimore County about 73 percent of residents are vaccinated compared to roughly 65 percent in the city of Baltimore.

Bishai said he was surprised when he learned from the state’s health department leadership that he was terminated. He later learned the county council voted to terminate him along party lines.

“It only took a couple dozen voices, but it alerted the local elected officials that: ‘oh, well, you know, what’s to lose, we can get political points by appealing to loud vocal people,’” he said.

Bishai said he sought a clear reason for his termination from the council and the state health department, but did not get one. He said he’d become a “scapegoat” for the state health department for enforcing state pandemic policies.

Brooke Torton, managing director of the Legal Resource Center for Public Health Policy at the University of Maryland School of Law, agreed that Maryland’s local health officers were subject to a lot of ‘finger pointing.’

“Nobody wanted to be, I think, responsible for orders that people didn't like,” said Torton, who is also a senior staff attorney at the Network for Public Health Law, a national nonprofit.

Torton added that some of the officers she’s spoken with have tried to “write off” the threats they’ve experienced.

“Still, it's very concerning,” she said. “Needing to send your family to live somewhere else, or change your route on your walk home or drive home from work.”

Torton has advocated for state laws that specifically protect local health officers. Maryland, she said, has none.

And that, based on a survey she conducted, means Maryland lags behind most states. Torton said 35 states, plus Washington D.C., have statutes that are broad enough to protect public health officials when they are being threatened and harassed.

“Bottom line is, Maryland was not one of those,” she said.

Of the states with statutes protecting public health officials, all but two states have laws protecting both state and local health officials.

In the latest legislative session, state lawmakers tried to pass laws that would protect county health officers. One bill, SB0956/HB1409, would have made it a crime to threaten a county health official. It passed the Senate, but failed to pass the House.

The legislature did override Gov. Larry Hogan’s veto of a bill that would have made it more difficult for the state health department to remove a health officer at will.

Bishai said at the root of his termination is a decades-long problem. Ideally, he said, he and his staff would have been able to spend more time engaging with the community and building trust.

That would have mitigated harassment and misinformation, but he said it wasn’t feasible.

“We don't have the workforce for it,” he said. “We are continually and systematically denied that workforce.”

For example, Bishai said, Congress has failed to pass legislation that would have established a student loan repayment program for public health professionals.

And Bishai said local health departments are understaffed, overworked and underfunded.  

“We had a public health crisis and could not pay our workers overtime. Period,” he said.

This, Bishai said, is a fixable problem that predated COVID.

“If there was a five-alarm fire, the firefighters get overtime. If there's a crime wave, the police get overtime,” he said. “So we have the biggest public health crisis of a hundred years, and the staff, contracted to work 40 hours a week, couldn't work 42 hours a week and get paid.”

Bishai also noted that MDH has relied on temporarily hiring more expensive outside help instead of relying on local talent.

MACHO director Maiorana said that couldn’t have been good for morale.

“Our staff, who are local health department employees, were working alongside people who were contractual. And they were getting paid hundreds of dollars an hour, next to our people who were getting much less,” she said.

Maiorana said that in lieu of payment, people who’ve worked overtime have received comp time.

“Who can use comp time in an emergency when you're a small health department and you don't have the bench behind you to take time off?” shesaid.

MDH declined to do an interview for this story, but forwarded WYPR a statement by Dr. Jinlene Chan, Deputy Secretary for Public Health Services.

Chan wrote that local health officers have been “invaluable in protecting our communities.”

She also highlighted a Baltimore Sun op-ed by State Health Secretary Dennis Schrader, where he describes local health officers as “heroes” who often work seven days a week and “put their own health and well-being on the line.”

Chan also noted that the governor announced earlier this year that he was budgeting a record $75 million for local health departments.

Anne Arundel County Health officer Kalyanaraman expressed optimism that this funding is the “first step in a multi-year process” in “right size funding” public health.

Kalyanaraman said part of the challenge in getting funding for public health is that it’s about prevention. That, he said, makes it “a victim of its own success.”

“When you do prevention well, you see less of a problem,” he said. “So that leads to cutting costs.”

That hinders prevention in the long run. Unless there is a visible nationwide crisis like COVID-19, funding drops off.

“We need to see if that investment is going to continue,” Kalyanaraman said.

Maiorana hopes that lessons from the pandemic will spur long-term change.

“We have a lot to do with recruitment, retention,” she said. “We missed an opportunity to pay people what they were worth.”

Torton, the attorney for the Network for Public Health Policy, said workers are exhausted, “physically, mentally and emotionally.” Funding remains on the line. Nationwide, she said, there are efforts to “chip away at public health authority.”

Torton said as we transition out of the pandemic, we still need legislation, more funding and stronger community partnerships that would build public trust. There needs to be more robust media campaigning and education, she said, about what local health departments do, and what their powers are.

Sticking to the status quo, she said, does not bode well for future health crises, or the next major pandemic. Hopefully, Torton said, there will not be another one for 100 years.

“There will be – there are – long term consequences as a result of this,” Torton said.