(upbeat music) - Welcome to Forum 360, a program with a global outlook and a local view.

I'm Ardith Keck.

The pandemic has caused disruptions in all of our lives, and we're really tired of it.

Can you imagine what the last few years have been like for the public health personnel?

The Summit County Public Health Department has been in the middle of it, trying to take care of Summit County residents with vaccinations, et cetera, while carrying on their other duties.

My guests today have really been in the middle of it.

They are Donna Skoda, director of the Summit County Public Health Department and Cory Kendrick, policy and legislative affairs manager at Summit County Public Health.

Welcome to you both.

- Thank you.

- You've been put in the spotlight in ways that are rare.

Donna, what have the last two and a half years been like at Summit County Public Health?

- Difficult to put in one word, but it's been very hectic obviously, because of the pace.

The virus was constantly changing.

It was very fast paced and, honestly, I think for a lot of it, we saw a lot of teamwork.

A lot of people pulling together.

But I would be lying to you if I didn't tell you it was very stressful.

It was a very stressful time.

Because it was an unknown virus, We were trying to prevent death and disability.

And at the same time, as you said, try to carry on some semblance of our regular programs when we had all hands on deck.

So it has been a very, very chaotic, difficult 30 months.

- I would expect that answer, certainly.

Cory, the disease is called COVID-19, can you explain why?

- Well, it's short for the SARS COVID-19 virus and the 19 is for 2019, when it was found.

- Oh, that's when it started.

- Yes.

- Mm-hmm.

Okay, what have you had to add to your regular duties?

- Well, I think prior to COVID being a worldwide pandemic, public health carried on many, many of the duties.

You know, we've always quietly behind the scenes participated in communicable disease control.

But when it became such a worldwide pandemic, and it became almost publicized, and a career.

Contact tracing became at a whole other level, case investigation became at a whole other level.

We had to do many, many communications to the community, educational outreach.

Then we had, you know, December 26th of '20, it would've been '20, we administered our first vaccine.

And since that day have been vaccinating every single day.

So we've had to do many, many more renditions of vaccine, and availability, and cases, and, you know, looking at who was eligible, who wasn't.

So it really has become all hands on deck with just trying to keep the vaccine work going and testing.

Because as you know, in the beginning, if you remember testing was not available.

and one of the ways you do disease.

- Neither was the vaccine.

- And you do disease control through testing, isolation and quarantine, but it was difficult to do.

And, you know, I always remember out of all of this, that about 12% of our cases were asymptomatic.

People didn't even know they had COVID.

- 12% Really.

- Yeah.

As, as Donna mentioned, you know, we've always done communal disease investigation, tuberculosis, for example, we might have a handful of cases that we're monitoring at any given point in time or some other diseases.

But you know, when this first started, it was a small amount of people we had.

And as it grew, really took our resources from figuring out how to scale from a small disease investigation team to adding on more and more of the health department.

We went from just a handful of cases.

And by the second year, our last peak, we had over 2000 cases in one day.

And so just trying to figure out how to scale that sort of volume over time that we've had to move on from each day, increasing our capacity more and more.

And we've just had staggering numbers as far as the amount of cases we had to investigate and contact trace, amount of tests we've distributed and administered and the vaccines we've given are in the tens and thousands.

So.

- Hmm.

Okay.

I think probably some of our audience don't have a clue what Summit County Public Health does.

So let's go through and tell them a little bit about what, what they do, what you do.

- Well, we're mandated by law in revised code to do all of the vital statistics.

So that's birth and death records.

And as you know, unfortunately, during COVID, many folks passed away.

And so we had to, we have to keep burying people.

You know, we had to keep issuing birth certificates and the death and birth certificates.

We also, many programs were shut down like our dental program shut down for a while, but we still, you know, we do dental.

We run the women, infants and children's program.

Again, was looking different during COVID, but we still run that program.

We're responsible for communicable disease control, which is, as Cory mentioned, you know, other things like tuberculosis, measles, anything else that might pop up, we're required to investigate.

And then when you get to our environmental health division, it's air quality, water quality, it's private home sewage, it's, we don't do any of the public sewer systems, but we do all of the private water systems, which can be like a middle sized and 15 persons or more like a vet office or a, a grocery, or they have private water systems.

We're required to make sure those are all safe and sanitary.

We're also food inspectors.

And we had to make sure that food was still happening and the inspections were occurring because as you know, as a, as COVID a lot of takeout started to happen.

- Ah, yes.

- And then you were allowed to take beverages with you as well.

The law was changed to allow alcoholic beverages to go with meals.

And then we opened up additional dining spaces in these folks, in these areas so folks could eat outdoors.

So we have had many changes that were happening as COVID went on.

So all of our required services that we do every day look different, but we had to keep 'em going.

- What about restaurant inspections?

You talked about the food.

- Yeah.

Yeah.

- Do, do you look at restaurants?

- Oh yeah, we were still doing that.

- Yeah.

- For ones that were open and the ones we could get out to.

A lot of 'em closed, unfortunately.

- And the, while the restaurants were closed, our enforcement operations team switched from inspecting restaurants to inspecting any sort of essential businesses that were open for the responsible reopening that was happening.

So we would get, you know, just tons of complaints in everyday 12,500 complaints to be exact (laughter) and 12,500 complaints in our environmental health team would investigate those to ensure that if essential businesses were operating, they were using hand sanitizer, they were masking, they were social distancing.

They were doing things in compliance with the state guidelines.

- And you should know the state guidelines kept changing 'cause they would issue different orders.

And as the orders changed and we ran a call center that was just wild.

I mean, that's all I can say about the call center.

- 40,000 phone calls that we received in the last two years regarding COVID.

- Yeah.

- 40,000.

- Yeah.

- Okay.

- So as you can see, you know, not only the disease investigation, but every aspect of the operation from the calls to the investigations to the communication had to be scaled.

And most of our staff had to be diverted to COVID.

- Does that mean that anything that you normally do was shortened?

- The state had some grace that they were giving to program areas, like WIC was no longer doing inpatient or in person visits.

Some grants would allow us to shift our work from like community gardening.

They would say we could do COVID response.

The federal government issued and allowed us to take some of our employees and stop some of those other non-essential activities.

But as I said, you know, you still have to bury people.

You still have to issue birth certificates.

People were still being born and unfortunately dying.

And you know, you still had to make sure people were safe in their homes.

And as Cory said in the businesses, we had to make sure folks that went to work were safe.

And so I think things got rearranged according to state guidelines and probably yes, not nearly as robust as normal.

- It ebbed and flowed constantly with the, with the demand and need of COVID versus the, the need of the community for other services and, and shifted accordingly based on what we're allowed to do and what needed to be done.

- Did you add staffing?

- Yes.

To some.

- I can imagine those people who are already busy.

- Right.

We were able to secure, the biggest problem for us Would've been our nurses.

We don't, we have limited number of nurses.

The state sent us nurses.

They had a contract with a company that allowed them to be travel nurses that could come in.

They also went to hospitals and that helped a great deal.

- Where on earth did they find nurses?

- Well, they had contracts, they were travel nurses.

They're paying very well.

And so they were willing to go ahead and travel.

So we received that staffing.

The county also offered us some support with some of their employees that helped us.

And we had volunteers, the Medical Reserve Corps.

And so yes, we did have individuals and, and I have to say, we will be forever indebted to the folks who volunteered and helped us because it was very, very.

- It was it very helpful.

Well, it was very helpful and it was the only reason we got through it.

- Wow.

I never thought of them, volunteers.

- Oh yeah.

They were fabulous.

- Some of our mass vaccination sites and testing sites Also we had some National Guard, a few of those events.

- Oh, that's true.

Yeah, I forgot that.

- That the state would send down.

So it just depended on the event.

Some of the larger scale events, we had had some help to the state and the National Guard.

And, but most of it was our staff, which is pretty impressive because throughout the whole thing, we've given over 75,000 vaccines.

And just, you know, when you look back at these numbers over the last two years and you look at the staff that we had, it's just, it's unbelievable what we accomplished.

- Yeah.

We, my husband and I have gotten our vaccines, vaccinations at the Summit County program.

- Oh good.

And I know how you did it and it was extremely well done, extremely well done.

So when you think about that staffing, adding on to the other things, the clinics and so forth that you still had to do.

Another one of the extra duties is interpreting for the public.

And I think you mentioned this and the evolving science, because things were changing at the beginning.

What was the impact of that?

- Yeah, it, it was because it was so constant.

The change was constant, whether you received information, you know, and the flow is the federal government, the state, the state to us, the Ohio Department of Health and CDC would do their best.

But at the beginning there was so much, just so much information flowing that you would, I went home every night and read 50, 60, 70, 80, 90, 100, 200 pages just trying to keep up on what was happening.

We finally had some folks who were just extracting, they were literally abstracting, excuse me, the articles and telling us what the high points were so that we could give 'em to our medical director and we could give 'em to, so we would know what was changing so quickly.

So yeah, it was difficult.

And then to try to communicate that and having it be unknown and making the fear that went into that, I think, you know, and I think a lot of people, when they're fearful, they tend to say, oh, it won't happen to me.

Or it's not true.

- And the public, because things were changing, they thought, oh, they're lying to me.

- Yes.

- They're not telling me the truth.

- Right.

- It's just that it was new.

And as the data was coming in, everyone was learning about the virus and, and how to best handle it.

So the masking guidelines changed, the quarantine guidelines changed, isolate .

Everything you know, changed pretty regularly, but it was just because it was evolving and operating off the best information possible at that given time.

And, and it was really hard to disseminate that to all the groups because, and then each group had different information on top of that.

So the schools may have slightly different guidelines than the businesses.

And individuals might have slightly different guidelines than essential workers at a given point in time.

So it was very dynamic and ever changing and depended which sector you fit into.

So it could be very confusing for the everyday person to digest all that.

It was confusing for us.

It really took us a lot of resources to go through and, and do the best we could to get that out to the public in any manner we could, whether it be interviews, social media, email blasts, faxes, anything we could think of to get it out to the public.

- Today we're talking about public health during the pandemic and with me, our Donna Scoda, who is the director of the Summit County Public Health Department, and Cory Kendrick, who is policy and legislative affairs manager at Summit County Public Health.

I feel as if I've, I've worked very hard because of all that you've talked about, but funding, what about the budget?

You talked about volunteers coming in and that would help the budget certainly, but did, did help come in the form of funding?

- Yes.

We were very fortunate that both the state of Ohio, the governor's office and the Ohio Department of Health have been very generous with COVID dollars to support our activities.

They were very, very generous.

The only problem is some of it's categorical.

So it takes a lot of tracking and working and to make sure you keep it all straight so that you can pass your financial audit at the end of the year.

The other partner we had was Summit County.

Summit County was very generous and helped us.

That's how we were able to secure some of our very early testing that we were able to test early on.

We had contracts with both Summa and Cleveland Clinic.

So we, again, owe just a great amount of thankfulness to the county and the state, or we would not have been able to do it financially.

- Well you can't add staffing and not pay them.

- Yes, the money that we, the response dollars that we spent, we probably spent 8 million the first year, and that was on response.

And that came from the state, from the county that helped us.

So Summit County, you know, under executive Eileen Shapiro were very, very generous.

- Cool.

I'm glad to hear that.

Did you receive political pressure?

This is yours.

(laughter) - That might be a question for both of us, but I wouldn't.

I, I would say that everyone really came together pretty well to try to, to, to communicate this the best they could in the community from the superintendents, elected officials.

I, I don't recall any particular pressure that we had.

- I don't feel like, yes at a certain level.

I mean, our country is very, become very polarized and politicized.

So from that perspective, the response had some political flavor to it.

But honestly, personally, we have been treated very well.

And I think if there was any request or ask or any, somebody wanting something or to know something, they were very respectful when the answer was no, that isn't what we can do.

- Okay.

That's good.

- Yes.

That's good.

So again, I, we feel very fortunate.

- What about the lessons learned?

Are there things that, that you could say because the US wasn't as prepared as it should have been.

I'm not sure about you, but certainly the US was not as prepared as it should have been.

So what would you say lessons learned.

- Oh, do we have two days?

(laughter) I learned a lot, but I'm gonna say, and I'll let Cory, we'll kind of go back and forth so we can, we have lots of lessons, but probably the one that will stick with me my entire life is that we had a whole group, a generation of people that we have left behind.

Whether it be for inequity, it be for employment situations, whether it be poverty, lack of education, knowledge deficit, you name it.

But we have a group of people that we are all responsible for and we should be not happy until every single person has the opportunity to have what they need.

And there is a digital divide like no other.

And because most of this, a lot of this was you had to go online to get a test appointment.

You had to go online to get an appointment.

You had to go to get a vaccine.

You know, it was all.

And a lot of folks couldn't do that.

- Yes.

The older generation.

And do not.

- And then the availability of broadband in poorer neighborhoods, individuals that work jobs where they, you know, I can remember when the nursing homes first in the beginning were so, you know, having a lot of COVID cases and we would find out that one person was working in three of those because that's how they pieced together one full-time job, because they were part-time in all of them.

And that, and then they're, they're, you know, spreading it to each place they go because they don't know.

So I think one of, you know, the lessons learned is that we have to be very cognizant of equity issues in this country because it harms everyone.

- 100%t agree with that.

I think we've learned some good ways to hopefully address that better in the future.

The other piece of this is the, just the scalability.

We've learned how to scale and, and shift better for next time.

And I think as Donna mentioned earlier, the testing, testing availability is so huge.

If you don't have the ability to test and determine who to quarantine as quickly as possible and, and early on contain the virus, it's, after a certain point, it's just too late and contact tracing and investigations isn't going to help anything from that point on.

So then you have to really focus on, on testing, testing, vulnerable populations and vaccination, if it's available.

- And we're still concentrating on testing because it's, it's vital.

- Yes.

And we're constantly, even now giving out thousands and thousands of home tests.

The state's still distributing those to the libraries, school systems and health departments.

So if anyone needs a home COVID test, stop on by the health department or call your local library and, and pick one up.

- Because of all the problems that COVID has cost, the administration now says there's a $3.5 billion investment in public health, a little late, but that's what is, is being proposed.

So does the health department have plans for that 3.5 billion?

Obviously you don't get it all.

- We would very much like to have the state invest in technology because not only was technology hard for consumers, but in, there's outdated, any kind of information management systems in the state.

The disease reporting system, the appointment scheduling it's all out of date.

It needs to be a direct web entry kind of a portal.

It, you know, there were health departments Ardith, that were getting their disease reports from fax.

- Oh my.

- And then had to turn it all around and enter it because of the technology again.

So we would like the state, certainly to do that.

- For everybody.

- For everybody.

That would improve everything across the state for response.

The other thing is, I think we really need to look at the plans we write.

We write beautiful plans.

They look nice, they're beautiful.

They say all kinds of great stuff, but, and we do practice them.

We look at 'em, but I think we practice them in a void.

We need to practice them as if the pandemic's going on right now with real people in neighborhoods and talk to them about a pandemic.

We need to talk to nursing home workers about disease control.

You know, you have to educate people before you need them to do something.

I mean, like I said, these plans are great, but if nobody knows about 'em, they don't really help.

- The, the scale of this was just so massive by the surge of the second year that, that no one was ready, the technology wasn't ready.

- Right.

- The infrastructure, the personnel, the training.

So just having that prepared for next time that there could be a possibility where every community is getting 2000 cases a day.

What do you do with that?

Just having that volume and dealing with that is, is really taxing.

So that really needs some investment.

- So obviously it's, it's taught you some things.

- Oh yeah.

- And you've learned from them.

And are there other aspects of your plan that could be communicated to the public soon or.

- Well, I think this is the year that the state has asked for all local health departments to redo their continuity of operations planning.

So we're working through that as far as just developing all of the sort of succession, what happens?

What do we do?

What happens if we have to shut down?

What happens if COVID makes us redirect staff again?

So that's all being updated.

I think that this county is embarked on a broadband project to try to bring broadband to some of these underserved areas.

And I think that those kinds of things are what we should start communicating.

And I don't think it has to be some highfalutin message.

I just think we need to tell people, you know, folks are really good about doing what they need to do if they understand.

And so we just have to make sure they understand, and they have the resources to do what they can do.

You know, people want the same things in life and we just have to try to help 'em get them.

And I really think that, you know, the more we can communicate, just simple things like this is the area where your health department is.

This is the number for the call center.

This is who can help you.

This is where you can get a test, you know, just basic information.

Most people are trying to keep their lives going.

You know, they still had kids.

They, they were homeschooling their children.

I mean, talk about these parents didn't sign up to be teachers or they would've been teachers, you know?

So it was just, we just have to think about all of this stuff and sort of get it to people so that they understand.

- Well, congratulations for responding as well as you were able to do.

This has all shown the importance of having Summit County Public Health there, especially during a public health emergency.

You imagine what the community would've been like, if that you weren't there.

Thank you, Donna and Cory for what you do every day.

And for coming on Forum 360.

This is Ardith Keck for Forum 360.

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