Pandemic proves need to invest in public health, Linn County director says

CEDAR RAPIDS — As Iowa begins reflecting on lessons learned from the COVID-19 pandemic, one local public health director says a key piece of that conversation should focus on strengthening the public health infrastructure.

“I’m not sure people are ready to face another onslaught of COVID-19 unless we have a robust infrastructure,” said Linn County Public Health Director Pramod Dwivedi.

According to Dwivedi, creating a robust infrastructure should focus not just on a state level, but also on the local level by channeling more funding into those health departments and building up public health staffing in Iowa.

Some funding is expected to reach local departments after the Biden administration and Congress allocated $7.4 billion from the American Rescue Plan to support public health, including grants to “expand, train and modernize the public health workforce for the future.”

Linn County has received nearly $44 million from that stimulus bill. Dwivedi said the county is assessing needs and determining how to allocate that funding, so its unclear still how much the public health department will receive.

This past week, the United States surpassed at least 600,000 novel coronavirus deaths since the pandemic began. However, the nationwide death rate has dropped sharply in the weeks since the COVID-19 vaccines have become widely available and more Americans have been inoculated against the virus.

In Iowa, about 44 percent of the state’s total population is fully vaccinated, or about 52 percent of Iowans aged 12 and older, according to state and census data.

Public health officials say that rate still is not enough for the population to reach full protection against the virus. Some estimates say a community will reach immunity against the virus when about 70 percent of the population is inoculated.

Public health officials say it's important for individuals to get the shot if they haven’t done so already. But with demand for the shot declining rapidly, Dwivedi said COVID-19 still poses a risk, particularly as more infectious variants of the virus continue to spread globally.

Linn County Public Health had built a strong preparedness plan about eight or nine years before the pandemic struck, which had equipped it to better handle the response to COVID-19, Dwivedi said. That effort included opening a new community health division and hiring an epidemiologist.

“We had this infrastructure in place and it became so critical to respond to the COVID-19 pandemic,” he said.

But the response still had its challenges, and not just from the sheer impact of the virus. Dwivedi said the constantly changing guidelines from federal and state officials made it difficult for local public health officials to form a consistent response. That was particularly true when recommendations from the state public health department differed from those of federal health officials.

Local public health departments are the trusted entity in communities, Dwivedi said, but with changing rules the job “became very challenging.

“How do we reconcile the differences? The state was saying something, but the (Centers for Disease Control and Prevention) is saying something totally different,” he said. “So we were in the crossfire all the time.”

After more than a year responding to the COVID-19 pandemic, many public health workers across the country are experiencing burnout, which could have serious ramifications on the profession, Dwivedi said.

“Quite a few of my colleagues (nationwide) have decided to actually quit or take retirement,” he said.

Impact felt at home

Like it did for millions of Americans, the pandemic lockdown also affected the personal lives of public health officials, including Dwivedi. Not only did he see the novel coronavirus reach his family in the United States, but also impact his hometown in India. Dwivedi immigrated to the United States in 1991.

Earlier this year, India also experienced an unprecedented surge in new COVID-19 cases, which overwhelmed its hospitals and resulted in the deaths of thousands.

But even before that, in March 2020, Dwivedi received a call from his brother that his mother’s health was declining and he needed to come to India. By that time, the country had suspended inbound international flights and his calls to the Indian Embassy went unanswered, leaving him unable to travel to see his family.

The ban on international travel also meant Dwivedi’s wife and younger daughter, who were visiting another part of India, were unable to return to the United States for months. They did return to Iowa in September.

At the same time, Dwivedi’s oldest daughter was living in New York City as a surge of the virus unfolded there over the first three months of the pandemic, infecting more than 200,000 residents and resulting in a 9 percent fatality rate, according to the CDC.

“I was horrified,” he said.

His mother’s condition continued to worsen until October, when Dwivedi decided to travel to Chakia, located in the northern part of the country, to be with her for three weeks. On his return journey, despite wearing two masks and a face shield, he became infected with COVID-19.

Dwivedi said his mother, Vaidehi Dwivedi, died while he was home in Iowa, still recovering from the virus. He described her as a great storyteller who had memorized the epic poem “Ramayana.”

“I left home when I was 18 years old to go to college, so my interactions with my mother were sporadic,” he said. “I would see her when I’d go home, but otherwise we’d talk on the phone. … It was tough. There were so many shared memories and stories with her, so her passing was very difficult.”

Though other public health workers have decided to leave the field after this difficult period, the pandemic has not driven Dwivedi from the profession. He said he had great support from his colleagues at the county health department as well as from local elected officials.

“I have followed no other profession but public health all my life,” he said. “The reason that I'm in public health is because my life's mission is really to make a difference in people's health, in the public's health. So I cannot quit.”

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