There were various points at which there was a growing awareness of the potential threat that COVID-19 posed to the globe, the U.S. and more specifically Utah, University of Utah Public Health Program, and its campus. According to Kimberley Shoaf, DrPH, professor in the program, “Early in January, many of us in the program expressed our concerns with the growing threat and discussed where we thought it would go and how it might impact us. Utah had an early case from the Crown Princess, which served as a very stark threat to the state. Many of us fielded calls from colleagues and friends around the country as to what they should do personally, for their businesses and families.”
Working quickly, the group put together a survey of faculty expertise in the Division of Public Health and the other divisions within the Department of Family and Preventive Medicine to share with the university health communications team. Faculty offered their expertise in infectious disease epidemiology, environmental health and emergency public health with the university. Much of that expertise was not initially utilized as many saw the growing pandemic as more of a medical problem and not a public health issue. Within the division itself, administration and faculty members began to discuss pivoting to online classes and a work-from-home setup.
As the pandemic grew in scope and severity, the State of Utah, Salt Lake County and the University of Utah realized the potential magnitude of the problem. Utah was the first state to cancel classes and invoke public health orders to close non-essential services after Rudy Gobert of the Utah Jazz tested positive for COVID and the NBA cancelled not only the upcoming game but the entire slate of NBA games for four months. This occurred on March 11, 2020, which coincided with the beginning of spring break at the University of Utah. The return to classes after the break was cancelled and the university pivoted to online instruction and work-from-home for the remainder of the spring semester.
Despite the monumental shift in their usual working conditions and responsibilities, faculty in the division reached out to public health partners in Salt Lake County, the Utah Department of Health (now the Department of Health and Human Services) and the other local health jurisdictions to offer assistance with contact tracing, ICS, hotlines and other services. The division has a history of providing students, with faculty guidance, assistance with emergency response operations, having previously done it during the measles outbreak of 2015. On the first day of COVID response in Salt Lake County, a number of Utah students were deployed to the poison control center, which had been repurposed as a COVID hotline.
Of this effort, Dr. Shoaf says, “We were fortunate to count on a great deal of expertise within the Division of Public Health that was relevant to responding to this public health emergency. Within our faculty we have a former EIS Officer who specialized in infectious disease epidemiology, an infectious disease MD/environmental engineer, an environmental engineer with specialty in infectious disease, a specialist in emergency public health and a former UDOH employee who directed the state’s PHEP program. Further, three of these individuals were in leadership roles in the Division at the beginning of the pandemic. This allowed the Division to make decisions for our faculty, staff and students as well as provide expertise to the University based on the best available evidence.”
Shortly after the initial wave of cases in Utah, the Utah Department of Health requested that the Division of Public Health stand up a cadre of contact tracers to function as surge capacity for UDOH and the local health departments. Sharon Talboys, PhD, and Dr. Shoaf led those efforts. Under contract from UDOH, more than 700 individuals were screened, hired, trained and functioned as surge capacity for the state for a period of time stretching over 24 months. At the peak, the program provided 250 contact tracers to the effort each week. The contract shifted to an on-call contract in May of 2022, making it possible to surge a much smaller cadre of contact tracers with a two-week notice when cases surged beyond the capacity of the state and local public health departments.
Amid the successes of their contact tracing effort, the division encountered significant challenges during the pandemic. “The first [challenge] was the struggle to maintain the normal academic responsibilities for those faculty who were functioning as public health practitioners on behalf of both our public health practice partners and the university,” says Dr. Shoaf. “For the team that functioned as part of the university incident management team, those roles, particularly in the first year, often exceeded 50 hours/week. In the meantime, those faculty were also teaching classes, attempting to conduct research and advise students. The second challenge was a result of attempting to implement best public health practices at a state institution in a state with a legislature that declared the pandemic over and ending the ability to issue mask mandates in April 2021 and requiring in-person classes and no mask requirements in fall 2021. While university leadership wanted to do what was right to protect the faculty, students and staff, their hands were often tied by the legal and political climate. However, in spite of these hurdles, the university throughout the last two years had higher vaccination rates, lower positivity, better compliance with quarantine and isolation, and overall better health than the surrounding community.”
While the challenges they faced were significant, the pandemic nevertheless provided opportunities for learning and growth. Of lessons learned through the pandemic, Dr. Shoaf says, “The change that will have the greatest impact on our ability to respond to future public health emergencies is to raise awareness of the incredible unwavering dedication of public health practitioners and academicians to the health of their communities. If politicians and the general public truly understood the dedication of these heroes, we would not have seen some public figures dismiss their (our) value in responding to this catastrophe. The lack of understanding of what public health does was often discussed prior to the pandemic. Little did we understand the impact that lack of understanding would have on our ability to respond. The second lesson that needs to be re-learned is that all public health is local. The CDC provides guidance and, ideally, trusts and collaborates with academic public health to do the science necessary to develop that guidance. But it is the state and local practitioners who need to take the lead for their community. Often during this pandemic, CDC would change the guidance and announce it through the media. Practitioners on the ground were left scrambling to change their policies and procedures, while their communities and elected officials were challenging them that they weren’t in compliance with the CDC.”
“The United States spent much of the early 21st century planning for this event that has been occurring over the last 30 months,” Dr. Shoaf concludes. “Funding to state, territorial, local and tribal public health for public health emergency preparedness has been declining since 2008. There was an academic program funding schools of public health to work with those public health agencies to provide training, exercises and technical assistance and conduct research into the best way to protect the health of the population during public health emergencies. We need those systems funded today.”
