How Do You Lead a State’s Coronavirus Response? Ask Her | Alisha Haridasani Gupta | The New York Times

Illinois’s health director, Dr. Ngozi Ezike, offers a glimpse into the round-the-clock, all-consuming effort of containing the coronavirus.

Credit…Sol Cotti
Alisha Haridasani Gupta

By Alisha Haridasani Gupta

  • May 27, 2020

— Dr. Ngozi Ezike, director of the Illinois Department of Health

A few weeks ago, Dr. Ngozi Ezike’s four children — ages 17, 16, 13 and 11 — sat her down to deliver a PowerPoint presentation they had put together.

It was a detailed assessment of how she was doing in her job as the leader of the Illinois Department of Public Health.

“It was like, ‘Well, we’re really proud that you’re doing this important work. It’s cool that you’re on TV,” recalled Dr. Ezike, “‘But now we’re totally over it.’”

Their main complaint: She was never home anymore. While family friends were filling the gap, checking in on them and dropping off treats every now and then, they felt like they hadn’t seen their mom in weeks. And when she did get home, she was on the phone late.

“They were breaking it down for me from their perspective,” said Dr. Ezike in a recent phone interview, which happened to take place on the same day as her youngest child’s birthday. “It hurt.”

“But I hope they’ll understand better with time why I had to sacrifice so much time away from them.”

Like Dr. Ezike, women across the country have been at the forefront of states’ round-the-clock, all-consuming emergency responses: More than 60 percent of state health directors are women, according to the Barbara Lee Family Foundation.

As appointed officials, state health directors typically play a behind-the-scenes role, identifying, tracking and planning interventions around public health risks.

But this crisis has catapulted them into the spotlight, standing side by side with governors and mayors, quickly turning them into some of the country’s most recognizable faces. (Ohio’s Dr. Amy Acton, for example, has become something of a local icon, with fan clubs and merchandise dedicated to her.) It is up to state health directors to corral data and come up with policy proposals for advising governors and the rest of the state on things like when to shut down, how to reopen businesses safely and where to set up testing sites.

But, in a combustible environment of heightened anxiety and increasingly partisan clashes over the emergency measures put in place, their every move and statement is scrutinized and dissected from every angle.

“I try to just stick with what’s the right thing to do and let the politicians do what they have to do,” said Dr. Ezike. “No one is positive of the exact right course — we’re building the plane as we’re trying to fly it.”

The criticism her team receives — and there is a lot, particularly over reopening the economy — is balanced out by the “many letters and cards of support and encouragement” sent to her offices, she added.

These days, Dr. Ezike’s itinerary of back-to-back meetings and calls kicks off at 6 a.m., when she gets daily updates from local health departments and emergency management and alternate care sites. Then there’s the televised news conference with Governor J.B. Pritzker, during which Dr. Ezike provides critical updates and takes questions from the news media. On some days, Dr. Ezike’s team takes calls from the White House, the Centers for Disease Control and Prevention and health directors from other states. Her day doesn’t end until about 11 p.m., she said, at which point she tries to go through her emails.

“But I’m struggling with that,” she confessed.

Illinois, while not the country’s worst hot spot, has undeniably been hit hard.

On Jan. 30, the first human-to-human transmission of the coronavirus in the U.S. was reported in Chicago — between a wife who had traveled to Wuhan, China, and her husband.

Dr. Ezike visited the couple in the hospital and it became clear to her the kinds of troubles that the country was about to face.

“We were waiting for official test results to return from the C.D.C. because we didn’t yet have the ability to run the test at our public health labs in Illinois,” she recalled. “The gentleman was considering ‘releasing himself’ from the hospital isolation — he was concerned about missing work and not providing for his family while sitting in isolation.”

“In those moments, I gathered my first inkling of the challenge to be faced in containing this virus and how one’s personal economic or financial situation would affect decisions that would affect not just the individual but the community as a whole.”

Then on March 21, Illinois became one of the first three states to implement stay-at-home orders.

“I think that significantly helped,” Dr. Ezike said.

To date, there have been more than 100,000 cases of coronavirus in Illinois and more than 4,900 deaths, bringing the state’s fatality rate to about 39 deaths per 100,000. That number is far below the country’s top three hot spots: New York, which has a fatality rate of 150 deaths per 100,000, New Jersey, where the rate is about 125 per 100,000, and Connecticut, which has a rate of about 105 per 100,000.

But Illinois also has some of the country’s largest black and Hispanic populations — communities that, according to the C.D.C., are at a greater risk of dying from the disease, in part because of longstanding inequalities that have made access to health care harder. Thirty percent of the people who have died in Illinois are African-American, according to the state’s public health department.

Most of those communities are largely concentrated in Cook County, which includes Chicago and its suburbs. The county currently has the most confirmed cases in the entire country, according to data from Johns Hopkins University. And, in early April, Cook County Jail became one of the country’s largest coronavirus clusters, with more than 1,000 infections among inmates and staff and six deaths.

These concerns were always top of mind, Dr. Ezike said. Before becoming Illinois’s health director, she spent 15 years at the Cook County Department of Public Health and was the medical director of the Cook County Juvenile Temporary Detention Center so she had seen the gaping socioeconomic disparities between communities and how that gap can have a knock-on impact on health care access.

“This virus didn’t create health disparities,” she said. “It’s just magnifying them.”

From the outset, she had her eye trained on the most vulnerable, including essential workers, many of whom are from minority communities. She has incorporated their needs into all of the state’s response proposals, from getting P.P.E. to those who need it most to providing targeted messaging and information. Dr. Ezike herself delivers her updates during the daily news conference in English and Spanish.

The virus has touched Dr. Ezike’s own circle, too: Extended-family members and family members of her co-workers have been infected, she said.

In February, before the coronavirus upended the world as we knew it, Dr. Ezike lost her father, an immigrant from Nigeria who spent most of his life in Los Angeles.

“I did bury him. We had very elaborate ceremonies for him in three cities and two continents,” she said over the phone.

She added: “But I think about how people can’t do that now and how difficult that can be. I think about that every time I think of the deaths we are reporting each day.”

The Coronavirus Outbreak

  • Frequently Asked Questions and AdviceUpdated May 28, 2020
    • My state is reopening. Is it safe to go out?
    • States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
    • What’s the risk of catching coronavirus from a surface?
    • Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
    • What are the symptoms of coronavirus?
    • Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
    • How can I protect myself while flying?
    • If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
    • How many people have lost their jobs due to coronavirus in the U.S.?
    • More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
    • Is ‘Covid toe’ a symptom of the disease?
    • There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.
    • Can I go to the park?
    • Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
    • How do I take my temperature?
    • Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
    • Should I wear a mask?
    • The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
    • What should I do if I feel sick?
    • If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
    • How do I get tested?
    • If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
    • How can I help?
    • Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.

Alisha Haridasani Gupta writes ‘In Her Words’ for The New York Times. @alisha__g

Disclosure: Smita Nair Jain has nothing to disclose. She doesn’t own stock in any publicly traded companies and does not hold investments in the technology companies. She has equivalent of the American 401(k) plan in India that is automatically managed. (Updated: May 31, 2020)

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