Orange County supervisors this week are expected to go behind closed doors and have a secret discussion about what they want to see in a public health officer.

Norberto Santana, Jr.

A pioneering leader in the nation’s rising nonprofit news movement and an award-winning investigative journalist. Santana has established Voice of OC as Orange County’s civic news leader, covering Southern California governments for more than two decades and reporting on Congress and Latin America. Subscribe now to receive his latest columns by email.

For the rest of us that won’t be in that small room, I figured I’d do my best to convene a public discussion about what exactly a Health Officer is supposed to do and whether taxpayers are getting the best deal from the current arrangement. 

Also note that given the failures of the county public health department over the past two years to meet challenges, cities like Santa Ana and Irvine are beginning to explore their own versions of health departments 

When the pandemic hit in 2020, our county supervisors were caught napping on the job just like the others before them when it comes to public health – so they scrambled to piece together an approach as best they could given the political volatility of the situation. 

Yet given the independent powers granted to the local health officer under state law to address infectious disease situations, supervisors had to confront a strong professional executive with topical experience. 

They wrestled with former OC public health officer, Dr. Nichole Quick, who kept watching every one of her health orders get politicked.

Quick eventually agreed to the 2020 Memorial Day reopening plan by requiring a local mask order. It marked the beginning of a political fight as county supervisors didn’t support her while public pressure mounted against her.

Supervisors eventually got their wish and she abruptly resigned.

According to the National Association of County and City Health Officials, Quick was just one of 300 public health executives that left their post that year. And in the wake of 2020, more than a dozen state legislatures considered changes to pare back health officer powers, the association reported. 

Now, while Orange County’s Republican-majority county board of supervisors was no fan of California Governor Gavin Newsom’s shutdown or masking mandates, they also never developed much of a local plan of their own. 

Instead, they opted for an approach they’ve used quite successfully in the past.

Fake it.

Appoint a phantom public health officer, one in name only. 

This approach worked well for supervisors over the years, such as in their confrontations with the county’s independent Auditor Controller, who likely died in 2019 from the stress of confrontations with supervisors. It also worked when they confronted their Performance Auditor, who eventually retired in 2015. Or the Office of Independent Review, which they attacked with a combination of weak funding over years and zero leadership since it launched in 2008. 

When it came to public health, supervisors conducted a lame recruitment process – one reportedly dominated by one question: mask mandates.

Out of that process, supervisors opted for the Health Care Agency head, Dr. Clayton Chau — a psychiatrist and former business partner with OC Supervisors chairman Andrew Do.

Chau also has a limited public health background

He was much more compliant than Quick to their political aim of not going hard on mask mandates or enforcement of any state masking mandates. 

Chau also resisted offering up virtually any COVID information on dashboards, like city case counts, only offering them after local media and residents protested. 

While Chau fought any kind of local outbreak listings, it’s been clear that the outbreak reporting required by the state’s worker safety agency, CalOsha, has really allowed policy makers to track outbreaks in real time. 

Chau also was very subservient to the political needs of county supervisors, in that no public briefings were held after the November 2020 elections, when Do became chairman of the OC Board of Supervisors.

Thus, as the deadliest part of the pandemic took hold in Orange County, public health officials stopped public briefings.

The public press conferences didn’t come back until 2022, when Supervisor Doug Chaffee became chairman.

Now, over the course of the pandemic, we’ve all witnessed what the powers of the public health department are.

The public health officer can have a huge impact on the approach to shutdowns, mandates, enforcement as well as education and outreach.

Indeed, because Chau has been the local face of many of those state mandates, he has drawn the ire of many anti-mask and vaccine activists who have criticized Chau for not refusing to enforce those standards. 

The controversy earned Chau the OC Medical Association’s physician of the year award. 

Ironically, the award and recognition largely came from Chau enforcing state orders, not from what Orange County developed. 

Where Chau did make a difference during the pandemic was in being more open to partnering with community groups and clinics with an eye toward diversity and equity, helping get the local players in position that ultimately helped Orange County get a handle on the first surge.

The efforts also set up the basics of an infrastructure that could confront surges with a mix of testing, hotel stays in overcrowded areas and informational efforts on preventative measures like masking and vaccines. 

Yet Chau never fully developed an effective response infrastructure, evidenced by the fact that the HCA has played catch up to four different surges with the same communities threatened every time. 

And under his tenure as head of the billion dollar Health Care Agency, key HCA executives keep leaving.

According to the National Association of County and City Health Officials, there are about 3,000 public health departments across the nation, with public health officers seen as the “chief community health strategists” in their community. 

In a Sept. 2021 letter to congressional leaders, association officials noted that local health departments were key players in “preparing for and responding to disasters, convening community partners to develop and execute plans, communicating with the public, collecting and analyzing key data points, partnering with health care providers, and coordinating with their state and federal partners.”

During the pandemic, health association officials reported that local health departments were critical in all phases of emergency response. 

Public health departments provided vaccinations, led testing and contact tracing services. 

They monitored the health of those who were exposed to COVID-19 and supported them in efforts to self-isolate. 

They used data from contact tracing investigations to identify trends and hot spots.. 

On top of all this, they kept their community members informed and answered questions, especially, officials note, “in light of the mis- and dis-information that has spread and divided communities.” 

Yet the National Association of County and City Health Officials also notes that the underfunding of public health seen here in Orange County has also played out across the nation.

“This work has been done despite years of underfunding, archaic data systems, reduced staff sizes, and increased polarization and politicization, making the largest public health challenge of our lifetimes even more difficult,” wrote association CEO Lori Tremmel Freeman in a September 2021 letter to congressional leaders on the state of local health departments. 

One key area where officials are seeing this underfunding play out in the pandemic, Freeman notes “is the availability—or lack thereof—of timely, comprehensive, and granular data.”

That kind of data here in Orange County, when tracked in the workplace by CalOsha, has definitely yielded realtime information that has allowed union leaders to press managers in responding to outbreaks.  

As we move forward, it seems clear that this kind of tracking data will be critical to allow us to spot surges quickly and tailor responses in real time. 

That’s going to likely require an investment of staff and money in building better COVID dashboards for Orange County. 

Nowhere has that been clearer than across Orange County schools, which were effectively shut down earlier this year as COVID cases spiked and school officials couldn’t keep up with contact tracing or updating virus dashboards. 

In her public report, Freeman noted that “While the sophistication of local health department data systems vary, as a whole public health data systems are antiquated, with far too many still relying on faxes and manual entry.” 

Freeman called for an overhaul of public health data systems to ensure accurate, real-time data is available.

Before the pandemic hit, few people focused on the role of their local public health officer.

For the most part, these officers oversaw local infectious disease outbreaks, like tuberculosis, and had broad powers to address such infectious situations – independent of local elected officials – as well as the mandate to conduct educational campaigns about public health. 

And the same national trend of defunding public health occurred here in Orange County.

Meanwhile, when it came to the pandemic response in Orange County, the most vulnerable areas in many cases were the last to see testing sites and the first where the sites went down. 

And the same areas got hit again and again with the most intense wave of sickness and death over the past two years. 

Now, throughout the pandemic, there’s been a lot of controversy over the ability of the public health office to mandate pandemic responses.

But there’s been very little attention on its obligation, indeed design, to educate, to conduct outreach.

The more that I look into what the office is designed to do, I better understand the need for the agency and its mandate. 

The Public Health Officer is supposed to convene a public conversation about threats to public health, especially during a pandemic.

In an acknowledgment of this fact, HCA officials last year began re-engaging after Voice of OC challenged them publicly by starting to host our own COVID video town halls last summer offering the public a chance to ask questions of experts and discuss the most pressing public questions about COVID. 

Deputy Public Health Officer Regina Chinsio-Kwong, who was appointed to her post in November 2020, attended the Voice of OC town halls last year and then started to become the voice that briefed reporters on media calls ever since. 

Chau’s never been heard from again, outside of a couple press conferences.

Now, I probably delayed Chinsio-Kwong from being appointed last September when I publicly questioned whether she was transitioning into the role.

[Read: Santana: Is Orange County Poised to Depoliticize Its Public Health Officer?]

To be clear Chinsio-Kwong has been accessible during her time and done an adequate job of answering reporters’ questions during brief media calls that are now held on a weekly basis.

County Supervisor Katrina Foley, who brokered a deal with OC CEO Frank Kim to have Chinsio-Kwong attend press briefings, is a fan of Chinsio-Kwong noting that she takes calls and has answered questions, as opposed to Chau who often dances around questions from the dais. 

And while Chinsio-Kwong is much much better than Chau, there are still questions whether her background as a medical doctor is the best fit for the informational challenge that confronts the Public Health Officer moving forward?

That’s why I can see the insistence early on from so many public health insiders who kept reaching out to me about the importance of a public health background for the public health officer, not just a medical background.

Many healthcare insiders pointed to the importance of an advanced degree, a Masters in Public Health, as central for any official in understanding the unique set of challenges and needed skill sets and training to meet them. 

Indeed, when I looked at a recent listing of public health officers across California, I noticed that most covering large counties held that kind of training and background. 

In addition to specialized training, many public health officials keep telling me the job has to be done as if you don’t want it. With a fearless attitude about confronting the toughest questions about equity. 

Ironically, that’s the best way to ensure that Orange County stays open with vibrant economic and recreational opportunities. 

By effectively managing data on infection outbreaks and leading important public health conversations, county public health leaders can put business and other social leaders in a position to gauge risk and enact protective measures as needed. 

That’s what is most needed.

Real time information. 

That allows people to act.

And that’s ultimately much more effective than any mandate.

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