For better and worse, she has said, her mood for the past two years reflected the ebb and flow of the coronavirus pandemic. And on this day in mid-March, cases were relatively low in Santa Clara County and her spirits high. “I feel so responsible,” said Cody, who is the county health officer, “so when things are going well, it feels really good.”
And when they were bad, they were often terrible. Exactly two years earlier — on a cold and gray day in March 2020 — Cody joined five other Bay Area health officers for an unprecedented news conference to announce the first shelter-in-place order in the U.S. pandemic, effectively locking down more than 6.7 million residents. A few days later, the rest of California followed suit.
Health officers around the nation were by then already working around the clock, scrambling to identify the earliest cases of COVID-19 and quickly develop strategies to save lives and stop the then-mysterious coronavirus from spreading. Most of them still keep punishing schedules: “I’m feeling physically unhealthy,” Cody said with a small laugh, citing a lack of exercise and accumulated bad habits. “Is there anyone who’s feeling healthy?”
The pandemic, now entering its third year, has been the greatest stress test in a generation for the fractured, thinly supported American public health system. Though the response in every county has involved scores of employees and volunteers, the burden of authority has fallen largely on local health officers, who in California are entrusted with remarkable powers in times of crisis. It’s been their name on every health order, from mask and vaccination mandates to capacity limits on restaurants and bowling alleys to bans on singing in church.
In the Bay Area, these once largely unknown public officials have often been celebrated for their aggressive response to the pandemic, issuing some of the most restrictive — and protective — orders in the country. But even here, they’ve also been vilified, at times singularly bearing the public’s most intense fear and frustration. They’ve been screamed at in public meetings and harassed on social media. Some health officers have even endured threats to themselves or their families.
Cody, along with Dr. Susan Philip and Dr. Nicholas Moss — the health officers for San Francisco and Alameda counties, respectively — sat down for interviews this month about this extraordinary time in public health and how they managed the most challenging two-plus years of their careers.
All recognized the immense responsibility they bore, but also took pride in being uniquely qualified to serve their communities. COVID, they said, had taught them difficult lessons in humility. “My job is to keep people from dying of COVID. But our ability in public health to prevent all outcomes is limited. Much of this is beyond our control,” Moss said.
Before the pandemic, these health officers were rarely in the public eye. Appointed to their positions, they’d appear a few times a year to talk about a local outbreak of measles or meningitis or some food-borne illness. Cody is now known nationally for her role initiating that first shelter-in-place order.
“I’m looking forward to being just an anonymous, never-heard-of her person, absolutely,” Cody said. “I love for public health to be spotlighted. But I don’t need to stay in the spotlight.”
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Of the three, only Cody started off the pandemic in the position of health officer. Philip and Moss took on their assignments within the first year, when their predecessors moved to roles with the state. Dr. Tomás Aragón, the former San Francisco health officer, was appointed the California health officer in December 2020, and Dr. Erica Pan, formerly of Alameda County, was made state epidemiologist in July 2020.
But all three already had long careers in Bay Area public health coming into the pandemic, and extensive experience with infectious disease control. Before assuming their ultimate roles, Philip and Moss led the earliest, on-the-ground COVID responses in their counties. In fact, said Philip, the toughest nights of the pandemic hit her weeks before San Francisco had even identified its first case.
As head of disease control and prevention with the San Francisco Department of Public Health in February 2020, Philip was one of only a handful of so-called experts in COVID, and thus among the first people doctors would call when they had a suspect case. No one, of course, was expert in COVID at the time — the virus was only a few months old. But Philip took call after call, the phone ringing all night, about patients with coughs and fevers, recently returned from China and unable to get tested for the coronavirus because testing was in such short supply.
“That was the most exhausted I’ve been since my first year out of medical school. At one point I was literally delirious,” Philip said. “It was physically very demanding and it was emotionally very taxing.”
The first year of the pandemic, and especially the winter of 2020 to 2021, was the most devastating, all three health officers said. They were initially hampered by a chaotic national response that put increasing pressure on state and local health officials to protect their own communities.
They often had to make tough decisions quickly, and with not nearly enough information. In Philip’s office on Van Ness Avenue, she still has a whiteboard in one corner with her predecessor’s writing on it, from a meeting in January or February 2020 — Aragon made a list in purple marker of the spaces they might need to protect, like schools and homeless shelters. It’s almost quaint, knowing now what was to come.
Cody recalled feeling similarly hamstrung by early uncertainties. It was an uncomfortable space for health officials who were used to collecting information and making decisions based on science and data and practiced protocols.
“It was striking how little information we had, and the stakes felt very high, even early on,” Cody said.
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Moss took over the health officer assignment in July 2020 — in hindsight, still early days of the pandemic — and the worst was yet to come. The Bay Area was a couple of months out of its first lockdown, and just beginning to see a major climb in cases and hospitalizations. Masks had only recently been held up as critical tools for protection. Health officials and the public at large weren’t yet exhausted by the pandemic, and hadn’t yet endured significant disease or loss of life.
Public health officials in every county were working around the clock that first year-plus of the pandemic. Some only ever went home to sleep, and rarely saw their families. A “light” day was getting home in time to tuck in children for bed.
Philip, whose children are 7 and 10 years old, said she missed most bedtimes and family meals for 18 months. To help her children understand her absence, she would talk about other mothers who were away for long stretches of time. “Some moms are on the International Space Station, and we are like a NASA family,” she told them. “Your mom’s in orbit for a little while.”
“My children understand the concept of helping people. And I’m in the best possible position to help the city,” Philip said.
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It was early December 2020 when Philip took the health officer assignment — an awful time. Cases were blowing up and public health officials said they never felt more powerless to control the spread of disease. Vaccinations arrived in the first week of December, but it was becoming apparent they’d come too late for many.
Even Cody, one of the leading health officers in the region and generally most restrictive in her orders, said she felt maddeningly ineffective that winter.
“From the start we’d been watching all of our numbers so carefully, and adjusting our policies. We’d been doing the best we could,” she said. “And then suddenly cases just started going straight up, and it felt like no matter what we did, we couldn’t protect people anymore.”
One night in December she found herself in the emergency operations center with the county executive, after everyone else had gone home. Cody began to sob, and then he did too, and they cried together for close to an hour. People were dying, Cody said, and they didn’t know how to save them.
“As health officer, I’m the registrar of births and deaths. My name is on every death certificate,” Cody said. “I always felt like, could we have prevented that death? Is there something we could have done and we didn’t do it?”
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Sitting on a bench outside his San Leandro office, a BART train humming overhead, Moss scrolled through photos on his phone for a recent shot of his 18-month-old son, born in the midst of the pandemic: The child has a cotton swab in hand and is gently sticking it up his dad’s nose. Moss insists the gesture was unprompted — his kid has had enough home COVID tests to know what he’s doing, never more so than during the most recent omicron-fueled surge.
As hard as the winter 2020-21 surge had been, the subsequent waves — delta last summer and fall, omicron early this year — were crushing too, if only because everyone, not least the health officers, had become so exhausted by the relentless uncertainty of the pandemic.
“When we first heard about omicron, that was very concerning, because it was really sweeping through other countries very quickly and we didn’t quite know the severity,” Moss said. “There’s always this fear that we have something that moves like omicron and puts many more people in the hospital.”
As this surge subsides and the Bay Area braces for the still-uncertain future, Moss, Cody and Philip said they’re also thinking beyond COVID, to the roles they and their successors may play not just in the next pandemic but in more familiar public health realms. They’re eager to step out of the limelight, but they don’t want to lose the public focus on equity and access to care and science — tenets of public health that were cornerstones of the COVID response.
“We’ll see if all people remember is that you made me wear a mask,” Philip said. “I hope not.”
Erin Allday is a San Francisco Chronicle staff writer. Email: eallday@sfchronicle.com Twitter: @erinallday
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