Public health workers say pandemic takes toll
SHEBOYGAN – On a particularly bad day this summer, Starrlene Grossman and Libby Jacobs commiserated before heading home from working at the Health and Human Services building, the heaviness of the day weighing on them.
It was the day after the state’s safer-at-home order was repealed. That meant the state-level framework they’d been leaning on was suddenly gone.
As health officer and lead health strategist, respectively, it was their job to come up with a plan to guide Sheboygan County through the pandemic.
It was dark outside — they’d started around 5:45 that morning and spent the day pulling from the limited research available to put Sheboygan’s next steps together.
Jacobs suggested taking some deep breaths.
Together, they decided the next day was going to be better.
When Grossman came in that next day, Jacobs played what she called their “happy songs”: “Just Like Heaven” by The Cure and “Come on Eileen” by Dexys Midnight Runners. They even danced before getting down to work at 6 a.m.
Local health departments have been thrust into the spotlight during the pandemic, making key decisions for their communities, even when there has been little or nothing to go off of from the state and federal government. At the same time, they’ve faced rhetoric that questions precautions against COVID-19, like wearing a mask.
About a dozen Wisconsin health leaders and more than 180 nationwide have left their jobs during the pandemic.
Asked how they keep going, Jacobs said: “It really is the only option.”
Sheboygan County’s Division of Public Health team releases daily updates on the county’s numbers, testing availability, changes in guidelines and current recommendations while doing contact tracing and working with organizations that need help or are seeking guidance on how to be safe.
The whole effort is coordinated by a team of people that has grown from 27 to 48 during the pandemic, working in the Health and Human Services building or from home.
While the team tackled problem after problem, it watched as community members became ill and, with increasing regularity, died from COVID-19. And as the virus raged on, the team had to reckon with misinformation and angry community members who accused them of trying to spread fear and control their lives.
Still, Public Health’s goal is unchanged: prevent, promote, protect.
“Some days, the emotional toll of this job is close to unbearable,” Jacobs said. “And then other days, it feels like the clouds part again and you put your armor back on and you are ready on the frontlines.”
EARLY DAYS
Normally, Public Health is “the silent worker bee within the community,” said Jacobs, who is the division’s public information officer in addition to being its lead health strategist. Public Health touches everything from preventing STDs to ensuring the steak you eat at a restaurant has been stored at a proper temperature.
When they are doing their jobs, nothing happens.
But the pandemic has changed that.
When they announced the county’s first cases March 13, “It just felt like it exploded,” said Clinical Services Supervisor Amanda Strojinc. Suddenly, Public Health was being pulled into every community conversation.
Strojinc remembers “blissfully and naively” thinking it would be under control by the fall.
“We had no idea what was coming,” she said.
They look back at when the county saw its first cases with the same distorted lens that has made time feel like it’s passing slowly and quickly simultaneously. The pandemic feels more like it’s been going on for two years, Strojinc said.
Since Public Health actively plans for emergencies year-round, they leaned on their pandemic plan to move into an emergency chain of command. That helped them determine how to funnel calls to the right people, create standing meetings and set up a panel made up of people from different sectors, which still meets regularly.
Their role as the “silent worker bee” proved beneficial. The relationships they’d already established meant they weren’t reaching out to anyone for the first time. And they had experience with outbreaks before, like the outbreak of multidrug-resistant tuberculosis in 2013.
Originally from Texas, Grossman, 33, was hired as a public health nurse to do case management during that 2013 outbreak.
She had attended UW-Green Bay, then Lakeshore Technical College, and returned to UW-Green Bay to complete her nursing degree. She set her sights on public health while working as a nurse in pediatrics, women’s health and acute care. She was frustrated by what she saw: a lack of support for families impacted by poverty, social isolation and limited resources. In public health, she’d be able to implement community-level solutions.
Before becoming health officer, Grossman worked in a couple different roles in the division, supervising communicable diseases and working on community engagement. She was promoted to health officer in March, right as the pandemic was starting. She doesn’t know yet what her job will look like when it subsides.
Asked what the hardest day has been so far, Grossman said for her it was that day the safer-at-home order was repealed in mid-May, when Grossman and Jacobs set to work on what would become Sheboygan’s Safe Restart plan.
Grossman worked a 14-hour day that day, put her 2-year-old daughter to bed, then continued to work well into the early morning, researching what other communities’ best practices were, what studies were showing, and how that information could be used to develop tools for the Sheboygan community. She and Jacobs worked similarly long hours for three days until the plan was ready.
KEEPING UP
Strojinc and her now-husband had to think quickly during the April shutdown. Plans to get married at the Mitchell Park Domes in Milwaukee turned into getting married in their backyard instead. They celebrated with a bonfire and cake and coffee outside with a few family members.
The day after her wedding, Strojinc went to Sunny Ridge Nursing and Rehabilitation Center early in the morning to help combat Sheboygan County’s first major COVID-19 outbreak.
It was the first time the National Guard came to the county to help during the pandemic, and it accounted for the county’s first two COVID-19 deaths.
After bringing her co-workers breakfast, Strojinc, 37, put on a full-body Tyvek suit and collected samples to be tested.
“We were at a really critical point,” she said.
As cases increased in the county, so did the pressure on Public Health.
Employees worked long days during the week and then into the weekends. There have been periods where Grossman has worked over 70 hours a week for several weeks in a row.
They do their best to honor requests for time off and encourage work-life balance, though. From the beginning, the message to everyone in Public Health was, “This is a marathon, not a sprint,” Grossman said.
Everyone on the team plays a part in the response to COVID-19, whether that’s through data entry, contact tracing or various aspects of controlling outbreaks.
The hiring process to bring on more staff members, like the 12 new contact tracers they now have, is a lengthy one. When you’re in a surge, you know you need more people, but hiring and training take time, Grossman said. It’s also hard to know how many people to bring on, she said.
Sheboygan County’s number of daily new cases didn’t start to reach double digits regularly until July. In the fall, the numbers started to climb faster. About a third of the county’s cases have been confirmed in the past month, and two-thirds of the county’s deaths have come since Nov. 1. As of Wednesday, nearly one in 10 county residents had tested positive, and 83 had died.
Even bringing on 12 contact tracers, the surge in cases has impacted how long they can interview people who test positive. In the beginning, interviews lasted around 90 minutes. Now, they only have time for about 30 minutes.
Up until the summer, Public Health was able to assign a case manager to each person who tested positive. They would make daily calls to monitor their condition and check in throughout their infectious period to see how they were feeling and if any other members of the household developed symptoms.
Now, because of the high volume of cases, they prioritize managing cases of people who are in high-risk settings. People who are fairly healthy or managing the virus well don’t get the follow-up. Public Health also no longer has the bandwidth to reach out to each infected person’s close contacts.
Even so, Grossman said, the team is making a difference.
Contact tracers have even been on calls where they’ve said ” ‘You sound like you’re in respiratory distress. We’re going to need to call 911,’ ” she said. And those people have ended up in the hospital for treatment.
‘WE HEAR YOU’
The politicization of the pandemic has added to the challenge, said Jean Beinemann, 64, who retired in 2016, but came back for six months to help with the pandemic response.
Local officials have been supportive, but elected officials at the state and federal level aren’t on the same page, something “that really impacts the work of a local public health worker,” Beinemann said.
Raised on a farm in Random Lake, Beinemann’s background is in nursing, followed by two-and-a-half decades in public health, during which she saw outbreaks of other diseases, like TB and Legionnaire’s.
“We pulled together as a community,” Beinemann said of previous outbreaks. “That’s what we really need now.”
But Sheboygan County saw its own backlash in August, when protesters gathered outside the courthouse and some held signs indicating the pandemic was a staged crisis while they called for freedom in making decisions about their health.
The protest took place before a County Board meeting during which a proposed ordinance was under review that would have created civil fines for violations of orders issued by the county’s health officer, Grossman.
The ordinance was ultimately shelved. It was contributing too much to the community’s angst, County Administrator Adam Payne said at a later meeting.
A pandemic in the age of the internet means there is more information for Public Health to digest, but that information is also available to the public. And with that influx of information comes misinformation, something Beinemann said is different than anything she saw during her career.
In interviews with the Sheboygan Press, Public Health employees emphasized how much research goes into their work.
“We don’t make these decisions in a vacuum,” Strojinc said.
While there may not be a decade’s worth of studies to pull from, Grossman said, they rely on the Wisconsin Department of Health Services or the Centers for Disease Control and Prevention. They stay up to date on published research from Harvard and Johns Hopkins, and they even look to other communities that experienced surges first.
People have lashed out at the Public Health team, expressing anger and frustration, Grossman said, but “I just try and remind myself that everyone’s going through a hard time right now.”
And they’ve also received just as many positive messages.
They understand some people are frustrated, angry and scared, Jacobs said. To those people, she said: “We hear you.”
HOPE LIES AHEAD
Morale has ebbed and flowed, Grossman said, but she’ll always remember how their team pulled together and supported each other.
On top of leading the community’s response to the virus, Public Health’s staff has been faced with the same decisions about their own health as the rest of the community: whether to cancel plans, whether to do curbside pickup or sit outside at a restaurant, whether to see people while wearing masks.
“Everyone’s in that boat. Everyone’s trying to make hard decisions,” Grossman said. “I think all of that kind of tells the more complicated story of what it’s like to be human during a pandemic.”
Members of the Public Health team have all at one point or another known people or had family members that have had COVID-19 or had to quarantine, Jacobs said.
“We don’t have any insider information, and we’re not immune,” she added.
Like Grossman, Jacobs’ first work with the division was during the 2013 TB outbreak, when Jacobs was an intern and awed by the epidemiological analysis done by the state and CDC. She remembers going out for fish with her family — “in Sheboyganite fashion” — and telling her dad she wanted to work in public health for the rest of her life.
After graduating from UW-La Crosse, Jacobs joined Public Health permanently, excited that in a single day, she might work on suicide prevention, STDs and child welfare.
But like everyone else on the Public Health team, Jacobs is looking forward to life after the pandemic.
Jacobs and Grossman each have a young child, something that presents its own challenges and takes its own emotional toll.
When Jacobs’ 4-year-old son was a close contact of someone who tested positive, she worked from home for 14 days while he quarantined.
Jacobs, a single parent, said one of the hardest things to contend with during the pandemic has been lost time with him, especially when the job can often feel thankless.
Beinemann is eager to continue to travel in her retirement.
When her father died this summer, her brother, who lives in Canada, couldn’t come home for a funeral. They want to celebrate his life.
Sheboygan County Clinical Services Supervisor Amanda Strojinc, center, works on correspondence while Health Officer Starrlene Grossman, left, and Lead Health Strategist Libby Jacobs, right, work socially distanced from each other in the main conference room at Sheboygan County Health and Human Services on Wednesday, Dec. 16.
Strojinc will have more time to dedicate to Hopefully Homesteading, an LLC she started before the pandemic. Strojinc teaches classes on things like beekeeping and home food preservation and supplies a couple local retailers with food products. Some of the proceeds go to local food pantries.
Grossman and Jacobs are both avid concert-goers. They’re longing to hear live music again.
At future concerts, Jacobs joked: “I will never complain about the price of a PBR again.”
There is hope on the horizon, as tens of thousands of doses of a vaccine are distributed to health care workers throughout Wisconsin, and widespread distribution is expected in 2021.
But until then, people all over the world, the country and Sheboygan County are still grappling with the virus — and dying from it.
For Public Health, the long days aren’t over yet, and they won’t forget the stories of those who lost their lives any time soon.
“You carry it with you,” Jacobs said. “It’s our job in public health to make sure that that doesn’t happen and it’s happening.”
Contact her at 920-242-7079 or [email protected]; follow her on Twitter at @domdomdiana.