COVID-19 stories from the front lines: The grueling pace of public health in a pandemic

COVID-19 first arrived on U.S. shores in January 2020 with the return of a Snohomish County, Washington, man who had traveled to Wuhan, China, and unwittingly brought back the deadly souvenir. Within weeks, the Seattle region had become the epicenter of the first COVID-19 outbreak in the U.S., and Jeffrey Duchin, MD, FIDSA, had the dubious honor of being right there where it all began.  

“We had the first U.S. outbreak and the first U.S. death attributed to COVID-19,” said Dr. Duchin. “In some ways, it’s not good to be first, but in other ways, we were lucky, because within a week we had 50 CDC assignees out here helping with the response as it was burning through our local long-term care facilities.”  

As chief of the Communicable Disease Epidemiology and Immunization Section for Public Health, Seattle and King County – and as the King County Health Officer – Dr. Duchin’s dual roles placed him at the center of the county’s pandemic response.   

Dr. Duchin is an ID hero, developing mitigation guidance and policies to reduce the pandemic’s impacts.  

“We were one of the first communities to recommend social distancing and teleworking, and then ultimately isolation and quarantine policies,” Dr. Duchin recalled. Additional responsibilities throughout the pandemic included educating and briefing elected officials and department leadership on the status of the outbreaks, liaising with the state health department and the CDC, vetting public health communications materials and seemingly non-stop press briefings.  

“It was quite stressful at the beginning. I’d been working 16 months straight without a break until just this past Memorial Day. We were doing weekly press briefings for what seemed like forever,” said Dr. Duchin. 

As vaccinations began to kick in along with a corresponding reduction in the numbers of new cases and hospitalizations, Dr. Duchin was able to get a bit more downtime. Still, he remains focused on the county’s immunization program, which faces the same challenges seen in immunization programs across the country.   

“Thankfully we are the most highly vaccinated county in the country relative to other counties of our size, but we still have gaps to fill, particularly among some of our ethnic and racial minority populations,” said Dr. Duchin. Like elsewhere across the U.S., King County’s immunization program is focused on the communities hit hardest by the pandemic, which are unfortunately the same communities that are most hesitant regarding vaccine uptake.    

Dr. Duchin brings a unique perspective to the pandemic’s many challenges, in part because he began his career as a physician working for the CDC’s Epidemic Intelligence Service (EIS) before training as an ID specialist. The result is a unique combination of both clinical ID and applied public health knowledge and experience. And, after being on the front lines of COVID-19, he believes the country needs more people like him.    

“One thing that is critically important is having people with a foot in both worlds – in clinical ID and in the public health system,” said Dr. Duchin. “It’s critical for our country and our communities.”   

Dr. Duchin believes that the knowledge and training in clinical infectious diseases and the type of applied, real-world training you get at the CDC’s EIS as a physician or post-doc are essential in producing the highest quality public health workforce to respond to ID emergencies.  

“I think they are complementary and both quite valuable in developing a cross-trained workforce that can best understand how to respond to an emerging ID pandemic – which includes not only treatment and diagnosis, but also collaboration with a wide variety of stakeholders around how to implement successful public health interventions,” said Dr. Duchin. “If we had a workforce with this skill set disseminated throughout the country – from small communities to big cities – and in leadership positions in health care and in government, I think we’d have a more informed workforce, more informed leadership and would have been more prepared in the first place for this type of situation.” 

An optimized workforce is just one of many things we need in order to be better prepared for the next global health emergency. “Pandemic preparedness has been an issue for a long time but in many ways, it has gotten a lot of lip service and not a lot of real attention – or resource allocations – from policymakers at the highest levels. We paid the price for that,” said Dr. Duchin.  

There is a lot to unpack as we reflect on the pandemic and plenty of work to be done. Meanwhile, Dr. Duchin’s hard work in King County, Washington, continues, thankfully at a less grueling pace.  

“The number of years I think I’ve aged during this pandemic I’m sure exceeds the chronological number of months that have passed. I’m not yet ready to pull the plug like so many of my colleagues, but I think that’s only because I was very fortunate to practice in a community where we’ve had great leadership,” said Dr. Duchin. “Our elected officials and our public health officials have been on the same page and supportive of one another, and our community in general is supportive of science and public health. That has certainly made my job a lot easier than those who’ve had to practice in communities where the political leadership and the public are hostile to their efforts.”  

Nonetheless, the level of stress and the long hours have taken a toll on Dr. Duchin and his entire team. “We are very grateful that our vaccines were developed so quickly and are so effective, because they really changed the course and tenor of the pandemic and allowed us all to have some time off,” said Dr. Duchin.     

“What I’ve experienced is typical of public health professionals and health care providers across the country who are on the front lines,” he added. “I think we’re all traumatized by the long hours and the intensity of the work. I’m sure we’re all looking forward to having some time to regain some balance and rejuvenate ourselves a bit before the next outbreak.” 

For more COVID-19 stories from the front lines, check out our latest annual report.