Local Boards of Health role in responding to COVID-19

I’ve spent the past four months like many of you holed up mostly at home. Rather than catching up on my reading and learning new hobbies I’ve had the opportunity to view and participate directly in the Massachusetts response to the COVID-19 epidemic. The Massachusetts Department of Public Health called me out of my semi-retirement to work full time for its Office of Local and Regional Health to assist the 351 Local Boards of Health across the state in responding to the pandemic. The overall effort has “flattened the curve” and we are in the midst of a gradual and deliberate process of reopening the Massachusetts economy.

Local Boards of Health have been responsible for enforcing the ever-evolving emergency orders, guidelines, and advisories that the governor and his administration have issued since the first stay-at-home order came down in March. From late March and through the month of April they monitored compliance with the stay-at-home orders and ensured that the essential businesses that stayed open did so safely. Since then they have overseen the gradual ongoing reopening, as a series of businesses and organizations have cautiously reopened their doors.

Many of the restrictions and limitations on local businesses and residents are unpopular and not supported by everyone. Local health staff have often been placed in uncomfortable and in some instances dangerous situations when confronted by business owners that want to open, residents who chafe at requirements for face coverings and social distancing, and local elected and appointed officials who disagree with some aspect of the orders and actively pressure local staff to act in violation of the state requirements. They’ve spent the past four months answering a never ending series of question like these:

When can my business open? I’m selling these masks I made, doesn’t that make me essential?

Why do I have to wear a mask to come here, I’m a free citizen?!

If everybody promises to stay socially distant can we have an outdoor concert for a few hundred people in the park?

I went by the grocery store and saw long lines of people who were standing close together without masks. What are you going to do about it?

It’s been a huge challenge for local health officials to answer these questions and enforce the rules, especially recently, as the reopening has caused so many changes to the orders and rules.

You may have read about the gym owner in central Massachusetts who opened early and refused to close despite many warnings and thousands of dollars in fines. The town finally had to turn off all the utilities to his building to force him shut.

A much scarier incident took place around the same time in Western Massachusetts when a local health agent and her family were harassed and threatened because she was doing her job.

As each new business and activity is allowed to open there is often a complicated list of do’s and don’ts and other guidance and instructions laying out how it can happen. Some business owners want to do it right and call in their local health agent to guide them through the process. Others business owners, anxious to reopen, have deliberately or not cut corners and not followed the guidance. Just a few of the challenges:

Some of the COVID-19 related restrictions enforced by LBOH, fall outside their everyday areas of concern and involvement. Local health agents play no regular role in overseeing gyms, museums, music venues, hardware and clothing stores, and so many more businesses that were closed and gradually opened up in recent weeks. This has created some uncertainty about enforcement procedures such as how to cite violators. LBOH have expressed frustration that they receive no formal legal advice from the state.

One specific complaint heard often is that state officials frequently express their public support for the heroic work of the clinical health staff response to the pandemic while their hard work is ignored and rarely mentioned in remarks by the Governor and other state officials. In recent days Secretary of Health and Human Services and other officials have tried to rectify that by making strong statements of support and appreciation. Dr. Fauci, the federal government’s leading infectious disease expert recently said that Massachusetts was doing a “really really good job” in managing the reopening.

We should acknowledge the outstanding efforts of the resource challenged local health departments in responding to the health crisis of our lifetime. As I write this Massachusetts is one of only ten states that has slowed the spread of the virus and continues to see a decline is new cases and deaths. Local health departments played a big role in making that happen.

Michael Coughlin is a member of Greater Fall River Partners for a Healthier Community