As pandemic widens, Oklahoma diminishes state epidemiologist role
08/09/2020 10:00 AM
Nurses on April 28 put hand sanitizer on their gloves before taking another nasal swab for COVID-19 testing at the Chickasaw Nation Purcell Health Clinic. WHITNEY BRYEN/OKLAHOMA WATCH
The new state epidemiologist who was to start work in August is Oklahoma’s third person in that role since the state’s response to COVID-19 started in March, raising concerns of inconsistent leadership as the role is diminished inside the Oklahoma State Department of Health.
In an Aug. 3 statement, the health department said Jared Taylor, an epidemiologist from Oklahoma State University, would be “serving as an epidemiology consultant for OSDH to ensure continuity of epidemiological support and expertise to public health stakeholders as agreements are finalized.”
Aaron Wendelboe, interim state epidemiologist, is returning to academic life at the University of Oklahoma’s Hudson College of Public Health. In May, Wendelboe notified health officials of his intent to leave by July 31.
In an interview with Oklahoma Watch last, Wendelboe said rising cases, hospitalizations and deaths meant the state’s infection curve has bent the wrong way and health officials need to win back the public’s trust. Many of the delays in testing and contact tracing stem from overburdened and outdated public health reporting systems.
“The key activities are still the same things: testing widely available, getting quick turnaround and then of course the case and contact investigation,” Wendelboe said on July 29. “We recognize there’s a delay that people aren’t getting notified in a timely manner, and we understand that’s not acceptable. I feel like I’ve been very transparent about those challenges and a lot of them go back to an outdated IT infrastructure where not a lot of things are automated. Also, we don’t have a very deep bench. The public health professionals we have are fantastic, but they’re exhausted and overworked. I think what we’re seeing is a symptom of underfunding public health for decades.”
Wendelboe was a contract employee, not a full-time state employee, at the agency. The OSDH paid the University of Oklahoma’s Health Sciences Center $13,260 per month for Wendelboe’s stint as interim state epidemiologist, according to his contract.
Wendelboe’s predecessor, Laurence Burnsed, was visible early in the state’s response to COVID-19, but health department leaders under former Interim Commissioner Gary Cox reassigned him to work with county health departments. Burnsed has since left the agency and now works at Mercy Health in Oklahoma City. He could not be reached for comment.
As the state epidemiologist, Burnsed was one of several deputy health commissioners. But the role of state epidemiologist is now far down the agency’s latest organization chart under Interim Health Commissioner Dr. Lance Frye, who took over in late May. The state epidemiologist position is now one of six departments reporting to Travis Kirkpatrick, deputy commissioner for prevention and preparedness.
Former State Epidemiologist Dr. Kristy Bradley said she’s disheartened by the diminished role of the state epidemiologist position amid Oklahoma’s response to COVID-19. Bradley retired from the health department in 2018 after 22 years. She was the state epidemiologist for 11 years.
“To my knowledge, there’s never been a state public health agency that has outsourced or contracted their state epidemiologist. It’s too critical of a role,” Bradley said. “Not only do you need a state epidemiologist, you need a very talented deputy state epidemiologist.”
Historically, the state epidemiologist would coordinate outbreak responses across health department programs, county health departments and partners like hospitals and emergency response agencies, she said.
During her tenure, Bradley led disease investigations ranging from Zika and SARS to Salmonella and E.coli. Those were more limited in scope than COVID-19, but she said the playbook remains much the same in responding to an outbreak. Bradley worked on the latest iteration of the state’s pandemic response plan in 2016.
“All the concepts of responding to an infectious disease threat are foundational. You use the same tenets or principles and just tailor them to the particular threat,” Bradley said. “It’s disheartening to see. It’s like nobody knew that we had been practicing and developing and fine-tuning that public health playbook in Oklahoma for years and years. Then everybody from the governor on down to Gary Cox, they just sort of kept it on the shelf and didn’t dust it off.”
Gov. Kevin Stitt instead formed an executive-level task force for the state’s coronavirus response. Much of the early public communications came from cabinet secretaries or the governor himself. The Oklahoma National Guard was given a key role in helping with logistical and administrative support. Frye, the state air surgeon, helped develop the state’s hospital surge plan and was involved with the state’s efforts to mitigate a COVID-19 hotspot in Guymon in May.
Wendelboe said his role was to give epidemiological advice, but with the knowledge that leaders have other considerations like the economy or disruptions to daily life to also take into account.
“There’s many decisions that are being made from different angles,” he said. “I think it’s hard for a state epidemiologist to sometimes know how to navigate some of the factors that are outside the straight epidemiological training. I’ve tried to be really respectful when people don’t take my advice. I understand that there’s other things that I’m not privy to.”
Wendelboe said public health agencies were the lead agencies in previous outbreaks he’s worked on. His background includes work on Ebola infections and with the Centers for Disease Control and Prevention in New Mexico.
“So I was working in a team of people who were comfortable in that role and had done it before,” Wendelboe said. “My understanding is with the previous pandemics, whether it’s Zika or pan-flu here in Oklahoma, I don’t think they rose to the attention that the governors wanted to be the incident commander. Obviously with the scope here affecting unemployment and stay-at-home orders, Gov. Stitt was effectively the incident commander and we needed to adjust from being a lead agency to being a support agency. That was a key difference.”
Nationally, state epidemiologists remain engaged but are exhausted, said Dr. Jeff Engel, senior advisor to the COVID-19 response with CSTE, a national association of state epidemiologists.
“I don’t think it’s burnout because I think they’re still very excited about the work,” Engel said. “But they know a lot needs to be done. And I think they’re really frustrated because of the collision of the science with politics and how many times they come up against the political decisions that’s against their better judgment from the science that’s available.”
Engel said epidemiologists aren’t typically political appointees and are usually insulated from personnel decisions higher up a public health agency’s hierarchy. It’s unusual for Oklahoma to be on its third state epidemiologist in the space of a few months. And it’s unusual for the position to be on a contract basis, he said.
Talented epidemiologists have options outside of public health, including academia, the pharmaceutical industry and more recently in healthcare as hospital systems respond to the COVID-19 pandemic, Engel said.
“If it becomes a revolving door, the good, qualified people are going to shy away from even applying,” he said of the challenges in hiring a full-time state epidemiologist.
Bradley said there’s an information vacuum when the state isn’t using its experts to communicate risks during an outbreak. As state epidemiologist, she would set aside several hours each day to brief the media or sit down for follow-up interviews. Briefings from public health officials in Oklahoma and Tulsa counties, as well as OU, have helped fill the gaps in the current response, she said.
“It’s weakening the state’s ability to respond to public health threats and to other public health needs by not having a knowledgeable, experienced, dedicated state epidemiologist,” Bradley said.
Health department spokesman Rob Crissinger said Wendelboe brought “exceptional infection disease expertise as the crisis unfolded.”
“As we transition in a long-term solution to lead our team of epidemiologists, we expect there will be more visibility among one of the Health Department’s top experts,” Crissinger said in an email.