Frustration, Exhaustion Setting in as Overworked Health Department Struggles to Keep Up with COVID-19

Six months after the deadly novel coronavirus arrived in Montana, public health employees are working nearly around the clock, confirming test results, performing contact tracing, coordinating with the medical community, reporting data, managing schools and long-term care facilities, and doing everything else in their power to keep the people in their communities healthy.

The women and men who work at the Flathead City-County Health Department (FCCHD) have chosen their work in part because they are driven to save the community from something like COVID-19, and none of them believed stopping a pandemic in real time would be easy. Still, the hours are brutal and the work is taxing. Staffers from nearly every division have been wrapped into the department’s incident command response, and employees are working late into the night and through the weekends, days that last as long as 13 hours and weeks that consume as many as 80 hours.

The 26 people on Flathead County’s COVID-19 response team — nurses, contact tracers, administrative staff and even an EMT — spend their days on the frontlines. Case investigators work nonstop to inform members of the community that they have either contracted a potentially fatal disease or tell them they have to stay home, and away from work, for 14 days, two pieces of news no one is happy to get. And the team must endure tragedy up close, like the way the virus has ravaged Whitefish Care and Rehabilitation, claiming 11 lives as of this printing and sickening nearly the entire building.

According to interviews with multiple health department workers, people are tired. Their brains are fried. And they are scared. Winter is around the corner, and it will add the flu and other complicating illnesses to the mix. With case numbers rising rapidly in Flathead County since Sept. 12, right now is the worst the pandemic has been in their community, and as long as schools remain open and a not-insignificant number of people refuse to wear masks or avoid large gatherings, there are fears that the situation could get worse before it improves.

And then there are the phone calls.

Kerry Nuckles, Flathead County’s Deputy Health Officer since 2017, spends late nights and weekends scrambling to keep her community safe from the virus. In return, some have called her a Nazi, sent threatening and intimidating emails, and screamed at her for hours on end. And she is far from alone in that regard. Health department employees have been through the emotional ringer for six months — facing criticism for not policing businesses or sporting events, having people refuse to abide by quarantines, fielding panicked calls from the healthy but concerned “worried well,” among other things. But the final indignity is the worst: the sight of anti-mask protests outside their offices and the conspiracy-fueled defiance of public health mandates, claims that fly in the face of the science-based opinions of public health officials, have been one loud metaphorical slap in the face to Nuckles and her colleagues.

“When you’re working so many hours, it’s just one more stress on top of everything else,” Nuckles said. “When you show up at the health department, or when you show up at public meetings, refusing to put a mask on when requested, it’s demoralizing for the staff. Because I think they see how hard they’re working and (that’s) just one more indication that we live in a community that has other ideas.”

Health department staff members paint a grim picture of disheartening protests, angry phone calls, unsustainable hours and sharply rising cases, leaving them feeling overworked, underappreciated and exhausted, and now flagging behind mushrooming outbreaks that threaten to drive up the numbers of sick and dead.

For starters, the health department is losing good people. Three of the 10 public health nurses who were working on the pandemic in March have left and one more is on the way out. Nurses play a vital role in controlling the pandemic, Nuckles said, as the only members of the case investigation response who can offer medical assessments. The department has brought over staff from other divisions within the department and hired non-nurses to fill in some of the gaps, but the losses hurt.

“I would absolutely say stress has contributed to losing nursing staff,” Nuckles said. “I don’t think that it’s specific to this community, and I think the people that we have lost are wonderful people who are smart and work so hard, but they have spent the last six months working their butts off and they are tired.”

The department is hiring, but recruiting has been a major challenge. Nurses are in high demand everywhere and the department is limited in what it can offer for compensation. Interim Public Health Officer Tamalee St. James Robinson said she “could easily find work” for a staff twice as large as the current one.

Indeed, staffs in some other counties are more than twice as large as Flathead’s. According to Nuckles, the FCCHD had 26 people monitoring COVID-19 as of Sept. 18 broken up into four teams — case investigation, contact monitoring, schools and long-term care facilities. In Lewis and Clark County, an area with 34,000 fewer people, according to U.S. Census estimates, the department employs 30 contact tracers, nine members of a technical assistance team, nine people on a quarantine/isolation team and six more on a support team, for a total of 54 women and men dedicated to tracking the virus.

A smaller staff has, predictably, played a role in the FCCHD struggling to keep up with its duties, particularly since cases exploded beginning Sept. 12. According to county numbers, there were 210 new confirmed cases of COVID-19 here between Sept. 12 and 18, more than 21% of the county’s total since March. State and local officials said the county has struggled to keep its reporting data up to date, in part because it must focus first on its primary objective, notifying and isolating positive cases and conducting contact tracing. The lack of reporting has led to a conflicting understanding of the scope of the pandemic, with the Montana Department of Public Health and Human Services (DPHHS) reporting 11 new cases in Flathead County between Sept. 12 and 16, when the county’s internal number was 149. In fact, only once since July 15 has the county and state reported the same number of new cases.

“We’re not really used to live broadcasting a pandemic as it unfolds,” Jim Murphy, one of the DPHHS officials overseeing the pandemic response, said. “Like with any broadcast, you’re going to have some glitches, you’re going to have some outtakes. We’re refining those systems as we go.”

St. James Robinson chalked the recent spike in cases in Flathead County up to a “Labor Day bump,” resulting from people recreating and congregating over the long weekend. School re-openings have played a role, too, as more and more students and teachers are testing positive and being placed into quarantine throughout the valley. On Sept. 21, the entire third grade class at Muldown Elementary School in Whitefish was placed into two-week quarantine after three individuals at that school tested positive for COVID-19.

Regardless of what is causing the spike, or whether or not numbers are being reliably disseminated, the surge has now impacted the county’s ability to track viral spread. With its current staff, days where two-dozen or more new cases are investigated, like nearly every day for the last 10, are a major strain. Each case requires an in-depth investigation of that person’s activities and interactions for the prior several days, and then extends to the dozens of people the infected subject may have contacted. Those people must then be tracked down, notified and quarantined. In a perfect world, all of that would happen on the same day.

In practice, especially in the last week, the department has tried to complete case investigations the following day. Then there are days like Sunday, Sept. 20, when the county reported at least 50 new cases — the largest single-day total thus far — and the goal was to reach everyone within two days. And the struggles at some overburdened labs to get tests processed are throwing another hurdle in the way.

“Between testing delays and case investigation delays, we’re not catching people fast enough to get them quarantined or isolated to stop the spread,” Nuckles said.

Nuckles, though, is not about to stop trying, nor are the coworkers she has spent endless hours with during an unprecedented spring, summer and fall. In conversations with the Beacon, Nuckles and St. James Robinson stressed repeatedly how appreciative they are of their staff’s effort, how understanding they were of those who have had to move on from the department, and how thankful they were to at least have their team as they struggle to understand the community around them.

“The way I get through my day is because my co-workers are there to support me,” Nuckles said. “It is a place where I love working and I know, 100%, that people here are working so incredibly hard. I am so proud of the amazing work that comes out of this place. We have rock stars on the staff here.”