On a typical morning in the age of COVID-19, Liane Jollon, executive director of San Juan Basin Public Health, puts on professional clothes and slippers before sitting down at her computer to lead the region’s response to the coronavirus outbreak from her home.
But as communities begin to reopen, Jollon returned to a makeshift emergency response room at the SJBPH office in Durango, where she offered community members a behind-the-scenes look at the fight against the virus.
Communities need testing, people need to understand how to safely live daily life and businesses need instructions about how to reopen. Jollon is at the center of those decisions, coordinating with the SJBPH incident response team and communicating with more than 100 local, state and national groups.
“She’s the public health director for two counties and four municipalities during a global pandemic,” said Chuck Stevens, La Plata County manager. “I don’t know how you put an order of magnitude on the role that she’s playing.”
As of Tuesday, the United States had 1.38 million positive cases, with 81,779 deaths. Colorado, with more than 20,000 cases, ranked 17th in the nation for the size of its outbreak. La Plata County had 67 cases and one death; Archuleta, eight cases.
“The toll this has taken on everybody is horrific, but we can’t stop doing it because we’re tired of it,” Jollon said. “We have to have enough structure built around it. I think that’s got to be disease containment. And I don’t think we have enough.”
Unlike other emergencies, like a wildfire, people cannot see the danger. The public generally does not see people being tested with nasal swabs, contact tracing to identify who might be infected, residents lying sick in quarantine or patients fighting for life in hospital beds.
Members of the incident response team rarely interact face-to-face with each other, but instead use videoconferencing platforms.
Between those virtual meetings, Jollon on May 5 explained how the emergency response works.
In the makeshift incident response room, which was abandoned in the wake of social distancing, Jollon set up her computer for the daily situation report meeting. In early March, the team used the room for two weeks before moving to remote work. Their notes were still scrawled on whiteboards and posters on the walls.
On busy days, Jollon is booked with meetings for the entire day. She starts at 6:30 a.m. and works in the middle of the night and on weekends. Her team follows suit: Their work days last up to 15 hours. Days feel like weeks; weeks, like months.
During the meeting, about 18 team members joined a conference call to present health care data, regional outbreaks and the latest news. An asymptomatic patient tested positive for COVID-19 while at a local hospital for another reason – a worrying example of the virus’ invisible spread, Jollon said. Are people following the face covering advisory? Should another mandatory order be issued? How would that work?
A mandatory mask order might seem simpler than complex guidelines and could send a stronger message to the community. But enforcement and requiring masks quickly becomes complicated, Jollon said. People could resent the order if they don’t see results quickly – which could erode SJBPH’s credibility.
La Plata County businesses will require face coverings for employees when they reopen, per the state’s safer-at-home order. Colorado is not yet requiring face masks for customers. SJBPH is focused on encouraging voluntary community compliance and distributing masks.
“We’re in a time period where we want people to embrace recommendations because it literally saves lives,” Jollon said after the meeting.
Jollon had a four-minute pause between one meeting and the next.
Each meeting serves a different function in the public health response. Some focus on identifying challenges or assigning tasks. Others are with medical providers or more than 100 stakeholders.
At 9 a.m., the team focused on a concerning trend: There was too much antibody testing, which indicates past exposure, and not enough diagnostic testing, which indicates current infection.
People have been enthusiastic about antibody testing offered through Cedar Diagnostics, a private laboratory in Durango. But the laboratory was booked for weeks with only one diagnostic testing slot each hour, the team said. Diagnostic testing rates were staying about the same or possibly decreasing.
Diagnostic testing is fundamental to containing the virus. The lack of it is like “fighting a communicable disease with blindfolds on. Sometimes we say with blindfolds on in the dark,” Jollon said.
The team discussed the issue for about 10 minutes before someone came up with a tool to solve it. Then, they were planning asymptomatic monitoring for workplaces through Cedar Diagnostics. By the next day, SJBPH had released a new arrangement with Mercy Regional Medical Center at Horse Gulch to provide diagnostic testing six days a week.
“Everyone thinks the finish line is a vaccine,” Jollon said. “If the rest of us are working toward diagnostic testing and surveillance, we can protect people until we have a vaccine.”
In the public health emergency response, Jollon plays the role of quarterback, coach, professor and general manager – delegating tasks, prioritizing goals and helping the team stay on task.
“I don’t think that I ever expected to be leading a local organization in a global pandemic,” Jollon said. “I’m so thankful to be doing it in this community where there is so much support and with this team.”
As incident commander, Jollon’s role is to lead SJBPH as it works to control the spread of the coronavirus. But disease control is different than managing the consequences of the outbreak on the medical system or the economy. SJBPH collaborates with and advises partners on those decisions.
“What I’m doing is scanning the horizon and learning where the potential successes and potential weaknesses are going to be in how we respond, then ... taking the pieces and moving them toward the target,” Jollon said. Her computer dinged indicating a new email. She would have about 55 unread messages by the end of the hour.
Jollon’s top priority is communicating the complexities of disease control to a public worried for its health and economy.
But even facets of the response that everyone can agree on, like the need for testing, quickly become complicated, Stevens said.
“Liane just seems to have this ability to cut through the clutter of a complex issue and break it down,” he said. “That is something that our entire community is benefiting from right now.”
Jollon is most concerned about credibility. Public health has to be transparent to be trusted, she said. But transparency related to releasing data has been a challenge.
For example, community members pushed for more outbreak and health care capacity data, like how many hospital beds are open and ventilators were available. Mercy Regional Medical Center gathered the data but repeatedly denied requests to release it. SJBPH had some data from Mercy but couldn’t verify it. SJBPH also had no control over how it was released to the public, Jollon said.
Mercy agreed to begin releasing data directly to the health department last week. (Jollon pointed out that Mercy helped with other data behind the scenes, such as regional health care modeling.)
The disease management is even more complicated because of its economic impacts.
Public health teams manage diseases every day without having to shut down businesses, Jollon said. But because the coronavirus was out of control, businesses had to close to give public health time to build its containment resources, such as testing and contact tracing.
In La Plata County, businesses have been “very patient,” said Jack Llewellyn, executive director of the Durango Chamber of Commerce. But they are nervous, even afraid. If they don’t get back to business as usual soon, they might not make it. At the same time, they want to implement guidelines to keep community members and employees safe, and they need time to adapt to new guidelines that SJBPH’s Safer La Plata order provided.
“(Jollon) is in a very tough situation. You’re having to juggle the safety of a community and health of a business and having to find that balance,” Llewellyn said.
With testing available, it’s easier to track the virus and safer for businesses to open. No matter what, some say the team’s approach is too heavy-handed, too fast or too slow.
Community members should be asking if the response is confused or should be moving faster, Jollon said.
“There’s nothing we’ve ever done as an organization or as a community in our lifetimes that is as consequential,” she said.
Amid the pressure, Jollon focuses on controlling the spread of the coronavirus and the lives that will be saved if the outbreak remains slow and small.
“She’s very proud to be part of the public health tradition in our country,” said Brian Devine, planning and logistics section chief (or in normal times, the SJBPH environmental health director). “She honestly really believes in it.”
Jollon says she entered public health to do something that mattered, and for her that involved health.
“What else does a person have but your health and your family?” she said.
smullane@durangoherald.com
