“You have to keep your eye on the ball”
State medical directors discuss lessons learned during pandemic response.
During the ACEP21 Colin C. Rorrie, Jr. Lecture, state health directors Anne Zink, MD, FACEP (Alaska) and Steven Stack, MD, MBA, FACEP (Kentucky) spoke candidly about the ongoing challenges they have faced as public health officials during the pandemic. Whether it was lack of infrastructure, public distrust, distracting politics or staffing crises, both EM physicians have learned, in the words of Dr. Stack, “how to be calm and keep your eye on the ball… And the ball, in this case, is how do we keep the most people safe from this disease as possible?”
Dr. Zink spoke first, setting the stage by detailing the unique aspects of life and health care in Alaska. The state spans a huge distance and is mostly traversed by plane and boat. Many families live in multigenerational homes, and most towns lack transportation and infrastructure. The average citizen has very limited access to health care. Historical context is also important when considering Alaska’s response to COVID-19 because back in 1918, the state was devastated by the flu pandemic to the point that it became known as “The Great Death.”
“[The 1918 pandemic] really changed everything for the state of Alaska,” Dr. Zink said. “Communities were devastated, languages were lost, cultures were lost.”
When COVID-19 hit her state, they knew they had to look at the lessons learned from 1918 to form their modern-day response. One thing they learned is that culturally, it is critically important to be inclusive of the 299 tribes in Alaska.
“When we were thinking about everything from testing to vaccines, we built in [tribal] input and structure from the beginning.” They worked side-by-side with the Alaska Native Tribal Health Consortium to execute a large-scale vaccine distribution that helped them get the vaccine out to rural areas as quickly as possible. She also emphasized the importance of working with non-traditional partners – tribes, schools – to coordinate public health efforts with the state, calling them the “most trusted voices in these communities.”
When Dr. Stack spoke about Kentucky’s response, he focused on process, mechanics and the unexpected tasks that were suddenly thrust upon state health departments at the onset of the pandemic. He said that being a state health director is “essentially running an emergency department for our entire state.” Kentucky is home to 120 counties, many of which are rural and hard to access. Much like Alaska, the variance within the state made it challenging to put together a one-size-fits-all plan. His team worked hard to pull people together and organize their activities in a structured way “so they can function despite the chaos.”
Dr. Stack described pandemic response as a similar mindset to working in the ED – being ready for anything that can come through the doors – just on a broader scale. “In the emergency department, the individual patient was my patient,” he said. “As a state health official, the community is my patient.”
Dr. Stack talked about the enormous challenge of rapidly growing Kentucky’s health care workforce and IT infrastructure to allow for contact tracing and better data collection. “It was a monumental effort, not unlike a startup company.” They were asking a government that normally moves “at a glacial pace” to move at light speed, and it felt like “a monumental effort, not unlike a startup company. Except I’m an emergency physician, not an entrepreneur.”
At the end, the presenters hosted a robust Q&A with the audience where they discussed several topics, including how to create stronger links between public health and emergency medicine moving forward.
“I think [it’s impossible to] over-communicate. You have to engage, engage, engage,” Dr. Stack said. “If you can find a way to sustain that engagement post-pandemic, I think that would be really helpful.”
Both Drs. Zink and Stack think emergency physicians are well-suited for these public health official roles because they are great at problem solving and looking at the big picture. They are buoyed by the increase in EM physicians who have taken on state-level roles during the pandemic and encourage other EM physicians to lean into the public health sphere.
“Every ER doc has a place of interest,” Dr. Zink said. “Find yours and lean into it. Find ways to connect it to public health. That’s a way we are going to transform health care.”
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