April 20, 2020

Paducah Mayor Harless, a Public Health Professional, on COVID-19

One Mayor’s Reflections
City of Paducah, Kentucky, Mayor Brandi Harless has a professional background in public health and has worked around the world studying and addressing crises. Now, the crisis has come to us all.

I’ve sat down to write this post about 20 times in the last two weeks. I’ve either been interrupted by a video conference call or an immediate need of someone in my community. I’ll bet, if you are a mayor or hold any other leadership role right now, you know what I’m experiencing. The time to sit back and think through what is going on is limited. As in any crisis, we are all in action mode.

I’ve finally found a few moments in the mornings to jot down my thoughts and share some thoughts with you.

When I finished graduate school at the Boston University (BU) School of Public Health back in 2008, I never would have imagined that I would be serving as the mayor of my hometown during the largest public health pandemic of our lifetime. However, I am thankful that I feel prepared for this moment from my professional and educational training. And yet, that doesn’t disqualify me from the natural human experience of being both worried and confident at the same time. On a daily basis, the thoughts pass through my mind of “Am I doing enough?” or “Am I doing the right things?” I keep reminding myself, go back to your training. Go back to what you know.

I’m not sure how many elected leaders in Kentucky have a public health background. And I in no way believe it is critical to anyone’s ability to lead through this pandemic. All experiences have value right now. These experiences brought us to run for office in the first place. We all share empathy and compassion for our communities, or we would not have become public servants.

But in case you are looking for some public health guidance during this very difficult time, I’d like to offer it from the perspective of a public health professional, who also happens to be a Kentucky mayor.

I’m not going to spend the words writing about the problem here. I think we all fully understand that we are living in the midst of a pandemic where a very contagious virus is spreading across the world. Our country is in crisis. I think by now, especially in Kentucky, we all realize that the most important thing we can do is the hardest thing: pulling back our economy to a bare minimum and begging our citizens to stay home.

By now, I’m sure you are also aware of why social distancing and sanitation are such important public health weapons against this virus. I want to share a few other thoughts and actions that may not have made it to your radar as frequently.

Public Health
1. The importance of the denominator - This might take you back to grade school when you were learning fractions. The denominator in this crisis is a very important part of the equation. With all of the charts and virtual graphics being tossed around in the media, it is important to understand how to put that data in context. The bottom part of the fraction (the denominator) accounts for the population level capture of the situation. When it comes to death rates, infection rates, and other data points, the denominator matters. And the hard part about this is, many denominators cannot be determined without widespread testing. That is, if everyone in the population were tested, we would know the number of positives versus negatives, and we could better determine the true reach and impact of this virus. In other words, be careful which numbers you toss around. The denominator matters.

“There are a lot of measures related to virus epidemiology, but the most fundamental are simple rates that most everyday folks use to assess personal risk. The crude or naïve ratio of how many bad outcomes divided by how many people are affected. It’s that fraction that can often drive both social policy and personal decision making. Like all ratios, it involves a numerator and a denominator, and while most public health surveillance focuses on the numerator, it is the denominator that may yield more valuable insight.” https://jphmpdirect.com/2020/03/13/the-covid-denominator/

Following and assisting the local healthcare community in getting testing up and running is a critical role to play as a local leader. I’ve taken the approach to offer my help and keep in touch with hospital CEOs and any physicians that are leading efforts to increase testing. At this point, the only real action I’ve been able to take is staying in touch and ensuring them I am here to help. I wrote a letter to our health care workers also thanking them for their service during this time and committing that we would play our role in ensuring our community is practicing social distancing and abiding by the governor’s orders. We distributed this letter through our hospital CEOs.

2. The importance of Contact Tracing - You’ve probably heard about this from your local health department. This is the practice of interviewing COVID-19 positive cases and finding out who they may have exposed over the days prior to their positive test (typically 14 days for COVID-19). This takes a lot of time and human resources to complete, especially when there are multiple cases at once. Each person who is identified to have been in contact with the positive case is assigned a low, medium or high risk for COVID-19. Each risk level is given different guidance. Consult with your local health department to learn more about how they are conducting these interviews and assigning risk.

This practice is critical to public health monitoring and surveillance of COVID-19. It is crucial that we maintain contact tracing as the case load grows. In some counties, this will take additional resources and creative approaches to finding people who can help with the interviews. In Paducah, I’ve offered to provide support from our police detectives should the time come that we need more capacity. They are trained in interviewing skills and could help add capacity to the health department if the number of cases became too high for them to trace on their own.

3. The importance of focusing on a different vulnerable population - The term “vulnerable populations” has been used during this crisis to describe those who are most at-risk of serious complications from COVID-19. They have been identified as the elderly and those with underlying chronic conditions. Another group to consider as “vulnerable” are those who may lose access to the very services that keep their life going daily. Those who seek food assistance from local food banks, who rely on services to help pay for things like utility bills and rent. Those who even without this situation struggle.

Access to Information 
We launched a local hotline to provide a central call point for anyone who needed to know about resources in the community. We equipped our City Hall team with the local resource guide published by the United Way, and they have become the one-stop place for citizens to call and get information. This also allowed us to track the concerns and questions citizens. Between March 24-April 3, here’s what that data looked like for Paducah.

“Reports” means people reporting other businesses or locations where social distancing or other orders are not being followed.

“Gov. Order Questions” are questions relating to how the governor’s orders affect them or their business.

We have launched a landing page with the goal of connecting residents to remote work through a partnership with Flex Jobs. The website paducahremoteworkers.com provides those interested in remote working opportunities with information about resume writing, remote job opportunities, in-demand skills for remote jobs, and a virtual job fair. Our local library has sponsored 75 monthly memberships to flexjobs.com.

Remote working is a growing trend across the United States and the world, and like many others, people in Paducah are without work or have seen a significant reduction in their wages in recent weeks. Because we live in a global economy with advanced communication technology, remote work can be a good option for those looking for employment during this time.

The launch of this website is a partnership among the City of Paducah, Paducah Area Chamber of Commerce, Paducah/McCracken County NAACP, West Kentucky Community & Technical College, and West Kentucky Workforce Board.

Food Pantry Deliveries
In Paducah, we’ve started with a focus on food. I’ve been in daily communication with our Community Impact Manager at the local United Way. She was able to keep in touch with our local food pantries. Upon our public transit closing due to safety concerns, the need for deliveries for our food pantries was imminent. We utilized the extra time and capacity of our public works team to work out a partnership with our three local food pantries to help with deliveries.

TRAIN YOUR DRIVERS! This was the most important lesson we learned in our efforts to help with deliveries. Initially, we had two departments send staff to help the food pantries. We quickly realized that we had not given enough guidance to make sure they felt safe. I then took over the training and showed up to meet the team myself. I ensured them that their safety mattered most to us and at any time they didn’t feel safe, they should feel empowered to turn down that specific delivery and return the food to the pantry. I provided them with homemade masks that a friend of mine created and I gave them my personal cell number to call if they became concerned for their safety. We also provided written guidelines on how to safely deliver the food to recipients.

Necessities Grants
Along with the local United Way executive director, I facilitated a call between the three main service agencies – Family Service Society, Paducah Cooperative Ministries and the local Salvation Army – to discuss the centralization of an individual fund to support those impacted by COVID-19. Over the course of a few Zoom meetings, we came up with the Necessities Grant that will provide either $250 or $500 gift cards (depending on household size) to those who demonstrate a need. The fund is small to start, but we felt like something was better than nothing and we are hopeful that our community will step up and contribute more funds over time. For your reference: https://www.unitedwaypaducah.org/necessitiesgrant

One of the greatest public health professors in the industry was Dr. Bill Bicknell. I had the privilege of having him as a professor. Unfortunately, he has since passed away. Several of my colleagues have written about him over the years and even more recently in the wake of COVID-19. Dr. Bicknell was the former Massachusetts commissioner for public health. He had a long successful career both in the U.S. and abroad helping to improve health systems.

My colleagues write:  “He reminded those of us working in health, “It’s vital to remember; we’re in the service business, whether we’re making policy or suturing a wound. We’re serving people who need help and are hurting. And respect. And the person who’s not at the table.”

“The Melon Lady” was his own anecdotal example for remembering the person who is not at the table. Kate Mitchell, a friend from my days at Boston University School of Public Health, writes:

A story Bill often recalled from his time as commissioner of public health for the Commonwealth of Massachusetts.

Bill was new on the job and working long hours. One evening as he was leaving the office, he noticed several perfectly good melons in the dumpster in the parking lot. Bill walked over, examined the melons and, after a healthy diagnosis, decided to bring them home to his kids. After a few more evenings of snatching free melons from the dumpster, a janitor approached Bill. He said, “Commissioner, you may not know this, but there are women who rely on this dumpster. They come here every evening looking for food.”

Every time I heard Bill tell this story, he concluded by opening his eyes, looking out across the auditorium, and declaring, “Let the melon lady be your guide.”

Another professor might have simply pointed out that, as global health and development decision makers, we have a moral obligation to consider the person not at the table — and to think critically about the far-reaching implications of our actions.

Leave it to Bicknell to hammer home the point with the story of the melon lady.   And the janitor.”

I apply this same philosophy to my role as mayor, and I constantly ask myself “Who isn’t at the table?” “How can I make sure I’m thinking about that person in my decision making?”

During this time, we will be making decision after decision about how to keep our communities safe. Thankfully, our governor has taken some of that burden from us and has been proactive in establishing executive orders for us to follow and rely on.

When I’m feeling overwhelmed, I remind myself of the role I believe we mayors and other leaders can play best during a time like this. We are facilitators and conveners. Our positions provide a unique opportunity to help get people in the room who may not otherwise be in the room together.

Early on in this crisis, I worked with emergency management to pull together leaders from the local school systems, hospitals, health department, emergency medical services, county and city first responders, and the judge/executive to hold a press conference. This has become a weekly occurrence. Every Friday at 2:00 p.m., the judge/executive, health department director and emergency management director gather safely in the Emergency Complex to hold a press conference. Other stakeholders like the hospitals CEOs or Chief Medical Officers join by Zoom and provide their updates virtually. We share a lot of information at one time, but it is important for our community to know we have not let up. We all continue to play our part day in and day out.

Being a local elected official is challenging at the best of times, but it’s also a great privilege. These times require us leaders to be our strongest and most focused. We must apply common sense, think about every decision, and do what must be done. But there is a light at the end of the tunnel. We don’t know when we’ll get there, but we will. I’m proud to be a small city mayor, and I am proud to see how many other mayors are responding to this crisis. I wish each of you the best on this journey and hope to talk with you about what you’re doing locally.

As a public health practitioner, I know we must rely on the science and numbers. As a mayor, I know we must always remember who we serve – citizens, employees, businesses, schools – and those not at the table.