Many American public-health specialists are at risk of burning out as the coronavirus surges back.
Saskia Popescu’s phone buzzes throughout the night, waking her up. It had already buzzed 99 times before I interviewed her at 9:15 a.m. ET last Monday. It buzzed three times during the first 15 minutes of our call. Whenever a COVID-19 case is confirmed at her hospital system, Popescu gets an email, and her phone buzzes. She cannot silence it. An epidemiologist at the University of Arizona, Popescu works to prepare hospitals for outbreaks of emerging diseases. Her phone is now a miserable metronome, ticking out the rhythm of the pandemic ever more rapidly as Arizona’s cases climb. “It has almost become white noise,” she told me.
For many Americans, the coronavirus pandemic has become white noise—old news that has faded into the background of their lives. But the crisis is far from over. Arizona is one of the pandemic’s new hot spots, with 24,000 confirmed cases over the past week and rising hospitalizations and deaths. Popescu saw the surge coming, “but to actually see it play out is heartbreaking,” she said. “It didn’t have to be this way.”
Popescu is one of many public-health experts who have been preparing for and battling the pandemic since the start of the year. They’re not treating sick people, as doctors or nurses might be, but are instead advising policy makers, monitoring the pandemic’s movements, modeling its likely trajectory, and ensuring that hospitals are ready.
By now they are used to sharing their knowledge with journalists, but they’re less accustomed to talking about themselves. Many of them told me that they feel duty-bound and grateful to be helping their country at a time when so many others are ill or unemployed. But they’re also very tired, and dispirited by America’s continued inability to control a virus that many other nations have brought to heel. As the pandemic once again intensifies, so too does their frustration and fatigue.
America isn’t just facing a shortfall of testing kits, masks, or health-care workers. It is also looking at a drought of expertise, as the very people whose skills are sorely needed to handle the pandemic are on the verge of burning out.
To work in preparedness, Nicolette Louissaint told me, is to constantly stare at society’s vulnerabilities and imagine the worst possible future. The nonprofit she runs, Healthcare Ready, works to steel communities for outbreaks and disasters by ensuring that they have access to medical supplies. She started revving up her operations in January. By March, when businesses and schools started closing and governors began issuing stay-at-home orders, “we were already running on fumes,” she said. Throughout March and April, she got two hours of sleep a night. Now she’s getting four. And yet “I always feel like I’m never doing enough,” she said. “Like one of my colleagues said, I could sleep for two weeks and still feel this tired. It’s embedded in us at this point.”
But the physical exhaustion is dwarfed by the emotional toll of seeing the imagined worst-case scenarios become reality. “One of the big misconceptions is that we enjoy being right,” Louissaint said. “We’d be very happy to be wrong, because it would mean lives are being saved.”
The field of public health demands a particular way of thinking. Unlike medicine, which is about saving individual patients, public health is about protecting the well-being of entire communities. Its problems, from malnutrition to addiction to epidemics, are broader in scope. Its successes come incrementally, slowly, and through the sustained efforts of large groups of people. As Natalie Dean, a biostatistician at the University of Florida, told me, “The pandemic is a huge problem, but I’m not afraid of huge problems.”
The more successful public health is, however, the more people take it for granted. Funding has dwindled since the 2008 recession. Many jobs have disappeared. Now that the entire country needs public-health advice, there aren’t enough people qualified to offer it. The number of epidemiologists who specialize in pandemic-level infectious threats is small enough that “I think I know them all,” says Caitlin Rivers, who studies outbreaks at the Johns Hopkins Center for Health Security.
The people doing this work have had to recalibrate their lives. From March to May, Colin Carlson, a research professor at Georgetown University who specializes in infectious diseases, spent most of his time traversing the short gap between his bed and his desk. He worked relentlessly and knocked back coffee, even though it exacerbates his severe anxiety: The cost was worth it, he felt, when the United States still seemed to have a chance of controlling COVID-19.
The U.S. frittered away that chance. Through social distancing, the American public bought the country valuable time at substantial personal cost. The Trump administration should have used that time to roll out a coordinated plan to ramp up America’s ability to test and trace infected people. It didn’t. Instead, to the immense frustration of public-health advisers, leaders rushed to reopen while most states were still woefully unprepared.
When Arizona Governor Doug Ducey began reviving businesses in early May, the intensive-care unit of Popescu’s hospital was still full of COVID-19 patients. “Within our public-health bubble, we were getting nervous, but then you walked outside and it was like Pleasantville,” she said. “People thought we had conquered it, and now it feels like we’re drowning.”
The COVID-19 unit has had to expand across an entire hospital wing and onto another floor. Beds have filled with younger patients. Long lines are snaking around the urgent-care building, and people are passing out in the 110-degree heat. At some hospitals, labs are so inundated that it takes several days to get test results back. “We thought we could have scaled down instead of scaling up,” Popescu said. “But because of poor political decisions that every public-health person I know disagreed with, everything that could go wrong did go wrong.”
“I feel like I’ve been making the same recommendations since January,” says Krutika Kuppalli, an infectious-disease physician who works in public health. The last time she felt this tired was in 2014, after spending three months in West Africa helping with the region’s historic Ebola outbreak. Everyone who experienced that crisis, she told me, was deeply shaken; she herself suffered from post-traumatic stress upon returning home.
The same experts who warned of the coronavirus’s resurgence are now staring, with the same prophetic worry, at a health-care system that is straining just as hurricane season begins. And they’re demoralized about repeatedly shouting evidence-based advice into a political void. “It feels like writing ‘Bad things are about to happen’ on a napkin and then setting the napkin on fire,” Carlson says.
A pandemic would have always been a draining ordeal. But it is especially so because the U.S., instead of mounting a unified front, is disjointed, cavalier, and fatalistic. Every week brings fresh farce, from Donald Trump suggesting that the country should do less testing to massive indoor gatherings of unmasked people.
“One by one, people are seeing something so absurd that it takes them out of commission,” Carlson says.
Public health is not a calling for people who crave the limelight, and researchers like Rivers, the Johns Hopkins professor, have found their sudden prominence jarring. Almost all of the 2,000 Twitter followers she had in January were other scientists. Most of the 130,000 followers she now has are not. The slow, verbose world of academic communication has given way to the blistering, constrained world of tweets and news segments.
The pandemic is also bringing out academia’s darker sides—competition, hostility, sexism, and a lust for renown. Armchair experts from unrelated fields have successfully positioned themselves as trusted sources. Male scientists are publishing more than their female colleagues, who are disproportionately shouldering the burden of child care during lockdowns. Many researchers have suddenly pivoted to COVID-19, producing sloppy work with harmful results. That further dispirits more cautious researchers, who, on top of dealing with the virus and reticent politicians, are also forced to confront their own colleagues. “If I cannot reasonably convince people I’ve been friends with for years that their work is causing tangible harm, what possible future do I see on this career path?” Carlson asks.
Other scientists and health officials are facing the wrath of a nation on edge. Unsettled by months of stay-at-home orders, confused by rampant misinformation, distraught over the country’s blunders, and embroiled in yet more culture wars over masks and lockdowns, Americans are lashing out. Public-health experts—and women in particular—have become targets. Several have resigned because of threats and harassment. Others face streams of invective in their inboxes and on their Twitter feeds. “I can say something and get horrendously attacked, but a man who doesn’t even work in this field can go on national TV and be revered for saying the exact same thing,” Popescu said.
Some critics have caricatured public-health experts as finger-wagging alarmists ensconced in an ivory tower, far away from the everyday people who are suffering the restrictive consequences of their advice. But this dichotomy is false. The experts I spoke with are also scared. They’re also feeling trapped at home. They also miss their loved ones. Louissaint, who lives in Baltimore, hasn’t seen her New York–based parents this year.
“I feel like I’m living in at least three realities at the same time,” Louissaint told me. She’s responding directly to the pandemic, trying to ensure that patients and hospitals get the supplies they need. She’s running an organization, trying to make sure that her employees keep their jobs. She’s a Black woman, living through a pandemic that has disproportionately killed Black people and the historic protests that have followed the killings of George Floyd, Breonna Taylor, and Ahmaud Arbery. During the ensuing reckonings about race, “I’ve been pulled into so many conversations about equity that people weren’t having months ago,” Louissant said.
“Someone said to me, ‘I hope you’re getting tons of support,’” she added. “But there’s no feasible thing that anyone could do to make this better, no matter how much they love you. The mental toll isn’t something you can easily share.”
These laments feel familiar to people who lived through the AIDS crisis in the ’80s, says Gregg Gonsalves, a Yale epidemiologist who has been working on HIV for 30 years and who has the virus himself. “I have friends who survived the virus but didn’t survive the toll it took on their lives,” Gonsalves told me. “I’m incredulous that I’m seeing this twice in my lifetime. The idea that I’m going to have to fend off another virus … like, really, can I have just one?”
But Gonsalves added that HIV veterans have a deep well of emotional reserves to draw from, and a sense of shared purpose to mobilize. His advice to the younger generation is twofold. First, don’t ignore your feelings: “Your anxiety, fear, and anger are all real,” he said. Then, find your people. “They may not be your colleagues,” he said, and they might not be scientists. But they’ll share the same values, and be united in recognizing that “public health is not a career, but a mission and a calling.”
Despite the toll of the work and the pressure from all sides, the public-health experts I talked with are determined to continue. “I’m glad I have a way in which I can be useful,” Rivers said. “I feel like it’s my duty to do what I can.”
All Rights Reserved for Ed Yong