Sara Cody never expected to be a household name. Yet, in March of 2020, she skyrocketed to national headlines after being among the first public health officers in the nation to enact stay-at-home orders to slow the spread of the COVID-19 pandemic. Cody is the public health officer and director of the County of Santa Clara Public Health Department. On June 26, she joined Stanford professor of law and medicine Michelle Mello in conversation. The virtual event was sponsored by the McCoy Family Center for Ethics in Society as part of the Center’s Arrow Lecture Series on Ethics and Leadership. The Arrow lectures were named in honor of the late Nobel Laureate and Stanford professor of economics, Kenneth Arrow, who throughout his career made many contributions to welfare economics, social choice theory, and collective decision-making.
During the conversation, Cody, ’85, described her experience navigating the extraordinary amount of power entrusted to local health officers during the pandemic. Public health officers often have to make tough — and sometimes unpopular — decisions. Cody recalled choking up during a press conference while announcing new limits on gatherings: “It really hit me, the full force of what it would mean for 100 people not to be able to gather and how many activities wouldn’t be able to occur.” Adding to the challenge was the lack of clarity and knowledge throughout the pandemic. Cody likened the experience to running an ultra-marathon without food, water, or map, “but we knew we had to run because if we didn’t run and get to the end of the race, people would be hospitalized, people would die, so we just had to forge on with what we had.”
Despite the immense challenges of combatting a pandemic of a new, unknown disease, Cody described the Bay Area health officers as being uniquely situated and prepared to make critical decisions. The first advantage these health officers had was trust. Cody noted that during the 1980s AIDS epidemic, the Bay Area health officers at that time began to work together to share information and resources. Since then, it has become a tradition for current officers to meet monthly over dinner to discuss the latest public health issues. “Those relationships helped us go quickly,” said Cody — and when combatting pandemics, timing is one of the most critical factors. The second advantage that Cody identified was California’s health and safety code, which is distinct from those of other states in the levels of authority it gives to health officers. Both advantages helped the Bay Area counties respond quickly to the COVID-19 threat and enact stay-at-home orders more easily than other areas and states.
However, although the Bay Area was relatively well-positioned to respond to the pandemic, diseases do not respect state and county lines. “As I reflect on this shelter in place decision, I think we were really living the limits of this federated system that we have in the United States, and this would become starker as the pandemic wore on,” said Cody. She identified a “lack of coordination and leadership” at the federal level, which pushed the important decisions down to the local level. As a result, many county public health officers found themselves making critical decisions with little federal support.
The politicization of the pandemic also increased the burden on local health officers. According to a survey Mello conducted in 2011, public health officers enjoyed high levels of public trust — 85% of American adults said they trusted the CDC and 74% trusted local health officials. However, the unpopularity of some of the COVID-19 prevention methods led some Americans to question the validity of decisions made by public health officers who are not democratically elected (although they are held accountable by elected officials). Many that disagreed with the restrictions that were being enforced pushed back — often quite aggressively. According to Mello, at this point in the pandemic over 250 health officers around the country quit or were forced out, and Cody herself has to have sheriff protection due to repeated threats to her life. There are also new laws cropping up in at least 15 states that seek to significantly limit the powers of health officers. “I think these laws are deeply concerning,” Cody said. "They move from health professionals to politicians."
Cody described some of the lessons learned from the COVID-19 response that, if implemented, could be hugely important in future health crises. One of the biggest lessons is the need for sustained public health funding rather than emergency funding as issues arise. “We need a shared understanding that we need a public health infrastructure and that this is a public good,” said Cody. She also highlighted the need for data and technology infrastructure that can share information across county and state lines. Finally, Cody believes that public health departments must advance racial and health equity by developing community partnerships and “moving from community engagement to real power-sharing.”
The pandemic underscored the essential role that public health officers play in the wellbeing of our nation, even when this work is unseen. Mello said that at the beginning of the pandemic, we were “sleeping the peaceful sleep of passengers on a ship who don’t know they’re sailing into an iceberg,” but Cody “took the helm very early” and worked in tandem with other county officials to set policies and practices to greatly reduce the rate of COVID-19 transmission. In closing, Cody described a deep dedication to the Santa Clara community that continues to motivate her: “As a community member, I feel I have the duty to do right by the community where I’ve always lived and the people there who I love.”