For many people a COVID-19 vaccine has been like the light at the end of the tunnel after a year long pandemic.
For public health workers though, it is just the next step in their response to the pandemic and according to Kim Hugen, Monroe County Public Health Administrator, her staff is planning on holding continuing vaccine clinics throughout most of 2021.
Still, things are beginning to look up now that the vaccine has arrived, as long as anther surge of the virus is prevented.
Before COVID-19 hit, public health ran several programs like HOPES a home visiting and parenting program for at-risk children up to five years old, a life skills program for fifth through seventh graders, foot clinics for people age 65 and older, immunization clinics for the public and immunization audits for the school district and daycares, a homemaker program which helps those 65 and older and the disabled who need minor assistance in the home, and health education campaigns in the community.
“All of those things have fallen to the way side this year unfortunately,” said Hugen.
Public Health is also involved in the emergency preparedness planning for the county. One aspect of that was anticipating pandemics and what should be done if one over happened.
“That has been in the works for a lot of years,” said Hugen. “This particular virus has been tricky in that the vaccine is a little bit more difficult to dispense because it’s not just hey stop in and get your shot.”
Hugen said when reports of a novel coronovirus first emerged they were getting reports from the state epidemiologist about what they should be doing to prepare for the virus.
“We do often hear, ‘Hey this has been identified in this country,’” said Hugen. “I think we were hearing that and thinking it’s not ‘if ‘but ‘when.’ So we were preparing … but I never thought I would be dealing with a pandemic in my lifetime to be honest.”
In the early days of the pandemic Hugen said the staff just tried to learn as much as they could.
“Initially we spent a lot time like everyone else watching the governor’s press conferences,” said Hugen. “Very often we don’t get information that much quicker then everybody else does in that sense.”
As Iowa implemented a partial shut down in March and April Hugen said they tried to be proactive and contact businesses and other people affected about the health guidelines and expectations from the state government.
At the same time the public health office was fielding a ton of calls from community members.
“We have three nurses here and we were switching on call,” said Hugen. “It got to be a lot, even on the weekends.”
Hugen said they dealt with both people angry at them about the guidelines as well as people angry at others for not following guidelines. But they also got a lot of support from the community.
“We’ve definitely seen a lot of support,” said Hugen. “And that’s kind of what got us through and continues to get us through, that most people are very supportive and appreciative of the work we are doing. We also get the people that are very angry at us for … doing our job.”
“I think it just depended on how it effected them at any given time,” said Hugen.
Throughout the year public health has also tried to provide education, service and aid to other groups in the community. With the help of a grant they received, the were able purchase bleach cleaning kits for businesses, PAPR suits for the hospital, and a UV light sanitizer that the county is still waiting to receive. Hugen said she believes it will be housed at the hospital and available for use by the community in the future.
The first diagnosed case of COVID-19 in Monroe County was in April of 2020. As of March 15, 2021 the county has seen 931 people diagnosed and 28 lose their lives to the disease. At one point in January 2021 Monroe County actually had the highest test positivity rate in the state of Iowa. Thankfully that rate has declined and continues to do so.
Public Health is required to call and interview everyone who tests positive for COVID-19 to this day. They ask questions about where the person has been recently, how they think they might have gotten the virus and who they have been around. In the early days of the pandemic Hugen said they would do up to three follow up calls. Now that is down to one call.
Public Health has always done communicable disease follow up. COVID-19 is just a new communicable disease and is spreading on a much larger scale.
“I would say if we had three communicable disease [cases] in a month prior to covid, that was a fairly busy month,” said Hugen. “Then we get to covid and … that was a bit overwhelming … trying to keep up with all those things we still have to do. … That became difficult to balance and still is sometimes.”
Since COVID-19 is a novel coronovirus, scientists have had to study it and relay new information about it to the public, doctors, health officials and government officials as the public was trying to deal with the disease. Hugen says because learning about the virus has been an ongoing process and still is, that has made some people less trusting of information about the virus.
“I feel like that makes people question a lot,” said Hugen. “The knowledge we have on Monday might be different by Friday. … I think that rapidly changing information made it very difficult for people to trust that we were staying on top of it and we were understanding what was going on trying to lead them through it.”
Rumors and false information spreading rapidly on the Internet also made public health’s job harder. Hugen said the hardest aspects of the job have changed day to day throughout the pandemic but getting negative feedback has been very difficult.
“When you go into the nursing field … you want to help people,” said Hugen. “When sometimes we get the negative feedback from folks that aren’t happy with the recommendations that we’re making or don’t believe in the virus … I think that was a struggle. … Unfortunately things that stick in your mind are the negative things that people say.
Hugen said the majority of things the staff hears is positive though. About 95 percent of people have been supportive and having a great team has made the more difficult aspects of the last year more bearable.
“We have an amazing team of people here,” said Hugen. “I don’t know that I would still be here without this amazing team we have here at Public Health.”
One of the biggest things to deal with for the last year has been the phone calls. Whether it was dealing with people seeking information in the early days, trying to do follow up phone calls during the depths of the surge of the virus when there were nearly 20 new cases each day or scheduling vaccine appointments now, the phone calls have never stopped.
Now that the vaccine has arrived, the workload for public health has just changed.
To date, the county has only received the Moderna vaccine and Hugen said they are not sure if or when they will receive any of the Johnson &Johnson vaccine that was recently approved for use.
Initially Public Health was the only entity with vaccine available. Now they are partnering with the hospital to help hold vaccine clinics. Some vaccine is also available at pharmacies now as well.
The county receives initially received about 100 vaccine doses per shipment from the state. Now they receive about 100 doses for first shots and 100 for second shots. Hugen hopes they can begin receiving more doses soon, but that is not up to her.
“I certainly hope that our vaccine starts coming in quicker,” said Hugen. “One-hundred doses a week is going to take a while to get folks vaccinated.”
People can call the public health office to be placed on a waiting list to receive the vaccine. Once public health knows how many doses they will be receiving in a shipment, they call the next people on the list to set up appointments. They then note when those people received their first doses to know when to call them back for their second doses, although it may not be exactly 28 days later.
Hugen said public health had gotten through most of their original wait list but once shots became available to anyone under age 65 with pre-existing conditions, the lists began to grow again.
Each vaccine vial contains 10 doses of vaccine and must be used within six hours of being opened or the vaccine must be discarded. Hugen said the staff has been very careful not to let any waste happen.
“We have not wasted one dose of vaccine,” said Hugen. “So I’m very proud of our team for that.”
Once someone receives their first vaccine shot they get a card indicating when they got their shot and the information is also entered into a state database.
Monroe County saw it’s biggest surge in cases after Thanksgiving and Christmas and Hugen said she is a little worried about another surge this spring.
“I think there has been a big push where people say ‘Okay I’m done, I’m ready to get back out,’ and trust me I understand that,” said Hugen. “I’m hoping that we don’t see that surge, but I think that potential is there, particularly in the younger population who are probably more likely to go on spring break trips.”
Hugen said she is also concerned with the virus mutating and how long the immunity from vaccine’s or having the virus can last.
“I think those are all things that are still being looked at and learned … and I guess we’ll deal with it as it comes,” said Hugen.
Hugen said as the pandemic continues, they are trying to balance their other responsibilities at public health with the ongoing crisis and our grateful for the community’s understanding.
“We appreciate any patience and grace we can get from the community,” said Hugen. “It’s been a long year with a lot of struggles and we’re trying really hard to continue to take care of our community like we have in the past.”
With so much extra work it has been hard for staff members to even take a day off and Hugen said everyone is looking forward to being able to take time off later this year.
“I think all of us are looking forward to time off in all honesty,” said Hugen. “Each of us have had a day here and there but as far as a week long vacation or anything like that those haven’t happened.”
“I have an amazing staff,” said Hugen. “They’re incredible. They’re all smart, hard working, motivated people and they make it fun. I can still come in and smile every day.”