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How Do You Lead a State’s Coronavirus Response? Ask Her How Do You Lead a State’s Coronavirus Response? Ask Her
(about 11 hours later)
— Dr. Ngozi Ezike, director of the Illinois Department of Health— Dr. Ngozi Ezike, director of the Illinois Department of Health
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A few weeks ago, Dr. Ngozi Ezike’s four children — ages 17, 16, 13 and 11 — sat her down to deliver a PowerPoint presentation they had put together.A few weeks ago, Dr. Ngozi Ezike’s four children — ages 17, 16, 13 and 11 — sat her down to deliver a PowerPoint presentation they had put together.
It was a detailed assessment of how she was doing in her job as the leader of the Illinois Department of Public Health.It was a detailed assessment of how she was doing in her job as the leader of the Illinois Department of Public Health.
“It was like, ‘Well, we’re really proud that you’re doing this important work. It’s cool that you’re on TV,” recalled Dr. Ezike, “‘But now we’re totally over it.’”“It was like, ‘Well, we’re really proud that you’re doing this important work. It’s cool that you’re on TV,” recalled Dr. Ezike, “‘But now we’re totally over it.’”
Their main complaint: She was never home anymore. While family friends were filling the gap, checking in on them and dropping off treats every now and then, they felt like they hadn’t seen their mom in weeks. And when she did get home, she was on the phone late.Their main complaint: She was never home anymore. While family friends were filling the gap, checking in on them and dropping off treats every now and then, they felt like they hadn’t seen their mom in weeks. And when she did get home, she was on the phone late.
“They were breaking it down for me from their perspective,” said Dr. Ezike in a recent phone interview, which happened to take place on the same day as her youngest child’s birthday. “It hurt.”“They were breaking it down for me from their perspective,” said Dr. Ezike in a recent phone interview, which happened to take place on the same day as her youngest child’s birthday. “It hurt.”
“But I hope they’ll understand better with time why I had to sacrifice so much time away from them.”“But I hope they’ll understand better with time why I had to sacrifice so much time away from them.”
Like Dr. Ezike, women across the country have been at the forefront of states’ round-the-clock, all-consuming emergency responses: More than 60 percent of state health directors are women, according to the Barbara Lee Family Foundation.Like Dr. Ezike, women across the country have been at the forefront of states’ round-the-clock, all-consuming emergency responses: More than 60 percent of state health directors are women, according to the Barbara Lee Family Foundation.
As appointed officials, state health directors typically play a behind-the-scenes role, identifying, tracking and planning interventions around public health risks.As appointed officials, state health directors typically play a behind-the-scenes role, identifying, tracking and planning interventions around public health risks.
But this crisis has catapulted them into the spotlight, standing side by side with governors and mayors, quickly turning them into some of the country’s most recognizable faces. (Ohio’s Dr. Amy Acton, for example, has become something of a local icon, with fan clubs and merchandise dedicated to her.) It is up to state health directors to corral data and come up with policy proposals for advising governors and the rest of the state on things like when to shut down, how to reopen businesses safely and where to set up testing sites.But this crisis has catapulted them into the spotlight, standing side by side with governors and mayors, quickly turning them into some of the country’s most recognizable faces. (Ohio’s Dr. Amy Acton, for example, has become something of a local icon, with fan clubs and merchandise dedicated to her.) It is up to state health directors to corral data and come up with policy proposals for advising governors and the rest of the state on things like when to shut down, how to reopen businesses safely and where to set up testing sites.
But, in a combustible environment of heightened anxiety and increasingly partisan clashes over the emergency measures put in place, their every move and statement is scrutinized and dissected from every angle.But, in a combustible environment of heightened anxiety and increasingly partisan clashes over the emergency measures put in place, their every move and statement is scrutinized and dissected from every angle.
“I try to just stick with what’s the right thing to do and let the politicians do what they have to do,” said Dr. Ezike. “No one is positive of the exact right course — we’re building the plane as we’re trying to fly it.”“I try to just stick with what’s the right thing to do and let the politicians do what they have to do,” said Dr. Ezike. “No one is positive of the exact right course — we’re building the plane as we’re trying to fly it.”
The criticism her team receives — and there is a lot, particularly over reopening the economy — is balanced out by the “many letters and cards of support and encouragement” sent to her offices, she added.The criticism her team receives — and there is a lot, particularly over reopening the economy — is balanced out by the “many letters and cards of support and encouragement” sent to her offices, she added.
These days, Dr. Ezike’s itinerary of back-to-back meetings and calls kicks off at 6 a.m., when she gets daily updates from local health departments and emergency management and alternate care sites. Then there’s the televised news conference with Governor J.B. Pritzker, during which Dr. Ezike provides critical updates and takes questions from the news media. On some days, Dr. Ezike’s team takes calls from the White House, the Centers for Disease Control and Prevention and health directors from other states. Her day doesn’t end until about 11 p.m., she said, at which point she tries to go through her emails.These days, Dr. Ezike’s itinerary of back-to-back meetings and calls kicks off at 6 a.m., when she gets daily updates from local health departments and emergency management and alternate care sites. Then there’s the televised news conference with Governor J.B. Pritzker, during which Dr. Ezike provides critical updates and takes questions from the news media. On some days, Dr. Ezike’s team takes calls from the White House, the Centers for Disease Control and Prevention and health directors from other states. Her day doesn’t end until about 11 p.m., she said, at which point she tries to go through her emails.
“But I’m struggling with that,” she confessed.“But I’m struggling with that,” she confessed.
Illinois, while not the country’s worst hot spot, has undeniably been hit hard.Illinois, while not the country’s worst hot spot, has undeniably been hit hard.
On Jan. 30, the first human-to-human transmission of the coronavirus in the U.S. was reported in Chicago — between a wife who had traveled to Wuhan, China, and her husband.On Jan. 30, the first human-to-human transmission of the coronavirus in the U.S. was reported in Chicago — between a wife who had traveled to Wuhan, China, and her husband.
Dr. Ezike visited the couple in the hospital and it became clear to her the kinds of troubles that the country was about to face.Dr. Ezike visited the couple in the hospital and it became clear to her the kinds of troubles that the country was about to face.
“We were waiting for official test results to return from the C.D.C. because we didn’t yet have the ability to run the test at our public health labs in Illinois,” she recalled. “The gentleman was considering ‘releasing himself’ from the hospital isolation — he was concerned about missing work and not providing for his family while sitting in isolation.”“We were waiting for official test results to return from the C.D.C. because we didn’t yet have the ability to run the test at our public health labs in Illinois,” she recalled. “The gentleman was considering ‘releasing himself’ from the hospital isolation — he was concerned about missing work and not providing for his family while sitting in isolation.”
“In those moments, I gathered my first inkling of the challenge to be faced in containing this virus and how one’s personal economic or financial situation would affect decisions that would affect not just the individual but the community as a whole.”“In those moments, I gathered my first inkling of the challenge to be faced in containing this virus and how one’s personal economic or financial situation would affect decisions that would affect not just the individual but the community as a whole.”
Then on March 21, Illinois became one of the first three states to implement stay-at-home orders.Then on March 21, Illinois became one of the first three states to implement stay-at-home orders.
“I think that significantly helped,” Dr. Ezike said.“I think that significantly helped,” Dr. Ezike said.
To date, there have been more than 100,000 cases of coronavirus in Illinois and more than 4,900 deaths, bringing the state’s fatality rate to about 39 deaths per 100,000. That number is far below the country’s top three hot spots: New York, which has a fatality rate of 150 deaths per 100,000, New Jersey, where the rate is about 125 per 100,000, and Connecticut, which has a rate of about 105 per 100,000.To date, there have been more than 100,000 cases of coronavirus in Illinois and more than 4,900 deaths, bringing the state’s fatality rate to about 39 deaths per 100,000. That number is far below the country’s top three hot spots: New York, which has a fatality rate of 150 deaths per 100,000, New Jersey, where the rate is about 125 per 100,000, and Connecticut, which has a rate of about 105 per 100,000.
Updated June 12, 2020 Updated June 16, 2020
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
But Illinois also has some of the country’s largest black and Hispanic populations — communities that, according to the C.D.C., are at a greater risk of dying from the disease, in part because of longstanding inequalities that have made access to health care harder. Thirty percent of the people who have died in Illinois are African-American, according to the state’s public health department.But Illinois also has some of the country’s largest black and Hispanic populations — communities that, according to the C.D.C., are at a greater risk of dying from the disease, in part because of longstanding inequalities that have made access to health care harder. Thirty percent of the people who have died in Illinois are African-American, according to the state’s public health department.
Most of those communities are largely concentrated in Cook County, which includes Chicago and its suburbs. The county currently has the most confirmed cases in the entire country, according to data from Johns Hopkins University. And, in early April, Cook County Jail became one of the country’s largest coronavirus clusters, with more than 1,000 infections among inmates and staff and six deaths.Most of those communities are largely concentrated in Cook County, which includes Chicago and its suburbs. The county currently has the most confirmed cases in the entire country, according to data from Johns Hopkins University. And, in early April, Cook County Jail became one of the country’s largest coronavirus clusters, with more than 1,000 infections among inmates and staff and six deaths.
These concerns were always top of mind, Dr. Ezike said. Before becoming Illinois’s health director, she spent 15 years at the Cook County Department of Public Health and was the medical director of the Cook County Juvenile Temporary Detention Center so she had seen the gaping socioeconomic disparities between communities and how that gap can have a knock-on impact on health care access.These concerns were always top of mind, Dr. Ezike said. Before becoming Illinois’s health director, she spent 15 years at the Cook County Department of Public Health and was the medical director of the Cook County Juvenile Temporary Detention Center so she had seen the gaping socioeconomic disparities between communities and how that gap can have a knock-on impact on health care access.
“This virus didn’t create health disparities,” she said. “It’s just magnifying them.”“This virus didn’t create health disparities,” she said. “It’s just magnifying them.”
From the outset, she had her eye trained on the most vulnerable, including essential workers, many of whom are from minority communities. She has incorporated their needs into all of the state’s response proposals, from getting P.P.E. to those who need it most to providing targeted messaging and information. Dr. Ezike herself delivers her updates during the daily news conference in English and Spanish.From the outset, she had her eye trained on the most vulnerable, including essential workers, many of whom are from minority communities. She has incorporated their needs into all of the state’s response proposals, from getting P.P.E. to those who need it most to providing targeted messaging and information. Dr. Ezike herself delivers her updates during the daily news conference in English and Spanish.
The virus has touched Dr. Ezike’s own circle, too: Extended-family members and family members of her co-workers have been infected, she said.The virus has touched Dr. Ezike’s own circle, too: Extended-family members and family members of her co-workers have been infected, she said.
In February, before the coronavirus upended the world as we knew it, Dr. Ezike lost her father, an immigrant from Nigeria who spent most of his life in Los Angeles.In February, before the coronavirus upended the world as we knew it, Dr. Ezike lost her father, an immigrant from Nigeria who spent most of his life in Los Angeles.
“I did bury him. We had very elaborate ceremonies for him in three cities and two continents,” she said over the phone.“I did bury him. We had very elaborate ceremonies for him in three cities and two continents,” she said over the phone.
She added: “But I think about how people can’t do that now and how difficult that can be. I think about that every time I think of the deaths we are reporting each day.”She added: “But I think about how people can’t do that now and how difficult that can be. I think about that every time I think of the deaths we are reporting each day.”
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