During normal times, public health professionals do their jobs and you rarely hear about them.
“We’re sitting there in the background, just keeping people safe,” said Dr. Denise Bonds, executive director of the Blue Ridge Health District.
But when the COVID-19 pandemic took hold locally, Bonds and her team took on a much more public role. In the last 10 months, the health district has nearly doubled the size of its staff to combat the COVID-19 pandemic.
The additional staff helped to conduct more than 5,200 testing clinics, contacted more than 20,000 people who were exposed to someone who tested positive for COVID-19, answered 11,500 calls to the hotline and responded to 2,858 complaints about alleged pandemic ordinance violations, among other tasks.
The agency recently changed its name from the Thomas Jefferson Health District as part of an effort to be more equitable and inclusive.
It was one of the first health districts in the state to create a dedicated coronavirus testing team. And it is one of the few to maintain a district-specific dashboard of COVID case data. The dashboard has been closely watched by community members and business operators and has helped to inform local governments’ response plans.
“Personally, this is one of the hardest things I’ve ever done,” said Bonds, who has led the district for six years and also recently became interim director of the Rappahannock Area Health District.
Bonds said the district’s goals for pandemic response are to ensure adequate testing in the community, investigate all cases and conduct contact tracing, respond to complaints in a timely manner and make sure the public has the information and data it needs.
“I think we have been very successful,” Bonds said. “And then on top of that, we were able to keep some continuity of our other critical services. Although COVID certainly consumes us, we have to keep a certain number of our regular services going to meet critical needs in the community.”
Those include providing flu shots, administering testing for sexually transmitted infections and inspecting well and sewage systems. The agency also offers family planning services, as well as support, education, food and health screenings for pregnant women, infants and children.
The district’s response to the pandemic has helped to keep case numbers from skyrocketing so far, but the team’s efforts have been especially tested during the current surge, which started around Thanksgiving. In recent weeks, the district has hired more staff members to investigate cases while also preparing to inoculate people against the virus.
In collaboration with Bonds and her staff, Charlottesville and Albemarle County adopted local COVID-19 ordinances in July with stricter restrictions than called for in Gov. Ralph Northam’s executive orders at the time. The local ordinances made masks mandatory in public and limited restaurants to 50% occupancy indoors.
“We just wanted to make sure that we were just well-grounded in science and facts, and they’re the experts,” said Doug Walker, deputy county executive. As Albemarle’s incident management team commander, he has worked with the Blue Ridge Health District on implementation of pandemic measures.
Emily Pelliccia, deputy chief of the Charlottesville Fire Department and commander of the city’s incident management team, said the city wouldn’t have been able to strategize and make a plan of action without the health district.
“If we didn’t have their expertise to rely on, we would have been sort of flying blind,” she said.
Dr. Costi Sifri, a professor of medicine and director of hospital epidemiology and infection prevention and control at the University of Virginia Medical Center, said the health district has been critical to getting testing and other resources into the community and to promote mitigation measures such as hand-washing, wearing of masks and social distancing, the latter two being unpopular at times and challenged by some politicians.
“I don’t think it’s any exaggeration that [the health district’s] incredible efforts over this last year saved lives,” he said. “… If there’s anything that this pandemic has shown us is that we cannot take for granted public health and safety.”
The community’s compliance with those measures, along with the health district’s broader efforts to curtail spread of the virus, helped the medical center from becoming overwhelmed with COVID-19 patients, Sifri said.
“This is a community that has flattened the curve,” he said. “We are in the next wave of this pandemic, and we understand that we still have some difficult times ahead of us, but the health department has helped see us through this so far.”
During the pandemic, the health district and medical center have worked together to quickly contain potential hotspots at long-term care facilities and to assist groups of people who are vulnerable to the virus.
Their level of communication and collaboration “doesn’t happen everywhere,” Sifri said.
Albemarle County Executive Jeff Richardson said the district is serving as a hub for the region, so different localities and agencies can be on the same page.
“They’re good on so many levels,” he said. “… We feel like they are a department within our organization, and they’re not a department within our organization. They’re a regional agency that serves so many needs across our region but their bedside manner, so to speak, is so customer service friendly.”
He added that health district staff were readily available to answer questions and were patient as they worked through different issues.
“They are crystal-clear communicators of very complex information that, in doing so, projects extraordinary competence and confidence in the information that’s available and in an evolving, changing, dynamic environment that has really defined the pandemic from the beginning,” Walker said.
“Because of having that grounding, it just obviously enables us to work so much better in how we then are serving our customers, which could be our employees and, of course, our community most importantly.”
District officials break down their COVID response so far into three waves.
In the initial wave, most of the district’s 91 staff members were involved with fighting the pandemic as some services, such as family planning and health inspections, were suspended and others moved all-online.
Then, in the second wave, those services started back up again, and more employees were hired as the testing and investigations teams were built up. By early December, 55 employees had been added to the payroll, with another 15 contractors in the works.
Bonds said that at first, responding to the pandemic was challenging because officials didn’t have a great understanding of the virus, information about the virus and treatment options kept changing and staff members were working overtime to contain the crisis.
As the district expanded its staff, Bonds said they were able to work more-regular hours. Over the summer and holidays, she encouraged the employees to take time off to recharge.
Through it all, Bonds said the district’s administrative staff has been essential as they worked behind the scenes to help hire new employees, get them on board and keep the office running.
The health district’s work in a typical year focuses on improving social determinants to good health, including housing and food issues, to help the community be as healthy as it can be, Bonds said. That mission will be even more important to help community members recover from the pandemic, which has had a disproportionate impact on communities of color and older residents, she said.
Most of the 96 people who have died from the virus in the Blue Ridge Health District were 70 or older.
So far, white people make up 52.7% of COVID-19 cases, 46.6% of hospitalizations and 70.8% of deaths in the district. African Americans make up 13.7% of cases, 33.3% of hospitalizations and 21.8% of deaths. Latinos comprise 15% of the cases, 12.7% of hospitalizations and 3.1% of deaths.
The third wave of the district’s response is under way as staffers prepare to vaccinate the approximately 250,000 people who live in the district. That effort involves hiring even more staff and building the infrastructure to sustain the program while continuing to investigate cases and offer other services.
Bonds said this pivot is exciting — “because we see it as the beginning of the endgame, as it were,” she said.
Bonds and other health district staff received the first dose of the Moderna vaccine Dec. 28. On Monday, the district is kicking off its vaccination program with a clinic for area EMS providers, dialysis center staff and Region Ten Community Services Board residential facility staff.
Sifri, with UVa, said the vaccination effort is a “herculean task” that the district is being asked to lead.
“So it’s been a long year for them,” he said. “It’s been a long year for everybody in health care. But the work continues, and they realize that. I have every confidence that they’re gonna see us through 2021.”