STEAMBOAT SPRINGS — Until June 2019, there was no Routt County Public Health Department. Instead, the county cut a check to Northwest Colorado Health to cover its public health obligations.

But by that summer, the Colorado Department of Public Health and Environment had informed the county that arrangement was not going to work anymore, and they needed to house public health within the county, not contract it out.

“It wasn’t just the state telling us that we needed to be moving those services in-house, but we began to realize that we could be doing a better job at public health by taking it in-house,” said Commissioner Tim Corrigan.

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Moffat County found itself in the same situation, and then-Commissioner Don Cook pitched Corrigan the idea of splitting a public health director, freeing up more money for direct public health services.

So, the Routt County set up a public health department that really had just one employee who split their time between the two counties, Corrigan said. That one person, Public Health Director Kari Ladrow spent three days a week in Steamboat Springs and two days in Craig.

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“At that point, there was no public health office, there was no public health staff, there wasn’t even a phone number quite frankly until the county hired (Ladrow) and she started standing all that up,” said Dr. Brian Harrington, longtime Routt County chief medical officer.

Ladrow and Harrington started working to build the department in addition to dealing with bat bites and potential cases of tuberculosis — typical things the department is there to do.

“Then the pandemic hit,” Corrigan said. “It became apparent very quickly that was just not a sustainable situation.”

Sharing a public health director was not going to work anymore with the increased demand of the pandemic, Corrigan said, so Moffat and Routt amicably ended the arrangement. With Ladrow opting to stay with Moffat County — a move that caught commissioners off guard — the county found itself trying to hire a new leader to guide its burgeoning public health department, just as the pandemic was ramping up.

 

Enter Roberta Smith

As luck would have it, a qualified candidate just happened to live in town.

“I moved up here during the pandemic, and when they needed a new public health director, I just happened to be here already” said current Public Health Director Roberta Smith, who has spent her whole career working in public health, both at CDPHE and as a nurse working in infection prevention with Colorado Children’s Hospital.

“It has always been my passion to work in public health,” Smith said. “I love the collaborative approach. I like the community health aspect to it. It was really fortunate that I was able to leave what I was doing to help Routt County.”

Smith didn’t walk into the new role empty handed though, as Ladrow had worked hard to hold things together as COVID-19 became a fixture in the world’s vernacular. When Smith started in the department it was her, an administrator, contact tracers and some contract nurses.

What helped Smith initially was her contacts with other public health officials on a state level and knowing what resources were available to her. Her prior work in immunizations taught Smith that acquiring a vaccination fridge to store shots was a high priority as well as finding some space for the department to operate.

She also had to hire an epidemiologist and a public health nurse.

“Those were some of the first priorities in terms of logistics — getting the public health program built and in the middle of a pandemic, when you are also dealing with cases and data and isolations and quarantines,” Smith said.

Getting ‘in the fight’

Smith hired Fritha Morrison as a temporary epidemiologist, and she still helps them today with case data. Later, epidemiologist Nicole Harty was hired, moving from Denver for the job because she felt a need to get “in the fight” against COVID-19.

“We have a pandemic, this is unprecedented times for us as a profession right now and that is exciting and challenging, and I feel like I need to be doing that work,” Harty said.

Harrington said he has felt a similar drive to step up and use his expertise to help navigate a public health crisis.

“When else but now should health care professionals step up and meet their calling?” Harrington said. “Whether we like it or want it, this is our time to serve our communities.”

About two months after Harty started in September, cases locally exploded, from 80 new cases of the virus in October to 480 new cases in November.

“I was just starting to get some systems in place, so we felt like we knew what we were doing, then the scale of our work changed,” Harty said. “Managing the data with that scale, we ran into new and different problems, and it was a constant adjustment and being, honestly, pretty overwhelmed with the amount of work.”

Over time they learned how to prioritize their work rather than jumping at everything being lobbed at them.

When talking with people who had just tested positive, Harty said she often needed to be very empathetic, consoling someone who had just received bad news. But there were other times when the person she was talking to didn’t want to follow quarantine or isolation guidelines or were uncooperative when trying to contact trace.

While they have some tools to use in these situations, as cooperating with contact tracers is part of the local public health order, they prefer to just ask people for compliance.

“We don’t really like to go to that enforcement level, it is not a comfortable place for us to be,” Harty said. “We have had to involve law enforcement in some instances to try to seek cooperation, and that is not my favorite day.”

Like Harty, Brooke Maxwell, the county’s public health nurse, said she applied for the position, having very little experience in public health but wanting to help take care of her community.

Maxwell also works in the emergency room at UCHealth Yampa Valley Medical Center and helped take care of some of the first COVID-19 patients hospitalized in the county.

“Little did I know that three weeks after I started my job that our case count would triple and that we would be operating at full speed for the foreseeable future,” Maxwell said in an email.

She said working in the ER has been a reprieve from some of her public health work, and her years of experience there set her up well to pivot into a public health role, now triaging situations rather than patients. When vaccines started becoming available, Maxwell has been central to the county’s effort, organizing clinics and appointments to get people their shots.

“Being a part of the largest vaccination effort in the history of the world is a humbling experience,” Maxwell said. “I’ve been able to serve my community in ways that I never dreamed of.”

80-hour work weeks

As for how much time they have put in, Smith estimates she has yet to work a 40-hour week, with most weeks coming closer to double that. Harty estimated her longest weeks have been 12 hours seven days a week. Even when they go home, the work follows them, as a new case could pop up at any moment requiring them to respond.

“We tried to have some on-call weekends, but when the cases got much more intense, we couldn’t because we all had so much to do,” Harty said. “I say that I don’t have any days off, just days I work less.”

Harrington, who was not compensated for his role before the pandemic, said there have been times over the last year when it has become a second job for him. Corrigan said the county is now paying him a stipend for his work.

Right around Christmas was an especially trying time in public health, as cases were hitting highs not seen before, and the county was trying to get ready for the vaccine rollout.

“On one hand you are so stressed out about these cases and what our community is going through and the deaths and the outbreaks, and then on the other hand, you have part of the solution,” Smith said. “I remember that was just one of those days where I went home very stressed, because there is just so much going on that is both positive and negative and kind of dealing with some of those conflicting emotions.”

Smith said her husband and friends have been really supportive through the course of the pandemic. County public health has also worked with the Routt County Crisis Support, which has helped her staff when they just needed to talk to someone — a resource Smith said has been invaluable.

Newest and the smallest

Commissioner Beth Melton said they have tried to be intentional with the hires in public health, adding temporary staff to address the immediate needs of the pandemic but also finding people who could stay with the department and shape what it will become.

“Rather than just hire a bunch of people that then after the pandemic is over we don’t really know what our public health department is doing,” Melton said. “We kind of wanted to build those simultaneously.”

Public health has been doing the job simultaneously as well, still working on more traditional services like dealing with animal bites, referring people for immunizations and dealing with other infectious diseases.

“It was definitely a juggling act,” Smith said. “Having an infectious disease background and having worked with public health programs before, I understood the other holes in the dike, if you will, that I had to put my fingers in.”

What comes next for the public health department, which is one of the newest and the smallest in Colorado, is already something that Smith and the rest of the staff are working on. Smith said many of the community partnerships they have built during the pandemic will become essential as they return to a more traditional public health role — a service the county has never really offered.

Harty has already picked back up the public improvement plan that Ladrow had started before most people had heard of coronavirus. Public health departments are required to draft such documents, and they are meant to be a thoughtful roadmap to better health outcomes in the county.

“It is this really great opportunity to use data, to talk to community members and really make an impact in the lives and health of you community, and it is in so many ways the opposite of pandemic world,” Harty said.

When the community reaches herd immunity, and the pandemic has passed, Harrington believes public health’s work wrangling the chaos of the last year will show the people of Routt County how important it has become.

“I think that is a strong thesis,” Harrington said. “This has helped many people understand the importance of public health and appreciate the stuff that it does.”