Threatened, harassed, doxxed: Public health workers forge on — Security teams protecting health officers
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* Kim Krisberg

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Sara Cody, MD, health officer and director of California’s Santa Clara Public Health Department, speaks about COVID-19 cases in February 2020. Seven months later, a man was arrested for threatening violence against Cody because of her work.

Photo by Melina Mara, courtesy The Washington Post/Getty Images

In July, local health official Faisal Khan attended a county council meeting to do his job — talk about COVID-19 data and offer guidance on the best ways to save lives and contain the spread of the virus. He left the meeting needing security detail for his entire family.

“I was prepared for a discussion, even skepticism,” said Khan, MPH, MBBS, director of the St. Louis County Department of Public Health in Missouri. “But in 25 years of public health service, I have never faced this sort of situation.”

That night at the council meeting, Khan explained why he and fellow county officials had decided to reinstate a mask requirement against a backdrop of surging infections, lagging vaccination rates and rising hospitalizations. Khan’s talk was met with jeers, taunts and verbal abuse. One council member pointed out that Khan was not born in the U.S.

As Khan left the meeting, an angry crowd hurled racial slurs and physically assaulted him, Khan later wrote in a letter to the council chair. The situation “saddens me beyond comprehension,” he told *The Nation’s Health.*

“Politicizing a public health crisis is never a good idea — it backfires spectacularly,” said Khan, an APHA member. “Our response should be a united front and we have failed miserably on that count.”

Usually known for working quietly behind the scenes with little fanfare, local health officials such as Khan have become targets for people’s frustrations with the COVID-19 pandemic, as well as verbal punching bags for bad-faith lawmakers and purveyors of disinformation. As a result, reports of public health officials being harassed and threatened have become all too common, from death threats and armed protests to online stalking and emails filled with racist and sexist abuse.

In June, a study published in the Centers for Disease Control and Prevention’s *Morbidity and Mortality Weekly Report* found that nearly 24% of more than 26,100 state, tribal, local and territorial public health workers surveyed this spring were feeling bullied, threatened or harassed due to work. Almost 12% had received job-related threats.

The problem not only endangers the safety and mental well-being of public health workers; it is pushing out leaders when public health needs them most. It could also make it harder to recruit new workers into governmental public health. According to an analysis from *Kaiser Health News* and The Associated Press, published in December, at least 181 state and local public health leaders in 38 states had resigned, retired or been fired since April 1.

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Erica Pan, MD, California’s state epidemiologist, speaks to a colleague in June 2020. She has been targeted with threats while working to protect people during the COVID-19 pandemic.

Photo by Francine Orr, courtesy Los Angeles Times/Getty Images

In August 2020, Joshua Sharfstein, MD, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health, coauthored an article in the *Journal of the American Medical Association* highlighting attacks on public health workers. He urged local officials to step up protections, including investigating credible threats, providing security detail when needed and prosecuting those who break the law. A year later, the backlash against local health officials seems to be getting worse, he said, egged on by legislative attempts in more than a dozen states to restrict and undermine the authority of health agencies to act in emergencies.

Sharfstein said many of the factors contributing to the backlash were entrenched well before COVID-19, such as political polarization and social media sites that make it easy to spread misinformation and extremist views. But he said elected officials and community leaders can help by speaking up in support of public health authorities and making sure workers are protected from threats.

“I think the next couple years will be critical (for public health),” said Sharfstein, an APHA member. “We really have to be prepared to explain to people how great public health is and why it’s so important.”

Georges Benjamin, MD, executive director of APHA, also urged elected officials to speak out in support of local health authorities and condemn harassment. A former health official in Maryland and Washington, D.C., Benjamin said he has spoken at contentious public hearings during his career, but never experienced the “vitriol and anger” public health workers are now facing.

“People forget that when you run out your local epidemiologist because you’re mad about masking advice, you’re also running out the person protecting you from all kinds of other diseases,” he said. “Elected officials need to control these public meetings and be clear that attacks on public health officials will be prosecuted.”

Many states already have criminal statutes on the books that could be used to protect public health workers, such as laws against obstructing government operations and harassing public officials, according to Brooke Torton, JD, senior staff attorney for the Network for Public Health Law-Eastern Region. Torton, an APHA member, conducted a 50-state survey about existing legal protections, which the network shared this year in response to growing questions and concerns.

However, laws are only as effective as their enforcement, Torton said. Long-term campaigns are needed to help people better understand what public health does and why it matters, she said.

“These officials have already been worked to the bone dealing with the pandemic and don’t have the time to pursue their own protection,” Torton, who is also deputy director of the Legal Resource Center for Public Health Policy at the University of Maryland, told *The Nation’s Health.* “When the pandemic is more livable, I think some of this (harassment) will scale back. But the next time there’s a public health crisis, it’ll be like reopening a wound.”

Some lawmakers are stepping up. In Colorado in May, Gov. Jared Polis signed a bill making it a misdemeanor to maliciously publish the private information of workers at public health departments, a practice known as doxxing. It also gave workers the option of removing their personal information from public records. State Rep. Yadira Caraveo, MD, who co-sponsored the bill, said she spoke with health officials around Colorado who were facing threats, from harassing phone calls and angry picketing outside their homes to one whose dog was poisoned.

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Barbara Ferrer, PhD, MPH, MEd, director of public health for Los Angeles County, works at a COVID-19 vaccination site in March. In June 2020, Ferrer released a statement about the death threats she and her family had received.

Photo by Scott Strazzante, courtesy The San Francisco Chronicle/Getty Images

Caraveo, a pediatrician in the city of Thornton who was busy treating a spike in kids with COVID-19 only a few months after the bill was signed, said she is especially worried that continued threats will add to a recent wave of health officials resigning across Colorado.

> “People are really dismayed that they’re doing their best to do their jobs and still getting personal threats because of it.”
> 
> *— Yadira Caraveo*

“It’s already pushing people out,” she told *The Nation’s Health*. “People are really dismayed that they’re doing their best to do their jobs and still getting personal threats because of it.”

In Oxford, North Carolina, Lisa Macon Harrison, MPH, health director at Granville Vance Public Health, said residents of the two rural counties the health department serves have been fairly supportive of its COVID-19 response. But staff has sometimes encountered anger, frustration and confusion, especially when following up with people about quarantining and isolation.

Harrison, an APHA member, said she is worried about the mental toll such backlash is taking on already-exhausted health department workers.

“It would be nice if the public health workforce was respected the same way the military was for preserving life and liberty,” Harrison told *The Nation’s Health.* “Right now, the opposite is taking place, but I hope we’ll get there.”

For more on protecting public health workers, visit [www.networkforphl.org](http://www.networkforphl.org).

*   Copyright The Nation’s Health, American Public Health Association