By Peter Maiden
Dr. Simon Paul is the public health officer for Madera County. He started in his position in February, just weeks before the first reported case of Covid-19 in Madera County. He took time out to answer questions about his work.
Q: What was in your medical experience that prepared you to become the public health officer of Madera County?
A: My clinical work for like the last 25 years has been in HIV AIDS. I was taking care of patients at the Ryan White clinic in Fresno for the last 17 years, and before that in New York City.
HIV work has a big public health component to it. Whether it’s individual-level things like partner notification, which is kind of classic disease investigation; or more widespread stuff like working with behavior modification, and risk reduction and things like that. There’s harm reduction to get people healthier, working with vulnerable populations.
The other part was medical treatment. Treatment in the last few years has gotten a lot better.
What I realized when I spoke with people in my work was that the bigger problems were really becoming public health issues over the last couple of years. I would see things like a rise in the number of cases of HIV, and I started working on trying to get funding to do outreach to youth to get on PrEP (a preventive HIV drug) and to get tested.
Those were all public health things—working with different communities, trying to see what would work to engage these groups. That’s kind of how my background fits into what I’m doing now.
Q: How were the early days of the pandemic for you? I read that Madera County’s first case was in March, and it was someone who had been on a Princess cruise. Last week, there were 54 cases and two fatalities in Madera County. Did you anticipate the level of infection we now have?
A: It was really hard to know. When we started to get more cases, I think what was surprising wasn’t just that we had more cases, but that when the stay-at-home order came in, it was so effective for keeping us from getting a rapidly increasing number of cases.
The timing of the stay-at-home order I think was really fortunate for Madera. It happened before there were hardly any cases at all, just one outbreak, and then there was really good contact tracing to keep it from spreading any further in the community.
Since then, we’ve just had sporadic cases here and there, often from people who travel to work outside the county. And again, we’ve been able to contain these cases from becoming bigger outbreaks.
Q: As Madera County approaches reopening business to some extent, do you see yourself in the role of economic management?
A: I think the health department’s main role is to clarify, define and explain what the health risks are and aren’t, and have people stay safe.
We are very aware of the economic consequences. We hear from businesses who’ve been impacted. People can be losing their businesses because they have nobody coming in the doors.
We hear from people who are losing their jobs. So, we are very aware of the impact of all of this on people.
I think one thing that’s been frustrating is there’s so much pressure for businesses to reopen. The means to support small businesses economically through this crisis has not been that effective for small businesses in areas like ours. So, if they had had better protection from going out of business, there’d be less pressure for them to reopen.
But again, our main goal is to work on the public health side of things.
Q: Do you think the pandemic causes concern for mental health?
A: I think one thing that’s been very hard for everybody is the degree of uncertainty. We’re starting to learn more about what the actual risks are and how to be safe. And especially in the beginning, people didn’t know how infectious this was, what the fatality rate was and if it was safe to go outside, and that’s constantly changing information. That would be stressful for anybody.
People can have a hard time being isolated in quarantine. If you’re prone to anxiety and you can’t get out and meet with people that normally would be supportive, that can be stress producing.
There’s also obviously a huge impact on people from economic consequences. If you’re out of work and having trouble getting unemployment insurance, or if you don’t qualify for it, those financial impacts can be incredibly stressful for anyone.
Q: What are your hopes for public health in Madera County in the short and long term?
A: I hope the county will continue working together well, pulling together to get through this. We are working well with the Sheriff’s department and their deputies, to ramp up case investigation and contact tracing. The Board of Supervisors was supportive in putting things in place to protect people. And what I’m hoping for in the short term is that we can start things up without having outbreaks.
For the long term, when we get past the whole coronavirus thing, then we’ll get back to more traditional public health. Things I originally got interested in are still important: fighting STDs, decreasing HIV rates and a lot of ways to improve community health, including community wellness programs, and [strengthening] access to healthcare.
There’s a lot of interest in the state now on adverse childhood experiences, which I think is incredibly important for minimizing health conditions in the long run. Adverse childhood experiences make for a huge risk of heart disease, cancer and obesity.
There’s a lot changing and happening quickly in California and in Madera, so it’s an exciting time to be in public health. But for the last two months, public health has been swamped by working on the coronavirus outbreak.
Peter Maiden is the photo editor for the Community Alliance newspaper. He studied media at UC Berkeley. Contact him at firstname.lastname@example.org.