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Dr. Angela Dunn was running behind schedule.
On Tuesday, Dunn — now the executive director of the Salt Lake County Health Department — was slated to make a presentation to her new bosses, the Salt Lake County Council, with the latest information about the COVID-19 pandemic.
Dunn, wearing a face mask, delivered the grim prediction from health experts that some 60 Salt Lake County children under age 12 could come down with COVID-19 when the school year starts. Some cases could be serious enough, Dunn said, that the county could see “one child being hospitalized with COVID every other day, if we don’t take any prevention measures.”
Dunn is recommending that schools and parents encourage kids under 12 — the age group not yet eligible to get a COVID-19 vaccine — to employ the measures that worked last year: wearing masks.
Dozens of angry parents — responding to a Facebook post that erroneously announced the council would vote on a mask mandate — also showed up for that Tuesday meeting. They spoke for two hours during the meeting’s public comment session and included statements that often were as inaccurate as that Facebook post.
References to data they found on social media, and such phrases as “psychological warfare,” “masks are child abuse” and “mark of the beast,” were dropped into the public record. Once or twice, they mentioned Dunn’s name, calling her a “coward” for not being there in person.
Dunn, waiting to make her turn to speak to the council, was working elsewhere in the Salt Lake County Government Center, and heard it all.
“It’s great that people are engaged,” she said later. “But when it crosses the line to disrespect and personal attacks, that’s wrong.”
In her new job leading the public health effort in Utah’s most populous county, Dunn remains, to her occasional frustration, the COVID-19 lightning rod she was as the state’s epidemiologist. That’s the job that put the 40-year-old Dunn in the public eye as she became Utah’s voice of calm reason and scientific analysis during the biggest public health crisis of the past century.
After speaking with council members Tuesday, Dunn sat down with The Salt Lake Tribune for the first time since taking her post at the Salt Lake County Health Department in June. She talked about the challenges of her new job, the lessons from her old one, and the ups and downs of the COVID-19 pandemic. Here, edited for clarity, is a transcript of that interview.
Masks, messaging and mandates
Tribune • What is the priority right now for you and the Salt Lake County Health Department, as far as the message you’re trying to get out about COVID-19 and vaccines?
Dunn • The No. 1 message is, of course, get vaccinated if you’re eligible. That is our No. 1 tool to fight this disease. And we just don’t have enough eligible adults who are vaccinated yet to provide that protection to our vulnerable, or those children who can’t get vaccinated.
Tribune • Children 11 and under are not yet eligible for the vaccine. How do you go about doing everything possible to help those kids until they can be vaccinated?
Dunn • We have to rely on increasing our vaccination rates among adults; 20- to 40-year-olds continue to be our lowest vaccination rate. And those are the parents of the kids under 12. … The second piece that we know is the most effective approach is mask-wearing. And as political, unfortunately, as that has become, it is scientifically proven to be the next best barrier to getting [at] COVID, other than a vaccine.
Tribune • The idea of having children masked in schools is obviously very emotional. How do you balance the emotional side of it with the scientific?
Dunn • My job is purely to provide the best scientific evidence, [and] recommendations, to our County Council and to our public — just as when you go to your primary care physician or your own doc. … That emotional piece is part of it. But I don’t let that impact my recommendations. I think we all need to be sensitive to and respectful of different opinions and ways of thinking. But that definitely won’t impact the advice I give. It helps me understand where the public is, and our goal in public health is always to meet people where they’re at. So if people are really against having their kids in masks and they’re not going to do it, what are the other options that they can do to keep their kids safe?
Tribune • After Tuesday’s public comments about a possible mask rule, two of the nine members of the Salt Lake County Council expressed the opinion that they would not vote for a mask mandate in schools. [Note: Any county health director can issue such a mandate, but under the pandemic “endgame” law passed by the Utah Legislature this spring, their county’s governing body could overturn it — and if county leaders don’t, the Legislature can.] Short of you, as the county health director, issuing a mandate, what can you do to suggest or recommend to people that kids mask up when they’re in school?
Dunn • One, is public messaging and a public campaign of trying to normalize mask-wearing again. It’s tough when you walk into a store and nobody’s had a mask and you’re the only one [masked] in there. You feel like you’re making a statement, but you’re not. You’re just trying to protect yourself and your family.
The other piece is I’m working directly with all superintendents in all schools, private and charter, throughout our county, on a weekly basis to try to help them understand how to keep the kids safe in their school setting, given some of these limitations and mandates and requirements. So we’re offering testing for anybody who wants it, helping them figure out how to arrange their classrooms again, to have that 3-foot or 6-foot distance. And what are those other layered approaches that they can take, if not a mask mandate.
Tribune • You talk about how your job with the county, you feel, is to give council members the best scientific recommendation. That’s very similar to what you were doing as Utah’s state epidemiologist. What is the difference, because you’re actually running a department, as opposed to being a part of one?
Dunn • The key difference here is I actually have the authority to write the mask mandate. In this instance, though, because the County Council can overturn it immediately, it is essential that I seek alignment with them before writing any mandate. … I don’t want to see this play out in the media, full of drama. … It really is futile for me to issue anything that they would just overturn the next day.
‘Becoming less effective’ at UDOH
Tribune • Let’s go back a couple of months to when you left the Utah Department of Health to take this job. What was the process for you coming over to the county?
Dunn • So I’ll start by saying [being executive director of the Salt Lake County Health Department] is something that I would have applied for, had COVID happened or not. This is an awesome opportunity in my career to serve at a more local, on-the-ground level. … COVID definitely expedited that a little bit. As the state epidemiologist, I was purely in an advisory role. And as the pandemic progressed and all the changes in the health department progressed, I saw my role becoming less and less effective, and it was time for me to move on.
Tribune • Why do you feel it was getting less effective?
Dunn • There were definitely different personalities at play. In the public eye, I became this poster child for, you know, [Dr. Anthony] Fauci, or the liberal left or whatever — people just pin that on me, right? It wasn’t my doing — [and it] likely alienated some of state leadership and didn’t allow me to be as effective as I wanted to be in my job. The people that work at [UDOH] are incredible, but they deserve a state epidemiologist that can be effective at all levels of state leadership. And I just felt that my time there was up and I could be more effective not only in Salt Lake County health but also state health by leading the Salt Lake County Health Department.
Tribune • There are critics who feel the pandemic “endgame” bill was the point where the Utah Legislature was done listening to the science, in a sense.
Dunn • Maybe that was part of it, too. I wasn’t involved in any of those conversations. I had already kind of been pushed out by that point. So I don’t think that had anything to do with me leaving specifically. But, yeah, I think it’s hard for any public health practitioner to see that bill and not feel undermined in some way.
Tribune • When you were at UDOH, you had to perform, it seemed, quite a balancing act to how far you could push with your advice. What was the biggest challenge in figuring out where you could push and where you couldn’t?
Dunn • I will say that when Gov. [Spencer] Cox became governor, it became a much more open conversation and I was part of that with him in the executive office there, and it really felt like a good partnership between health and the executive branch. I felt free to express my opinions. We had a very open dialogue about a lot of controversial things, and he’s very open with his thought process and how things are going. And we all have different jobs. And I honestly would never want the elected official job. I’m sure he would never want the health officer job. And so it was a great partnership. So that was fantastic.
The hard part came in negotiating the politics with legislative leadership. That’s tricky, because it’s not as open of a conversation. So it was hard for me to understand where people were coming from, what they expected and where they wanted to go. Yet their influence on the health department and how we responded to things was immense. And so it was a trickier situation with the legislative leadership.
Tribune • What was your learning curve like, in terms of having to navigate the political side of things?
Dunn • [Laughs.] Sharp and quick. I mean, it started the spring of — was it 2020? Was it only 2020?
Very quickly, before we even had our first first community spread, it became evident that we needed elected officials to be engaged with how we responded. [In] public health, we just respond and we do what we know is right. But I don’t think we engaged our elected officials early enough or quick enough. So they didn’t have a good understanding of what we were doing or what we were capable of doing. And so [they] assumed we weren’t doing anything or didn’t know what we were doing. So, you know, they try to fill that void with more, I would say, aggressive leadership on their part.
But my learning curve was just as steep as the rest of public health — nationally, too, not just in Utah. I am, clearly, very transparent and open, and I have no ulterior motives. I’m really here for just the health and the science. So it’s hard for me to interact with people who might keep their cards closer to them and have other motivations. I’m savvier now. At the beginning, I was not as savvy to kind of all those backroom discussions and how those things played out behind the scenes. But now I understand their impact.
Tribune • At the end of June of 2020, you sent a memo to Gov. Gary Herbert —
Dunn • Oh, “Memo-gate,” that’s what I fondly call it. Oh, that was a frustrating time.
Tribune • — When Utah was at around 200 cases a day. And you wrote that if we got up to 500, then things would have to change rapidly. Two days after you sent it out, that email was reported in The Tribune. And then, as they say, all hell broke loose. What was the lesson for you there as far as how to handle things?
Dunn • Here’s the thing: If I were to go back in time, I wouldn’t have done anything different.
So here’s what I was feeling in that moment, and I remember it so well. June of 2020, I was out of every conversation. I was banned from attending meetings. I could not have influence. But I’m watching the data and I’m seeing people get infected, knowing what’s coming, seeing what was happening — Italy was all the rage, right? There were tons of deaths [there]. We were going to become Italy, [if we didn’t] figure this out.
And my only voice was an email. … I felt like it was my duty to make sure that [my] health and medical advice was heard by those who were making the decisions for the sake of the public. That was the background to writing that memo, to say, “OK, if you’re not going to listen to me, I’m going to put it in writing. And here you go.” It was not my intent at all for it to get leaked, because drama doesn’t help anyone. It doesn’t help the public health cause, it doesn’t help people engage with public health more. But, alas, it got leaked.
After that, there was an outcry. “Why isn’t there [a health official] at the table?” And shortly thereafter, I was at all of the governor’s leadership meetings. Was I an effective voice? I don’t know. But at least, I had a seat at the table.
Tribune • After the email became public, Jefferson Burton, who was then running UDOH, issued a statement saying there’s no truth to the rumor that you were getting fired. Now, usually if somebody puts out a statement like that, somebody somewhere has had the conversation that you should be fired.
Dunn • Absolutely. I was on vacation in Moab and was getting calls from some legislators saying that I was going to get fired.
Tribune • So, what was that like from where you were?
Dunn • I’m in a very fortunate position, where I have experience and expertise, and I took a job in public health in order to make sure the public has all the information they need to keep themselves healthy. And when I see that that’s not being done, I will continue to be that voice. And so if the trade-off is getting fired by doing something right, OK. To me, that’s a nonstarter. I’m not someone who will just give in to threats, because I’m just here to help people, to save themselves and their families. … At some point, you just have to take that risk.
Bad days and good days
Tribune • In the past 18 months, what was your worst day regarding COVID-19?
Dunn • I don’t remember the specific day, but it was when initially our hospitals were completely overwhelmed and not able to provide care. And I have friends that work in ICUs and in the hospitals, and those are my colleagues, people that I went to medical school with, that I trained with. And in addition to protecting the public, I view my job as helping my clinician friends and colleagues — who are caring for patients one-on-one — be able to provide that best care. And because COVID cases had overwhelmed our health care systems, I took that on myself. I had somehow failed.
I get it that, yes, there’s a bunch of different forces at play there. It wasn’t me alone, but somehow I was not effective in my ability to control the pandemic, rather, from a policy level, from an elected official level, or from a science level. And that resulted in my physician colleagues not being able to do their job. And that’s heart-wrenching. That was a day I definitely broke down.
Tribune • In the past 18 months, what’s been your best day with watching the pandemic?
Dunn • God, the day I felt elated is the day I did my first PSA [public service announcement] for the vaccine. The vaccine wasn’t even out yet, but we were filming it in anticipation. And it was like this light of “We are here, we have an effective vaccine and we can promote it to people.” That was an awesome feeling.
Tribune • We were both there at LDS Hospital last December, the day the first health care workers in Utah got their shots.
Dunn • That was so cool. I think it still gets lost on people how quickly we were able to come up with an effective vaccine. It just blows my mind.
Tribune • What is going to be the indicator for you that we are well and truly done with all of this?
Dunn • Definitely once a vaccine is available to all. We are so close. I would even say 5- to 12-year-olds. It is important for 6 months to 4 years old to get vaccinated, but they’re not causing a lot of problems. But once we get our school-age kids vaccinated, we can legitimately treat this like other vaccine-preventable diseases. Until that moment, we’re not going to be there. The caveat there is the booster. Hopefully, we don’t have enough spread that’s causing more mutations that escape our vaccines. But I have confidence that 2022 is going to be a good year. [Knocks on table.] I hope I didn’t just jinx myself there.