Like an iceberg, our collective community’s response to the COVID-19 pandemic goes largely unseen — and only a small part of the work reaches the public’s eyes. I was privileged enough to be witness to part of the work that took place. I want to share a small glimpse into their story.
I was part of the county’s Emergency Operations Center for the COVID-19 response from its inception. Those that don’t know how an EOC works, let me give you a quick crash course. It is driven by a uniform process that is used at every level (local, state, federal) of emergency response called an Incident Command System. ICS creates a structure that allows emergency responders to speak a common language and organize in a fashion that facilitates the ability to quickly operationalize and logistically support a crisis response plan.
When the EOC was stood up on March 24, the Douglas Public Health Network had already been several weeks into an operational response mode to COVID-19 and had built an epidemiological team that is still the envy of most Oregon counties. DPHN is led by their executive director, Teresa Mutschler and their medical director, Dr. Robert Dannenhoffer, who is also the county’s public health official. The delegated leader of the county’s response was Commissioner Tim Freeman. He brought in KC Bolton, CEO of Aviva Health, who oversees local federally qualified health centers — and is also a retired Army colonel and combat veteran with emergency response experience in standing up hospitals in war zones.
KC was quickly designated as the incident commander, and Teresa Mutschler later became co-incident commander. He and Commissioner Freeman built an incident command team that included physicians — Dr. Dannenhoffer, Dr. Harry “Chip” Taylor, and Dr. Tanveer Bokhari — public health professionals, trained expert emergency managers, logistical experts, fiscal experts and public information professionals, from within and outside of county government. This was an impressive group of accomplished professionals, but the question in my mind was how, having never worked together, would they coalesce into highly functioning unit?
Commissioner Freeman led this group, and the first order of business was to develop incident command objectives:
- Minimize loss of life for Douglas County citizens through education, mitigation and containment
- Protect the medical system from being overwhelmed with cases by coordinating long term strategic response plans and identifying local thresholds with appropriate local response
- Ensure safety of all health care providers by facilitating the acquisition and distribution of available personal protective equipment by utilizing local, state and federal resources
- Ensure appropriate timely and coordinated communications to cooperators and the public
- Support operational needs by leveraging available Douglas County resources.
These objectives were the incident command team’s guiding doctrine. Within days, individuals that hadn’t known each other before were working seamlessly together with common goals and direction. They worked quickly to gain situational awareness, and finding the key data points to guide the decision making process. As data was tracked, there was a point early on in the EOC where the trends indicated the local hospital would likely be overwhelmed with cases by Easter, if not sooner. Had that happened, plans had already been put in place to be operationalized to deal with this on a medical and community level. This involved planning and logistical efforts for contracts, securing potential facilities, PPE and coordinating with FEMA requirements. This was serious work and everybody understood the consequences of not meeting our objectives.
For several weeks I came to the courthouse, which was closed except for the EOC work, at 5:30 a.m., only to find Commissioner Freeman already in his office either meeting with key staff, members of the medical community, or on the phone with someone in Washington D.C. in regards to meeting the needs of our local community’s COVID-19 response. At one point early on, Commissioner Freeman stated to the incident command team that there is always a political risk of doing too much, then seeing the crisis fall short and having people say you overreacted. He then said politics will have no place in this EOC: “If we do too much, it will still have been a training exercise worth doing.”
Given the number of global pandemics that the Douglas COVID-19 response team has had experience addressing in the past (exactly zero, if you need reminding), trying to determine just the right amount of a response made absolutely no sense. So the incident command team planned for the worst-case scenario. Commissioner Freeman looked at the medical and public health experts in the room and said, “Tell me what you need.” Then he and the rest of the board responded by making it happen.
While the worst-case scenario didn’t happen, this continues to be a war fought on many fronts. There is the front line work of containment done by DPHN through testing and contact tracing — and through the work of local clinics, physicians and CHI Mercy Medical Center to test for and treat positive cases. There is the work of mitigation done by public education through the Joint Information Center, where multiple agencies make sure that the most up-to-date information is getting to the public in a consistent manner (as well as Dr. Dannenhoffer’s Facebook Live events). There is the planning work done by the EOC to ensure appropriate levels of responsiveness for any level of change in the crisis. Senior leaders from numerous agencies are working together to make sure all these efforts are coordinated towards the same goals and objectives — to win the war on every front.
There is a reason, not dumb luck, that Douglas County has weathered this crisis as well as it has. That reason is due to hundreds of people working hard behind the scenes to mitigate the impact of COVID-19. It is also because a responsive community has listened to its leaders and have taken precautions to prevent the spread of the disease. The county commissioners have been a part of leading and supporting many of these efforts. Attitude reflects leadership — and the attitude that I saw in the EOC from every person was to look to the collective group and ask, “What do you need?” and then make it happen.