With just over a hundred full-time employees, the Pasadena Public Health Department has been a historically small operation with a tight budget, and rarely the focus of much public attention.
Of course, that changed when a pandemic came to town.
The scrappy department sized up, stepped forward and punched above its weight, leaving outdoor dining open while other jurisdictions could not and collating more complete, accurate data sets faster than its big-budgeted peers.
It did this while juggling its proportional share of case investigations and vaccine distribution and, at this point, the city has vaccinated significantly more of its seniors than Los Angeles County as a whole.
Its performance has been hailed by current and former city officials, but it’s not without its critics.
Some members of the City Council repeatedly pushed for the city health department to buck county regulations and strike out on its own. Others questioned if the city could have moved faster and done better in the early days of the pandemic. And some continue to ask if the health department fell short responding to deadly outbreaks in elder care facilities.
Chief among the critics is Councilman Tyron Hampton who, this week, repeated his call for the city to review the department’s performance.
Still, one year after the pandemic upended life as we knew it, Pasadena finds itself on the fragile precipice of recovery and many are praising the department’s leader, Dr. Ying-Ying Goh, who is both the city medical officer and its public health director. She came into the latter role just nine months before Pasadena saw its first coronavirus case.
As the pandemic progressed, Goh grew more capable and confident in her new role, some officials said, helping to lead Pasadena through an unimaginably hellish year; it was hardly an easy task.
For years, leaders and staff at the Public Health Department have been responsible for a wide berth of programs, ranging from health inspections and tobacco prevention, to homeless assistance and maternal health. That’s not to mention the niche roles: bioterrorism response, local oral health programs, kindergarten readiness, you name it.
The 112 full-time Public Health Department workers “all wear many hats,” Goh said.
“We all do an extremely deep and wide scope of work, and it’s hard when you have other responsibilities. You might not be able to do them because you’re switching to COVID response and there isn’t anybody else. There’s no duplicative training.”
That translates to 16- and 18-hour days oftentimes, and rarely an off day.
Goh said she can count “on maybe four fingers” how many days off she’s had since last March, including weekends.
The same goes for Dr. Matt Feaster, the city’s epidemiologist, who helps lead the five-person Communicable Disease Prevent & Control Division. He’s the staffer who’s responsible for managing all of the city’s data on its various dashboards.
Because of Feaster’s efforts, time after time, Pasadena has been quicker to offer a more complete and holistic picture of its coronavirus situation.
In the early months, it was infection rates in elder care facilities, something Pasadena had a clear picture of weeks before Los Angeles or Long Beach. Now, it’s vaccination rates and the difficult-to-calculate data showing how many folks still need to get the jab in each demographic — something Long Beach still can’t provide.
It’s a distinct source of pride for Goh, not that it’s a competition, she said.
“No matter how small you are, you still have a core set of functions you need to produce,” Goh said.
While Los Angeles County is processing tens of thousands of cases a day and Pasadena may only be processing a hundred, that’s proportionate to their relative populations. The dashboard, meanwhile, is just as resource-intensive to create for Pasadena as it is for Los Angeles, she said.
At the center of the city’s pandemic response, it’s Feaster and his small team — several nurses and nursing director Vivian Gonzalez, as well as Goh herself.
“Once the pandemic hit, we had to multiply that team by a factor of five before there was even funding to support it,” Goh said.
They needed people to call coronavirus patients, figure out how they got infected and who they may have interacted with before they started quarantining.
With every surge, Pasadena had to bring on more staff. When cases would subside, they’d go back to their day jobs, whether that was in other parts of the health department, or the city’s Planning Department, or its libraries and everything in between.
“And we’d pull them back — back and forth, back and forth, several times, flexing up and down,” Goh said.
Whether cases were going up or down, there was always work that needed to be done.
“It’s the pace of change, that’s what’s so exhausting,” Goh said.
When cases got worse, the health department needed to come up with restrictions and it was never a simple decision, Goh said.
When there’s a surge on the horizon, they have to lock things down swiftly — but always keep in mind what the public will tolerate and what the city can reasonably enforce.
At the beginning of the pandemic, it was easier to get compliance with stricter provisions. As the long year dragged on and economic consequences started piling up, the calculations began to change.
It was a similar conundrum when cases started to subside: How much leeway can the system support before infections start to mount up again?
No matter what, everything’s always a rush, Goh said.
When a surge is coming, they needed to move quickly to save lives. When it subsides, they need to move quickly to save the economy.
“There hasn’t been a break,” Goh said. “Everyone has been working so hard — holidays, weekends, nights. With the exception of maybe September with a couple of weekend days off, it’s just been relentless.”
The winter surge was particularly difficult. No matter how much they staffed up, the cases kept mounting — instead of 20 or 30 cases on average each day, like they were seeing in the spring and summer surge peaks, respectively — it was 200 cases a day at the winter peak.
It’s impossible get enough staff to keep up with that caseload, she said. Plus, right as the winter surge was peaking at the new year, vaccines started showing up on Pasadena’s doorstep.
While rollout was chaotic and disjointed at first — marred by misinformation, unpredictable shipments and the quirks that come with designing a distribution system from the ground up — at this point, nearly 87% of all Pasadena seniors over 65 have gotten at least one dose.
In Los Angeles County as a whole, just 36% of its seniors between the ages of 65 and 79 have been vaccinated. In its over 80 crowd, just 11.4% have been inoculated.
Despite repeated requests from media outlets, Long Beach has yet to produce this data.
Praise and criticism
Pasadena’s health department earned kudos from City Manager Steve Mermell as well as former Mayor Terry Tornek, who held the post through much of the pandemic, alongside some other members of the current City Council. But Councilman Hampton is not among them.
He believes the health department did a fine job, excluding its performance with nursing homes and elder care facilities. Factoring that in, Hampton said, “It’s an abysmal failure.
“People lost their lives. Maybe some of those people would be here, or maybe not. I just know for certain that we did not do all that we could. If we did all we could, I wouldn’t have been fighting.”
Mermell, Tornek and the health department staff strongly disagree with Hampton.
“For people to misinterpret the nursing home tragedy as a failure of the Pasadena Public Health Department, that’s one of the biggest misunderstandings of this whole thing,” Mermell said.
While Hampton acknowledges that Pasadena has more nursing homes per capita than Los Angeles County or Long Beach — and he knows that the county and state are legally responsible for nursing home enforcement in Pasadena, not the city — he believes that Goh’s emergency powers allowed her to take on a bigger role.
Mayor Victor Gordo, for his part, believes the situation is unclear and hopes that further analysis will show exactly what the city could have done, legally speaking.
“We cannot wait for another moment of crisis to clarify these issues,” Gordo said in an interview.
Hampton started calling for the city to remove uninfected nursing home residents from facilities that were seeing huge increases in cases before they caught it too. He believed operators weren’t being responsible in prevention infection.
It’s a reality that was borne out when one facility, Golden Cross, was shuttered and evacuated after city officials badgered the state for weeks, complaining about unsanitary and illegal living conditions — not to mention, a complete lack of infection control.
“I understand the humanitarian argument you have to do something but we have no practical option to take custody of people and no practical place to move them,” Mermell said.
One suggested location, the city’s convention center, was setup to be an overflow hospital for those who had very mild cases. It was never used, but it also wasn’t appropriate for this population, Mermell said.
“These were people who were very frail,” Mermell continued, arguing many could have died if they were moved — the same case elder care advocates have made in the past.
Feaster, for his part, believes the criticism is linked to Pasadena’s more complete data set: Pasadena had tested every resident and staff member in these facilities nearly a month before Long Beach or Los Angeles.
Once Long Beach and Los Angeles had as robust data as Pasadena, it became clear that something had gone wrong in the Crown City’s facilities — but it wasn’t any better elsewhere.
“We knew what was going on before anyone else,” Feaster said. “That’s what happened. And when you’re first, you’re often the first to be criticized.”
Light at the end of the tunnel
At this point in the pandemic, few in the health department are new to criticism.
Goh herself has become more adept at dealing with confrontational encounters with critical City Council members; her communication abilities have improved alongside it, Councilman Andy Wilson said.
In the early days of the pandemic, Goh’s addresses were centered on the science and what every other jurisdiction was doing, Wilson opined. Now, she’s taking a more holistic view and embraced the “complexity and richness of her role, balancing competing priorities” between health, social and economic outcomes.
As proof, he points to her decision to keep outdoor dining open when Long Beach and Los Angeles County closed. When she was asked by the council to make similar decisions earlier in the pandemic, she refused, drawing the ire of some on the council.
But it’s not just department heads who have taken heat.
Many of the folks who answer the phones at the health department have been screamed at by members of the public who “take out their frustration, their suffering on our staff,” Goh said.
In the beginning of the pandemic, they were berated over tests that were difficult to come by. Now, it’s about vaccines, which are still in short supply.
When it happens over and over, it starts to weigh heavily, Goh said.
Swaths of the department have been front and center to the widespread death and trauma this virus has caused, particularly contact tracers who talk to patients and family members. They also have to call those whose family members have just passed away.
Goh is looking for a therapeutic resource to bring to her staff at some point.
All of it takes a toll, she said.
Mermell, for his part, says he wants to find two weeks to send the entire on a Hawaiian getaway over the summer when this is all said and done.
And, if all goes according to plan, there’s just one last piece of the pandemic left to manage: the vaccination process.
While supply is still short now, Goh is confident that there will be enough doses for everyone who wants one by May 1. At this point, it’s a race between new variants and more vaccinations.
“We are in an incredible position of privilege in the Untied States, and we have to take full advantage of it,” Goh said. “That means now is not the time to stop masking. Now is the time to mask more so that as we vaccinate more, we can have these reopening happen without transmission.”
Staff writer Hayley Munguia contributed to this report.
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