PROVIDENCE, R.I. (AP) -- Vilified, threatened with violence and in some cases burned out, dozens of state and local public health officials around the country have resigned or have been fired amid the coronavirus outbreak, a testament to how politically combustible masks, lockdowns and infection data have become.
The latest departure came Sunday, when California's public health director, Dr. Sonia Angell, quit without explanation following a technical glitch that caused a delay in reporting virus test results -- information that was used to make decisions about reopening businesses and schools.
Last week, New York City's health commissioner was replaced after months of tension with the Police Department and City Hall.
A review by the Kaiser Health News service and The Associated Press finds at least 48 state and local health leaders have resigned, retired or been fired since April across 23 states. The list has grown by more than 20 people since the AP and KHN began tracking departures in June.
As of Monday, confirmed infections in the United States stood at over 5 million, with deaths topping 163,000, the highest in the world.
The departures of so many top leaders around the country make a bad situation worse, at a time when the U.S. needs good public health leadership the most, said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.
"We're moving at breakneck speed here to stop a pandemic, and you can't afford to hit the pause button and say, `We're going to change the leadership around here and we'll get back to you after we hire somebody,'" Freeman said.
Many of the firings and resignations have to do with conflicts over mask orders or social distancing shutdowns, she said. Many politicians and ordinary Americans have argued that such measures are not needed, contrary to the scientific evidence and the advice of public health experts.
"It's not a health divide; it's a political divide," Freeman said.
Some health officials said they were leaving for family reasons, others had planned to retire, and some left for jobs at other health agencies, such as the U.S. Centers for Disease Control and Prevention. Still, many left amid threats and a pressure-cooker environment.
After West Virginia Gov. Jim Justice demanded the resignation of Dr. Cathy Slemp in June over what he said were discrepancies in the data, the move was criticized by public health experts at Johns Hopkins University. Slemp said the department's work had been hurt by outdated technology like fax machines and slow computer networks.
"We are driving a great aunt's Pinto when what you need is to be driving a Ferrari," Slemp said.
Since 2010, spending on state public health departments has dropped 16% per capita, and the amount devoted to local health departments has fallen 18%, according to a KHN and AP analysis. At least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a skeletal workforce for what was once viewed as one of the world's top public health systems.
In Oklahoma, both the state health commissioner and state epidemiologist have been replaced since the outbreak began in March. The governor's first pick for health commissioner was forced out in May because lawmakers were concerned he wasn't qualified.
In rural Colorado, Emily Brown was fired in late May as director of the Rio Grande County Public Health Department after clashing with county commissioners over reopening recommendations. The person who replaced her resigned July 9.
She said she knows many public health department leaders who are considering resigning or retiring because of the strain.
"I think there's a leadership gap. Our elected officials in positions of power, whether presidents, governors or mayors, they aren't supporting staff better or aligning messages," forcing public health officials to bear the political pressure, Brown said. "It's really hard to hear that we could be losing that expertise."
Weber reported from St. Louis. Associated Press writer Sean Murphy and KHN writer Anna Maria Barry-Jester contributed reporting.
Weber is a reporter with Kaiser Health News. This story is a collaboration between The Associated Press and KHN, which is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente.