Dr. Anthony Chen, director of the Tacoma-Pierce County Public Health Department, was in high demand in July as school boards and superintendents, public and private, sought guidance on reopening in September.
“They were asking me to project a month or two in advance what was going to happen, but all I could tell them is what was going on that day,” Chen said. “At that time things were just going crazy. We saw no end in sight. Every day our cases were going up. It was painful.”
As with any issue, Chen said there are people who understand the reasons behind public health decisions and other people who are more peripheral but impacted and unhappy. “Most people don’t hear all the explanations; all they hear is the one piece — ‘He said we can’t go back to school.’ ”
Chen said, “People have a hard time having conversations and honestly a lot of the way communication occurs now is not synchronous. You can post on Twitter, Facebook, or send an email; it’s not a dialogue.”
People often load up and escalate — lobbing personal attacks while they’re at it. “That’s the unfortunate part,” he said. “I think people are taking their anger out at the wrong things.
“This is one of the big challenges for us. We always have to understand that there are going to be differences of opinions but that we need to stay focused on what is right scientifically and from a public health standpoint, and that’s what guides our work.”
Chen’s father was a physician who did public health work. He came from Taiwan and was part of a team that eliminated malaria from the island, an incredible achievement at that time. Employed by the World Health Organization, his father moved the family every five or six years, living in southeast Asia and the Solomon Islands.
“I’d read about international development, clean water projects, stuff like that, in magazines from the WHO and the U.N.,
which set the stage for how I conceptualize health,” Chen said. “Growing up I enjoyed being outdoors and around animals. I was not the greatest student — I’d rather be out catching bugs and looking at birds and plants than studying.”
In college Chen focused on biology, from one-cell organisms to animals and ecosystems. His second year required social science and there he discovered a passion for his second major in anthropology, which he described as very systems-oriented, like biology and ecology.
“I didn’t particularly want to go to med school, but hey, my mom made me,” he said.
Chen attended Duke University in North Carolina for medical school, and a group he got involved with spent most of its time in a poor, rural northeastern part of the state.
“We lived in people’s homes and did health fairs and community organizing around health. It made me want to take care of people,” he said. Chen chose family medicine, where he could still perform some surgeries, deliver babies, and care for children and the elderly, which was still systems-oriented: “You don’t just care for the patient, but the whole family.”
His background in systems theory led Chen beyond the family unit to also consider their physical as well as their social and political environment. His holistic perspective was well-matched for working within all those systems, he said.
Chen’s first real job was teaching in a residency satellite program in Seattle that treated immigrant and refugee patients as well as some of the homeless people who lived downtown. Later he moved to a community clinic within the system, with a very diverse population.
“It became clear to me after nine years that I could be as good a doctor as I wanted to be in my clinic, but somebody in Olympia or Washington, D.C., who knew nothing about health care, was going to pass laws that significantly impacted the health of my patients,” he said. “I needed to know more about policy.”
He left for Harvard to do a fellowship on minority health policy and earned a master’s degree in public health.
Chen was hired for the top post at TPCHD in 2008. He’s been working seven days a week since the pandemic arrived, along with most of his staff.
Things have improved since April and May, he said, but haven’t returned to normal. There are always cases that come in over the weekend to be investigated. Chen described days when over 20 businesses reported COVID-19 cases. Staff helped them decide who should get tested and who should stay home, quarantine and isolate.
“We’re running three public health emergencies: COVID-19 and the response to it; racism — which we declared a public health crisis in June — and now a wildfire smoke emergency,” Chen said. “I’ve been very happy with how we’ve been able to respond to this unprecedented demand on us. It all reflects the dedication of my whole staff; they are incredible.”
Chen acknowledges concern heading into fall with the flu season on top of the pandemic. He said his team is trying to be very conscious of the stress people are under.
Chen’s hope is not for miracle cures. “We know how to do this when there is no vaccine and no cure. We pull from the playbook of public health and we can control the spread of diseases. We did it with Ebola; we still don’t have a vaccine or treatment but we were able to contain it in Africa. Same with MERS and SARS — we have no vaccine, no cure.”
He is encouraged seeing partners like business communities and schools stepping up to get out the message: If we want businesses to reopen we’ve got to control this virus and part of that is to wear masks.
“We need you to activate your social networks,” Chen said. “Some people will listen to me, some people listen to you, and some people won’t listen to either of us. But maybe they’ll listen to their sports coach or the owner of their favorite restaurant… Understand that we may have to give up a little bit now, but we’re doing that to get back some of the things we really miss.”