Paschal Nwako, Ph.D., MPH, is a graduate of the Ph.D. in Health Sciences program in the School of Health and Medical Sciences at Seton Hall University He is also the County Health Officer and Public Health Coordinator for Camden County, NJ, charging him with the safety and wellbeing of more than half a million people.
Throughout his career, Nwako has seen and faced numerous public health crises, but none that compare to the current pandemic known as COVID-19. Like many healthcare professionals, Dr. Nwako's every day routine has shifted to combating the spread of this virus.
Dr. Nwako walks us through the changes he has faced as a leader of one of NJ's leading county health departments, comparisons to other 21st century pandemics and his view on the public health profession.
1. Explain how your role as County Health Officer changed or evolved during the current pandemic.
My county health department has been prepared for pandemics, including biological, chemical, and viral attacks. We continuously perform drills, crisis, and emergency risk communications, tabletops, functional and full-scale exercises about various public health threats. Still, nothing can prepare any public health department for the escalation of the COVID-19 public health emergency and a worldwide pandemic. Public health departments can withstand a certain level of workflow, but COVID-19 surpassed that capacity for all health departments. My county has 37 municipalities, and dealing with the various levels of government structure, including majors, police departments, fire departments, schools, and the public in a public health emergency is an arduous task. The intensity of conference calls, individual calls, text messages, emails, and other activities geared towards COVID-19 is not scaled for any health department to withstand. My role shifted from developing and administering a program of public health activities including, but not limited to environmental health services, maternal and child health services, public health nursing service, communicable and chronic disease control services, public health laboratory service and health education services to daily communicating with the state department of health, elected officials from all 37 municipalities and juggling many responsibilities including staff working from home and responding to complaints other than COVID-19. Everyone wants information and seems to want it at that moment. My focus changed to dealing with daily positive cases and contact tracing of all cases plus their close contacts. Developing and administering a public health program in a public health emergency is like working in a war zone or a disaster afflicted emergency room. From procuring COVID-19 test kits, personal protective equipment, and supplies for the healthcare system that cannot find any to buy. You realize that you are competing with other health departments for resources. Daily updating the media, county and municipal officials, and getting updates from the medical examiner's office regarding deaths becomes a regular routine. An average of four conference calls every day, seven days a week, becomes normal.
2. How is the Camden County Health Department working to prevent further spread of prevent further spread throughout the county?
The County Health Department is mandated under NJ statutes to investigate communicable diseases. The Camden County Department of Health has primary jurisdiction to isolate or quarantine individuals or groups of individuals if an infectious disease has affected Camden County residents in public health emergency implications. We actively investigate cases through contact tracing of COVID-19 patients in Camden County. Staff members daily contact positive patients and find out their symptoms, who they came in contact with during the time they were symptomatic, who they live with, and how they interact. County Health staff work with schools, first responders, homeless shelters, nursing homes, long term health centers, fire, police, EMS, laboratories, elected officials, corrections departments, law enforcement, community health centers, hospitals, physicians, drug treatment centers, home health agencies, transit companies, urgent care centers and the general public in answering their questions regarding the spread of COVID-19 and how they can better protect themselves. There are materials on the CDC website www.cdc.gov, New Jersey COVID-19 website www.covid19.nj.gov, and Camden County website www.camdencounty.com on how to prevent people from contacting coronavirus and prepare for COVID-19. The general theme to all the messages is handwashing, social distancing, wearing face masks, and contacting primary care provider when you have symptoms of COVID-19.
3. What happens when a case of COVID-19 is identified in Camden County?
County health employees actively monitor the communicable disease registry and surveillance system for COVID-19 cases that live in Camden County. The facility or the laboratory inputs test results into the CDRSS system after a Camden resident is tested at any facility in NJ. The County Health Department will investigate all positive cases and proceed with contact tracing.
4. Can you explain the differences in this major health event versus others you have encountered as a county health officer?
There is no comparison of the COVID-19 pandemic to any other public health crisis that my generation has witnessed. It is unprecedented and surpasses all different responses to the public health community. Public health deals with the flu season each year. No two seasons are the same because strains mutate each year. It can be challenging to predict what will occur in a particular year. Unlike COVID-19, effective vaccines and antiviral medications are available that can help reduce and prevent the flu.
Additionally, many people have residual immunity having been infected with the flu from years past, as their bodies have sort of built immunity. We don't have any immunity to COVID-19 that we know of at the moment. It appears to be more contagious and deadly than the flu so far, but this could very well change as we learn more.
In 2002, Severe Acute Respiratory Syndrome (SARS) originated from China, as a type of coronavirus that spreads quickly through respiratory droplets. Generally, the SARS death rate was higher than COVID-19. However, COVID-19 has already claimed more lives within a short period compared to SARS. Contact tracing was effective with SARS, mainly because symptoms were severe and, therefore, more comfortable to identify and contain.
In 2009, a new type of flu H1N1 strain came into the infectious diseases scene. People were terrified because there were no vaccines at the time, and the novel strain was spreading fast. There was no immunity during the start of the outbreak. Antivirals were available to facilitate recovery, and by the end of 2009, some vaccines combined with high levels of immunity protected people from the flu season. H1N1 claimed 12,000 lives in the United States.
Ebola in 2014, was deadly, killing up to 50 percent of those who got sick from the virus. It is predominantly spread through bodily fluids like sweat and blood that presented during the last stages of the disease. This made Ebola symptoms detectable among a population. Ebola was not as contagious as COVID-19. Ebola's symptoms were so severe, and health officials did not find it difficult to quickly identify a person and isolate before they could spread the virus in public. The symptoms of Ebola are very noticeable, and people don't walk about shedding Ebola virus-like they do with COVID 19.
Each discipline within the field of public health is projected to grow over the next decade, resulting in a positive job outlook for those entering the profession. Serving las emergency management directors, health and safety engineers, environmental scientists, medical and health service managers, biostatisticians, epidemiologists, and more, public health workers contribute significantly to the overall wellbeing of society. As evidenced over the last few months, as the world continues to battle the COVID-19 disease outbreak, these individuals are essential to identifying, containing, and eradicating the spread of infectious disease and other health hazards.
To those entering the line of work, Dr. Nwako says that, "Public health practice is a rewarding area of health science where you are always in contact with the public and work with teams for the primary purpose of promoting health, preventing diseases, and protecting the lives and safety of the residents they serve. It is an honor to lead a team of health professionals that serve the public."
"Dr. Nwako is just one example of our many PhD program alumni who have assumed executive leadership roles not only in New Jersey but across the nation. His exemplary leadership, especially during these challenging times, is a testimony to our innovative PhD program in preparing leaders to serve in a variety of community roles," says Brian B. Shulman, PhD, CCC-SLP, Dean of the School of Health and Medical Sciences.
Categories: Health and Medicine