Dr. Sara Cody: Public Health Hero

I’d like to take a moment to sing the praises of Dr. Sara Cody, Director of Santa Clara County’s Public Health Department. The San Francisco Chronicle shared a great story about her (stuck behind a paywall here) that I wish had gotten wider distribution.

She is, to be frank, an obscure bureaucrat. That sentence may not bring to mind someone who takes bold, decisive action to save thousands of lives. You could fill in any quality that politicians like to associate themselves with and ‘obscure bureaucrat’ would be its opposite.

Building on her decades of experience in public health, she knew three crucial facts. First, she knew the approximate exponential growth rate of the novel coronavirus. And she knew how to extrapolate that growth into the future. Second, she understood that there’s a lag between infection, diagnosis, hospitalization, and death. The number of people who will need ICU treatment for coronavirus ten days from now has already been set, whether we know the number or not. Third, she knew the surge capacity of Santa Clara ICUs.

In the days leading up to Sunday, March 15th, Santa Clara’s health department was already setting precedent after precedent under Dr. Cody’s leadership. They were the first to ban public gatherings of over 1,000 people. Three days later, they dropped the limit to 100. None of it was working. A lack of testing, caused by mistakes outside of her jurisdiction, likely made her work much harder. Some politicians were aware a shelter-in-place order was a tool public health departments could use in a worst case scenario, but believed it was weeks away.

By the end of the week, Dr. Cody could see that the Bay Area was out of options. The number of people already infected with coronavirus was likely already so high it would saturate our ICUs. The only way to avoid turning critically ill patients away at the door weeks later was to take drastic action right then.

Facing an epidemic that spreads 30% every day, educating and persuading politicians would have taken too long. So she unilaterally decided to order Santa Clara County’s 1.9 million residents to shelter in place. Before making her order public, she called her counterparts in five nearby counties and explained her projections. Experts themselves, they understood and immediately agreed to issue identical orders in their own counties. Dr. Cody’s order, the first of its kind in the history of the United States, then covered 6.7 million people. Only after the directors made their decisions did they inform the mayors. Crucially, they did not ask the mayors. They told them.

The mayors were taken off guard by how quickly the order came. That’s understandable. They had all been proactive about responding to the virus, but they’re not epidemiologists. If Dr. Cody had waited a few days until they were comfortable with the idea, we may have been given an order with less scary wording like ‘stay at home’ instead of ‘shelter in place.’ But the softer rhetoric would have come at the cost of a full doubling in the number of infections. Besides cutting off the virus’ growth in a California hot spot, the Bay Area order likely made Governor Newsom’s statewide order come faster.

When she was getting her M.D., I’m sure Dr. Cody never fathomed that she might one day need to place millions of people under quasi-house arrest. When the moment came, she did not hesitate. If anybody in government deserves to be called a hero for the way they’ve handled the coronavirus, it’s Dr. Sara Cody.

 

 

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