Dr. Nirav Shah made a now-famous remark at a routine legislative committee briefing in mid-January:
“There’s a virus in China I’m concerned about.”
Shah, director of the Maine Center for Disease Control and Prevention, was answering a legislator’s question about “What keeps you up at night?” at a time when very few people in America were paying much attention.
Two months later, the human and political landscape has changed almost beyond recognition, as state government struggles to keep up with seemingly impossible demands for accurate information as the coronavirus pandemic builds toward its peak. It also must keep basic public services going as most Mainers “self-isolate” or keep their daily public activities to a bare minimum.
The briefings that Shah now conducts every weekday – with video conferences on weekends – have become not only must-see television and streaming, but vital sources for health-care providers, emergency responders, state agency officials and legislators.
Shah gets high marks from almost everyone for both his fidelity to science and his analytical ability – he studied economics at Oxford University and has a law degree, which allows him to present complex information in a pithy and memorable way. He’s been joined at some briefings by Gov. Janet Mills and Health and Human Services Commissioner Jeanne Lambrew, who is a former health-care adviser to President Barack Obama.
Mills’ most recent appearance was to announce the first death of a Maine resident at the hands of COVID-19. As of Tuesday, there had been five deaths and 303 cases – both totals certain to rise in the days ahead.
State Sen. Geoff Gratwick, D-Bangor, is especially impressed by Shah’s knowledge and ability to communicate. At an impromptu joint session of the Legislature March 5 – just 10 days before the session’s premature end – Shah spoke “for 45 minutes, without notes,” Gratwick recalled. “He dazzled us. There were no extra words, no digressions, just a powerful overview of what was in front of us.”
Yet while Shah’s command may be notable, it’s not perfect. It was at the outset of his March 5 presentation that he attributed the “What keeps you up at night” question to Gratwick, while in reality, it came from the HHS Committee’s co-chairwoman, Rep. Patricia Hymanson, D-York, – who like Gratwick and Shah is a physician.
Shah had been outlining Maine CDC’s top three priorities, all unexceptional, when Hymanson asked her follow-up question. When she heard his response, she jumped to attention and thought back to her days as a young resident in New York City, dealing with a mysterious virus later identified as the cause of the AIDS epidemic.
Shah established his public health credentials in Cambodia, where he figured out how to get international aid donations directly to rural health clinics, bypassing the corrupt middlemen who were pocketing much of the money.
Ironically, given his current standing, Shah’s hiring just a year ago was a rare moment of controversy over one of Mills’ appointments. Shah had been criticized for what was perceived as a slow response to a 2015 outbreak of Legionnaires’ disease at an Illinois veterans home, where he held a comparable position at the state CDC.
Both Gratwick and Hymanson said they were satisfied that Shah had followed all state and national CDC protocols and that he had “forthrightly” addressed the Illinois issues; the responsible Veterans Administration director did resign.
And Gratwick said he doesn’t like to think what would have happened had the coronavirus struck during the previous administration. He’s a fierce critic of former Gov. Paul LePage, saying he “basically destroyed the public health system of Maine.”
Hymanson draws another contrast, with Gov. Mills’ leadership during the crisis.
“She understands that she needs to see the whole picture, and balance all the needs,” the lawmaker said. One of Mills’ remarks at a briefing struck her, that “You have to skate to where the puck is going to be. That’s what we all have to do.”
The daily Maine briefings, so different from comparable proceedings in Washington, are orderly affairs, with Shah’s opening statement followed by questions from assembled reporters, who quickly convey the news through newspapers, television stations and websites.
Eric Russell, the Portland Press Herald reporter who alternates with Statehouse correspondent Kevin Miller, said the briefings “are enormously helpful,” and offer “real transparency into the decision-making going on.”
Behind the scenes, the briefings represent the culmination of a huge amount of information-gathering and analysis, coordinated by Robert Long, Maine CDC’s communications director, who works closely with Shah.
Until last August, Long, an editor with the Brunswick Times Record and Bangor Daily News for 17 years, had been looking forward to some quiet time, perhaps doing substitute teaching. Instead, he said he was recruited to apply at Maine CDC, and after an interview with Shah, took the job.
The interview, he said, “was what made the job much more attractive.”
Long called his new boss “brilliant,” and while, on rare occasions, Shah might be thrown off-stride by a question, “he’s pretty unflappable. His intellectual energy is what helps get us through each day.”
Long started by handling traditional CDC program efforts – “diabetes prevention, the WIC program, radon and public water supplies, tobacco cessation.” Then, “It all changed.”
No one at Maine CDC is getting much sleep, and Long said the experience “is like election night every day. There’s an urgency and a gravity to the work that drives us.” He added, “I no longer miss election night.”
At the briefings themselves, the sign-language interpreters who flank Dr. Shah attract a lot of attention through their movements, which some find distracting. Long explains, “This isn’t a translation; it’s an enactment of the words,” adding, “I’ve learned a whole lot about an area I knew almost nothing about.”
The briefings actually don’t consume much of Long’s time, though he does frequently help Shah with messaging at their daily conferences. Communication with other state agencies is paramount, where the workers who Long said impress him most are “responders who are on the phone at 2:30 a.m., talking with a doctor who thinks he may have a case.”
And while the workload can seem overwhelming, “we do take some time off,” he said. “We aren’t going to be very effective if we try to go 24/7.”
Shah, for his part, has been scrupulous about not criticizing federal actions concerning the pandemic. But occasionally he allows an inference to be drawn.
After Maine received a new shipment of personal protective equipment, which includes gloves, masks and face visors for health-care workers, he said, “It’s still not sufficient. We’ve got an umbrella, and we’re in a hurricane.”
While Maine CDC gets high marks, not every state agency does.
Russell, of the Press Herald, said that for another reporter’s story about the impact on prisons and jails, the Department of Corrections “declined multiple requests for interviews.”
“It’s never been more important than now for us to keep pushing for answers, to keep asking the right questions,” he said.
Another aspect of the CDC director that strikes observers is how Shah is able to go beyond the discussion of cases, outbreak vectors and community transmission to the larger picture.
At one recent briefing, he concluded, “We will get through this, and we will do so partly because our approach is informed not just by science but by kindness, humanity, and compassion. We can and must remain together even though for now we may be apart.”
Douglas Rooks has covered Maine issues for 35 years as a reporter, editorial writer, columnist and former editor of Maine Times.
Lessons from the AIDS epidemic?
Dr. Patricia Hymanson was doing her residency at a New York City hospital in 1983 when she noticed “a lot of patients coming in with white tongues, fever, and a shortness of breath. We had absolutely no idea what it was.”
Within a few months, the HIV virus had been identified, and America’s AIDS epidemic had begun.
“We had no protection, and no knowledge of what we were getting into,” Hymanson recalled. Frontline workers in emergency rooms “were giving injections, putting in deep lines, handling urine and feces. No one wore gloves. No one had masks.”
Despite its rapid spread, AIDS went unacknowledged by the Reagan administration until Dr. Everett Koop, then the surgeon general, began talking in public about a communicable disease, not a biblical plague. His words and actions are now remembered as a turning point in public health history.
Hymanson is now a Maine state representative from York, and co-chairwoman of the Legislature’s Health and Human Services Committee. She wondered how much we’ve actually learned from the AIDS experience, and sees the same lack of preparedness, and the same neglect of protections for health-care workers that she experienced nearly four decades ago.
“We thought that surely, people would protect us. They wouldn’t ask us to assume undue risks, ignorant of the possible consequences,” she said.
Yet only days after the arrival of COVID-19 in Maine, she said, “we were running out of masks. There wasn’t nearly enough equipment. We may run out of beds.”
The coronavirus pandemic is far more widespread than any viral illness since the Spanish flu of 1918, and is far more easily transmitted than AIDS or Ebola.
Yet Hymanson still wonders whether change in the health-care system will come fast enough. “That’s what really upsets me,” she said.
— Douglas Rooks