SALT LAKE CITY — With dozens sick from hepatitis A and hundreds more at risk of the illness during an outbreak in Utah, Salt Lake County public health workers set all boots on the ground to try to halt the disease's spread.
The most at-risk population included Salt Lake's homeless community — the least likely to seek medical attention, said Gary Edwards, Salt Lake County Health Department executive director.
It's work that oftentimes flies under the radar.
"In the case of individuals that are homeless, making that contact is not easy if they're not hospitalized, and we're able to go and find them in the hospital. … In the case of this hepatitis A outbreak, we had to be out on the streets, along the Jordan River, trying to identify individuals, trying to vaccinate individuals to be able to get the outbreak under control," Edwards recalled.
"It was certainly a different model for us. But this was not a population that was going to come to us. We needed to go to them."
For its effective response to the outbreak and other innovations, the Salt Lake County Health Department was recently named Local Health Department of the Year in the country by the National Association of County and City Health Officials.
Hepatitis A is a contagious liver disease that begins with infection from the hepatitis A virus. It is transferred by close contact with someone who has the disease, eating shellfish harvested from sewage-contaminated water, and through sexual contact with someone infected with hepatitis A.
Before 2017, the majority of outbreaks of hepatitis A in the United States were related to imported food items, the national Centers for Disease Control and Prevention reports.
While about half the states in the U.S. have experienced or are experiencing hepatitis A outbreaks in recent years, Utah and California have been the only two that have declared an end to the outbreaks. Utah’s outbreak was declared over in late 2018 after about 17 months and 281 cases. Nearly 200 of those cases were in Salt Lake County, according to state health data.
Winning the award is "the result of a very dedicated team of employees who love what they do and are committed to helping Salt Lake County residents be as healthy as they can," Edwards said.
About 400 employees work for the department.
According to Edwards, what other health departments can learn from theirs is that "we are always trying to learn from other departments. Whenever we are faced with a challenge, one of the first things we do is ask ourselves, 'Who could we reach out to and find out if they've dealt with this, and how have they done it?'"
The department is also celebrating its 50th year as a combined city-county health department.
In that time, the Salt Lake County Health Department, and public health in general, has changed drastically. In the early days, public health involved visiting homes to provide medical care and trying to assure clean water, Edwards said.
"And while we continue in those efforts, we are not as much the clinical health care provider … but we work primarily with communities to try to help them identify areas where they can improve the health of their community."
With those changes has come the need to adapt.
That shift created challenges for workers as their roles changed, Edwards said. Some staff members who wanted to continue providing clinical services have moved on, or "had to shift their focus" to stay in public health.
But many of those who stayed have stayed for decades, like Ilene Risk. Her job involves high-tech investigative work, tracking down diseases and their sources.
Risk, the county's epidemiology bureau manager, said when there's an outbreak like hepatitis A, "it just kind of amps up the energy around it, because we're all just so curious and want to find out the source."
"So it's also a lot of excitement, just trying to come together with all the ideas, and logistically bringing in the Utah Department of Health who stays in touch with CDC," she explained in her office overlooking downtown Salt Lake City.
For Linda Bogdanow, epidemiology supervisor and gastrointestinal specialist, "I'm never bored. It's always, I feel like I'm in school. Always. Just always learning things. And the people I work with," she said.
She even enjoys the more pungent parts of the job.
"Nothing makes me more happy than a positive stool sample," Bogdanow explained, because it helps her investigate diseases. "We really do just light up when we can do something. It feels good to help people feel healthy."
Tara Scribellito, infectious disease nursing supervisor, said she's stayed with the department for about 10 years because "I love the ability to really make an impact on a widespread scale. So I can see directly what we do on a daily basis impacting our population and community as a whole, which is really, really neat."
Nurses in her department administer treatment to people with tuberculosis and other infection diseases.
"And it's an underserved population, so it's a really, really fun population to work with. And there's never a dull moment in infectious disease."
Loi Huynh agreed, adding that he loves working with people who come from different countries in his job as an infectious disease nurse. "Basically, I deal with a lot of people that come from other countries and speak other languages. They really, really make me feel like I'm part of their families," he said.
"We see all kinds of people, from wealthy to really poor, noneducated, educated, and all kinds of people. We walk in their shoes," Huynh explained. "So that's public health."
The biggest health concerns in Salt Lake County that public health workers are now trying to tackle are air quality, maternal and child health, the opioid crisis and suicide prevalence, according to the executive director. The health department is now working to keep real-time data on chronic diseases like diabetes and asthma to try to help the community.
"We in public health often say that our work usually goes unnoticed, and that's good for public health. If we're not out there, then things are being taken care of," Edwards said.