To all appearances, Baltimore is in Covid-19 recovery. The city’s vaccination rate is at 64%, in line with the national average. Indoor mask mandates have been lifted, and children are back to school in person. It is beginning to seem as if the worst is over, and we can cautiously return to normal (although the BA.2 variant could change things).
For City Health Commissioner Letitia Dzirasa however, normal is exactly where we don’t want to be.
Normal for Baltimore is a place where entrenched economic disparities have created an uneven playing field. Large parts of the population have little economic opportunity and even less access to quality healthcare. So, when Covid-19 hit Baltimore just one year into Dzirasa’s new job as Health Commissioner, she was laser-focused on using it as a chance to redress those problems.
She kept underserved neighborhoods firmly in mind when making decisions and allocating resources to combat the pandemic, and it paid off. Despite early fears that the city’s social ills and chronic poverty would result in catastrophic loss of life, a report by Johns Hopkins Bloomberg School of Public Health in September gave the city high marks for its handling of the pandemic.
Dzirasa is quick to dismiss any attempt to give her credit. She emphasizes instead the vast amount of teamwork that took place over the past two years as the city struggled with the disease. Collaboration with mayors Jack Young and Brandon Scott, as well as other city agency leaders and staff were key. Public-private partnerships formed in the early days of the pandemic with Johns Hopkins, UMMS and CareFirst provided the critical ability to track and share data. Those organizations followed up with economic and medical assistance, as well as the training of healthcare workers, something the understaffed and underfunded health department could not have managed alone. Support from the state government and a surprisingly high rate of insured residents also played important roles in keeping city residents safe.
Nevertheless, Dr. Dzirasa, with her dedication to healthcare equity, expertise in data science, and collaborative leadership style, has been described as having been “the exact right person for the job’ of leading the city’s response to the deadliest medical event in over a century. “Letitia was created in a lab to combat Covid” her former colleague Jeff Amoros told the Baltimore Sun. “Her vision for health is rooted in equity”.
“A lifelong passion” is how Dzirasa, age 40, describes her interest in medicine. She has followed an unswerving path towards that goal. A Meyerhoff Scholar at University of Maryland Baltimore County, in 2007 she graduated summa cum laude from Meharry Medical College, an HBCU in Nashville. After completing a pediatric residency at Johns Hopkins, she worked as a primary care physician in an east Baltimore clinic. Later, in several leadership roles at Baltimore Healthcare Systems, she used recent innovations in technology to meet the needs of a large network of patients. Prior to her job as Health Commissioner, she spent three years as Health Innovations Officer at Fearless Solutions LLC, the local tech nonprofit founded by her husband Delali.
You’ve been operating in crisis mode since day one. What has it been like having Covid take up so much of your time when Baltimore has so many other urgent healthcare needs?
Yes, lots of urban healthcare needs certainly, across the city. The thing about the pandemic is that it’s a public health emergency in every sense of the word, a communicable disease, spreading quickly in real time. There are other epidemics — violence, substance abuse – which are absolutely priorities, but they have longer-term policies and planning structures in place, as well as education, that are ongoing. Covid-19 is an acute disease where you can immediately implement therapeutics – treatments, vaccinations — to turn the tide of the illness. It’s an acute emergency vs. a sustained emergency. It’s been especially challenging from a workforce perspective because our people have been supporting the Covid response and at the same time trying to do their pre-pandemic jobs.
What were your priorities for the Health Department before Covid?
One thing I’ve always been passionate about from my training at Hopkins and in community medicine, is equitable access to care. Covid provided an opportunity to deliver that. We were very intentional about where we placed our testing resources and our vaccination clinics. Our goal was to serve communities that have been marginalized, often with little or no access to medical care. Another important issue for me is obesity in childhood because it is so closely related to the social determinants of health and so strongly affects health outcomes. A third is trauma informed care, a treatment approach that takes into account trauma that individuals may have experienced in their lives. We supported the Elijah Cummings Healing City Act sponsored by councilman Zeke Cohen and are training thousands of city employees to engage with constituents in a way that provides empathy and respects their life experience.
Dr. Anthony Fauci said on February 8th in the Financial Times that the pandemic phase of Covid is ending, and that going forward, decisions about Covid protocols will be made on a local, rather than a state or federal level. Does this make your job easier or harder?
(Laughs) Well, I feel like we have always been making decisions on a local level!
We have always looked to the CDC and the state for guidance, but when Hopkins and CareFirst approached us early on to start a heath care partnership, we very quickly decided to partner with them, and that was a local decision. Keeping our restrictions and lockdowns in place, school closings, testing sites were all local decisions.
Would you agree that Covid-19 is winding down? What is the biggest Covid-related issue the Health Department is dealing with now?
I would not say Covid is winding down. There are still areas of the city where less than 30% of residents are vaccinated. We are still actively vaccinating, still actively testing. Pediatric vaccination was only approved in November. Those children are being vaccinated now, and infants 6 months to four years will probably be the next group. We continue to test, especially in underserved areas. Maintaining access to testing in the event of another wave of Covid will be an ongoing concern.
The Health Department ran a social media campaign at the height of Covid to get residents tested and vaccinated – from funny tweets and memes to Facebook and Reddit posts. Of all your ‘reach out’ efforts, which do you think was the most effective?
You know, honestly, the social media stuff is cool, and it garnered a lot of attention, but we started a program called Value Ambassadors which really moved us forward. We hired around 120 Value Ambassadors, people from areas that we identified as being most impacted by Covid and hardest to reach. We trained them to engage with people in their own neighborhoods about Covid. They knocked on doors, distributed flyers, manned info tables, texted. That program has been extremely effective. We are still sifting through the data for exact numbers, but that program has made a big difference, reaching over 110,000 residents. And they’re still doing the work.
What is your position on anti-vaxxers?
You know, everyone has different reasons for why they believe in something, so I try to be relatively tolerant. But in terms of going down the rabbit hole of social media on that topic, I kind of let my comms team manage that. I really try not to engage with those folks.
Tell us about your TEDx talk, ‘Why We Shouldn’t Go Back to Normal’
We did that to reach people who aren’t in public health or social sciences, who were perhaps unaware of the data showing how social determinants directly impact health. Much of this came to light during the pandemic, and I think a lot of people just legitimately didn’t know. But in Baltimore and in cities like Baltimore, there are factors going back generations – red-lining is one example – that pre-dispose Black and Brown people to poor health. We now know that where there was red-lining, there are higher rates of high blood pressure, more tobacco retailers, less green space, more pollution. Residential segregation can create as much as a twenty- to thirty-year difference in life expectancy from one neighborhood to the next. And now that we know that, we can’t ignore it and go back to what has been the norm. We have to forge ahead and address the inequities that have gotten us here.
From your time at Fearless, you bring a special awareness of digital technology’s role in public health. Where to you think that technology can have its biggest impact on health outcomes?
One of the things the pandemic allowed us to highlight was how data can help facilitate rapid healthcare response. For example, I would love to have a dashboard, certainly for Covid, but for other diseases and conditions, so that folks could understand what’s going on in their community. I think if you can see, ‘Wow, I didn’t know that we had so much high blood pressure or diabetes,’ it hopefully becomes a way to engage people, to say, ‘hey, we need help here’, and we can then allocate the resources to do that .
What would you like to be able to do at the Health Department that you have not been able to afford?
Workforce development. I am really thankful for recent funding from the ARPA. One of the things I am excited about is that it will allow us to continue to fund some critical staffing, like the Baltimore Health Corps. During Covid we brought on 250 community healthcare workers, hired and trained with a flexible purview, who could be deployed as needed — whether that be contact tracing, administering tests, or assisting in vaccinations efforts. The ARPA funding will allow us to keep a portion of these workers on staff to help with ongoing vaccination efforts. One of my biggest worries is that the ARPA money goes away, so we are also making sure that we’re putting in place public health infrastructure – whether that’s from a data perspective or other technical needs for long term sustainability — so that when the funding is gone, we still have something to show for it.
What is your priority for the Health Department going forward?
I’ve been very encouraged by the mayor’s support of the Child Fatality Review, which addresses the causes of youth violence – children at risk of being victims or perpetrators of violence in the community. This program reviews every childhood death from birth to age 17 that happen across the city. Our job in public health is to work across multidisciplinary teams, in other words, to track these children through the health system, the school system, the court system, DSS. The idea is to share data, to facilitate discussion, to get a complete picture of why this keeps happening, to see how and where we can reach these children, and what policy recommendations we can make to stop these fatalities.
How do you keep from burning out in a job like yours?
I exercise a lot, and that has been very helpful to me. We have a Peloton bike and treadmill; I use those four or five days a week. And I’m incorporating yoga and strength training into that. Also, I try to make a conscious effort to take the phone off the hook and to have time with my family.
