Dr. Sara Cody reflects on her front-and-center role during the pandemic

Santa Clara County Public Health Director Dr. Sara Cody has worked at the county health department for more than 23 years. She became health officer in 2013. Photo by Adam Pardee.

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Dr. Sara Cody reflects on her front-and-center role during the pandemic

Santa Clara County Public Health Director Dr. Sara Cody has worked at the county health department for more than 23 years. She became health officer in 2013. Photo by Adam Pardee.

Dr. Sara Cody faced the biggest challenge of her public health career in January 2020 as the COVID-19 pandemic began to unfold. Emerging from her mostly behind-the-scenes roles as Santa Clara County health officer and director of public health, Cody — a self-described introvert — was suddenly thrust into an unwelcome spotlight that made her a recognized national leader for making bold and sometimes controversial decisions.

Cody, who ordered the first stay-at-home directive in the nation, was on the forefront of addressing the pandemic from its start. She created an incident command center as early as Jan. 23, 2020, just days after learning of the first COVID-19 case in the nation. She developed a contact-tracing program to try to contain the outbreak. She went on to galvanize other health officers in the nine Bay Area counties to work together and with a common voice. With her team and multiple community partners, she has focused on health equity in underserved communities by making vaccines readily accessible.

As of April 11, 90.7% of all eligible Santa Clara County residents ages 5 and older have completed their initial series of vaccinations compared to 74% of residents statewide and 65.8% nationally, according to county and CDC data.

As an epidemiologist by training, Cody said she knew the risks that could come from a viral or bacterial outbreak. Working as a federal Epidemic Intelligence Service officer for the U.S. Centers for Disease Control and Prevention, she investigated the global 1996 E. coli bacteria outbreak linked to unpasteurized Odwalla apple juice and led an investigation into a salmonella outbreak of raw milk cheese in Santa Clara County. She has overseen many investigations of diseases, including SARS and H1N1.

SARS-CoV-2 was different: She was facing a global pandemic on a magnitude that hadn't been seen in more than 100 years.

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"I've never experienced a chronic crisis pandemic, which is what everyone has experienced — 'chronic crisis,'" Cody said.

In recognition of her work during the pandemic, the Palo Alto Chamber of Commerce and the Palo Alto Weekly are honoring Cody with the Tall Tree Global Impact Award. It's only the third year the award has been given in 42 years.

Santa Clara County Health Officer Dr. Sara Cody speaks during a press conference in San Jose on July 2, 2020. Photo by Magali Gauthier.

Cody spoke with the Weekly about what it's been like to be the person charged with making health decisions during the pandemic.

Calling herself "just another kid," Cody was born and raised in Palo Alto. She attended Walter Hays Elementary School, Jordan Middle School, Palo Alto High School and Stanford University. After receiving her medical degree from Yale School of Medicine, she became a resident in internal medicine at Stanford Hospital. She's been at the county health department for more than 23 years, first as deputy public health officer before taking the reins as public health officer in 2013.

Cody said the closest she had come to anything like COVID-19 was when the H1N1 influenza virus emerged in 2009.

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"I remember the feeling of 'Oh my gosh, it's actually happening. We're in the middle of this pandemic' and that we've thought about it, trying to prepare for so long," she said. "I do remember that feeling and kind of getting an adrenaline rush just thinking about it."

H1N1 fizzled, but she encountered that same concern in December 2019 and January 2020 when the SARS-CoV-2 virus began to emerge.

On the morning of Jan. 31, 2020, she received a call that the first case of COVID-19 had been identified in Santa Clara County. Two days later, there was another case. Both patients had traveled from China. Nearly four weeks later, on Feb. 28, the first case of transmissible COVID-19 was identified in the county. The patient, a woman in her 60s, died nine days later.

"Things were happening very, very quickly at the beginning, and what I experienced was that time kind of changed. ... We got very focused on what was right in front of us. Time sort of telescoped down," she said.

Ordering the initial lockdown was the hardest decision she had to make, Cody said. She knew the decision would especially affect the most vulnerable, who couldn't go to work or would lose their jobs, she said. She became tearful during a March 2020 press conference when she announced limiting the number of people who could gather to 100. This also meant closing school campuses.

The last thing she wanted was to close schools, but it became clear that most educational institutions couldn't keep up with the cleaning and sanitizing protocols that authorities thought were necessary to keep the virus from spreading to children and their families, she said.

Cody struggled with what that decision would mean, she said.

"During the press conference, for whatever reason, I started thinking even more about all of the life events that wouldn't be able to happen if more than 100 people couldn't gather. And that sort of flashed across my mind, literally in the middle of the press conference, and I got a little choked up. Not the first and not the last time," she said.

Cody said decisions had to be made, and she had an obligation in her capacity as health officer to make them.

"The law gives you the authority in this position and to each county, and if you're sitting in that position, you're the one with that authority, like it or not. ... So it felt more that if I was in that position, if I had that duty, and if I had the ability to take an action that was going to be very protective, and nobody else could take it, then much of the time I sort of felt like I didn't have a choice, even if it was going to be extremely difficult," she said.

Many health officers resigned around the country after facing enormous pressure from politicians, businesses, and an angry and fearful public. Cody hung on.

Her husband, a professor of medicine and health policy at Stanford University, was an "extraordinarily important and helpful thought partner early on. I had a lot of pandemic-related conversations with him," she said.

On a personal level, it's life lessons that have kept her going.

"Rowing in college, I was not a very talented rower, but I really wanted to do it. It was really hard and extremely painful. ... The rowing and the mindset for the rowing experience turned out to be quite helpful to me during the pandemic, and things that I could draw on like, 'I felt like this before, and I made it through,'" she said.

Cody said she also has had "phenomenal support" from the public health teams, the County Counsel, county executives and other departments, which have worked in solidarity.

"I've never felt like I've been alone at all. I think that more than anything, it is what has sustained me," she said.

Still, she has experienced the mental stress of living through a pandemic, she said.

"I don't really know anyone who hasn't had their moments, and I certainly had my moments," she said.

'Being in chronic crisis means that there's always another decision that's right in front of you that needs to be made.'

-Dr. Sara Cody, health officer and director of public health, Santa Clara County

Hiking helps most to regain her equilibrium, to "just go be in the hills or go to the beach, or being outside. Being outside helps me more than anything else. It was a little bit tricky during the first year and a half of the pandemic because I always had the company of the Sheriff (for protection), so I never kind of had that feeling of, 'I'm free. I'm alone.'"

Looking to the future, Cody said she doesn't think the pandemic will be over anytime soon.

"I think the pandemic is going to have a very, very long tail," she said. "So I think it's going to go on for a while.

"For me, what I miss is time for reflection because being in chronic crisis means that there's always another decision that's right in front of you that needs to be made," she said.

Read more stories on the 2020 and 2022 Tall Tree Award honorees:

Dr. Yvonne "Bonnie" Maldonado: 'Constantly adapting'

Cammie Vail: Paying it forward

Pastor Paul Bains: 'Hope' for the unhoused

Hal Mickelson: Steering the future of Palo Alto's past

Roger Smith: Finding justice for murder victims' families

Palo Alto Players: The art of lifting a community's spirit

Peninsula Open Space Trust: Committed to conservation

Premier Properties: Taking care of businesses

Homewood Suites: Opening it doors to nonprofits, people in need

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Dr. Sara Cody reflects on her front-and-center role during the pandemic

by / Palo Alto Weekly

Uploaded: Fri, Apr 15, 2022, 7:01 am
Updated: Wed, Apr 20, 2022, 8:55 am

Dr. Sara Cody faced the biggest challenge of her public health career in January 2020 as the COVID-19 pandemic began to unfold. Emerging from her mostly behind-the-scenes roles as Santa Clara County health officer and director of public health, Cody — a self-described introvert — was suddenly thrust into an unwelcome spotlight that made her a recognized national leader for making bold and sometimes controversial decisions.

Cody, who ordered the first stay-at-home directive in the nation, was on the forefront of addressing the pandemic from its start. She created an incident command center as early as Jan. 23, 2020, just days after learning of the first COVID-19 case in the nation. She developed a contact-tracing program to try to contain the outbreak. She went on to galvanize other health officers in the nine Bay Area counties to work together and with a common voice. With her team and multiple community partners, she has focused on health equity in underserved communities by making vaccines readily accessible.

As of April 11, 90.7% of all eligible Santa Clara County residents ages 5 and older have completed their initial series of vaccinations compared to 74% of residents statewide and 65.8% nationally, according to county and CDC data.

As an epidemiologist by training, Cody said she knew the risks that could come from a viral or bacterial outbreak. Working as a federal Epidemic Intelligence Service officer for the U.S. Centers for Disease Control and Prevention, she investigated the global 1996 E. coli bacteria outbreak linked to unpasteurized Odwalla apple juice and led an investigation into a salmonella outbreak of raw milk cheese in Santa Clara County. She has overseen many investigations of diseases, including SARS and H1N1.

SARS-CoV-2 was different: She was facing a global pandemic on a magnitude that hadn't been seen in more than 100 years.

"I've never experienced a chronic crisis pandemic, which is what everyone has experienced — 'chronic crisis,'" Cody said.

In recognition of her work during the pandemic, the Palo Alto Chamber of Commerce and the Palo Alto Weekly are honoring Cody with the Tall Tree Global Impact Award. It's only the third year the award has been given in 42 years.

Cody spoke with the Weekly about what it's been like to be the person charged with making health decisions during the pandemic.

Calling herself "just another kid," Cody was born and raised in Palo Alto. She attended Walter Hays Elementary School, Jordan Middle School, Palo Alto High School and Stanford University. After receiving her medical degree from Yale School of Medicine, she became a resident in internal medicine at Stanford Hospital. She's been at the county health department for more than 23 years, first as deputy public health officer before taking the reins as public health officer in 2013.

Cody said the closest she had come to anything like COVID-19 was when the H1N1 influenza virus emerged in 2009.

"I remember the feeling of 'Oh my gosh, it's actually happening. We're in the middle of this pandemic' and that we've thought about it, trying to prepare for so long," she said. "I do remember that feeling and kind of getting an adrenaline rush just thinking about it."

H1N1 fizzled, but she encountered that same concern in December 2019 and January 2020 when the SARS-CoV-2 virus began to emerge.

On the morning of Jan. 31, 2020, she received a call that the first case of COVID-19 had been identified in Santa Clara County. Two days later, there was another case. Both patients had traveled from China. Nearly four weeks later, on Feb. 28, the first case of transmissible COVID-19 was identified in the county. The patient, a woman in her 60s, died nine days later.

"Things were happening very, very quickly at the beginning, and what I experienced was that time kind of changed. ... We got very focused on what was right in front of us. Time sort of telescoped down," she said.

Ordering the initial lockdown was the hardest decision she had to make, Cody said. She knew the decision would especially affect the most vulnerable, who couldn't go to work or would lose their jobs, she said. She became tearful during a March 2020 press conference when she announced limiting the number of people who could gather to 100. This also meant closing school campuses.

The last thing she wanted was to close schools, but it became clear that most educational institutions couldn't keep up with the cleaning and sanitizing protocols that authorities thought were necessary to keep the virus from spreading to children and their families, she said.

Cody struggled with what that decision would mean, she said.

"During the press conference, for whatever reason, I started thinking even more about all of the life events that wouldn't be able to happen if more than 100 people couldn't gather. And that sort of flashed across my mind, literally in the middle of the press conference, and I got a little choked up. Not the first and not the last time," she said.

Cody said decisions had to be made, and she had an obligation in her capacity as health officer to make them.

"The law gives you the authority in this position and to each county, and if you're sitting in that position, you're the one with that authority, like it or not. ... So it felt more that if I was in that position, if I had that duty, and if I had the ability to take an action that was going to be very protective, and nobody else could take it, then much of the time I sort of felt like I didn't have a choice, even if it was going to be extremely difficult," she said.

Many health officers resigned around the country after facing enormous pressure from politicians, businesses, and an angry and fearful public. Cody hung on.

Her husband, a professor of medicine and health policy at Stanford University, was an "extraordinarily important and helpful thought partner early on. I had a lot of pandemic-related conversations with him," she said.

On a personal level, it's life lessons that have kept her going.

"Rowing in college, I was not a very talented rower, but I really wanted to do it. It was really hard and extremely painful. ... The rowing and the mindset for the rowing experience turned out to be quite helpful to me during the pandemic, and things that I could draw on like, 'I felt like this before, and I made it through,'" she said.

Cody said she also has had "phenomenal support" from the public health teams, the County Counsel, county executives and other departments, which have worked in solidarity.

"I've never felt like I've been alone at all. I think that more than anything, it is what has sustained me," she said.

Still, she has experienced the mental stress of living through a pandemic, she said.

"I don't really know anyone who hasn't had their moments, and I certainly had my moments," she said.

Hiking helps most to regain her equilibrium, to "just go be in the hills or go to the beach, or being outside. Being outside helps me more than anything else. It was a little bit tricky during the first year and a half of the pandemic because I always had the company of the Sheriff (for protection), so I never kind of had that feeling of, 'I'm free. I'm alone.'"

Looking to the future, Cody said she doesn't think the pandemic will be over anytime soon.

"I think the pandemic is going to have a very, very long tail," she said. "So I think it's going to go on for a while.

"For me, what I miss is time for reflection because being in chronic crisis means that there's always another decision that's right in front of you that needs to be made," she said.

Read more stories on the 2020 and 2022 Tall Tree Award honorees:

Dr. Yvonne "Bonnie" Maldonado: 'Constantly adapting'

Cammie Vail: Paying it forward

Pastor Paul Bains: 'Hope' for the unhoused

Hal Mickelson: Steering the future of Palo Alto's past

Roger Smith: Finding justice for murder victims' families

Palo Alto Players: The art of lifting a community's spirit

Peninsula Open Space Trust: Committed to conservation

Premier Properties: Taking care of businesses

Homewood Suites: Opening it doors to nonprofits, people in need

Comments

Bystander
Registered user
Another Palo Alto neighborhood
on Apr 15, 2022 at 7:50 am
Bystander, Another Palo Alto neighborhood
Registered user
on Apr 15, 2022 at 7:50 am

The first I remember seeing her was when she became a meme all over the internet for licking her finger before turning the page at a press event while she was talking about being diligent about handwashing and other actions to prevent the spread.

She definitely seemed to enjoy her power and was always on local tv much more than other counties' health officers. It appears to me that the counties did not talk to each other much as here in the north of the county we had more in common with San Mateo than Gilroy! Driving 5 minutes north for a haircut anyone?


ALB
Registered user
College Terrace
on Apr 18, 2022 at 5:53 pm
ALB, College Terrace
Registered user
on Apr 18, 2022 at 5:53 pm

Never forget that Dr. Sara Cody lead the public health response in Santa Clara County and the country then followed. She is a hero. I have compassion for her being in front of this pandemic and risking the wrath
of those who do not respect science. Thank you Dr. Cody — you are a star.


Forever Name
Registered user
Another Palo Alto neighborhood
on Apr 20, 2022 at 11:20 am
Forever Name, Another Palo Alto neighborhood
Registered user
on Apr 20, 2022 at 11:20 am
Bystander
Registered user
Another Palo Alto neighborhood
on Apr 20, 2022 at 2:20 pm
Bystander, Another Palo Alto neighborhood
Registered user
on Apr 20, 2022 at 2:20 pm

Additionally, what happened about the mask mandates on planes when a judge ruled on Monday and the airlines acted immediately, should have happened here in Santa Clara when everywhere else was lifting them but we still had to wear them.

I feel sure that so many of the restrictions we had here, particularly for businesses improperly posting a sign or similar other health breaches, was not legal. If anyone who has had their business ruined by these restrictions, they should sue. Oh, but they are now bankrupt, so haven't got the money to do so.


Virginia Smedberg
Registered user
Old Palo Alto
on Apr 20, 2022 at 10:37 pm
Virginia Smedberg, Old Palo Alto
Registered user
on Apr 20, 2022 at 10:37 pm

To those of you who disliked her decisions: did you stay healthy? or did you get sick? How about your friends and family? My family and friends mostly stayed healthy and I lay the "blame" for our health, happily, at Dr Cody's (and those who supported her) feet. You can complain all you like. I still wear a mask when I'm around people I don't know who have been around who knows who else. Covid is a virus. As my doctor says, viri are opportunistic. I don't intend to give any of those little buggers any opportunities I can help, to have more generations and thus mutations.


Bystander
Registered user
Another Palo Alto neighborhood
on Apr 21, 2022 at 10:43 am
Bystander, Another Palo Alto neighborhood
Registered user
on Apr 21, 2022 at 10:43 am

Virginia. As you say, we have come through this quite healthy, but have had family get sick before and also with vaccinations. These are only one side of the health story. We also have in our circle families with suicide, domestic violence, as well as increases in alcohol/drug use and chronic loneliness. There are also some failed businesses that we used to enjoy visiting.

Perhaps we should be thanking our health officials for these also.


Forever Name
Registered user
Another Palo Alto neighborhood
on Apr 21, 2022 at 4:29 pm
Forever Name, Another Palo Alto neighborhood
Registered user
on Apr 21, 2022 at 4:29 pm

Interesting that my entire post above was removed. Hmmmm....

Exhibit A:
Apparently anyone who disagrees with a Public Health Director receiving media attention, or awards, or disagrees with SCC Cody's policies specifically, must be silenced. Par for the course. In spite of the fact that some UCSF doctors, Stanford doctors, and many other actual medical doctors with clinical practices, and medical professors, at world renowned medical institutions disagreed with CA State Health Director and SCCPHD Cody's policies and publically published op eds, articles, petitions, and data supported studies to the contrary (too many to post links to here). Specifically, for example, Dr. Jean Noble UCSF, Dr. Monica Gandhi Director of Covid Response at UCSF, and Dr. Vinay Prasad UCSF, to name just a few, were outspoken critics of CAPHD and SCCPHD Cody's lockdown policies. In addition, there are 929,000 medical professionals around the world who have signed The Great Barrington Declaration to call for communities to open up and pursue Focused Protection. Ironically, this became the CDC's current strategy one year after the fact. LetThemPlay CA parent/student lawsuit won their case against CA Health Director in 2020, and CA had to settle on ALL accounts bc CA had zero data to support youth sports being shut down for an entire year - and SCC had to open sports immediately in spring 2021. And no, the rest of CA and the country did NOT follow Cody. For example, many counties in CA proceeded differently (Marin, San Mateo, northern CA like Placer County, and other CA counties in northern and southern CA). In the rest of the U.S., schools were open in many states as of Aug 2021 (TX, Ohio, FL, etc). Even Colorado's Democratic Governor ended all restrictions and state of emergency in July 2021. Along with many other states that did not subscribe to Cody's policies and whose Governors opened schools and businesses. These are facts and there is no justifiable reason to delete this post.


panative
Registered user
Midtown
on Apr 21, 2022 at 11:03 pm
panative, Midtown
Registered user
on Apr 21, 2022 at 11:03 pm

Sara Cody is a hero, full stop. I am in awe of her, as is true of so many in my circles. It's hard to express the degree to which I have taken comfort from her calm, reasoned, expert leadership, especially early in the pandemic. I hope she knows that she has many, many people in her corner who are profoundly grateful for her service.


Forever Name
Registered user
Another Palo Alto neighborhood
on Apr 22, 2022 at 11:00 am
Forever Name, Another Palo Alto neighborhood
Registered user
on Apr 22, 2022 at 11:00 am

Just one example of SCC Cody's policies that some expert practicing medical professionals opposed (in addition to lockdowns, crushing local businesses, and school closures which these doctors also publically opposed). World renowned UCSF doctors, including Dr. Jean Noble UCSF Covid Scientist, acknowledged Covid "Expert". Pres. Biden's OWN covid adviser Michael Osterholm opposed the sweeping mask mandates, and was ignored by the CDC! See below.

SF Chronicle 4/19/2022
"Four COVID experts say it’s time to accept reality: Vaccines work, mask mandates don't"
Web Link
Excerpt:
"Unfortunately, some experts at the Centers for Disease Control and Prevention and elsewhere have largely ignored this high-quality evidence and instead continued to point to lower-quality observational studies that appear to show benefit. The desire to find justification for official mandates is perhaps understandable, especially following the sudden policy shift in early 2020 toward promoting masks as a key strategy. Coronavirus expert Michael Osterholm, an adviser to President Biden, reflected on this abrupt about-face, particularly on cloth masks: “Never before in my 45-year career have I seen such a far-reaching public recommendation issued by any governmental agency ... This is an extremely worrisome precedent of implementing policies not based on science-based data or why they were issued without such data.”
and
"Newly released data from research in the United Kingdom warn that COVID restrictions have significantly set back physical, social and emotional developmental milestones. Citing such developmental concerns, the World Health Organization has never recommended masking children under 6, nor have Scandinavian countries for children under 12."




Bystander
Registered user
Another Palo Alto neighborhood
on Apr 22, 2022 at 11:17 am
Bystander, Another Palo Alto neighborhood
Registered user
on Apr 22, 2022 at 11:17 am

According to Nextdoor, there was a protest on Fabian yesterday as Dr. Cody was getting her Tall Tree Award.

The fact that this protest is not mentioned as a news item causes me to raise some questions.

Is the reason it was not news in the Weekly due to police encryption, or censorship of protest against health restrictions during the pandemic? Either way, this caused problems for people trying to get where they were going and there is a video now on Nextdoor. It seems that the place to turn to news of what is going on is Nextdoor rather than local newspaper.

Additionally, it is interesting that this was happening at the same time Obama is talking about misinformation, dangers of social media for fake news, and similar concerns at Stanford. This has been widely reported. But we have to get our news from Nextdoor.

Does anyone see any irony here?


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