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: