A Blunt Change of Command

She said she wore her “kickin boots” for her last day as health commissioner. Dr. Oxiris Barbot quit last week with a protest against Mayor Bill de Blasio’s handling of the pandemic and a warning that the mayor needs to listen better to the heath department’s experts to protect New Yorkers.

“To successfully brace against the inevitable second wave,” Barbot, a pediatrician from the Bronx, told the department’s staff in a farewell message, “your talents must be better leveraged alongside that of our sister agencies.” Going forward, she told the staff, it was essential that they be able to do their work “without distractions.”

Barbot’s blunt farewell, and her resignation letter expressing “deep disappointment” to the Mayor, affirmed in public what many officials had been reporting behind the scenes.

“There have been months and months of conflict between the health department and City Hall,” said one city official. “It started to get pretty bad in March with debates over the shutdowns. There has just been an endless list of matters, big and small, where public health officials had differences with the officials at City Hall.”

Barbot, this official said, stood staunchly behind the health experts of her department, putting her at odds with the mayor.

For his part, the mayor made it clear he had fired Barbot. He characterized the ongoing tension as a failure of teamwork on Barbot’s part.

The Challenge Ahead

Prominent health experts, however, portrayed the conflict as consistent with a larger pattern of government leaders from the White House down resisting scientific and medical expertise.

“The New York City Health Department is one of the greatest public health agencies in the country and in the world,” said a former commissioner, Dr. Tom Frieden, who is now President and CEO of Resolve to Save Lives, a global health nonprofit. As Barbot had, Frieden focused on the challenge ahead. “All New Yorkers will be safer when our Health Department is allowed to lead the public health response to Covid and other threats to our health.”

Will the health department’s experts be allowed to lead?

That challenge now falls squarely on the new commissioner, a 39-year-old internist, Dr. Dave A. Chokshi, the son of Indian immigrants, living now in Jackson Heights with his wife and 14-month-old daughter.

Perhaps Chokshi’s most interesting credential is that he has spent the past six years working deep inside New York City’s other major health agency, Health + Hospitals, the public hospital system.

The schism with Barbot was brought dramatically into view when the mayor stripped the health department of the all important task of testing for coronavirus and tracing infections and assigned it to Health + Hospitals.

“Health + Hospitals is a huge operational organization and it made sense to turn to it for something this big and unprecedented,” the mayor said at a news conference last week.

“I leave my post today with deep disappointment that during the most critical public health crisis in our lifetime, that the health department’s incomparable disease control expertise was not used to the degree it could have been,” Barbot wrote to the mayor.

Reopening Schools

Repairing this schism is one of Chokshi’s first tasks. Keeping the virus contained hinges on whether testing and contact tracing, which has gotten off to a shaky start, will be effective.

Chokshi pointed out that the rate of infection, which is what testing and tracing is designed to reduce, is the threshold measure for the discussion of reopening schools and, beyond that, gyms, malls and indoor dining. Right now the infection rate is around 1%, below the 3% rate the mayor says is necessary to allow for in-person schooling.

“It’s pretty straightforward; we built the largest test-and-trace corps in the United States of America and we’ve beat back the virus,” de Blasio said.

The quote illustrates one of the challenges Chokshi is taking on with the mayor, who has developed a reputation for being inattentive to detail. While both facts are true – the infection has been brought under control and the Test and Trace Corps is substantial – the Mayor’s timeline is clearly false.

It was the aggressive lockdown, which the Mayor was dragged into, and the wide adoption of masks and distancing that curbed the spread. In fact, the rate at which the virus is being transmitted in New York City bottomed out in early May, and has been creeping up since. The Test and Trace Corps was launched June 1.

The challenge now is to keep transmission low while reopening the city. That is the purpose of testing and tracing. Keeping the scientific facts straight will be crucial in this. It is fair to say that the Mayor’s critics will be keeping a close eye on Chokshi’s willingness to speak up for those facts and the experts in the Health department.

“Shown Tremendous Disrespect”

When Chokshi posted a routine message on the health commissioner’s twitter account – saying he was “proud to join a team that I know cares deeply about science, equity and compassion” – the feed quickly filled with mistrust of the mayor.

“What @BilldeBlasio has done has demoralized many in one of the great public health departments in the world,” wrote Gregg Gonsalves, Assistant Professor of Epidemiology at the Yale School of Public Health. The mayor has “shown tremendous disrespect for public health overall,” he added, and “turned city’s response to COVID into a pissing match between H + H & Department of Health. It’s reprehensible.” Then directly addressing Chokshi, Gonsalves wrote: “That’s your burden now.”

Chokshi was clearly treading carefully in his first few days in office. A morning TV anchor asked if he could give a couple of lessons the city had learned from the worst days of the pandemic. Chokshi offered his “core four:” stay home, wear a mask, social distance and wash your hands.

The anchor, Dan Mannarino of Pix11 News, sounded frustrated as he pressed Chokshi: “With all due respect, those are for individuals. I’m asking what is the lesson learned from the city perspective what they could have done better?”

“One of the lessons for me, looking back on it, is the critical importance of science and insuring we stay abreast of the most current evidence,” Chokshi answered.

“Coronavirus is something new,” he said. “Not just for New York City, not just for the United States. For the entire world. Science matters for us to be able to address this pandemic.”

The reporter then asked if he preferred pizza or hot dogs. “I’m a vegetarian,” Chokshi replied.