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‘Exquisitely uncomfortable, but … a duty I had’: Sara Cody ’85 reflects on leading county’s COVID response

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Santa Clara health officer and public health director Sara Cody ’85 recounted her experience of battling public health dilemmas and personal threats while responding to the COVID-19 pandemic and urged community members to build partnerships with local leaders during a lecture event on Thursday.

The virtual event, hosted by Stanford’s McCoy Family Center for Ethics in Society as part of the Arrow Lecture Series, featured a presentation by Cody and a conversation between her and professor of law and medicine Michelle Mello ’93.

Cody was recently awarded Stanford’s Zale Lecture and Award for Public Service for her COVID-19 decision-making. In recent months, Santa Clara County has lifted most restrictions for community members amid falling case rates and rising vaccination rates, culminating a long-term effort to contain the spread of the pandemic. On March 16, 2020, Cody issued a shelter-in-place order across Santa Clara County — one of the first such regulations in the country.

“The shelter-in-place was the biggest decision that I’ve made in my public health career,” Cody said.

During her previous announcement prohibiting gatherings of more than 100 people on March 13, Cody said that she choked up after realizing the “full force” of the new mandate on the activities in her community. But the early case count nearly doubled in the following 48 hours — a “breathtaking” growth rate of the virus early on in the pandemic even despite the early restrictions.

During a crisis, according to Cody, public health practice requires forceful and immediate action, leading to a departure from the typical levels of stakeholder engagement and shared decision-making involved in public health policy.

For Cody, holding such authority was “exquisitely uncomfortable, but at the end of the day I felt it was a duty I had.”

Colleagues and community representatives have praised Cody for her leadership during the pandemic. “Dr. Cody is an example of public health leadership not just following the science, but hunting it and wrestling it to the ground,” Mello wrote to The Daily. “Her courage in taking unpopular but necessary measures saved countless lives.”

The Center for Ethics in Society “felt strongly that her leadership during the past 20 months has been extraordinary,” said the center’s executive director Joan Berry.

Center for Ethics in Society faculty director Rob Reich M.A. ’98 Ph.D. ’98 described Cody’s decision-making as “bold and controversial,” as the onset of the pandemic pushed public health officers into the spotlight. But Cody’s health leadership was also met with disagreement and disapproval from some members of the public, impacting her personal life.

After implementing the shelter-in-place order, Cody received threats of violence toward herself and her family, according to Cody. When asked how she worked through these threats, she directed her appreciation toward the community of health and county leaders.

“I might be the most supported health officer in the United States,” she said. “I have phenomenal support in the county … from the county executive to the county council and county sheriff” who protected Cody when she began receiving threatening letters. These challenges also strengthened her ties with her colleagues in Santa Clara County and the Public Health Department, she added.

Trust in public health officials is still under threat, according to Cody. For instance, some states have recently signed and proposed laws that limit the abilities of health officers to enforce guidelines such as quarantine borders.

In conversation with Mello, Cody applied lessons from her recent experience toward improving the accessibility of health resources, especially for low-income and minority groups, which have been affected disproportionately by the coronavirus pandemic. Given that 40% of Santa Clara County’s residents were born outside of the United States, Cody said that “developing partnerships with community leaders and moving from community engagement to real power-sharing” is the most important step in preparing for the next widespread emergency.

Before the presentation concluded, Mello asked Cody how she foresees the future of public health, particularly with students entering the field after such tumult.

“I think of it as a big family, we all know each other,” Cody said. “You can do small things that make a big difference in public health and it is enormously, enormously gratifying.”

“The opportunities are tremendous,” she added. “So come on in.”

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Jack is a high school student in The Stanford Daily's Summer Journalism Workshop.