Public health is an inextricable part of public life today in Kansas, it's measles and tuberculosis that occupy headlines and dinner table conversations. Five years ago, even three years ago, it was COVID 19, the global pandemic that killed millions changed the way we approach work, school, social life and public health crises. Today, I'm talking with the former top health official in Kansas who guided the state through the pandemic and later left it all behind. Dr Lee Norman was the secretary of the Kansas Department of Health and Environment for three years. He's a recently retired colonel in the US Army Medical Corps, a career that spanned six decades, and he now works in the private sector. This is the Kansas reflector Podcast. I'm Anna Kaminsky, Mr. Norman. Thank you so much for being here with me today. Thanks, Anna, appreciate being here. So what were you doing at this time five years ago?
You're asking me to take a walk down bad memory lane. Aren't you? We're in the thick of COVID 19. We had at Katie. He keep in mind that Katie, he has three sectors. It's environment, it's Medicaid and it's public health, and this just wasn't really on the plan when I assumed the position in 2019 so to answer your question, five years ago, we had set up incident command. We were meeting 24/7 365, some parts and pieces of our personnel, and trying to figure out, without having enough resources, without having vaccine, without having any medications, without having any testing, what the heck we going to do with this lethal virus that has now landed in the United States?
What was it like to work in public health during that time, you
know, early on in the blink of an eye, about maybe the first four weeks, it was going swimmingly well. People were stunned. People were uncertain how to respond, but it very quickly morphed into a contentious issue in terms of the decisions that were made the executive authority, executed by the governor, and then our recommendations based on, what do you do with the brand new virus that nobody has ever seen before? Maybe the I had just come back from the Middle East, I had been on an army deployment, 2017 2018 and I saw the last novel Coronavirus infection, which is still going on, by the way, in the Middle East and other places called MERS, the Middle East. Respiratory Syndrome, 52% case fatality rate, meaning more than one out of every two people. So I was traveling around all these hospitals and in the civilian sector throughout the 12 countries, and figuring out, if we have an injured soldier, Ill soldier, do we want them, or any of our allied forces, for example, would do we want them to go there? And how many cases of MERS you have, because it was mostly transmitted in health care facilities, and half of them died, and they were treating it rather cavalierly, that, yeah, we have eight cases a month in our hospital. So I came back thinking, Well, we did a lot of medevac instead of having him in those kind of hospitals. So come back. I then joined the governor's cabinet in 2019 and I had a hunch that something was brewing, matter of fact, an interesting story in December of 2019 so the first case wasn't even in the United States, ostensibly. Maybe there were some cases. I don't know. We won't, maybe ever know that. But in 2019 December, I was down in San Juan, Puerto Rico, and gave a lecture called modern day epidemics and why we have them, to a group of legislators from all over the country. And my fifth slide on this slide deck was a guy in a moon suit, in a hazmat outfit, holding a bat, about the kind of fly, a bat that and the headline, and this is open source document. This wasn't in a classified document. Open Source. It said, there's a novel virus, there's a novel Coronavirus. And this was in Myanmar, not China. It was in Myanmar. This is a story that hasn't been much told, and yet it's in the public domain. There is a novel virus occurring in Myanmar that's similar to SARS and MERS, but it hadn't been really characterized yet. I don't know if it was the what turned into COVID or not. And then. Of course, we started hearing about cases in China, including a little community that or a large community that I never heard of before, Wuhan, China. And then it was the following January that we learned of cases coming into the United States. And it was so ironic. I was at the US House of Representatives in January of 2020, so over five years ago, providing testimony the legislators who wanted me at the House to talk about the biggest threat to the health of Americans vaping. So I met with our federal delegation afterwards, and including some of the staff in the White House, and said, You know, I think we have another problem, and it's not vaping. I mean, vaping is a problem, but I said, we have something else coming down the road. And I won't mention our federal delegation, but one of the members said, you know, the house is allocating $5 million to study this new Coronavirus, and I remember very distinctly saying, You better add a couple more zeros onto that number, because it's going to be a big deal. So we set up incident command at Katie he which is a whole different rhythm, and it's like what you do for disasters. And my staff, of course, looked at me like I was a nut case, and said, Why are you doing that? And I said, Well, it's going to be a big deal, and that's why we're doing this. They grumbling. Lee said, okay, these you're the Secretary, I guess. So. It was off to the races, and it was a, I call it a battle rhythm. You know something about being in the military for six decades every now to get a phrase creeps into my vernacular, battle rhythms are entirely different than peacetime. And so we are off to the races.
What did you learn from it all, individually, and then, what do you think we as a collective, in terms of the American public in public health, what did we learn?
Well, and I think to really answer that question, what we and your viewers, listeners need to really do is to roll the tape back in their brain and not look at it through 2020 hindsight. Monday morning quarterback in 2020 hindsight. Oh, we shouldn't have closed the schools. Oh, we shouldn't have had restrictions on mass gatherings. And yeah, we know that now there's some things that could have been tweaked, particularly around schools, but we didn't know that it wasn't going to be. And I say we, I'm talking about the CDC and HHS and all the other ones. We didn't know that it wasn't going to be 50% fatality rate. So we had an imagine our societal meltdown if we had 50, 50% case fatality rate. And we have to remember COVID 19 is the largest mass casualty event in the history of the United States, there's been no mass casualty event bigger than COVID. So to look back at it cavidly And said, that's just the flu. Well, first off, it's not the flu. Coronaviruses are not the flu. So yeah, maybe we overshot a few things. Maybe we under shot in a few others. But I don't think that in retrospect, cap, given the knowledge that we had then, that we would have been it would have been unconscionable to be more cavalier about it than that. Some of the states got off lucky. Some of them were devastated. And and I have to say something, that President Trump was, he didn't really get it, but his administration did pretty well. I don't even remember the operation warp speed was. Operation warp speed was the the federal group run by General Gustav perna, a four star general and to get vaccine to market, and I give them a lot of credit, and Doctor Fauci for all the arrows being shot at him, very few of his boss, I might add, the president, but they they really were part of the team and advising operation warp speed that really helped us To get the vaccine. Because here's the issue. The issue is, and you know, when the governor did the schools closures on March 60, stay at home order on March 30, and a gradual return on May one, and then the the legislature pulled her privileges by Memorial Day. So that was what, barely over two months that she had executive authorities to do what she did, those were exactly the right things to do. And and then a gradual as we got testing equipment. You know, at the beginning, we didn't have any way to test you. And then or the infrastructure, and we eventually got hundreds of soldiers and volunteers and others to do immunization clinics and testing clinics and those things keep in mind, we didn't have testing ability. We had no therapeutics, and it was until much later that we had the vaccine. And the goal was, what the goal was to with applying public health standards minimize the spread until we have a vaccine. And this will make you smile, because everybody's going to line up and want to get the vaccine, because this is such a lethal disease. And once we get everybody has a vaccine or two, then we're going to go live happily ever after. Oops. One thing I will say, we are a little slow on and thank God for the bunch of the psychiatrists and psychoanalysts and everything that live in Topeka from and are still working. Menninger grads and and former staffers I early, early on, contacted some of them and said there's some so there's some kind of social psychology going on here that I do not understand, and they're not believing me. Why wouldn't people believe me? Why wouldn't people believe all the public health and the strong guidance being provided? And it was really well well before the legislature in Kansas acted on May 27 we recognized that there was a considerable resistance being built up to following those recommendations.
You kind of started getting at it a little bit. But what role does public policy play in all of this, whether it's specific to COVID or just dealing with issues of public health in general. And then you also got at this a little bit too, you know? What about personal autonomy? Yeah,
well, public policy is the overarching umbrella that allows us to do or not do stuff, and it's also what holds the purse strings. And when I came in in 2019 as secretary, one of the things that I I wish I had the graph to show you, Kansas has had a had had, at that point, a 30 year decline in the public health of the state of Kansas. Now that includes things like obesity and smoking and heart disease and cancer, but it also includes things like immunization rates and a bunch of other things. So public health in the state of Kansas, which wasn't in 30 years earlier, was in the top 10 in terms of this very well perform study done decades over decades, and Kansas had done nothing but slide 30 positions out of our 52 states and territories that were in the study. So we were vulnerable. We were not the laboratory in Topeka was literally falling apart. We had to, we had to monitor the ceiling tiles to make sure they didn't fall on our people that were there, and they did sometimes. So the I tell you, the state of public health in Kansas was way low, and it was for what we would call kind of phase zero. We're maybe okay right now, as long as nothing bad happens. But then when something bad happens, and you mentioned at the top, measles and tuberculosis and let alone a mass casualty event like COVID, we were, in no way as a state geared up for that. I mean, because, and it's not obvious to the public, we had to bring in trucking, we had to bring in laboratory equipment, we had to bring in warehouses. We had to, we had to use hotels for accommodating people that needed to be with kind of quarantine away from their very sick family members. And those are all the things that are behind the curtain that nobody sees. And we tried to, and I tried the governor, tried to have regular enough press conference so we could say, here's what's going on up to and including today, but tomorrow, things could be different. And it was really fun to try to communicate. And I will say that I think the press was kinder on me than the legislature was because, and I understand, we don't want to contain we don't want restrict personal freedoms. But, you know, emergency time, if you had a nuclear bomb dropped, or a, you know, a terrorist attack, like in Oklahoma City, people rally around it and but people rally around things for about blink of an eye. You know, four weeks was pretty unusual to have that kind of engagement. And after that, it became distinctly unfun. I worked starting when we set up instant command. I personally worked every day for 100 weeks, not every day for 100 days, every day for 100 weeks. That's two years and over 700 days and and that's what our staff did, same thing, terrific effort, but a lot of controversies there you.
Speaking of public policy, the legislature recently passed new laws that will limit they expand the authority of the legislature to public gatherings and also change children's vaccination requirements in your mind, with the the perspective of going through and leading the state through a time when both of those things were considerations, what do you see looking forward as the impact of those changes? For instance, if, if something like the COVID 19 pandemic at its scale were to happen again? Yeah,
well, maybe I was too long in the army, but I think there is an artillery analogy here. And sometimes you overshoot, and then sometimes you undershoot, and then you do a calculation, and you hit the middle. It's like we're seeing at the federal level. Now the President is undoing a lot of the policies done by the prior president. Now in Kansas, the policies will stick, because Kansas will remain a Republican dominated legislature for probably the rest of my lifetime, at least that being the case, I think we have to be very mindful of a lot of this is not new. A lot of this is known since the Middle Ages. Masks do work. Large gatherings when there's infectious diseases, bad, hand washing good. So I mean, a lot of these things are no different than what they were in the 1700s even so. And yet, everybody wants to, I shouldn't say everybody, half of everybody, kind of wants to undo the benefits that of public health and and mock it even, which is particularly hurtful. I think, I think that the legislature needs to one, respect personal autonomy and responsibility. And then secondly, if people are want to have more autonomy, I think they have to listen to very, very good guidance. And guidance can change, and it's scientific guidance, and it's and it's epidemiological. Look at numbers, numbers, you know, they can be manipulated, but they don't lie if it's done ethically and correctly so. And I personally like the idea of more personal autonomy, you know, did we overshoot in schools? Probably, but we only found that out once we found it out, you know, you can't find that out on day one. What if half the kids died, you know? Oh, we would have had a different conversation, you know. So I think it's really critical to be thoughtful about investing in public health and having public policy that fosters public health, I didn't even do a single executive order regarding COVID When I was secretary. Not a single one. I advised the governor, the governor, to her credit, conversed with a lot of the other governors around the country to kind of build a consensus, to find out what is the safest and kind of most lenient, almost, approach that we can take and still keep our public safe. So I'm proud of our decision making. I think taking away executive authorities from the governor or from county commissioners and county health officers who are closest to the work. You know, we have 105 counties, and they're the ones that are closest to the work. We work very closely with those folks, and I'm very proud that we they were very engaged, and we haven't talked about it yet. But one of the most difficult was the vulnerable populations of older people and people with disabilities. The man the local health departments, they know where those people live. They knew the zip codes. They they knew everything, and they would find them and and see if they were alive, even because a lot of them, they don't call in if they're not living or doing well. So pretty, pretty pleased with how the governor's decision making and her staff went, and I think we helped to contribute to
that Sure. Well, tell me a little bit then about vulnerable populations and how, how the interaction with public health during this time, you know, kind of exposed those vulnerabilities or or shown a light on them?
Yeah, the and, you know, vulnerable people can be vulnerable for many different ways. Some are unhoned. Some don't have access to public or any kind of transportation. Many don't have any access to computer technologies or even cell phones. So they're difficult to reach. You have to knock on their door. The other thing about it is when, for example, we have a vaccine that is life saving, matter of fact, the vaccine 4.3 million given on my license. If you got it in Kansas for those first two years, and you look at this, it'll be my name on it. So I paid a lot of attention to those 4.3 million vaccines. The reason I bring it up is the vulnerable. Populations. To answer your question, if nature would have taken its course, all those vaccines would have been given in Johnson County, Wyandotte County, Sedgwick County, and maybe a couple of them in southwest Kansas, where people would have come out lined up, thought, taxis or whatever, that left about 100 counties where they would not have gotten into people, and that being the case, we need relied heavily, and they rose to the occasion the county health departments to say, Doc, you get us a vaccine here. And I'm very pleased with the model we took to push it out to 103 health departments in under five counties. There are other states nearby, like the one immediately to the east of Kansas, that took it completely different. And Randall Williams, my counterpart there, and I got along so well, we would immunize whoever, if it was a Missourian in Kansas or Kansas in Missouri, we do it anyway the but they took a different tab. They they sent back all the vaccine out to about five or six different big hubs and locations. They didn't make it to the rural counties. So a rural county, they could be totally fit. But if you're a rural county and you don't have access to testing equipment, therapeutics or vaccine. You're a vulnerable population.
So can we take that and apply it to the measles outbreak that we're seeing right now in rural Kansas counties and rural counties across the United States? How does that fit in?
Well, I'm I've been at this long enough I remember I've taken care of measles, mumps, rubella and tetanus, even they both died. Let me give you a clue. You don't want to slip on your tetanus vaccine or any of them. So we have another wonder drug called the measles, mumps rubella, or in some in children, measles, mumps, rubella, varicella, meaning chicken pox, vaccines. They will prevent, they will always prevent measles from occurring. It's an it's a disease of unvaccinated and then a few others. Some people, their their immunity wanes. But this isn't that hard. People need to get vaccinated when their kids probably again as a young adult, and then occasionally as an older adult, if immunity can't be guaranteed through prior vaccine or the blood tests that can be done, then to be boosted, incredibly safe vaccine. And then there's a few people that got vaccinated in the 60s. That was a killed vaccine. That wasn't very good. They need to be re immunized. What I would say is, if you've been exposed, talk to your doctor. If you were vaccinated or of uncertain vaccination status, probably better just, I just get the vaccine. Of course, I was in the military. I got stuck with more vaccines than I could imagine, including the MMR again as a young adult, even in the 70s. So I feel pretty good about that, but I just think we need to be people need to listen to public health guidance and but the trouble is, the way that the it's blow the tide has changed is that people tend to not believe the CDC and not believe public health. And I hope that the pendulum swings back. And if I had one hope, it would be keep an open mind and and hope the pendulum swings back in favor of public health,
I have one last question for you. You mentioned how ahead of the pandemic you did this talk in Puerto Rico, where you know, you kind of had that hunch. Is there anything that you or colleagues in the health world are talking about now that you think might impact folks later?
Well, I know what I'm talking about and and that was, I then had clearance. I had, I'll go into what level of clearance, but it was I had access to materials and information that I couldn't disclose. And yet it was so there's a lot of classified information out there that wasn't shared with general public health, general population, and yet, I remember looking at it and saying, why the heck is this classified? This is something that needs to be in the hands of the at least our public health officials and federal and HHS and disaster response officials. I think we need to break down the when there's no reason to have something be classified. I think we have to break down those barriers and say, let's use that information. Let's get it out there. If we know in March of 2019 there's a COVID 19 brewing, or in November of 2019 you know, we can start gearing up. We did a KD he, and they didn't know why. And I'm telling you why it was really good. I'm glad I had that information Mike in my head and but I. Been talking about, but we just did it anyway.
So what are the ways that people who might not have that privilege be able to prepare in the way that you're mentioning?
Well, I think a couple things. One is, we have to be invest in public health and to say, what are you know, we're phase zero. You heard me mentioned earlier, we're not geared up for a big immediate response. What would that take? And we know what that takes to do that. We know what there are certain kinds of supply chain things, and my head is about ready to explode on these tariffs for one well, for a number of reasons. The one is that India and China provide us not only with brand name and generic pharmaceuticals, but they provide us with the the components that then are manufactured into pharmaceuticals in the United States. If we get cut, cut down on the pharmaceuticals or the pharmaceutical component in importation in the United States, we're going to have immense drug shortages, and we can't afford to, and that's it doesn't take a crystal ball to see that coming. But that's also true with supplies. I'm not sure, and I appreciate what the President's trying to do with gear up domestic production, but our masks, our gowns, our gloves coming through domestic production, I don't, I don't know. I don't have, I'm not close enough to that to know, but to invest in in public health is a good first stop start.
Dr Norman, thank you so much for your time and for talking with me today.
Okay, you're welcome. Good to see you. Anna applause.
