Prior to 2020, Dr. Karryl Rattay was likely among the least publicly recognizable officials in the state, despite serving as director of the Delaware Division of Public Health for 11 years by that time. The COVID-19 pandemic would quickly change that, making her and her office one of the most publicly discussed for years. On June 30, she departed her longtime role for new opportunities, but took time to talk with Delaware Business Times about her career, the experience of leading through COVID, and what’s ahead in public health. [caption id="attachment_224274" align="alignright" width="400"] Dr. Karyl Rattay | PHOTO COURTESY OF DPH[/caption] The conversation has been lightly edited for clarity. You’ve ended up being the longest-tenured public health director in the country, what does that mean to you that you've been able keep this is a job that serves at the pleasure of an administration? It means a lot to me. I love public health. At the core, I am a public health professional. And it was an amazing honor to me to be chosen by under the Markell administration by Secretary Rita Landgraf to serve in this role in 2009. And as Gov. Markell’s administration was winding up, I certainly understood that it may make a lot of sense for Gov. Carney to choose a new, different leader for the Division of Public Health, but was so extremely honored and thrilled when he called and asked me to stay on – that actually is rare. I didn't know him well before the pandemic, but certainly I got to know him well during the pandemic, and he was the right governor at the right time for sure. When you look back pre-COVID was there was there an event that really stood out in your mind as one that maybe woke the public up to public health as a serious concern? I started right as H1N1 hit Delaware in 2009, and I do think that was certainly an event that put people on their toes. When it first began to circulate, we did not know what our mortality rate was going to be with H1N1There were a lot of similarities (to COVID-19) and Delaware did a great job with H1N1, being one of the first states to be able to test just like we did for COVID as well. But we didn't have a vaccine at the time. There were just a lot of unknowns and a lot of fear and uncertainty. Ebola was another experience where although we really had almost no Ebola in our country, because the fatality rate was so high with Ebola, clearly there was a lot of focus on public health. Your office has been successful through some programs and initiatives to reduce infant and cancer mortality, increase data reporting, and transparency with some of the state's reporting metrics. The healthier our population is has an impact in many, many ways. Healthier people learn better or are able to achieve more sustainability with their employment – just a better quality of life. Everything we do in public health is with partners. And I think that's one of one of the most exciting aspects of public health is being a part of bringing so many different partners together to tackle health issues. Infant mortality is a great example, where we have the Delaware Healthy Mother and Infant Consortium. Hundreds of people are in our state participate in this work to improve outcomes for moms and babies. And so public health has a role in bringing people together. This same group is very much focused on addressing our inequities as Black babies born in our state are two-and-a-half times more likely to die in the first year compared to white babies. They come together to focus on geographic areas in the state where we can make the biggest difference and we have some bold policy and clinical initiatives, and social services, that come together to really support moms, babies’ families, and to see these results. For me, that's what's really exciting and exhilarating about public health is to see people come together to see these kinds of results. You’re an Ohio native who spent some time around the region as a board-certified pediatrician and ended up at the U.S. Surgeon General's Office. How did that experience help prepare you for this role in Delaware? I will always be grateful that I had the five years in pediatric practice. I loved those years I think they gave me a foundation of the health care system and health care issues. But when I was four years in, I really decided I wanted to focus on public health and prevention. So that's when I ended up at University of Maryland doing additional training in preventive medicine and epidemiology. And part of that training led me to work at U.S. Department of Health and Human Services headquarters in D.C. That whole experience opened so many different doors for me. It's really just to better understand the federal government's HHS and the broad scope of services and work that is done through HHS. Many of the connections and individuals I've met during that time are still people who I'm very close to. Someone I worked at HHS in 2002 was Dalton Paxman, who is now the Region 3 HHS regional administrator. We worked very closely together during the pandemic. [caption id="attachment_224276" align="alignright" width="300"] DPH Director Dr. Karyl Rattay said she became more concerned abotu COVID following a discussion with a colleague in Washington state. | DBT PHOTO BY JACOB OWENS[/caption] When did it really kind of dawn on you that COVID was truly going to be a really big deal here in the U.S. and in Delaware? This wasn't the first time we've seen a novel infection somewhere, and we keep an eye on it, like Ebola or MERS-CoV. So, I tend to remain optimistic, but prepare at the same time. It was early January 2020 when our team started to have regular calls to get ourselves prepared and ready. But it really was when my colleague, John Wiesman, who was the health official in Washington State, pulled all the health officials together one Sunday and said, “Let's talk about what's going on in Washington. I want you guys to learn from my experience here.” That was probably several days after they began to see cases, and that's when I knew it was just a matter of time. We're going to see it in Delaware. And once it was found in the country, you knew you weren’t really going to be able to box it in. There were so many unknowns. We did not know how contagious it was. We did not know exactly how it was spread. We did not know if it could be spread through asymptomatic individuals, which was a game changer. And while there were assumptions that perhaps it could be spread by asymptomatic people, it's rare that you actually see that kind of spread. I think that's what has made this pandemic so challenging – we were really functioning early on with very limited information and just doing the best we could. You may recall early on that we were only allowed to test people who had traveled right. And in California, they were saying we need to we need more tests, we think we have more people with COVID. As you start having conversations with Gov. Carney and some of the Cabinet members, what was their reaction? I recall a conversation with Gov. Carney probably about a decade ago when he was still a congressman and we gave him a tour of our warehouse and he was talking about how he was fearful of a pandemic. So he asked a lot of questions at that time about pandemic preparedness. As this was starting to bubble up, I did begin conversations with Delaware Emergency Management Agency Director A.J. Schall pretty quickly. We briefed the governor pretty early on, far before we saw our first cases here in Delaware. We work hard on having plans in place and executing those plans, but with this we were confronted with when to declare a state of emergency? What legal authority comes with that? And the thinking changes just a little bit because you're dealing with now new knowns but also unknowns. [caption id="attachment_224277" align="alignleft" width="300"] DPH Director Dr. Karyl Rattay became a weekly presence during the governor's COVID press conferences, like this one in June 2020. | DBT PHOTO BY JACOB OWENS[/caption] As a scientist, having to translate what you know to a public that seemed increasingly divided about what to do with COVID and how serious it was, how tough was that for you? I think that being in this role and being in public health for this amount of time, the naivete that I had 20 years ago has gone away. I realized that when it comes to policy and public opinion, science doesn't always rule. But I never expected it to be as frustrating as it was during this pandemic. I've never seen misinformation counter science to this degree. I have long understood that not all decisions are made based on science, but I've never had the experience where there's just such disbelief and distrust in what the science is actually telling us. As you became a part of the governor’s press conferences through the pandemic, what was that experience like to be thrust into the public eye? Interestingly, in some ways, because we weren't out in public that much and I was so focused on this response, I'm not sure I really put a lot of thought into it. I think that as some of the issues became more contentious. I think more and more people knew how to find me – even finding my personal cell phone – and some of that was uncomfortable. Some of the threatening emails or outreaches that I received became very uncomfortable at times. I've never been one to seek the limelight, but I think for public health, it just has to be a part of what we do in order to inform the public. I will always be grateful to the governor for really respecting the science. We had very regular calls, at times daily calls, and he always wanted to know what the science was saying. That didn't always mean decisions weren’t made based on the economic impacts. There are many things that went into the decision-making, but when I saw my colleagues in other states, where their leaders would completely disregard the science, I constantly felt so grateful that that was not our experience here. And I think the governor gave me that time because he really wanted the public to hear the science from a scientist. As you look back over the last two years, how do you grade yourself? Would you have done anything differently? I am thrilled with how the Division of Public Health came together. That being said, we did not have the infrastructure we needed, and that was so incredibly stressful. We did not have the data systems in place, we started a case database. Every morning, in our Emergency Operations Center, the first thing I would do at like 6 a.m. was go to this whiteboard and look at the situation. How many cases? How many hospitalizations? How many deaths? We had almost no epidemiologists. When we started, we pulled people from chronic disease and maternal child health – anybody who had any data background at all to come help. When I look back, I hope that public health in the state and nation never finds ourselves so inadequately staffed and prepared again for it to be able to respond to something like this. I hope that this was a big lesson that underfunding public health infrastructure is a really bad idea. [caption id="attachment_214370" align="alignright" width="300"] ChristianaCare Medical Assistant David Overton is vaccinated by Assistant Nurse Manager Kristin Macey at Wilmington Hospital in December 2020. | PHOTO COURTESY OF CHRISTIANACARE[/caption] Have we reached the endemic stage or are we still in a pandemic? Well, it still is a pandemic. Right now, as of (June 24), our community levels in two of our counties are low for the first time in probably about six or seven weeks. So, we just had a little bit of a surge but it looks like, for the most part, a lot of that's in our rearview mirror for this particular Omicron surge. I would love to say this is all behind us, but the tricky thing with this virus is it keeps mutating – there's two new strains of the Omicron variant that look like they're pretty good at evading the immune protection that comes from either previous infections or possibly even immunization, although we think immunization is going to still help protect. It is a fear that these circulating strains may give us potentially a devastating resurgence in the coming months, and then who knows what additional mutations are in the future. I'm going to remain hopeful that with all the immunity that is out there in the community now between vaccines and infections, we're never going to be where we were in 2020 again, but we're just not out of the woods yet. And that's unfortunate because we're all ready to be. You aren’t retiring, but you haven’t publicly discussed what your next role will be. Any hints? Will you stay local? We are definitely staying in Delaware. Our kids are in high school here, so we are not going anywhere. My true passion will always be really around maternal child health and addressing the health inequities and disparities. I'm still not ready to say where I'm going, but I am excited for a new chapter that's not so intense 24/7.