“It was the biggest surprise that was also the longest time in the making.”
That’s how Annette Gaudino, state and local policy director for the New York City–based health think tank Treatment Action Group (TAG), described the news on Aug. 4 that Oxiris Barbot, M.D., the city’s health commissioner since 2018, was resigning from her post.
The news came after months of tension involving Mayor Bill de Blasio’s handing off the complex and challenging task of COVID-19 contact tracing from Barbot’s Department of Health (DOH), which has a long and esteemed history of doing such tracing for other diseases including HIV, to NYC Health + Hospitals, the city’s public hospital network, which has no such experience.
The resignation of Barbot, the city’s first Latina health commissioner, came only days after a New York Times story showed how COVID-19 contact tracing in New York City, contracted out from H+H to a private company, had frustrated its 3,000 hired tracers with what they called managerial disorganization and pressure from city officials to advertise that the program was making a difference, whereas, in fact, fewer than half of COVID patients contacted have offered up names and contacts for those they had been in touch with.
Advocates said that scaling up an effective contact tracing program for a brand-new disease would be difficult anywhere—those contacted must trust and understand the program enough to surrender the names and contacts of family and friends—but that it had been hobbled from the outset by de Blasio’s decision, which many said they found mystifying, of moving the job from DOH, which has done such work for decades for diseases including HIV/AIDS, to H+H.
“It was always going to be hard to do Test + Trace [the city’s name for its contact tracing program], especially given the wide spread and prevalence of COVID,” says Gaudino. “Tracing works best when a disease is in low-transmission clusters. But this administration has only put it on its back foot even further. Every decision the mayor has made has hampered Test & Trace’s ability to succeed.”
Said Jeremiah Johnson, a TAG colleague of Gaudino’s, “It’s upsetting to see yet another very knowledgeable, professional, quality leader who happens also to be a woman leaving the DOH.” In 2018, Barbot’s predecessor, Mary Bassett, M.D., M.P.H., also a woman of color, left the DOH’s top post to take an academic post at Harvard. She had been harshly critiqued by de Blasio for the DOH’s handling of a Legionnaires’ disease outbreak in the city in 2015.
An even more recent exit from DOH was Oni Blackstock, M.D., a Black woman physician with an HIV specialty who, upon hearing news of Barbot’s resignation, tweeted, “It was painful to see the disrespect with which Dr. Barbot was treated. To have two Commissioners of Health—both women of color—resign under Mayor de Blasio’s tenure is an indictment of his leadership.” (As early as 2017, a New York Times story noted the unusually high exodus of women from de Blasio’s administration.)
The exit of Barbot “is a real blow to the city,” said Sutton King, M.S., who heads Urban Indigenous Collective, which advocates for the health of the city’s Native American population, and who was at a press conference last week with Johnson, Gaudino, and others calling out DeBlasio for his COVID response. “It really says something when we see another high-ranking woman of color in the de Blasio administration resigning. It appears he’ll appoint women of color but won’t really listen to them or respect them.”
Charles King, the CEO of the HIV nonprofit Housing Works, like Johnson, Gaudino, and Sutton King, is part of the city’s community-based COVID-19 Working Group, which aims to advise city officials on the pandemic. He said of the city’s contact tracing program, “I think Barbot’s concerns early on about moving the program from DOH to H+H have proven correct in alarming ways, and for that reason, [de Blasio] had to get rid of her and is now taking advantage of this opportunity to consolidate H+H’s power.”
He added: “I think we’re going to see a continued complete lack of transparency on issues of COVID data,” supplanted by “happy stories to make it look like T+T is going well, when in fact they don’t have their act together. My big fear is that we are going to see a second wave of COVID here in NYC—and the bungling of T+T guarantees that we are not going to be ready for that.”
King pointed out that de Blasio, shortly after announcing Barbot’s resignation, named her replacement: Dave Chokshi, M.D., M.Sc., FACP, an H+H doctor—and, until recently, an H+H health officer. The mayor even went so far as to have former U.S. Surgeon General Vivek Murthy, M.D., praise Chokshi, calling him “an extraordinary public health official.”
King says that the appointment signals de Blasio’s continuing prioritization of H+H over the DOH. “It’s taking a deputy of [H+H head] Mitch Katz and putting him over the health department,” said King, adding that Katz appears to be doing what he did in Los Angeles when he was head of public hospitals there—merging them with the LA health department, so that he might be effectively in charge of both entities.
Why so? “Power, of course,” said King. “And there’s no rationale to merging DOH and H+H. They have completely different functions. One is to deliver medical care to the most marginalized New Yorkers; the other is to set public health policy.” He said that trying to consolidate the two agencies would be “a huge mistake.”
On Aug. 4, there was also worry among advocates that the next DOH leader to leave, amid what appears to be almost a staggered walkout protest against de Blasio, would be deputy commissioner Demetre Daskalakis, M.D., M.P.H., the gay infectious disease specialist who has become a folk hero of sorts for his bold, sex-positive, and community-engaging approach to HIV prevention in New York City.
Gaudino said she hopes that Daskalakis stays. “We need him more than ever right now. Often in bureaucracies, the highest-profile positions take all the heat, but people the next layer down, like Demetre, are really implementing the vision and determining so much.”
Gaudino added that perhaps the time was coming for mass protest against what she called de Blasio’s sidelining of public health experts in the fight against COVID-19. (It is not clear if Barbot resigned of her own will or was pushed out; according to The New York Times, one city official said she quit because she knew she was going to be fired.)
“The politicians are removing the public health leaders,” said Gaudino, “and as advocates and community leaders, we really have to get together and come up with our demands. We can’t just ask the city, ‘Please give us better leadership.’”
But she wondered if de Blasio was past the point of no return, noting the recent exodus of his staff amid citywide criticism that the mayor has kowtowed to the New York Police Department in the face of mass protests calling for dramatic police defunding and reform.
“As with Trump,” Gaudino said, “it seems like he has a very close circle that’s getting smaller by the day, and those are the only people he listens to, evidence and context be damned.”