Montgomery County Health Officer talks reopening during the pandemic

Bethesda Interview: Dr. Travis Gayles

Dr. Travis Gayles, Montgomery County’s top health official, talks about the cautious approach to reopening during the pandemic, threatening emails he’s received, and whose opinion matters most to him

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Photo by Joseph Tran

Thursday, March 5. It was 5:45 p.m. when Dr. Travis Gayles, Montgomery County’s top health officer, saw his cellphone light up with an incoming call. He was at home in Silver Spring, getting ready to shower after his regular spin class and thinking about his plans for dinner.

The call was from Fran Phillips, Maryland’s deputy secretary for public health services at the time. “Travis, congratulations,” she said. “You all are the first ones. We’ve got three cases in Montgomery County.”

The county was the first jurisdiction in Maryland, Virginia or Washington, D.C., to have confirmed cases of COVID-19. Gayles, 41, knew it was only a matter of time before he’d receive that kind of call. “There are certain [phone] numbers that you see and think, ‘This can’t be good,’ ” he says.

Gayles had trained for a pandemic, but this would be his first time leading a response. After talking to Phillips, he set up a call that included County Executive Marc Elrich, county council President Sidney Katz, then-Chief Administrative Officer Andrew Kleine and others to tell them the news. That night, Maryland Gov. Larry Hogan announced that all three Montgomery County residents had contracted the virus while on a Nile River cruise in Egypt. Then the contact tracing began.

Gayles has been the county’s health officer and chief of public health services since September 2017. His position is dually appointed by the state secretary of health and the county executive. His appointment was approved by the County Council. Before COVID, his primary focus in the county was promoting campaigns on subjects such as vaccines, flu shots, anti-vaping, HIV clinical care and other programs.

Gayles, who is single and does not have children, has been praised and criticized for the decisions he’s made on how fast the county would reopen, whether schools would be allowed to hold in-person instruction, and what mandates would be put in place to keep students and staff safe. On July 31, he issued a directive ordering private schools to remain closed for in-person instruction until at least Oct. 1. Three days later, Hogan issued his own order, overturning the county’s directive and prohibiting local health officers from deciding whether the schools should reopen. Private schools could decide for themselves, Hogan said. Gayles then issued another order on Aug. 5, citing a Maryland law that allows county health officers to “act properly” to avoid the spread of a disease that endangers public health. But he was overruled again when Maryland Secretary of Health Robert Neall sent a memo to local health officers on Aug. 6, contending that the state’s policy is that private schools in Maryland shouldn’t be closed in a “blanket manner.”

Gayles feels that he was caricatured as a “political animal” for his decisions regarding the reopening of private schools. “Quite frankly, that was not fair. It was not called for and it led to distractions from being able to stay focused on the work that we’ve been committed to doing in keeping people safe. It was probably the moment of greatest frustration in terms of how a decision that was made based upon science and data was manipulated and characterized in a way that was not accurate and not fair. I wouldn’t change anything we’ve done,” he says. “We were executing fully within our rights and responsibilities based on the state laws in terms of the guidelines and instructions that health officers had. End of discussion.”

A native of Chase City, Virginia, Gayles graduated with a dual bachelor’s degree in public policy studies and African American studies from Duke University in Durham, North Carolina, before receiving his Ph.D. in health policy and community health from the University of Illinois at Urbana-Champaign in 2006. He earned his medical degree at the University of Illinois College of Medicine in 2009—he’s the first physician in his family—and in 2012 became a research fellow at the National Institute of Mental Health, focusing on the intersection of victimization, violence and high-risk behaviors of adolescents.

Before turning to public health, Gayles was an adjunct professor in the Department of Health Sciences at DePaul University in Chicago and a clinical instructor in pediatrics at Northwestern University’s Feinberg School of Medicine. During his time at Northwestern, he also served as a pediatrician and director of HIV testing services at the Ann and Robert H. Lurie Children’s Hospital of Chicago. After moving to the D.C. area in 2015, Gayles served as chief medical officer for the HIV/AIDS, Hepatitis, STD, and TB Administration and division chief of the STD-TB control division for the District of Columbia Department of Health.

Bethesda Magazine met with Gayles in mid-September at the county’s Dennis Avenue Health Center in Silver Spring.

When did you become interested in pursuing health? What motivated you to choose this career?

I think I made the decision to go into medicine back in early high school—probably freshman year. Up until that point I was convinced I loved civics and government, still do. I was going to be an orthopedic surgeon. The plan was to major in biomedical engineering and specialize in biomechanics because I was fascinated by artificial limbs and joints. I was going to go that route, and then about a year and a half into it, the curriculum at Duke was heavily engineering-based, which I was not a fan of, and I had a conversation with my advisers. I ended up applying [to a Ph.D. community health program at the University of Illinois], and I got in and I didn’t have to choose [between medicine and public policy and health]. So that’s how I ended up doing an M.D. and Ph.D. in community health.

Did your parents recognize your interest in health at an early age? What kind of significance does being the first physician in your family carry for you?

My parents’ emphasis growing up was not profession specific. I remember a lot of people used to say they were strict. The expectation was you should expect to make honor roll—that should be your baseline, that kind of thing. They created the culture that whatever you chose or selected to do, do it well. I think something they instilled growing up was that there may be people who are more talented than you, or maybe even smarter than you, but there should never be an instance where people outwork you. That’s something I’ve always carried with me. At every step of the way, they were and continue to be extremely supportive in terms of encouraging me to pursue those particular dreams and passions.

I had to work to get here, but recognizing I come from generations of folks who worked really, really insanely hard doing jobs that they probably didn’t necessarily enjoy but they did it to support their families and to create a space for me, my siblings and my generation to be able to do the stuff that we’re doing. In many instances, they didn’t have the opportunities that we had because they grew up in a segregated society. I would wager based upon how hard they worked that had they been given the opportunity, there probably would have been other doctors along the way.

Do you have any memorable moments from early in your career or experiences that changed you or your perspective?

One time I was post-call trying to get out of the [children’s] hospital and a mother was running behind me, trying to catch my attention. I’m like, ‘Oh no, what’s going on?’ She stopped me. It was a Black mother who said, ‘I just wanted to grab you because my son’s been coming to the hospital for years and he’s never seen a Black male doctor and I wanted to introduce him to you.’ Whether some look at it as a responsibility, I look at it as a privilege because representation matters.

I’ve been very thankful in my career to move forward and be in some important places where important decisions are being made. I don’t always see other people who look like me at the table or [who] come with my own personal experiences in terms of [the] demographic group I belong in. I take that very seriously and try as best as I can to make sure my job is to represent everybody. It’s to provide guidance to everybody.

The first patient that I delivered a diagnosis of being HIV positive was an 18-year-old young man in Chicago. This was the first time I was delivering this diagnosis on my own, I was nervous about it. When I told him, he was like, ‘OK.’ I said, ‘Tell me more. You seem very unmoved by it.’ He went on to say, ‘That’s the reality of my demographic. People who look like me, live where I live, love who I love—I assumed it would happen at some point by virtue of where I live and who I am.’ That stuck with me and bothered me that this was a young person who at some point had created this sense of  ‘this is what is likely to happen based on my lived environment.’  I’ve tried to think about leveraging my space, my career, my professional efforts to try to change that so that as a kid growing up, your ultimate trajectory is not defined by your lived reality. It is shaped by it, but it doesn’t have to be your expected baseline.

What have been the greatest challenges for you personally in leading the response to this health crisis? How has that experience affected you?

I think one of the tough things is—and we don’t talk a lot about this in public—that health is a nonpartisan, apolitical thing. A larger public response is a political, can be a political partisan thing. That’s been difficult, particularly given when you have so many different influences that come out and say all sorts of things. I often joke, [but] I sincerely mean this, that there are two people in the world whose opinion that I care about—and those are my parents. As long as they think I’m doing OK and moving in the right direction, that’s what’s most important. It wears on you when you see some of the stuff that people send in. It becomes a personal subjective thing when really we’re operating on an objective, nonpartisan, apolitical perspective. When you’re operating from that perspective and many others aren’t, and they twist everything in that way, it’s exhausting to kind of have to fight that.

Have you received threats from the public?

We’ve received concerning emails where I’d had to have some conversations with the police department to talk about potential security. There have been threats of folks showing up at my house and protesting and things like that. A lot of derogatory language [has] been put out there by people. They don’t know you at all. There have been some that have been borderline, like, we need to keep an eye out on that. It’s amazing the stuff people put out with their names associated with it. People will send emails from their work accounts where you’re like, really?

Is the derogatory language racial?

Yeah, highly racial overtone. That tends to be the most common one. There’s been some homophobic comments mentioned. I think I can think of one colorful email that was probably the worst of them all, that basically everything you could think of, there was something in it that [was] addressed. I think the language said something to the effect of, ‘Your parents should be embarrassed by you’ and, ‘Your father would be embarrassed but you know, let’s not be getting it twisted, you don’t even know who your father is.’ It’s just that kind of crazy. How do you even put that into writing or do it? It’s been a lot of that. I think there was a popular theme of me being a diversity hire, not being really qualified for my job. So that kind of stuff, where it has no basis and it is what it is.

How many emails like this would you say you get a day?

Probably the times where we received the most negative feedback were when we chose not to move forward in reopening with the state originally, and around the decision around nonpublic schools. I would say at that time [an] average [of] maybe 50 emails a day at least from folks not happy—50 to 75 a day, around that.

When you have to worry about your safety or staff members’ safety, does that distract from the focus on the public health response?

It does because when you go home, you’re tired and you carry that with you. We know that any of the decisions or guidance that we put out there may not be popular, but it’s not about being popular, it’s about sticking to the facts and sticking to the data and executing as much as we can from that. At the end of the day, I stand by every piece of guidance that we’ve put forward. We’ve tried to be as transparent and up-front as possible. When there have been instances where we’ve received information to show that we’re not moving in the right direction, we’ve quickly pivoted. When it came to face coverings, we did not have a face-covering mandate in place. But when it was clear that the CDC said, ‘Actually, yes,’ we put one in place. We were the first in the state to do so for our employees and first line of responders. When it came time to [put] in a mandate, we were the first [jurisdiction] in the state to do so, back in June—about a month and a half before the governor put one in for the state.

How many hours a week would you say you’re working? How has that affected you?

Early on, I would say probably every day you get up [for a] first call, 7:30 a.m., and you’re emailing up until 11:30 p.m. at night. Now it’s a bit more manageable. I would say I tend to, in the evenings, probably do a couple of hours dependent on what needs to get done. I’m trying to be very careful about sketching out boundaries for self-care and personal health and well-being and getting to the gym. I go [to the gym at] off-peak times where there’s not a large crowd of folks, and make sure to adhere to the policies and practices we’ve put forward in terms of cleaning surfaces, face covering on, trying to physically distance as much as possible during those times.

Do you do anything else to recharge at the end of the day? Do you have a routine?

Sure, I play tennis. I’m a competitive tennis player and I play in a few leagues. So when that activity was reinstituted, the leagues popped back up. My true biggest vice is travel, but I can’t really do that right now. I love to travel and experience new cultures and see and try new things. I have a goal—I’d really like to have traveled to 50 countries by the time I turn 50. I’m currently at 31. I’ve got eight years and some change to get to 50.

What would you say has been your lowest moment over the last six months?

The first one—and I still struggle with this one because we were hit hard and it was just trying to figure out how to avoid it—was the nursing home situation and the lives that were lost. We were proactive, but we still got smacked and hit really hard with that. It’s tough balancing that sense of we failed vs. unfortunately there was a lot of asymptomatic transmission before we really understood that and it got into the settings. Certainly we have a lot of systems in place now to prevent that from happening again and, knock on wood,  we’ve been able to get those numbers down and keep things low. My two remaining grandparents lived in a nursing home and they both passed away last year within six months of each other. After having spent a large amount of time over the last two to three years with them in that nursing home setting, that probably added to that heaviness from that.

You have “played it safe” in reopening and lifting restrictions slower than the state and been criticized for those decisions. As a county health officer, you’ve taken this strong stance even if it is in direct opposition with the governor. Why?

Because it’s guided by science and evidence and data. I can’t speak to the data that the governor sees, I can only speak to what we see. When I’m looking specifically at Montgomery County, I also have to look at it in the context of the region that we’re surrounded by, so our peer counties and the National Capital Region in Maryland, as well as D.C. and our peer counties in Northern Virginia. When looking at our numbers, sometimes that casts a very different picture than the overall state picture that the governor looks at in terms of their numbers. I’m not in the room when they make decisions and I don’t know who’s in the room when they make those decisions. When the governor reopened [in Phase 1] and we said, ‘No, we’re not going to go because our numbers are too high,’ we waited. Not only did we wait, we did ultimately move forward but we also kept some precautions. I would wager to say that approach has helped us drive [the] numbers down. Now the challenge we have is we’ve got to go even further, and that’s what we’re trying to figure out: How do we break the plateau, if you will, and the slight uptick in cases to get us back down on that downward trajectory? But no, I stand by that trajectory and that guidance.

We utilize data that we get from the Maryland Department of Health. We get a surveillance report on a daily basis. We have a surveillance division. They compile information from the state, they compile information from the CDC. They also compile it from a number of databases that showcase the impact of our hospitals in terms of how many people are showing up to the emergency room, those kinds of things. They also mine the data in articles and journals to be able to find the most up-to-date, relevant articles to provide for me and other staff to have to read. That’s usually what I read late at night after answering emails, to make sure we’re up to speed on what’s happening and what’s going on. There are sites such as Johns Hopkins; Harvard has a COVID-tracker site as well that allows for comparisons. We’re in constant communication with other health departments [and] we share information if we find stuff out.

Have you felt, or do you feel, pressured by the governor’s positions on reopening, schools and other issues?

I don’t, personally, because we’re going to continue to do what we need to do to keep people safe. It is a little frustrating when there is politics injected into that and partisanship injected into it. I was brought in to provide health advice, and we’re going to give what we feel is the best health advice based upon facts, data and science. Any of that political stuff—I’ll leave that to County Executive [Marc] Elrich and the council to go back and forth with the governor. Because that’s not what we’re here to do.

How has the reopening of some private schools impacted the rest of the county, and COVID-19 conditions? Are you concerned there will be more cases because of some private schools operating with in-person learning?

I think the heart of the matter is higher levels of community transmission. I don’t want it to seem that we’re blaming nonpublic schools as the source of it. I think the source is we just still haven’t achieved lower community transmission, so that regardless of the space you’re walking into—the schools or a business—there’s still increased risk that you’re bringing COVID-19 into that space.

It is challenging in the setting of schools because there is a high volume of folks who are in a place for a longer period of time. You go to a gym, you go to a restaurant, you go to other places—you’re there for a shorter period of time as opposed to being in an enclosed shared space for six to eight hours at a given time. Certainly, with the recent information that has shown a higher percentage of cases falling into younger areas, we are a little bit concerned and nervous where there are settings where young people are getting together and there’s this increase for potential transmission in those spaces.

What role did you play in the decision to not reopen Montgomery County Public Schools for in-person learning? Is it possible that the schools will open earlier than planned?

The role of the health officer is to provide guidance per regulations that are laid out by state law. In any instance where there’s a public health question, I’m asked to provide that guidance and we do our due diligence in terms of researching as much as possible, getting background information about best practices, all those kinds of things. Any decision or guidance that comes from the health officer has been carefully discussed. There isn’t an instance where you’d see something coming from me that has not been discussed at length with the county executive and his staff and the county council before that’s released. The reality is we continue to base those recommendations and guidance upon [the] numbers and where we see them. Right now, we have not achieved [conditions to allow public schools to reopen]. I think MCPS left it open to say they would reevaluate at the end of the fall quarter to see where they stand in terms of being able to move forward.

Critics have said the county crippled the economy with tighter restrictions. Do you feel you made the right choices?

I and our team have been empathetic to the economic realities that exist. But we’re also very empathetic to the health realities that exist in terms of keeping people safe. We didn’t create this. We’re doing our best to try to mitigate transmission and to [limit] the spread of disease because ultimately we would love to get to a point where we can open things back up broadly. But the reality is, if we increase points of transmission and points of contact, we’re never going to achieve the numbers where we lower the burden of the virus in the community. Unfortunately, we do recognize that that is going to keep certain businesses and industries not being able to function.

Has this health response revealed any holes that need to be addressed by the county as far as health services? How do you plan to address those?

I think the response has brought out a big gap [in] the modernization of the public health infrastructure for service delivery. When things are fine and [health departments] operate in the background, we’re also one of the first places where budgets get cut. Contact tracing programs have been cut in [federal and state] funding for the last five years. We still get results by fax. People are like, ‘How is that possible?’ There are areas where the technology needs to be updated and modernized where everything is electronic. When are we actually going to start fixing [health disparities and health inequities]? Hopefully a big piece of this moving forward will also include more multidisciplinary approaches that bring different government agencies together to address those social determinants.

If you faced another pandemic in the future, what would you do differently?

We’re not done with this one. I think unfortunately we’re going to see some more bad days before we completely clear things. I think it’s important for folks to understand that. What is different is we do have some institutional experience now with having dealt with this for a number of months that will hopefully help us respond to those potential bad days better than when we first got hit. I think in terms of best practices, really locking down on our congregant situations, so nursing homes, assisted living facilities. Making sure that those who are most vulnerable in those situations are covered as soon as possible.

This is going to be the ongoing thing: balancing the need to open things up with science. I think the challenge will be if we get hit with another one, or if this one worsens, there’s a lot of people who I think have reached the point where it’s, ‘Well, things aren’t that bad.’ So it’s almost like we can live with 80 cases a day as long as we’re not seeing fatalities or the hospitals overrun. I don’t support that. I want to see them go down. Because any time you’ve got a virus living in your community at higher transmission levels, you’re asking for trouble.

Briana Adhikusuma covers the county government for Bethesda Beat. The Bethesda Interview is edited for length and clarity.

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