Guiding Maine through the pandemic

Nirav Shah, the director of the Maine Center for Disease Control and Prevention, knows he is lucky.

Shah is the public face of the state’s coronavirus response and has observed the vitriol directed at many of his public health colleagues across the country, including armed protesters and threats to their families.

But that backlash has not happened in Maine.

Shah told The Hill he believes one of the key reasons is that Maine has the oldest population in the U.S., with an average age of 45.1, compared with 38.5 for the rest of the country.

He added the other reason is that Mainers believe in science. When he asked them to stay home, people listened.

“They understand the implications of not taking these measures. The import of unchecked pandemics in Maine is very visible to everyone. It’s on everyone’s mind,” Shah said in a recent interview.

He is sympathetic and said he has spoken with public health director colleagues, who have been subjected to protests, “just to help them out. But suffice it to say I’m thankful that Mainers have not responded to good public health advice with violence.”

While the U.S. pandemic response has been highly politicized, Shah, who recently became president of the Association of State and Territorial Health Officials (ASTHO), noted that public health and politics have always been intertwined.

“There’s always passion around [public health], and where there is passion there is politics, so that is, I don’t think, a new phenomenon. I think it has become more pointed and pronounced with respect to COVID … because of how omnipresent COVID is,” he said.

During his daily media briefings to give the latest pandemic updates, Shah seeks to stay above the fray. He tries not to comment on political matters but says he doesn’t shy away from straight talk about the reality on the ground.

He doesn’t get bogged down in scientific jargon and recognizes that every statistic also has a human impact.

“If there’s bad things going on, I want people to hear about it from me first. So, building that trust that I am not providing a biased view, or a view that only behooves the administration, that’s really, really critical,” Shah said.

Shah also isn’t shy about the fact that his advice and guidance are constantly changing.

“I’ve tried to be really flexible throughout the pandemic. That requires me sometimes publicly to say, ‘Yep, I’m changing my mind on something. What I thought yesterday is not what happens today.’ That’s OK,” he said. “That is that is the nature of doing policy in a pandemic. Policies will change, facts will change. You should expect that, but I have an obligation to you to let you know that.”

Shah’s trust-building methods have worked so well that he’s gained celebrity status in the state. The slogan “In Shah We Trust” is printed on T-shirts, bumper stickers and mugs, and there are more than 35,000 members in the Fans of Dr. Nirav Shah group on Facebook, which sports the motto: “Keep Calm and Listen to Dr. Shah.”

Shah’s face also graces the wrappers of chocolate “Shah Bars” made by local company Wilbur’s of Maine.

Shah, 43, has medical and law degrees from the University of Chicago, and after medical school, he worked as a health care attorney in Chicago before becoming public health director of Illinois in 2015 under former Gov. Bruce Rauner (R).

Shah arrived in Maine in May 2019 after Rauner lost a reelection bid, and his first order of business was to rebuild the state’s public health agency after it had been decimated by budget cuts ordered by former Gov. Paul LePage (R).

He said he spent about eight months slowly “beefing up programs that had been left for nothing by the previous administration.” He filled long-vacant positions, including public health nurses and laboratory staff.

Shah said he was “lucky” that he had time before the pandemic hit, and his team was well-positioned to respond. 

Still, he said the COVID-19 crisis has required the agency to be creative in terms of staffing across different departments, because “there is no world in which any state health department has all the staff they need … to deal with a pandemic before they have a pandemic.”

As the new president of ASTHO, an organization that represents and advocates for public health officials and their agencies, Shah said the budget issues he faced when he first got to Maine are unfortunately common in state health departments. His most immediate priority at ASTHO is to make sure states are appropriately funded for a successful vaccine rollout.

States had pleaded with the Trump administration for more funding to aid in the coronavirus vaccine rollout, but they were repeatedly rebuffed because officials at the time did not believe states needed the money.

Congress eventually allocated $4.5 billion for state vaccine efforts in the December COVID-19 relief bill, but the money has only recently started to flow.

Shah said he considers those funds a “down payment” with more needed going forward.

President Biden is pushing for an additional $350 billion for states as part of his $1.9 trillion stimulus package.

Longer term, Shah said he wants to make sure state health departments have enough staff to do their jobs, and he is “encouraged” that the Biden administration is talking about adding 100,000 more people to the public health workforce.

“Public health has been systematically underfunded in the decades leading up to this pandemic,” Shah said. “This is sad to say, [but] it’s an opportunity to remind people of the need to have strong public health. And what can happen when it’s systematically underfunded.”

Maine has been one of the rare highlights of the U.S. COVID-19 response, with about 46,000 cases, 706 deaths and 1,571 hospitalizations at press time. Last month, the seven-day average positivity rate dropped below 2 percent for the first time since before Thanksgiving, and it has stayed down.

Twenty percent of Maine’s population has received at least one dose of a coronavirus vaccine.

Shah said the numbers are encouraging, but he wants to make sure they continue trending downward.

“I don’t do victory laps,” Shah said. “We are still in this. I am proud of my team. I’m proud of Maine people for believing in science, believing in good public health recommendations, but we’re still in this. And then, especially with variants on the horizon, I think we’re in the eye of the storm right now.”