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EH Heroes in the time of COVID-19: Tom Butts

May 12, 2020

Thomas Butts, MSc, REHS has been a NEHA member for 36 years. He currently works on environmental health programs as a consultant and as an hourly employee for two local health agencies in Colorado. Tom was appointed to the Colorado State Board of Health in March of 2019, and he will soon take a seat on the NEHA Board of Directors as Second Vice-President. Prior to his retirement in 2017, he spent his career with Tri-County Health Department, the local public health agency that serves three counties and over 1.5 million people surrounding Denver. Throughout his career, Tom has served in leadership positions with many environmental health organizations, including as a regional representative, treasurer, and then president of the Colorado Environmental Health Association (CEHA). Because of his extensive experience, and numerous connections across the state, Tom offers a broad overview of the environmental health response to COVID-19 in Colorado.

How has your work changed since the outbreak of COVID-19 in Colorado?

My work before COVID-19 was partially what you might consider special projects and partially EH program work. The special project tasks included contributing to county oil and gas regulation from an environmental public health perspective and providing content in the areas of air quality, water quality, noise, and odor in situations where huge changes are occurring at the state level to increase regulation focused on the reduction of impacts to public health and the environment. This statute-driven change also allows local government to go above state standards for local land-use related issues (creating more of a floor than a ceiling). Another task was to support the development of a county climate action or "Climate Smart" plan that focused on mitigation of the impacts that are or are likely to occur in the community. Again, complimentary state-level activity on greenhouse gas reduction is also underway.

The second line of work was supporting an Environmental Health Services group during an EH Director transition which included engaging with EH staff and administrative support for EH programs, a review of general program practices and fee setting processes, and providing program guidance as needed (e.g. implementing new elements of a food safety scoring and rating system).

As COVID-19 emerged, my focus became much more about supporting the EH professional staff working with regulated entities (retail food, childcare centers, body art facilities) to ensure they understand and are complying with, local and state-issued public health orders. I am also supporting the process of safe food donation to community food banks or sales of produce, meat, and dairy directly from regulated facilities within the new guidelines. I have been supporting the role of EH in collaboration with legal counsel and law enforcement in fielding and responding to complaints about businesses violating public health orders.

Colorado is a state with numerous rural communities. What challenges do EH professionals face when serving and protecting rural communities during this crisis?

The challenges I have observed come in a couple of forms. The local environmental health system in Colorado is county-based. For a smaller county that often means that there is only one environmental health professional employed or in some cases the state is the service provider. This means there is little to no surge capacity or backup available in less populated counties. Parts of Colorado are also heavily impacted by tourism in the winter and summer. This creates staffing challenges, often addressed by seeking some seasonal staff or shifting staff duties. In the winter, tourists flock to mountain resorts in rural areas, while in the summer tourism is more broadly spread. Not surprisingly, balancing the demand for increased summer retail food special events and a short building season for onsite wastewater systems is a challenge.

Before COVID-19, discussions have raised the concept of developing a system/resource that would be available on a short-term fill-in basis during staff changes or illness. This has occurred when mutual aid was called into play during localized large wildfire and flood disasters over the past 10+ years but has not been formalized for non-emergent situations. What is unusual is that COVID-19 has stretched every agencyas EH professionals are pulled into incident response roles and public information roles. This had required that agencies implement their Continuity of Operations Plans to reprioritize local activities often organization-wide.

The Colorado Directors of Environmental Health is a key resource for the EH professionals across the state. The organization has members from 38+ organizations that execute EH programs in many of the 64 counties in Colorado– from 1 person organizations the largest in the state. The group actively supports the profession via quarterly meetings and an active Google group where COVID resources and information has been shared.

Across the country, health departments are partnering with nonprofits, the federal government, and the private sector in new ways to keep their communities safe. What unique and beneficial partnerships have you seen take place in Colorado as we work through this together?

County and multi-county health departments often seek specific funding from the Colorado Department of Public Health and Environment and the U.S. Environmental Protection Agency (EPA) for air, waste, and water quality projects. Prior efforts have also included working with the U.S. Department of Housing and Urban Development (HUD) on indoor air quality in housing projects.

The West Central Public Health Partnership received a 5-year grant from the Centers for Disease Control and Prevention (CDC) to provide private well owners with a FREE well water test. The purpose of the well-water testing program is to promote and protect the health and safety of private well-water users in the West Central Region of Colorado. The Delta County Health Department is coordinating this project in cooperation with the public health departments in Gunnison, Hinsdale, Montrose, San Miguel, and Ouray counties.

Tri-County Health Department received a grant from the Robert Wood Johnson Foundation, The Pew Charitable Trusts, and Kaiser Permanente Colorado to conduct a Health Impact Assessment of two community projects.

Denver Department of Public Health and Environment (DDPHE) is building on work started in 2019 to increase air monitoring through a nationally recognized effort called Love My Air Denver, which is funded through 2021 via the Bloomberg Philanthropies' Mayor's Challenge and in-kind support from DDPHE. The Love My Air program focuses on increasing the monitoring of fine particulate matter at or near schools through a formal partnership with Denver Public Schools. These efforts are expanding in 2020 to include additional locations and to evaluate more pollutants.

With a relatively new and unique School of Public Health (supported by 3 university systems) and an accredited EH program at Colorado State University, more capstone and practicum projects benefit local public health than ever before. Many public health and environmental health professionals interact regularly in supporting courses or as part-time faculty.

What can NEHA, and other professional associations, do to help EH professionals during this crisis?

It is a bit surprising how little mention of EH professionals and their role(s) in this response there has been in the media or even from state governmental leaders. I believe the efforts of EH professionals, playing major roles in local and state Unified or Incident Command systems, working with regulated community partners to define and redefine health-based operations, participating in contact tracing as part of disease investigation teams, and responding to all the important and urgent EH situations that continue to happen will be vital to the success of the response. We need to share the stories of these efforts wherever possible.

Having a go-to source for consistent guidance and best practices would be quite helpful and would be widely shared.

The Colorado Environmental Health Association hosted a virtual happy hour for members from across the state, where we could reconnect with our peers from across the state to share challenges and successes. This activity was well received and helped to re-energize those that participated.

The strain of this pandemic has been felt acutely by those who are essential workers (environmental and public health professionals included). What advice would you give to EH professionals who are working under such stressful conditions?

The profession has been actively involved in general local preparedness and response during the anthrax letters, the H1N1 response, foodborne outbreaks, waterborne outbreaks, and various hazardous materials and air quality responses. I am confident that EH professionals are a talented and flexible group that adapts and responds! I would encourage EH professionals everywhere to seek opportunities to apply our skills and abilities where appropriate, to support each other, to take care of yourself and your family, to seek support from behavioral health resources as needed, and to look ahead for opportunities to impact the recovery in our communities.