Humboldt County Board of Supervisors Chair Estelle Fennell said she didn't know what to expect when Health Officer Teresa Frankovich called the board into a special update meeting on Sept. 2. These updates — which allow the board to meet privately with those guiding the COVID-19 pandemic response to receive information so long as they aren't providing direction or making decisions — would be against California's open meeting laws in normal times. But these obviously aren't normal times and early in the pandemic — back in March — Gov. Gavin Newsom recognized the importance of keeping elected officials updated in real time on a dynamic situation and issued an executive order allowing these types of briefings.

Fennell said they were fairly frequent in the early days of the local response but much less so now, months into the pandemic, and it was unusual that Frankovich was calling for one less than 24 hours after she'd briefed the full board in open session, detailing the state's new tiered system for monitoring COVID-19 activity across its counties. Once the full board convened on a video conference call, Frankovich — who for months has served as both the public face of Humboldt County's pandemic response and the person most singularly responsible for setting local rules — told the board she was resigning .

"It caught me off guard," Fennell said. "It's something I had contemplated could happen because Dr. Frankovich has been basically burning the candle on both ends, working 80-hour weeks and on call 24/7, but I was surprised. And concerned for her. I wanted to know that she was OK."

A recent review by the Kaiser Health News Service and the Associated Press found that at least 50 state and local public health leaders have resigned, retired or been fired since April, including nearly a dozen in California. In addition to shouldering intense workloads under incredible pressure, some have faced intense, politicized backlashes — and even threats of violence — from residents displeased with masks, lockdowns and health orders.

As Fennell knew, Frankovich — as unflappably positive and optimistic as she often seems — had not been immune. Just the day before announcing her resignation, she'd faced a string of vitriolic diatribes from members of the public at the board's Sept. 1 meeting. One deemed current state and local health orders "freaking bullshit" before telling Frankovich, "I don't like you and I want you to leave" and intoned that her orders were "literally killing people." Another urged her — a practicing pediatrician — to "think about our youth" and the social impacts of her decisions, before another likened her orders to unconstitutional "cruel and unusual punishment," and referred to her as a "lawless leader."

Fennell declined to discuss the specifics of what was said at the meeting but said Frankovich assured the board of two things. First, she was not bowing to pressure or running from backlash — this was simply the best time for her to step away from a job that had grown leaps and bounds bigger than the one she'd signed up for. And second, she would stay in the position until the board hires a replacement and then hoped to continue on with public health in a part-time capacity to ease the transition and continue helping with the response.

Later in the day, Frankovich — who stepped in as the county's then part-time health officer in January just weeks before it would see its first confirmed COVID-19 case — struck the same chords while answering questions from the media.

"I'm 60, my husband is 70, I have an aging parent and there are things I need to do that are really difficult to do when you're working more than full time in a position like responding to COVID," she said, later saying flatly that neither pressure from local officials nor public backlash played into her decision. "Certainly, it is not pleasant to listen to that nature of comments and, I think, I certainly am supportive of civil discourse and we have not always had that. However, no bully at a meeting is going to make me leave this position. It really is a decision that's based on family need and looking at the projected term of this event."

Knowing the local COVID-19 response is likely to extend well into — if not through — 2021, Frankovich said she realized she wouldn't be able to see it through the end. With that in mind, she said it made sense to begin the transition to the leadership of a new health officer now, in a period of relative calm when the county isn't seeing a dramatic surge in new cases.

But Frankovich's resignation does come as the October start of flu season fast approaches, with winter trailing on its heels, both of which officials expect to complicate efforts to contain COVID. It also puts the board of supervisors — by nature a political body — in charge of recruiting and hiring Frankovich's replacement during a highly politicized pandemic.

When Humboldt County reported what the New York Times has determined was the first confirmed COVID-19 case in rural America back in February, Frankovich was just three weeks into her job and had never spoken to Sheriff William Honsal. The two spoke by phone that day, kicking off what would become a deep — and at times strained — partnership in the county's pandemic response, with Frankovich having the authority to issue health orders to close businesses, force residents to shelter in place and wear facial coverings, among other things, and Honsal running the county's Office of Emergency Services and serving as the enforcement arm for Frankovich's orders.

Reached by phone hours after Frankovich's resignation, Honsal said she'd called him shortly before she met with the supervisors to tell him of her decision, which he said came "out of the blue."

"But I understand the position she's in and the amount of pressure and stress this position has put on her," Honsal said. "It's a tremendous amount of pressure to put on any one person. It's a seven-day-a-week job. There is not a point in time in the last six months where we have not thought about this. Every day there's something and you cannot take a break from it. It's very, very difficult to be on the frontlines essentially for six months. But she took it on her shoulders and ran with and took the responsibilities of working late nights, weekends and constantly trying to do her best."

Honsal paused, then marveled at the way Frankovich seemed to hit the ground running into a pandemic response the likes of which the county hasn't seen in a century with a staff she'd only just met and a medical community she'd only just joined after moving to the area in late 2019 from upstate Michigan after her husband's retirement.

"It's like being the general of an army you've never trained with," Honsal said. "She's been the pivotal point in all this."

Honsal conceded that he and Frankovich haven't always seen eye to eye, describing their roles as at times representing "competing interests," with hers implementing measures necessary to slow COVID's spread and his trying to protect residents' constitutional rights. In other areas, those "competing interests" have caused deep public rifts between health officers and local sheriffs. But Honsal said Frankovich steadily won his trust and respect with her diligence, intelligence and methodical approach to the job. Over time the two developed a strong rapport, he said. Sure, there are disagreements, he said, but they now happen behind closed doors between the two of them so they can represent a united front in public.

While pockets of criticism exist on all sides of the county's response — for every person who thinks businesses should fully reopen and kids should be physically back in classrooms there's one who thinks the county was too slow to order facial coverings and too quick to reopen — the objective measures speak for themselves, said Stephanie Dittmer, president of the Humboldt-Del Norte Medical Society.

When California released its new tiered risk assessment system late last month, Humboldt was one of just 11 of the state's 58 counties to rank in the lower two tiers. But Dittmer said that's only the latest indication that the county's response has largely been on point.

In a matter of months, Dittmer said Frankovich and the county were able to coordinate and organize multiple testing sites and a protocol for triaging and prioritizing patient samples, greatly expand sample processing capacity at the Public Health laboratory, help hospitals build out surge capacities, expanded the county's ability to conduct contact tracing investigations and coordinated with the state to build an alternate care site to take patients in the event hospitals become overwhelmed. They've also helped develop complicated operational protocols for everything from restaurants and schools to skilled nursing facilities. And when the mobile testing facility they'd lobbied the state hard to locate in Eureka began having major problems returning results in a timely manner, Frankovich and her team looked elsewhere, forming a groundbreaking partnership with Del Norte County, United Indian Health Services, the state and Humboldt State University that would more than double local testing capacity and ensure timely results.

"We are lucky to have had her and she has set the stage for Humboldt County to be prepared for the next phases of this pandemic," Dittmer said.

And perhaps most impressively, Dittmer said Frankovich has done all this while also becoming the face and voice of Humboldt County's pandemic response, regularly appearing before the board of supervisors or in media availabilities to patiently and graciously walk the public through what the county is doing and why.

"She's really put herself out there," Dittmer said. "If you look up and down the state, there's very little comparison."

But Dittmer said it was just recently — when a pair of staff members at a skilled nursing facility in Fortuna tested positive for COVID-19 — that the full scope of Humboldt County's preparedness (and Frankovich's central role in it) fully hit home. Dittmer said she both works as a physician and has a family member living at the facility, so she both got an up-close look at and had a vested interest in the county's response.

Dittmer said Frankovich moved quickly to implement new protocols and testing regimens, which she credited with not a single resident becoming infected despite COVID having entered the facility.

"It's unheard of — it's unheard of for us to have a skilled nursing facility walk away from something like that without having a resident infected," Dittmer said, adding that she gives Frankovich "a lot" of credit for that outcome. "She's the one that's helping us set those protocols on the back ends. The public doesn't see her doing that job. They just see the outcomes."

There's much more the public doesn't see, said Susan Buckley, who retired in 2017 after serving 25 years in county public health, the last eight as public health director, and volunteered to help with the county's contact tracing efforts a few months back. When contact investigators run into a complex case, Buckley said they often turn to Frankovich for help, adding that she and Public Health Director Michelle Stephens also put together a complex data management system to help track investigations, as well as residents in quarantine or isolation.

"The presence of the resources we've seen here are a testament to the capacity, the competence and the forward thinking of local health leadership," she said.

Buckley said she's also been impressed by Frankovich's down-to-earth manner — she insists staff call her "Terry" despite four years of medical school and a master's in public health from the University of California at Berkeley — and the ease with which she interacts with people.

"I'm sure everybody at Public Health's heart kind of stopped for a moment [when they heard she was stepping down]," Buckley said. "But this probably makes complete sense. She's done a remarkable job. She's got systems in place. She's not going anywhere and you can't sustain the kind of workload she's had for much longer."

When the county announced Frankovich's hire in late January after she was selected from a pool of three candidates, it received little fanfare or interest. The county issued a short press release, which a couple local news outlets posted online. But, outside of the local medical community, the news was largely met with a collective shrug, if it was seen at all. That clearly won't be the case this time around.

"It's much different now, trying to recruit into this pandemic," said Dittmer.

And the hiring process will undoubtedly now carry a political component in ways it didn't in the past, though Buckley stressed that whether it's nutrition programs, addiction treatment or needle exchange programs, "It's always political. Public health is always political."

But this time some fear there will be a temptation for some to support a particular candidate for a specific outcome — like speeding the pace of reopening or closing the county's borders to tourists — instead of an individual's knowledge base, skillset and competence.

Fennell said the board will discuss the hiring process at its next meeting, Sept. 15, but expects the process will see the county Health and Human Services and Human Resources departments put together a panel with "subject matter experts" to vet candidates' qualifications and, ultimately, put a hiring recommendation forward to the full board, which will have the final say. As with all aspects of the pandemic response, Fennell said it's important the board understand its role.

"Who we really need to listen to are those who know what they're talking about — the doctors and scientists," Fennell said. "And our role on the political side is to make sure government provides the resources to guide the response. But we should all feel what's most important is human health. It shouldn't be a political football at all."

But there's no getting around the fact that the county will be looking for someone to step into an 80-plus-hour-a-week job that's highly visible and open to wide scrutiny and even backlash. For her part, Dittmer said there are a host of highly competent and qualified people in the local community and the board has traditionally allowed outgoing health officers "significant input" into the hiring of their successors, which she's hoping will continue.

Fennell said she's hopeful Humboldt County's relatively solid positioning compared to the rest of California — with testing, investigation and treatment infrastructure in place and a testing positivity rate (1.4 percent) that's more than three times lower than that of the state as a whole (6 percent) — might also bring candidates from out of the area, making for a more competitive process. And everyone interviewed for this story stressed how grateful they are that not only has Frankovich pledged to stay in her position until a replacement is hired, but also to assume a part-time role aiding the response moving forward after that.

There's no question Humboldt County is at a potential pivot point, as summer turns to fall and flu season looms, while the local case count continues to climb, having gone from 32 cases in June to 100 in July to 155 in August, and the public face and driving force behind its pandemic response steps away from her role. Asked how local residents should feel at this uncertain moment in an uncertain time, Dittmer paused.

"I think we should feel grateful," she said. "It's appropriate to feel sad and disappointed but, mostly, we should just feel grateful."

Thadeus Greenson (he/him) is the Journal's news editor. Reach him at 442-1400, extension 321, or [email protected]. Follow him on Twitter @thadeusgreenson.