Education or enforcement? Reopening rulebreakers force health departments to choose.
When the Monroe County public health department issued a public notice earlier this week that people were potentially exposed to the novel coronavirus at a tavern in Rochester, the department said the announcement was not intended as a punishment.
Despite New York state’s reopening rules that require face coverings for customers and employees and distance between diners, the county health department said contact tracing revealed that “face coverings were not widely worn and there was little social distancing” at the tavern.
Another warning about an exposure at the Dragonfly Tavern on Park Avenue came Thursday, when the county said again that a person with COVID-19 visited on a different day last week and possibly infected other patrons.
But the health department did not take any enforcement action against the tavern or its owners or managers. Instead, said public health department spokesperson Steve Barz, “We have talked with them about the guidelines in place ... and reiterated the need for face coverings and physical distancing.”
It’s a decision emblematic of the normal role of a public health department, health commissioners and researchers said.
“The focus of public health, almost always -- really, almost always -- is on education,” said Jean Wactawski-Wende, an epidemiologist at the University at Buffalo.
“We talk about prevention by trying to educate and inform people,” she said. “That’s the strategy.”
Public health departments are stretched thin under normal circumstances, she said. They have even less capacity to focus on enforcement during a pandemic.
“Is that really where we want to spend resources? Ticketing somebody for not wearing a mask in a restaurant? To me, that’s a waste of resources. We’re short-staffed,” Wactawski-Wende said.
In Monroe County, public health commissioner Dr. Michael Mendoza said he, too, tends toward education over enforcement.
“The larger context here is, you know, what is the role of the health department? And, in general, although we have a few areas where our specific role is enforcement, I largely view my role as supportive and educational and to promote health.”
Mendoza said the health department has the authority to issue citations, levy fines, and, ultimately, order an establishment to close. But he prefers not to.
“I do think we get a lot further with support and coaching and education than we do with trying to crack a whip,” Mendoza said.
He acknowledged that the pandemic might compress the amount of time or level of offenses that the health department is willing to handle with education alone, but he said there’s no clear guidance for how exactly to mark the transition from carrot to stick.
“There is no rulebook, ‘How Do You Enforce Social Distancing,’ because this is not something anybody’s had any direct experiences with.”
Monroe County has not fined or closed any businesses as a result of reopening violations, Mendoza said.
In Erie County, the health department has issued violations to two food service facilities and ordered four to close for breaking the reopening rules, said spokesperson Kara Kane.
The lack of an instruction manual for balancing education with enforcement makes an important decision very difficult, said University at Buffalo professor of biomedical informatics Peter Winkelstein.
“If you’re too lenient, people say it’s not important. If you hammer too hard, you get pushback,” he said.
“Some people respond better to education, and some people are much more about, ‘It’s the law, you’ve got to do it.’ And I think you’ve got to kind of do both things. But how is a very good question.”
Further complicating the process is state guidance that cuts county health departments out from some enforcement decisions.
New York state says that many of the rules around reopening should be enforced by local municipalities and then, if violations continue, state regulatory agencies. That progression bypasses the county health department.
Mendoza said his department can enforce reopening regulations, but he wants to save that power for “urgent issues that are life-threatening.”
“We want businesses to stay open. We want people to have a healthy experience, and we want to have a vibrant local restaurant life,” he said.
“I believe that, in providing education, we can appeal to everybody’s better judgment to do the right thing.”