January 20, 2022

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How Mandy Cohen prepared to handle a pandemic in NC

By the time Dr. Mandy Cohen arrives home most days, it is already past 7 p.m., and she has missed dinner with her two daughters, who are 5 and 8. The oldest is in second grade, and one of her school assignments has been to keep a journal amid the pandemic.

“Her journal is very different, I think, than other kids’ journals just because of what I do,” Cohen said with a laugh during a recent phone interview. She’s 41, a medical doctor, and now she’s in her third year as the secretary of the North Carolina Department of Health and Human Services.

In many ways, Cohen is the literal and figurative face of North Carolina’s response to COVID-19. She has become recognizable through her almost daily on-camera briefings. She is the official most responsible for advising Gov. Roy Cooper and shaping policies to contain the coronavirus.

And for those efforts, Cohen is The News & Observer’s Tar Heel of the Month, which honors people who have made significant contributions to North Carolina and the region.

Cohen’s life, like the lives of North Carolinians everywhere, has changed considerably during the past two months. For one thing, there are now no off days. Work starts not long after she wakes up at 6:30 a.m. It doesn’t end until long after her children have gone to bed.

For another, she said her husband, Sam, has embraced his new role as work-from-home dad and family chef. They’ve been married 10 years. When they met, she was completing her internal medicine residency in Boston and he was finishing law school at Harvard.

Cohen used to prepare all the family meals. Now, she said, her kids have reported that their father’s cooking has “gotten much better.” When Cohen came home one night recently, her 8-year-old shared her entry in her journal for school.

It read: “I can’t wait until the coronavirus is over so I can have dinner with mom again.”

“Which of course made me sad,” Cohen said.

As prepared as possible

In one way, it is impossible for anyone in Cohen’s position to have prepared for the magnitude of what is arguably the most defining, life-altering public health crisis of the past 100 years. Yet in another way, she has been preparing for this moment for the past two decades, since a summer in Washington, D.C., ignited her interest in the intersection of health care, policy and medicine.

In her younger years, Cohen thought for a while that she would pursue a career in music. Her brother is a professional French horn player in New York City, and she grew up singing, playing the violin and the piano. Instead of entering a music conservatory, though, she followed a different path — one that led to her addressing a national crisis before her 35th birthday.

That crisis arrived suddenly in 2013 with the attempted launch of the website HealthCare.gov. It was supposed to provide a way for people to sign up for health insurance under the Affordable Care Act. But the website did not work. Cohen was recruited to help fix it, and within six months, she was leading the health insurance marketplace from the federal level.

“That was an intense time,” she said. “…And it felt like five careers in six months.”

One of the most important lessons from that time that has carried over into this one, she said, is “really the importance of transparency.”

“When things are uncertain, and all decisions are hard and have unintended consequences, the best you can do for folks is to try to explain your thinking,” she said.

Cohen has attempted to apply those lessons to her role in leading the state’s response to the virus. Her work has earned the acclaim of her peers, and contemporaries. Mike Sprayberry, the state’s director of Emergency Management, has formed an especially close bond with Cohen since the start of the pandemic.

Sprayberry, who served in the Marines and the North Carolina National Guard before joining state government, has described Cohen as his “battle buddy.” More precisely, Cohen is “the technical lead” of the state’s emergency response team. Once she arrives at the State’s Emergency Operations Center, her days begin with an 8:15 a.m. meeting with Sprayberry.

They meet at 9 with their larger teams. A briefing with Cooper follows. The other day, Sprayberry said, he was on a congressional delegation call about the coronavirus response. At the end of his remarks, he introduced Cohen.

“And I announced her when I got through speaking as the best secretary of health and human services in the nation,” Sprayberry said. “And I wasn’t blowing smoke. I believe it. I mean, she’s in it. She’s totally dedicated.”

Winning over lawmakers

A little more than three years ago, when Cooper appointed Cohen to her position in January 2017, she entered an unenviable political climate. Skeptics in the Republican-dominated General Assembly at first viewed her unfavorably, if only by association. She’d served for years in the Obama administration, as a leading official in the agency that runs Medicare and Medicaid.

“I think the initial reaction was, ‘You’ve got to be kidding,’” said Donny Lambeth, a Republican state representative from Winston-Salem. “She’s coming out of Washington from the Obama administration. And there was questions about that, and questions about her.

“Particularly how strong she would push some of the Obama administration agenda items.”

Cohen was only 38 at the time, with a youthful appearance that belied her experience and credentials: three Ivy League degrees, with more than a decade of high-level work in national health care policy and administration behind her. One of her first tasks, upon her arrival in North Carolina, was to win over the lawmakers who questioned why Cooper had appointed her.

One of Cohen’s first visits was with Lambeth, a former hospital CEO who is among the most influential budget writers in the legislature. When Cohen came by his office, Lambeth said, he “wasn’t sure who she was.” Lambeth, 70, thought she might be a student hoping to make an introduction.

“She introduced herself and we had a great conversation the first day,” he said.

Two months later, in March 2017, Cohen received unanimous support from the state Senate committee that had been considering her qualifications. Those days of questioning her seem especially distant, Lambeth said, given Cohen’s overall performance the past three years and the job she continues to do while leading the state’s response to the virus.

For the past two months, Cohen has been at the center of every decision the state has made concerning the pandemic.

She has often found herself explaining those decisions, as she did during a press briefing on Thursday, while sharing the data behind them. Cooper on Thursday extended the state’s stay-at-home order through May 8. Moments later, Cohen explained the reasoning, and used several graphs to illustrate that North Carolina’s rate of new cases still has yet to decline.

“I feel really good that we’ve made decisions to protect folks,” she’d said in an earlier interview before Thursday’s announcement. “Because this virus just moves so fast. So we feel good about where we are. I feel like we have definitely slowed the rate of viral acceleration.

“The question is, Where do we go from here?”

The news on Thursday, that the state lockdown would persist at least eight days into May, came in contrast to moves other states have made in recent days. In Georgia, the governor has announced that some nonessential business can begin reopening later this week. In Florida, the reopening of some beaches have attracted crowds. In Tennessee, the state reportedly will not extend the stay-at-home order that expires at the end of this month.

In North Carolina, meanwhile, Cohen has embraced a data-driven approach, which has demanded caution. Seven weeks into shutdowns of varying degrees, more than a month into what essentially amounted to a statewide lockdown, Cohen acknowledged that one of her greatest concerns is complacency.

“I think there are smart and appropriate ways that we can reopen North Carolina, but I don’t think it’s ever going to go back to the way it was, fully” without a vaccine, she said. “… This is so hard, I get it — this staying at home. It’s awful. Everyone is getting stir crazy. They miss their churches, they miss their friends.

“They miss their normal lives, and they want to get back to that, and I totally appreciate that, and I want that, too, for me and my family. But I worry if we go too fast — and particularly certain parts of our state — that we will see a resurgence of virus and more loss of life. That is what this is all about.”

Grew up in New York

Cohen grew up on Long Island in Baldwin, N.Y., about 30 miles east of Manhattan. Her parents still live there. Medicine ran in Cohen’s family, and that influenced her at an early age. So did the thought, she said, that her mother might not have had a fair chance to become a doctor. Cohen’s maternal uncle became a doctor, while her mother was a nurse practitioner.

“Gender played a role in terms of what careers she thought she had available to her,” Cohen said. “… I think she always felt like, as a woman, she wasn’t able to go to medical school. It was her brother who did.

“And so there was always a bit of, ‘I have a daughter, I want her to go to medical school.’”

Cohen did, but not before a transformative experience during her undergraduate years at Cornell. There, she studied in the College of Human Ecology, which “was really about how people interact with the world,” Cohen said. One summer, instead of studying abroad, she accepted an opportunity to work in Washington, D.C., for Sen. Ted Kennedy.

The most significant connection Cohen made that summer in Washington, though, was with Bruce Vladeck, who ran the Centers for Medicare and Medicaid Services. Cohen worked for Vladeck, and he became a mentor who helped her define her path. Her experience that summer crystallized her interest in the systemic challenges of health care from the inside out.

“I always heard about all the problems in health care,” Cohen said. “People would say, ‘Why are you going into health care, there’s so many problems?’ But that was exactly why I wanted to go into health care, because I wanted to see how I could help fix some things.”

Cohen went on to medical school at Yale and eventually completed a residency in internal medicine at Massachusetts General Hospital. She earned her master’s in public health at Harvard, and focused there on health care leadership. Some people, she said, tried to tell her to be content to become a doctor after her residency. By then, though, she’d decided her trajectory.

Nowadays, she said, “we have a lot of doctors who sort of bridge those worlds” between medicine and the policies and systems that surround it. The path was less worn, though, when she started on it. Since arriving in North Carolina, Cohen has emphasized her desire for Medicaid expansion. That has put her at odds with Republican lawmakers, and yet she has still received their overall support.

“I appreciate the way she approaches it,” said Lambeth, the Republican state representative from Winston-Salem. “It doesn’t mean we always agree on a lot of things. We have differences of opinion, and disagreements on policy sometimes. But she has a perspective, and sometimes members have different perspectives and yet she’s always willing to listen.”

As a former hospital CEO, Lambeth appreciates Cohen for another reason.

“There are people, particularly in an upper-level management position, that’s never been in the trenches,” he said. “And I think she’s been there, and I think I appreciate that as much as anything. Because she knows the ins and outs of health care.

“And I can’t always say that for some of the prior secretaries of health that I’ve worked with.”

Secretary of the NC Department Health and Human Services Dr. Mandy Cohen speaks during a briefing on North Carolinas coronavirus pandemic response Monday, April 13, 2020 at the NC Emergency Operations Center in Raleigh.
Secretary of the NC Department Health and Human Services Dr. Mandy Cohen speaks during a briefing on North Carolinas coronavirus pandemic response Monday, April 13, 2020 at the NC Emergency Operations Center in Raleigh.

Tracking coronavirus since December

In late December and early January, Cohen said, she and her team began tracking the the novel coronavirus as it began to wreak havoc in China. When workers constructed a hospital in 10 days in Wuhan, China, Cohen said she began to fear how the virus would spread. She can remember where she was in January when she thought North Carolina had its first case.

That turned out to be a false alarm. Soon enough, though, it was here. The state’s first case was officially diagnosed in early March. By the second week of that month, life had changed throughout North Carolina. The ACC’s basketball tournament was canceled. Restaurants soon closed. The stay-at-home order soon went out.

For Cohen, the days became longer.

Last week, it was Passover. Cohen usually wears a necklace with the chai symbol, which in Hebrew symbolizes life and health. She talked last week about how her family had to celebrate Passover differently this year, and she said people reached out to thank her for sharing details about her family and faith.

She said she tries to remind herself: “This too shall pass.”

“I have a great team of support here,” Cohen said. “So I’m not doing this alone. … I think I take pride in being able to go home for a short period of time and see my girls, and remember that there’s a world outside this crisis.”

These days, her daughters are learning how to play the piano. The 5-year-old can already play with both hands and read music and that, Cohen said, has made her a “proud mama.” She misses family dinners, but when she arrives home her girls greet her “with a little concert.”

Not long after, Cohen is back on the computer, reading the news and the latest scientific studies.

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