By Michael Howell
Ravalli County’s Public Health Officer Dr. Carol Calderwood was this year’s recipient of the Elaine Fordyce Award for excellence in prevention, investigation and surveillance of communicable disease, for her leadership in dealing with the pertussis (whooping cough) outbreak that ravaged Ravalli County, the state of Montana and the entire Northwest last spring. The award was presented to Calderwood by the Montana Public Health Association.
Dr. Calderwood, serving as Public Health Officer for Ravalli County, made some difficult decisions during the pertussis outbreak that took lives elsewhere in the state and the nation. Her most controversial decision during the outbreak was to exclude un-immunized students from attending school in Corvallis and Victor, the two schools with documented cases at the beginning of the outbreak.
Calderwood explained in an open letter to the community at the time that infants are at increased risk due to large groups of people in the county that do not vaccinate. She said it does two main things. Firstly, instead of having only a rare, isolated, mild, sporadic case of pertussis, an un-immunized group is susceptible to clusters of disease. Secondly, this pulls down the county’s overall “community immunity” rate. It increases risk for the whole population, especially for the most susceptible, such as scattered medically exempt individuals, adults or elderly people whose immunity has waned, and all infants.
Calderwood made the decision when 22 cases had been identified in the county, primarily in Victor and Corvallis schools. At least two people had become seriously ill, with one baby transferred by ambulance to Missoula for hospitalization.
As Dr. Calderwood wrote, “The decision was not a light one, as I realize the impact is far reaching and inconvenient. After extensive contemplation, however, I realized I was not comfortable to head into another week of this outbreak without erring on the side of caution. I would not be able to live with an outcome of failed public safety, especially infant death, if we had not done all we could to control the spread at this time.”
As Ravalli County Public Health Nurse Judy Griffin put it, “Carol (Calderwood) wrote this letter in response to the extreme negativity she was experiencing from many sides concerning the exclusion of Exempted Students from public schools during the outbreak. Carol remained strong in her assessment and plan. Eventually it was proven to be the right decision, although not the most popular or convenient decision, in reversing the sharply rising positive pertussis cases. In effect, her strength bolstered credibility of our County Health Office by increasing our immunization rates within a population that, historically, has refused to consider the benefits of vaccination.”
In his own letter of support for the nomination, Dr. Marshall Bloom, Associate Director for Scientific Management at Rocky Mountain Laboratories in Hamilton, made a similar assessment, stating, “Dr. Calderwood’s decision was totally appropriate and was based solely on a logically developed rationale that the schools provided ‘potentially unsafe environments for the unimmunized’.” Bloom notes that although it was Dr. Calderwood’s decision to make, it was endorsed by the Ravalli County Health Board, the Health Emergency Advisory Team and the Board of County Commissioners.
“Subsequent events have patently demonstrated that this was the correct course of action,” wrote Bloom. “Dr. Calderwood’s actions showed great courage and an unwavering dedication to the health and safety of all local residents.”
Dr. Calderwood said that the county’s response to the pertussis outbreak was a team event with lots of highly qualified individuals involved.
She admitted to losing sleep over the decision. “But it does come down to a decision that has to be made by the individual in authority at the time,” she said.
Calderwood said that she especially appreciated the award because it comes from a group of her peers in the public health sector.
“I have a lot of respect for this group’s recognition,” she said.