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‘Heartbreak on top of heartbreak’: California’s first surgeon general navigates the pandemic

Dr. Nadine Burke Harris
Dr. Nadine Burke Harris, shown in her San Francisco backyard, was appointed by California Gov. Gavin Newsom as the state’s first surgeon general in 2019 and tasked with creating a governmental office to tackle the state’s health problems.
(Paul Kuroda / For The Times)

When Dr. Nadine Burke Harris received her COVID-19 vaccine in Oakland last month, she internally rejoiced.

As California’s surgeon general, the state’s top physician, she was glad to get the Johnson & Johnson vaccine to show others it was safe. But one of the most critical parts of the pandemic’s vaccine rollout — reassuring Black and brown communities that the vaccines available are safe — is an ongoing task.

“I think that I myself probably didn’t realize how ... just that level of tension that I was holding, you know, around it,” Burke Harris said in a recent interview. “The fear of exposure, the fear of getting sick, it wasn’t even conscious for me. It was that awareness, that idea of being protected. ... I would, of course, want everyone to feel that feeling.”

Burke Harris, 45, a Jamaican American pediatrician born in Canada and now based in San Francisco, has so far spent half of her tenure as one of the nation’s most influential public health figures guiding California’s efforts during the pandemic.

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Her sweeping charge by Gov. Gavin Newsom to create a governmental office tackling the state’s health problems, including adverse childhood experiences, toxic stress and healthcare inequities, has amplified the need for solutions amid the pandemic.

She is the first person to be California surgeon general, and is building on her legacy as the first Black person and first woman to have the role. It’s rare to see a Black woman lead in an even rarer position — only three other states have a surgeon general.

“One of the things that I find most infuriating about health inequities is that they are so endemic that people believe they are insolvable, and that makes me ill,” Burke Harris said. “That’s intolerable to me.

“Part of being in the role of state surgeon general is having the opportunity to say, ‘No this is not something that’s going to happen.’ We’re going to put our back into it and use our full force and weight to push against these inequities.”

Dr. Nadine Burke Harris is California's first surgeon general.
Dr. Nadine Burke Harris participates in a Zoom meeting at her San Francisco home.
(Paul Kuroda / For The Times)

But Burke Harris is still learning how to sit in the discomforts of her work amid the “heartbreak on top of heartbreak” in the last year.

It hurts to know 60,000 California residents so far have died during the pandemic. It hurts to see people of color dying at disproportionate rates from COVID-19. And it hurts to know there is community healing to be done.

Still, Burke Harris’ voice is calm, assuring and, one would dare say, even hopeful. Her days are a flurry of Zoom calls, reading reports and studying new data. But she sticks with a strict morning routine that includes decaffeinated coffee, 20 minutes of meditation and a walk in the Presidio in San Francisco with her husband before getting her four sons ready for school.

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Los Angeles County continues a drop-in COVID vaccination option for anyone 16 and older. Appointments are wide open in other counties too.

She’s trying to follow the philosophy of the importance of witnessing inequities and getting close enough until it hurts to see every day.

“The hardest part of the job is sitting in proximity to so much harm and suffering, and sitting there long enough to be a difference,” Burke Harris said.

Growing up in Palo Alto, with her mother working as a nurse and her father working as a biochemist, Burke Harris knew she wanted to be a doctor at 4 years old. She would sometimes make patient house calls with her mom after school. Burke Harris would read mail to elderly patients.

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A proud “super hardcore science nerd,” she would help in her father’s lab and in the greenhouse. Her dad would join Burke Harris and her brothers on science experiments around the house, such as adding vinegar to different foods and calculating air resistance when making paper airplanes.

‘That combination between caregiving and science, for me, I was probably born for it.’

Dr. Nadine Burke Harris

She completed her undergraduate studies at UC Berkeley, medical school at UC Davis and received her master’s of public health at Harvard. She did her medical residency at Stanford. In 2007, she became the first medical director for the California Pacific Medical Center Bayview Child Health Center in San Francisco and in 2012 founded the Center for Youth Wellness, a clinic focused on identifying and treating toxic stress in children.

“That combination between caregiving and science, for me, I was probably born for it,” Burke Harris said.

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But there’s been heartache over the years. In August 1993, one of her brothers, who has a mental health disorder, went missing and hasn’t been heard from since.

While her family has not lost anyone to COVID-19, Burke Harris’ mom was in the intensive care unit twice last year for non-COVID issues. She said having her own stress management plan and leaning on her support system got her through.

“I was working really hard, working on the pandemic, working with my team and then in the middle of meetings and Zooms and calls I was on the phone with my mom’s doctors every day,” she said.

Dr. Nadine Burke Harris works in her home in San Francisco.
Dr. Nadine Burke Harris’ days are a flurry of Zoom calls, reading reports and studying new data.
(Paul Kuroda / For The Times)

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Newsom appointed her to the role in 2019. He had previously appointed Burke Harris to the San Francisco Citizens’ Committee for Community Development while he was mayor.

The governor wrote in the surgeon general’s report that adverse childhood experiences and toxic stress could cost California over a trillion dollars in the next decade from “years of life lost from poor health, disability or early death.”

“We must listen and be advised by the evidence that clearly tells us that cumulative adversity, particularly when experienced early in life, is a root cause of some of the most detrimental, longest lasting and costly health challenges facing our state and nation,” Newsom wrote.

Burke Harris has made adverse childhood experiences and the health effects of stress some of her main focuses. Research has found varying forms of abuse, neglect and a child’s household experience can lead to long-term health problems such as heart disease, stroke and cancer.

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In 2014, she gave a 16-minute speech with TEDMED on the importance of finding ways to identify and treat people who have experienced childhood trauma. The speech has more than 8.5 million views.

In the last year, Burke Harris has found herself trying to persuade people to wear masks and manage vaccine rollouts and statewide shutdowns.

The lowest point of the pandemic for Burke Harris was last spring, when she and her colleagues in the state operations center watched then-President Trump talk on television about how beautiful it would be to have packed churches and an open economy by Easter.

She and other public health officials were working on contact tracing, COVID-19 tests, getting supplies, and various data projections. Reopening by Easter was impossible.

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“I went into the bathroom, and I sobbed,” Burke Harris said. “I felt like we were all working so incredibly hard, and then there was this other narrative out there that just didn’t have any foundation in reality or science or data, and it only was making our job harder. That was a moment that I broke down, I would say.”

Dr. Nadine Burke Harris meditates in her backyard in San Francisco.
Dr. Nadine Burke Harris’ strict morning routine includes 20 minutes of meditation.
(Paul Kuroda / For The Times)

Burke Harris’ role amid the pandemic has included overseeing the state’s Community Vaccine Advisory Committee and planning how the vaccine will be equitably distributed to vulnerable populations. It also includes helping community leaders talk to people unsure about the vaccine and combating misinformation.

Her office released a playbook on stress relief, urging people to make a stress management plan that includes exercising, sleeping and maintaining nutrition.

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California officials have faced criticism during the pandemic, particularly when vaccine access codes meant for Black and Latino communities were being misused by people who were not yet eligible. Burke Harris said building trust is an ongoing process.

“I think maybe one of my favorite parts of working in government, especially in this pandemic, is to witness the way that my colleagues in government continue to show up and recommit and try to fix our mistakes and try to solve some big problems,” she said.

Despite reopening gains, experts think herd immunity is a ways off, and they say several factors will keep COVID-19 a fact of life for some time.

Burke Harris has touted the state’s success with its ACEs Aware initiative, in partnership with the Department of Health Care Services, which has trained 17,115 health providers to screen for adverse childhood experiences, recognize toxic stress and respond with trauma-informed care.

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Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network, recalled Burke Harris saying in their first meeting that she was “deadly serious about addressing health disparities.”

She has witnessed Burke Harris leading discussions on how the COVID-19 vaccines would be distributed statewide with the Community Vaccine Advisory Committee. Savage-Sangwan said these are tough conversations, as multiple groups vied to have the communities they serve prioritized.

Burke Harris is charged with “marshaling the resources of state government to address these real long-standing problems and even addressing equity ... it’s not something government has always been good at or engaged in,” Savage-Sangwan said. “Being in the position to move the giant bureaucracy of the state of California to address health equity is a huge challenge.”

Burke Harris is looking ahead to how the state will help people heal.

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She wants to “cut ACEs and toxic stress in half in one generation” and work across education, law enforcement and the workforce to heal and recover from the pandemic, according to her surgeon general report.

Earlier in April, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, declared racism a serious public health threat. Burke Harris said the decision on whether California will make the declaration is ultimately up to the governor.

“I think without a doubt it’s clear that racism harms the health and well-being of Californians,” Burke Harris said, “and whether that is a declaration and what the specifics [are] of how we address that, I think that’s what we are all still figuring out.”


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