On January 13, 1919, as the third wave of the so-called Spanish-flu pandemic began, the governor of Ohio, James Cox, delivered his inaugural address. Propagandist bulletins from the U.S. Public Health Service had called the virus “a very contagious kind of ‘cold,’ ” but Cox used his speech to note the “appalling” number of fatalities—the United States ultimately lost some six hundred and seventy-five thousand people. The federal government was of little help. Only five of Ohio’s cities employed full-time health officers. “And then when the outbreak was acute outside the municipalities, conditions were even worse,” Cox said, referring to an earlier wave. “In fact, they were well-nigh unspeakable.” Cox urged the “radical reorganization” of Ohio’s more than two thousand separate health jurisdictions and said that the need for “scientific resistance” to public-health emergencies was “second in importance” only to fighting in the First World War.
Exactly a century later, a new governor, Mike DeWine, took office. DeWine, a Republican, was Ohio’s former attorney general, and, in the early two-thousands, he had been a U.S. senator. The state’s public-health system now consisted of a hundred and thirteen independent programs in eighty-eight counties. The population was largely older, and there were many smokers; opioid addiction alone had recently killed tens of thousands of Ohioans. “Public health had been ignored for decades,” DeWine told me. “It was something we took for granted.”
Ohio does not require the state’s top health official to be a physician: when DeWine took office, in 2019, the most recent directors had been a lawyer and the former head of the Ohio Turnpike Commission. DeWine wanted a medical doctor for the cabinet position, one who could both lead a large staff and, he told me, “communicate to the people of the state of Ohio about health issues in general.” His top adviser, Ann O’Donnell, recommended Dr. Amy Acton, whom she knew through the Columbus Foundation, one of the country’s largest community charitable organizations.
Acton is fifty-four. In 1990, during the crack-cocaine epidemic, she interned at Albert Einstein College of Medicine, in the Bronx, where she saw “rooms full of babies in incubators” who had contracted diseases in utero and would soon die. “It was devastating,” she told me the other day. “I saw how things can spiral.” Acton left clinical medicine to pursue teaching and philanthropy; by the time DeWine took office, she worked as a community research and grants officer at the Columbus Foundation.
O’Donnell thought that Acton would make a good health director partly because she had heard her mention a “tough childhood.” Acton is from the north side of Youngstown, in northeastern Ohio. Her father, who had worked in a steel mill, and her mother, an artist, divorced when she was three. Acton and her younger brother Philip lived with their mother, who remarried when Acton was about nine, after having moved around a lot. This deeply unstable period ended with the family spending part of one winter living in a tent, and with Acton, at age twelve, accusing her stepfather of sexual abuse. O’Donnell told me, “My mother used to talk about suffering: the people who have suffered have something special about them.”
Acton had a steely warmth that made her approachable; a former Ohio State University professor, she was skilled at explaining complex subjects. She and her husband, Eric, a schoolteacher and cross-country coach in the Columbus suburb of Bexley, had, between them, six grown children. “Her way of seeing, and of operating in the world, is not bureaucratic,” O’Donnell told me, adding that DeWine considers her “as much an artist as she is a scientist.” Acton lacked experience in the public spotlight, but O’Donnell strongly urged the governor to choose her anyway.
Acton began work on February 26, 2019, immediately thinking of Ohio’s nearly twelve million residents as her patients. Shortly after her swearing-in ceremony, she defended her department’s budget before a legislative committee, explaining that part of her duties involved emergency preparedness. Breaking from her written comments, she told the lawmakers, “I will be on call, most nights, for as long as you know me, with the worry of these issues.”
Ohio’s legislature contains a far-right element, and there is anti-vaccine sentiment in the state. Acton wanted to create a path for all Ohioans to understand how they could flourish, and told me, “How do you build that, as a community?” She and I were talking, last week, in Columbus, at the offices of the foundation, which is headquartered at the historic former governor’s mansion. The first time we met, we sat spaced out, on benches, in a leaf-strewn courtyard. Acton, who is dark-haired and lean, wore a black dress, tights, flats, a trench, and, snug around her ears, a taupe toboggan twinkling with subtle sparkles. Wellness, she explained, involves more than the mere absence of disease. Public health calls upon societal protections, many of which are beyond individuals’ control: food safety, immunization, the eradication of poisonous lead. As health director, she had been working on modernizing the state system for nearly a year when she began hearing about a “weird pneumonia” afflicting Wuhan, China.
Wuhan is the capital of Hubei Province—Ohio’s sister state. Scores of people routinely travel between the two locations, for business and school. Thousands of Chinese students attended Miami University, near Cincinnati. Ohioans had been taking sea cruises, and touring places like the Nile River, Acton told me. By the time the C.D.C. and the White House started having regular press conferences about COVID-19, in February, she suspected that the virus was already seeded in Ohio.
The Arnold Sports Festival and Arnold Classic were scheduled for the first weekend in March. The annual sporting event—founded by Arnold Schwarzenegger, the actor and former California governor—draws more than twenty-two thousand athletes and tens of thousands of spectators, and involves a trade show. Acton said, “We had this whole discussion. Arnold Schwarzenegger’s on the phone—so you’ve got that voice.” She and DeWine decided to largely close the event to most spectators. DeWine told me, “Everybody thought we were crazy.” But bringing in thousands of people from eighty countries, for four days, portended “disaster.”
Observing chaos in the federal response—“The C.D.C. was saying one thing, Health and Human Services another”—Acton had been making other defensive moves. She had moved up a long-planned tabletop exercise in pandemic control, and deployed health tips online. Her self-assembled network of advisers included infectious-disease specialists and other experts she had met through her service on the board of the Association of State and Territorial Health Officials, which represents more than a hundred thousand public-health officials. Her communications director’s brother Rajeev Venkayya was a pulmonologist who had focussed on vaccines at the Bill & Melinda Gates Foundation and who had worked in the George W. Bush Administration, developing the nation’s influenza-pandemic plan. (The Trump Administration later dissolved the federal pandemic office; Joe Biden has said that, if elected, he will restore it.) Acton also had begun making short public-service videos. Wearing a white medical coat, she told Ohioans, “I want you to be prepared.”
DeWine declared a state of emergency on March 9th—when there were only three confirmed COVID-19 cases in Ohio. He and Acton started holding daily press briefings. Ohio’s network affiliates carried the pressers live, at two o’clock. On March 12th, DeWine became the first governor to announce the closing of K-12 schools; he and Acton shut down polling stations, effectively rescheduling the Democratic Presidential primary. Acton told the public, “The steps we’re taking now will absolutely save lives.” On March 22nd, after imposing one of the nation’s earliest stay-at-home orders, she said, “This is our one shot, in this country.” As if speaking directly to those who were accusing her of overreacting, she said, “I am not afraid. I am determined.”
The press conferences became appointment viewing in Ohio. A Times documentary producer watched seven weeks’ worth of these pressers and turned the material into a six-minute op-doc, “The Leader We Wish We All Had,” which declared that “other leaders should pay attention” to Acton’s effective use of vulnerability, empowerment, and “brutal honesty.” One clip showed Acton tearing up when she said, “People at home: you are moving mountains.” Acton told me, “I would look at the camera and I could feel the people on the other side.”
A singer performed an Amy Acton tribute song on YouTube (“I trust you completely”; “You look so fine in your long white coat.”) The National Bobblehead Hall of Fame and Museum unveiled an Amy Acton figure. Little girls dressed up like Acton and staged living-room press conferences. On Facebook, a fan page accrued more than a hundred and thirty thousand members. An Ohio nurse told an NBC affiliate, “I actually cry pretty much every time I watch her, because she’s very inspiring.” At a presser, Acton, after reading one child’s thank-you letter aloud, said that as a public servant it was her “job to do this for you.” In a poll, in March, seventy-five per cent of Ohioans said that they approved of DeWine’s management of the coronavirus crisis while forty-three per cent approved of the way President Donald Trump had handled it. The poll also included Acton. She, too, had a much higher favorability rating than Trump—sixty-four per cent.
Nationally, DeWine was being praised, along with the governors Charlie Baker, of Massachusetts, and Larry Hogan, of Maryland, as “the rare Republican official who does not automatically fall in step” with Trump. In Ohio, DeWine’s over-all favorability rating was also high. But, by the end of April, with the economy in trouble, some of Ohio’s Republican lawmakers were insisting that he reopen businesses. On April 27th, DeWine announced a phased reopening, for May. The next day, after being assailed by other Republicans, he backed off a plan to require masks at reopened businesses, calling the restriction “offensive to some of our fellow-Ohioans.”
Trump and his allies had set a publicly disparaging tone against health officials, including Dr. Anthony Fauci, the nation’s top infectious-disease expert. On April 18th—a particularly dire moment in the pandemic—the President’s son-in-law and senior adviser, Jared Kushner, had bragged to Bob Woodward, “Trump’s now back in charge. It’s not the doctors.” In Colorado, nearly seventy per cent of local public-health officials reported receiving threats, and some resigned. In Washington State, one county official had to install a security system after making a simple phone call to remind a quarantining family to stay home: “Accusations started flying that we were spying, that we had put them under house arrest,” the official told NPR. In Nebraska, a former TV meteorologist and mayoral spokesman anonymously sent Adi Pour, head of the Douglas County health department, at least fifteen threatening e-mails, including one that read, “There was a lynching outside the Douglas County Courthouse a century and one year ago. You’re next, bitch”; in another, he wrote, “Maybe I will just slit your throat instead. That will get you to shut the fuck up.” (The meteorologist, Ronald Penzkowski, pleaded no contest to third-degree assault and stalking.) Fauci, after receiving death threats, was assigned a federal security detail.
In June, several physicians, writing in JAMA, called the harassment of health officials “extraordinary in its scope and nature,” and a “danger to the ongoing pandemic response.” They wrote that the attacks on public-health officials represented a “misunderstanding of the pandemic” and “a general decline in public civility.” The incivility started with the President: “The environment deteriorates further when elected leaders attack their own public-health officials.”
An “Anti Amy Acton” page appeared on Facebook, containing such posts as “We will always hate you Abortion Amy!!” (The Ohio health department oversees clinics that perform abortions.) She was called a “witch,” a “disgrace.” In one photo, the marquee at Phil’s Lounge & Beer Garden, in Sharonville, said, “Fuck you DeSwine and Hackton.” Protesters disrupted Acton’s press conferences by chanting outside the statehouse and pressing their faces against the windows. After Acton, who is Jewish, mentioned hosting a virtual seder, for Passover, protesters showed up at her home, with guns, wearing MAGA caps and carrying “TRUMP” flags. Their signs read “Dr. Amy Over-re-ACTON” and “Let Freedom Work.” They brought their children. DeWine told demonstrators, “I’m the elected official” and “Come after me.” Acton was assigned executive protection—a rare measure, for a public-health official—along with a retinue of state troopers.
As pressure mounted for DeWine to fully reopen Ohio, six county-level G.O.P. chairs jointly wrote to the governor, in early June, saying, “We are telling you that the damage you are doing economically is translating politically.” Republicans were “angry, disappointed, and dismayed” at DeWine’s “big-government approach.” In an editorial, the Columbus Dispatch noted certain lawmakers’ contributions to a “toxic hybrid of ignorance, fear, and hatred.”
The state’s three largest amusement parks joined a number of other businesses in lawsuits against Acton, demanding that she allow them to reopen. Republican lawmakers introduced legislation intended to strip her of her emergency powers. DeWine vowed to veto any such bill, but Acton began to worry that she might be forced to sign health orders that violated her Hippocratic oath to do no harm. On June 11th, she resigned.
Trump won Ohio in 2016, with more than fifty-two per cent of the vote. He is expected to win the state again, though narrowly. Despite surging hospitalizations and record infection rates, the President has gone on holding campaign rallies. Thousands of supporters mingle for hours, most not wearing masks, despite evidence of community spread in the wake of Trump gatherings. On October 23rd, the day before a Trump rally in Circleville, Ohio, I met an old man in a Navy cap who complained that the annual pumpkin festival had been cancelled and that the public was being forced to stay outdoors. When I explained that this was meant to protect people, he said, “From what?” Along the highway into Circleville, someone had installed a large stencilled sign that read, “JOE BIDEN IS STUPID” and “TRUMP IS A GREAT MAN.”
The next afternoon, at the rally, at the Pickaway County fairgrounds, Trump lied that “tens of thousands” of people were outside the gates and congratulated attendees for getting in. He ranted about “Sleepy Joe,” “Crazy Bernie,” “Shifty Schiff,” “treasonous things,” the “plague,” “favored nations,” and “quadruple” taxes. Biden, he said, will offshore your jobs, confiscate your guns, open your borders, eliminate your private health care, terminate your religious liberty, defund your police, destroy your suburbs. Fracking, dead birds, widespread blackouts, more fracking: “You frack till your heart’s content!” A trio of masked nuns in habits and purple vestments stood in the crowd behind him; one held a Bible aloft, as if administering a blessing or warding off a curse.
Progressives have complained that DeWine, who co-chairs Trump’s Ohio campaign, has failed to disavow the President at a crucial national moment. When I spoke with the governor, on Friday, he told me, “I know there’s people who want me to spend my time blasting Donald Trump; I’m sure there’s Trump supporters who think I have not talked enough about the President. But I’ve got to stay focussed.” Maintaining “a good relationship with the President of the United States—whoever the President is” allowed him to govern, he said. In 2022, DeWine is expected to seek a second term. His supporters suspect that he will “be primaried” next year by a far-right challenger.
The COVID-19 death toll stands at well over five thousand in Ohio and more than two hundred and thirty-one thousand in the United States. By the end of February, the national toll could reach half a million, according to a recent study by the University of Washington School of Medicine. DeWine has methodically been placing preparatory phone calls to every public-health team in Ohio. He still has not found a permanent replacement for Acton. In September, he named a new state health director. She quit within hours of DeWine’s hiring announcement, having reportedly decided that the job would pose a risk for her family.
After Acton left her cabinet position, she briefly remained an adviser to DeWine. In early August, she vacated that official role, too, and soon returned to the Columbus Foundation. (She still informally counsels the governor.) When I saw Acton last week, homes in some parts of town still displayed “Dr. Amy Acton Fan Club” yard signs.
Acton had given no media interviews since leaving government. She agreed to talk to me because she believes that, as we enter a dire pandemic phase, paired with a potentially tumultuous post-election period, the country needs, in its wellness “playbook,” a long-term emotional-survival strategy. She told me that leaders need to “lay down the science of how we could lose another two hundred thousand people, just like that.” As a public-health figure, Acton, a registered Democrat, strove to be apolitical. She and DeWine worked well together despite their party affiliations. Acton strongly believes that, should Biden win, he must not leave “a quiet space” between now and the Inauguration. “We cannot wait two and a half months to start leading and messaging” about unity, she said.