Dr. Gary Anthone
Chief Medical Officer, Vetter Senior Living
Former Chief Medical Officer and Director of the Division of Public Health
Nebraska Department of Health and Human Services

Relying on Nebraskans

Former Nebraska Chief Medical Officer and Director of the Division of Public Health Gary Anthone and his team played a major role in translating national public health guidance for implementation at the local level. While working with material disseminated by the U.S. Centers for Disease Control and Prevention (CDC), they found it challenging to communicate changes in guidance on vaccination and social distancing. They developed their own materials to better explain what people should do to protect themselves and their families.

“The guidelines that were coming out from the CDC were difficult to interpret and communicate to the public. I remember being at one of the press briefings that we had with the governor. As we were up at the podium speaking about guidelines, they were changing. I know they had to change as the pandemic changed, but still I thought that that was probably something that could have been done a little bit better. When we decided how we were going to allocate and distribute the vaccine, we had all sorts of different algorithms that were so complicated until we decided to focus on the elderly and the medically disabled. That made it simple. It was a great decision on the governor’s part to do it that way.”

Once they decided on effective formats the next task was making sure everyone knew about them.

“We had daily press briefings in the governor’s office for the first year and a half. I don’t know how many states did that, but it was invaluable for our state. It was broadcast on local broadcast and Nebraska public television. We invited members of the community to give updates at the daily press briefings with the governor. We had regular calls with all of the major associations throughout the state, including and at least weekly calls with the Commissioner of Education. They were very involved in helping us make decisions.”

Nebraska’s health department struggled under the daily crush of COVID briefings and changing information. To help with organization, state officials hired the McChrystal Group, a consulting organization led by former Department of Defense leader and retired four-star General Stan McChrystal, to set up a fusion cell to organize the response and daily calls and briefings.

“Our briefing team was myself, the state epidemiologist, our incident command, our data strategist and then, later on, we did have a hospital preparedness person. We met on a daily basis for almost the first two years.”

The state worked closely with the University of Nebraska Medical Center (UNMC), an institution with federal support for outbreak response. Anthone visited the biocontainment unit when he started in 2019 in his role as Nebraska’s Chief Medical Officer. At the time, he had doubts about the utility of the large investment the unit required, but he changed his mind in 2020. Nebraska was able to use learning from UNMC’s early role in repatriating U.S. citizens from Wuhan and the Diamond Princess cruise ship to learn more about the virus and shape its own response to the pandemic accordingly. 

“What an advantage we had in Nebraska to have UNMC take part in the early response early on in January of 2020. When we went to UNMC, I couldn’t believe the infrastructure and the response from CDC and the US Department of Health and Human Services. There were probably 200-300 people there in that building, organizing the repatriation.”

“At the start of the Omicron surge we were hearing from the hospitals that we needed to get our patients discharged. There were patients in the hospital that didn’t really need to be in the hospital anymore, but they couldn’t find any facilities to take them. So we set up three decompression facilities throughout the state to help with those discharges, and it became a very successful program, in collaboration with the hospital association. “Our major surges in Nebraska were mostly related to meat processing plant facilities. I remember visiting the hospital during the first outbreak we had in Nebraska in a meat processing plant in a town of about 40,000 people. I expected to see people being intubated in the hallways and crashing down the emergency room. And it was not like that whatsoever. The hospital had a very good Internet command structure, and totally just a great thing to see, and gave me a lot of comfort. And then I could relay that to the governor, and the hospitals really had it under control.”

Driving with Data

For the first several months of the pandemic, Anthone and his team relied on personal communication with hospitals to obtain data across the state. By the early winter, hospitals were able to digitize and automate tracking of COVID patients and available ICU beds, and the state created a dashboard for the public to use on a daily basis.

It took us until maybe the fall of 2020 to get that dashboard up and running. Fortunately, we didn’t have a surge in Nebraska until the very end of that year, and that gave us a little bit of time.

Data were critical for other decisions as well.

“One of our first major decisions was about whether to continue on with our Nebraska State High School basketball tournament, and I think we were one of the first states to limit the attendance at those events, and that was done in collaboration with the Department of Education and superintendent association here in Nebraska. As far as the governor, he would always want to base it on the data. Every day we would hear the same thing from him, ‘I want to know the data. I want to know what’s going on as far as the hospitals are concerned, as far as what else is occurring throughout the state where the surges are.’ So he based almost every decision as a data-based decision.”

“We were responsible for providing data to the governor. If we didn’t have it, and he would ask for it, we would get it. One of the senators asked about whether there were political decisions involved. I didn’t think politics entered into any of our decisions. I never thought, ‘Oh, boy, this is a political decision.’ Or ‘this is not a decision that’s not based on the data or what we think is best for the public.’”

Like many other states, Anthone’s team faced challenges around flashpoint issues like testing, school closures, vaccinations, mandates, and hospital staffing shortages. But advanced planning and persistence helped the small state meet its needs. For example, Anthone reports that PPE wasn’t the problem in Nebraska that it became in other states because Nebraska had used federal funding to pre-purchase PPE and hired a transportation company to distribute it.

“Eventually, the governor partnered with a company out of Utah, which set up our testing in Nebraska. Ultimately, we provided free testing throughout the state through the whole pandemic, until the public health emergency ended. We had a great working relationship with our National Guard, which was responsible for most of our testing at the “test Nebraska” sites at the beginning, and then they were responsible for administering the vaccine at a lot of our public sites for vaccination. We didn’t do any statewide mask mandates, we didn’t do any vaccine mandates. But maybe because we’re a smaller state, one of the successes was relying on the people of Nebraska and not on us telling them what to do.”