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Martha Buchanan, In the Middle

Brandon Hollingsworth, WUOT News

Sixteen years ago, when Dr. Martha Buchanan joined the Knox County Health Department, she held tight through a steep learning curve, one of scale.

“As a physician, you have the patient in front of you, and that’s who you work with,” Buchanan said. “Now, my patient is the entire community.”

Today Buchanan and her staff are going through another big learning curve, this time of situation: the COVID-19 pandemic, in which two of Buchanan’s critical partners in decision making -- the libertarian county mayor and the progressive city mayor -- have been at odds over the best path forward and some of her “patients” in the community are reluctant to follow guidelines that counter their expectations of social and economic behavior.

In a recent conversation with WUOT News, Buchanan talked about the difficulties she faces in helping manage Knox County’s response to the first major pandemic in living memory. The task is complicated by how rapidly the illness became yet another political and cultural fault line. Knox County Mayor Glenn Jacobs has made no secret of his disagreement with safer-at-home orders and what he feels is too slow a pace for getting juice back into the economy. Knoxville Mayor Indya Kincannon distanced herself from early calls to re-open businesses, and voiced some reservations as the political tide in favor of re-opening swelled in April. In the middle was Buchanan.

“There’s been political pressure from both sides,” Buchanan said. “Political pressure to go more slowly, political pressure to go quickly. It’s the nature of how we operate. It’s the nature of being a public servant.”

Both Jacobs and Kincannon would like to have seen timelines and re-opening plans proceed “a little differently than they did,” Buchanan said, but they accepted the Health Department’s advice and for the most part supported it publicly.

Credit video still/Knox County Health Department
Buchanan briefs the press, May 19, 2020.

Like public health officials in many states and Dr. Anthony Fauci and Dr. Deborah Birx on the federal level, Martha Buchanan has become a prominent public face of COVID-19 response in the Knoxville metro area. Her briefings are streamed live online. Excerpts are shown on the evening news and help set the agenda for the morning papers. The exposure and the responsibility make her an easy target for anyone looking for an outlet for their frustrations. The three-phase plan to re-open Knox County businesses is a good example, she said.

“It’s not just the elected officials that are giving us political pressure,” Buchanan said. “It’s other people as well. We’ve got people on both sides who are not happy with us. So maybe we’ve struck a good medium of being reasonable and thoughtful about our plan.”

Buchanan’s medical training and a slowly growing body of knowledge about the novel coronavirus have helped guide her decisions, from recommending who should get tested, to how and when to re-open businesses to minimize a surge of new cases. But she readily admits there’s still a lot to learn about a disease whose playbook is being written even as the game is well underway.

“In trying to write this plan, I wish we’d started writing [it] much earlier than we did,” Buchanan said. “We were really busy responding and…making sure we were doing all the right things in the shutdown, so planning for the re-open wasn’t at top-of-mind. I wish we’d had more planning time.”

Buchanan says one important takeaway has been the importance of helping specific businesses understand how they can safely serve their customers. The rules that apply best to manufacturing are not ideal for hairstylists or restaurants, for example. And business owners themselves are as divided as politicians about the best way to navigate the uncharted waters.

“It’s been a mixed bag. Some folks think we’re going too soon, some think we’re not going soon enough,” Buchanan said. “There are folks who are like, ‘Why are we not in phase one? Are we ever going to get to open?’ And that’s an understandable question.”

Because the virus is still poorly understood, Buchanan has occasionally been at something of a disadvantage when fielding questions from reporters and politicians who want firm predictions and unequivocal answers. When she doesn’t know the answer, she says so. Where information is scant, she does not speculate. She has been patient in conversations with a press corps that isn’t immersed in the world of medicine.

Credit Brandon Hollingsworth, WUOT News
Buchanan gives a briefing outside the Knox County Emergency Operations Center, March 19, 2020. Dawn Munroe is the ASL interpreter.

Beyond government officials, business owners and reporters, Buchanan and her staff also have to count on the cooperation of a public fractured over how seriously it takes the threat of COVID-19 and what it's willing to accept to help keep cases at a manageable level. Some people see requests to wear a mask as an affront to their liberties or a restraint on their normal social behavior. Others, concerned about health risks, are reluctant to resume pre-pandemic social and economic activity. It’s not unusual for adherents of either side to go after the other on social media.

One tweet called her an “unelected dictator,” and a Facebook post called the county’s public health officer a “power hungry little troll.” But the majority of social media commentary is more positive toward Buchanan and understanding of her efforts. One Twitter user said he’d stay home “just cause she said it,” and a Facebook post appreciated her “empathy and level of calm.”

Buchanan has lost her composure in public only once, on March 27, when she announced an anomalous spike in suspected suicides in Knox County. Her voice quivered with emotion as she begged the people hearing her words to seek help if they needed it.

Even though no one else in the county has to face exactly what Buchanan faces, to say nothing of doing it for weeks on end, the doctor is loath to say what she’s going through is unique.

“I have really great friends. I’ve had friends who have brought me food, friends who are checking in on me,” she said. “But this is stressful for everybody. So go ahead and say yes to that friend who wants to bring you dinner.”

But, she hastened to add, visit safely, from six feet away or while wearing a mask.

Which is exactly what one would expect: Even when talking about downtime and self-care, Martha Buchanan is still on the job, thinking about her 470,000 patients – the people of Knox County.