While working long hours to lead the fight against the coronavirus pandemic, health officers nationwide, including Santa Clara County Health Officer Dr. Sara Cody, have been subjected to unprecedented threats and intimidation over their directives to keep businesses and schools closed and their orders that the public should wear masks.

Health officers in Shasta, Orange, San Benito, San Bernardino, Yolo, Nevada, Butte and Orange counties have left their posts since the pandemic began. Two state health officers have also departed, according to Kat DeBurgh, executive director of the Health Officers Association of California.

Some said they planned retirement; others left for other reasons, but all have departed during the most stressful times of the pandemic. It's likely the timing isn't coincidental, she said on Monday.

"No one ever says 'the pressure got to me,' but burnout is certainly a factor. They have spent countless hours working without a break, and on top of that they are being harassed and threatened by the very people they are trying to protect," she said.

These threats reach to the very top. On Wednesday, the nation's leading infectious disease officer, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN he has received death threats and his three daughters have been harassed. Fauci has had to hire security for himself and his family. He said he is not going to step down.

In California, Orange County Chief Health Officer Dr. Nichole Quick resigned on June 8 after receiving threats over her order for residents to wear face masks, according to news reports. A local anti-vaccination attorney also publicly exposed Quick's boyfriend's name and disclosed her home address, saying protesters in masks were planning to show up and do calisthenics on her front doorstep until they passed out, according to CalMatters.

In San Diego, a caller during a virtual county board of supervisors meeting ridiculed Dr. Wilma Wooten's appearance and gave out her home address, according to KPBS.

San Benito County Health Officer Dr. Marty Fenstersheib abruptly resigned April 28 after the Board of Supervisors criticized his orders to contain the coronavirus. Formerly Santa Clara County's public health officer, Fenstersheib now heads this county's COVID-19 testing task force under Cody.

Cody is among the most prominent and visible faces in the fight against COVID-19. She led Bay Area health officers in what became the country's first stay-at-home order. Praised early on for her foresight and leadership, as the pandemic has worn on, she has faced at times scathing criticism for a notably cautious approach to reopening the economy.

A May 23, full-page ad published in the San Jose Mercury News publicly attacked her integrity. Paulette Altmaier, former Cisco vice president and a philanthropist, "On Behalf of the Suffering Residents of Santa Clara County" accused Cody of "cratering our economy" and demanded she "permanently donate your salary and future pension toward the relief of those you are impoverishing" as a moral obligation "to share the pain you are inflicting on others."

Cody also has faced multiple threats. The Santa Clara County Sheriff is investigating, a sheriff's spokesman said.

Cody did not return a request for comment regarding the threats. The county, in a July 1 statement, condemned the behaviors.

"The county of Santa Clara is grateful to our public health officer for having the courage to make science-based decisions, which, with the overwhelming support of the community, have saved thousands of lives during the COVID-19 pandemic.

"Unfortunately, these decisions have placed a spotlight that has made our public health officer the target of serious threats from a few individuals. Even though those individuals represent a tiny fraction, we take those threats extremely seriously and are taking all the necessary steps.

"We condemn any effort to harm or intimidate our public health officer, an individual who deserves our respect and appreciation for having the bravery to make the tough calls needed to protect the health and wellbeing of all our residents, including the most vulnerable members of our community," the announcement stated.

During a phone interview in late July, Supervisor Joe Simitian said that, while there are going to be hard questions asked of public health officials in a crisis, "to threaten the safety and well-being of anyone working to keep us safe is appalling."

It is a line that should never be crossed, he said.

"I'm concerned there are too many people who think it's OK to cross that line. In almost any crisis, circumstances bring out the best and the worst in people," he said. "This is one of those times when even a small minority and not even a significant minority, can do real damage."

DeBurgh said the threats and intimidation might have a chilling effect on public health, both during and after the pandemic. She is worried communities could lose accomplished individuals such as Cody in the wake of the pressure. Those doctors and related medical professionals could choose to go into the much more lucrative private practice rather than put up with the demands of their public health roles, she said.

"Who is going to want to step into this role if by doing so they are going to be threatened?" she said.

Taken altogether, the burnout, threats and intimidation experienced by public health officials during the COVID-19 pandemic could have devastating and long-lasting impacts on public health agencies for years to come, she said.

The pandemic has exposed longtime and ongoing weaknesses in the public health system, she said. While public health officers have come under scrutiny for not ramping up testing more quickly during the pandemic, DeBurgh said systemic underfunding of public health agencies is to blame.

"Many public health labs have closed in recent years. Since 2003, 10 local public health laboratories have closed in California. There are now 29 local public health labs in our state, the same number there were in 1950, when the population of California was just over 10 million," she said in an email.

This erosion affects the health of the community, she said, noting the current consequences: COVID-19 tests take longer and community outreach and awareness campaigns become more limited and take longer to roll out.

During non-pandemic times, public health officers focus on other issues pertaining to community health, from sexually transmitted diseases to environmental health to childhood vaccinations.

"When public health works, it's invisible," she said. People never hear about the many diseases their public health departments prevent. There's no cholera in the water, for example, because of public health policies, testing and enforcement, she said.

Cody has remained steadfast in her determination to not let COVID-19 get out of control, as it has in some other parts of the state and the country.

A Stanford University and Yale School of Medicine alum, she has more than 25 years of experience in Santa Clara County public health and infectious diseases. She earned a two-year fellowship in epidemiology and public health to work as an epidemic intelligence service officer with the Centers for Disease Control and Prevention.

She was hired by Santa Clara County's public health department in 1998 as the communicable disease controller/deputy health officer overseeing surveillance and investigation of 83 reportable diseases, according to a 2015 Yale School of Medicine profile announcing her appointment as county health officer. She has conducted investigations on outbreaks, participated in planning for public health emergencies, infectious diseases, and bioterrorism, and responded to SARS, H1N1 and other public health emergencies.

Cody has not taken the weight of her decisions during the COVID-19 pandemic for granted. When she and health officers from other counties held a press conference in March to announce shutting down schools, Cody appeared to fight back tears.

The decision was one she previously expressed great reluctance to make. She said she understood the effect the shutdown would exact.

"I know it will have a big impact on our community and our families," she said.