A mixed-methods approach was taken to describe lessons learned by local health department leaders during the early stages of the COVID-19 pandemic in New York State and to document leaders' assessments of their departments' emergency preparedness capabilities and capacities. Leaders participating in a survey rated the effectiveness of their department's capabilities and capacities in administrative and public health preparedness, epidemiology, and communications on a scale from 1 to 5; those partaking in focus groups answered open-ended questions about the same 4 topics. Subjects rated intragovernmental activities most effective ( x = 4.41, SD = 0.83) and reported receiving assistance from other county agencies. They rated level of supplies least effective ( x = 3.03, SD = 1.01), describing low supply levels and inequitable distribution of testing materials and personal protective equipment among regions. Local health departments in New York require more state and federal aid to maintain the public health workforce in preparation for future emergencies.

Objective: Understanding the challenges public health workers have faced is critical to reinforcing, revitalizing, and strengthening the public health workforce. We measured and identified the level and causes of psychological distress among public health workers during the COVID-19 pandemic in New York State. Methods: We used a knowledge, attitudes, beliefs, and behaviors survey to ask public health workers at local health departments about their experiences working in public health during the pandemic, including questions relating to harassment from the public, workload, and work/life balance. We used the Kessler-6 scale to measure participants’ psychological distress using a 5-point Likert scale, with higher scores indicating greater psychological distress. We calculated descriptive statistics and conducted a regression analysis to determine the factors associated with public health worker psychological distress, and we coded open-ended comments for qualitative analysis. Results: During September 7-20, 2021, 231 public health workers from 38 local health departments completed the survey. Respondents were predominantly non-Hispanic White (89.6%), female (82.1%), full-time employees (95.1%), and located in Upstate New York. On a bivariate level, the strongest predictor of distress was job satisfaction (–0.388), followed closely by COVID-19 fatigue (0.386) and feeling bullied or harassed by the public (0.331). In the regression analysis, 2 additional factors were associated with distress: considering leaving their job due to the pandemic and concerns about exposure. Themes from the qualitative analysis strongly supported these findings. Conclusions: Understanding the challenges public health workers have faced during the pandemic is critical to inform the actions needed—stronger state laws protecting against harassment, workforce incentives, and commensurate funding—to reinforce and revitalize our frontline public health workforce.