Connecticut’s new top doc, short on government experience but long on clinical expertise, braces for the challenge of the COVID-19 pandemic

When Dr. Manisha Juthani was weighing whether to leave her post at Yale University to take the helm of the Connecticut Department of Public Health, she was reminded of what Dr. Rochelle Walensky said when the Biden administration tapped her to lead the Centers for Disease Control and Prevention.

“Every doctor knows that when a patient is coding, your plans don’t matter. You run to the code,” Walensky, a professor of medicine at Harvard Medical School and the chief of infectious diseases at Massachusetts General Hospital, said last December. “And when a nation is coding—if you are called to serve, you serve.”

On the brink of a similar transition from academia and clinical work to government service, Juthani took that message to heart. And while the COVID-19 pandemic in Connecticut may no longer be the crisis it once was, she is clear-eyed about the challenges that lie ahead.

“I don’t think Connecticut is coding quite at the level that it was 18 months ago,” Juthani said Monday morning at the Department of Public Health offices in Hartford. “We’re in a slow rumble. We’ve got a patient that is relatively stable but in the ICU. We are helping to get [them] through to be able to get discharged to the floor and be able to go home.”

A week into her tenure as the state’s new public health commissioner, Juthani seemed at ease, seated in a conference room punctuated by the American and Connecticut state flags. Even-keeled and charismatic, she is also frank, acknowledging that she does not bring a wealth of state government experience to the post, which involves running a state agency with nearly 700 employees and a $150 million budget.

But the experience she does have — as an infectious diseases expert, physician and in clinical administration — is critical to the new role, guiding the state through the ongoing coronavirus pandemic.

Infectious disease specialist

By the time she took a public service leave of absence this year to join DPH, Juthani was serving as an infectious diseases physician and an associate professor of medicine and epidemiology at the Yale School of Medicine. She arrived in New Haven in 2002, after serving as the chief resident at the Memorial Sloan Kettering Cancer Center, and joined the Yale faculty full-time four years later. Her research focused primarily on infections in older adults, including urinary tract infections and pneumonia.

Juthani grew up in Edgemont, in Westchester County, New York, the daughter of two physicians — her father is a cardiologist and her mother a psychiatrist — who emigrated from India in 1970. There was little doubt in her mind that she would follow in their footsteps. But it wasn’t until after earning her medical degree at Cornell University and becoming an intern and resident at New York-Presbyterian Hospital that she realized she was most drawn to infectious diseases. She still remembers the case of the emergence of typhoid fever in New York City in 2000 that the city public health department traced back to a single employee of a local restaurant.

She now lives in Fairfield with her husband, a Connecticut native. They have a son in high school, a daughter in college and relatives scattered throughout the state — many of whom traveled to Hartford in July to cheer on her nomination as public health commissioner, the first Indian-American in state history to hold that post.

Last year, Juthani gained attention in Connecticut media when she joined a group of other doctors who signed a letter urging Lamont to shut down gyms and indoor dining, as COVID-19 cases mounted in the state. But now, Connecticut is in a far different position. Hospitalizations have largely declined in recent weeks and currently remain below 300. (Last December, they peaked around 1,200.) The state’s weekly positivity rate stands at 2.23%. In her first press briefing as commissioner, Juthani expressed “cautious optimism” about the state’s COVID-19 trajectory.

Additional restrictions?

Now, Juthani said she does not see an urgent need for further restrictions to return, even as Connecticut once again enters the fall and winter. The state’s vaccination rate is among the highest in the nation — and will continue to grow as younger children become eligible for the COVID-19 vaccine, potentially this fall. Booster shots are beginning to roll out, providing extra protection for older and more vulnerable residents.

“These are the hopeful things that give us our best chance going into this winter,” she said. “Having said that, is there the chance that some variant from somewhere in the world comes and causes a surge and a two-month cycle again? It’s possible. If we’re lucky and that does not happen, I anticipate that we will continue to see COVID-19, but that maybe it will be at a plateaued rate throughout the winter.”

Within a few years, Juthani suspects, there will be a “routine cadence” to COVID-19, defined by surges primarily in the winter, as is true for the common cold or the flu.

Still, Connecticut needs to continue to increase its vaccination rate, she emphasized. As of Monday, 68.5% of all Connecticut residents and 78.6% of those 12 and older were fully vaccinated. And while the vaccination rate has slowed considerably in recent weeks, Juthani said that state and federal vaccine mandates could provide the state with the extra boost it needs.

On Monday, a few blocks from Juthani’s office at DPH, a group of protesters lined the sidewalk outside the State Capitol, railing against mask mandates for school children and the possible extension of Gov. Ned Lamont’s emergency powers, which expire Thursday. Activist groups across the state opposed to masking and vaccinations — many fueled by misinformation — have gained strength over the course of the pandemic.

Juthani’s charge as public health commissioner, as she sees it, is to provide vital information and resources to all residents of Connecticut — though she recognizes that there are some people she “might not be able to get through to.” But as a physician, she said, she is used to talking with patients who are resistant to her counsel. During her last rounds as a Yale clinician before joining DPH, she met one-on-one with patients who were adamantly opposed to the vaccine. In those conversations, she said, she prioritized direct, fact-based care.

“Some people have told me, ‘Well, we don’t know everything there is to know about the vaccine,'” she said. “And I would say, ‘Well, we don’t know everything there is to know about COVID. But what we do know is that the vaccine is saving a lot of people’s lives and it is allowing us to open up life in a way that we were unable to do without the vaccine.'”

On a more fundamental level, she stressed, vaccines have a centuries-long history in America and are part of the reason “why we are able to live in the way that we live.”

Juthani is quick to point out, as well, that the state’s vaccination efforts must prioritize reaching communities that have the most difficulty in gaining access to vaccinations.

As a physician this past spring, she said she met with a young Hispanic woman who had been hospitalized with COVID-19. The patient proudly told Juthani that she gets all her shots — yet she had not managed to obtain a COVID-19 vaccine. She lived in a multi-generational home with young children, life was hectic, and she had been unsure about how to get her vaccine. Conversations like those have shaped Juthani’s view of how critical it is to concentrate resources around increasing trust in, and access to, vaccinations.

“When I say it’s important to me personally, it’s because I’ve seen people where you understand who we need to really reach and why our work is so important in reaching those people,” she said. “It’s our obligation as a society to take care of everybody. That is what the Department of Public Health is supposed to do.”

Eliza Fawcett can be reached at elfawcett@courant.com.