This story was powered by America Amplified, a public radio initiative.
For Dr. Lori Drumm, the trouble began after she cancelled a rodeo in rural Deer Lodge, Mont.
"The rodeo attracts many, many people from all over the state," she says. "There'd be no way of enforcing social distancing and the wearing of masks."
As the part-time public health officer for Powell County, Drumm is charged with guiding the county's response to COVID-19. So she cancelled the event. But soon after news got out, around 30 people showed up at the hospital where Drumm works her second job as a family physician.
"Some of the people were waving the Constitution," she says.
They argued Drumm's decision was way out of bounds. The gathering came after months of grumblings and online name calling from what she says are a small but vocal group of locals angry at her response to COVID-19.
"They want everything to be open full-time," she says. "They don't want to wear masks, they're upset that they can't sit at the bar. They just want to be fully open."
One of the protesters, Robert Miller, later wrote a letter to the editor of the local newspaper, the Silver State Post, saying they were invited to the hospital by a county commissioner for an open meeting with Drumm. But Drumm wasn't notified, she says, and the group's appearance at the hospital was the final straw. Soon after, she quit her position as Powell County's public health officer.
"An angry group came to my place of employment," she says. "I can't control that from happening. But I can control the reason they want to come here and see me. So I felt I had to resign so that wouldn't happen again. I was concerned about the safety of the hospital."
Drumm's resignation follows more than two dozen other public health officers across the country calling it quits since the pandemic ramped up in April, according to a recent review by the Associated Press and Kaiser Health News. As the response to COVID-19 becomes increasingly polarized, they are often leaving because of threats or fierce political pushback over public health decisions.
In his letter in the local newspaper, Miller cheered Drumm's resignation.
"We are a free people and we will stand up to those who act as dictators," Miller wrote. "This country was founded on Judea/Chrisitan law and we have a moral obligation to not be afraid but to stand up to tyranny. We refuse to be encumbered in the yoke of their bondage."
This rhetoric has become more common as states continue their rollercoaster reaction with COVID-19, locking down businesses and then opening them up as cases surge and wane. The economy is limping and in rural, conservative communities public health officials are taking the brunt of the criticism.
"I think people have every right to say what they don't like about these measures," says Graham Mooney, a public health historian at Johns Hopkins University School of Medicine. "But it's certainly unfortunate that public health officials feel that their only response is to step down because they provide an incredibly valuable service."
Mooney says the wave of resignations is unprecedented in modern U.S. history. But he also stresses that anger directed at public health officials was not uncommon in prior disease outbreaks and pandemics.
"Certainly there have been public protests and demonstrations against public health regulations in the past," he says.
Sometimes these protests turned violent. In Milwaukee in 1894, an angry mob of thousands threatened public health officials with knives and clubs during a smallpox outbreak. Many didn't want their children taken to hospitals and didn't believe the infection needed medical attention.
"The demonstrations were so vociferous and the complaints so loud that the public health doctor was eventually kicked out," Mooney says.
In the late 19th and early 20th centuries, Mooney explains, both politicians and regular Americans were constantly airing grievances against public health officials over everything from epidemics to mandatory vaccinations to new health guidelines. It was the norm.
But as disease outbreaks lessened in the United States, public health workers faded into the background of American life. The job became relatively uncontroversial. Most disagreements between public health leaders and politicians happened behind closed doors, according to Mooney. That is, until COVID-19 cases began surging in the spring. Without a cohesive national response, the pandemic is forcing state and local public health officers to make quick, drastic and controversial decisions to lockdown communities, shutter businesses and cancel events. That's drawn considerable backlash.
In Montana's Ravalli County, commissioners released a statement last month saying they would not enforce Gov. Steve Bullock's recent mask mandate. The move prompted county public health officer Carole Calderwood to submit her letter of resignation after 13 years of service.
"I was surprised and I felt my authority was somewhat undermined," she says.
The commissioners later walked back the statement after public outcry from many local residents. They clarified that they wanted people to wear masks but they weren't going to force them to do it. Calderwood says they also reached out to her and explained it was a miscommunication. But the damage was done.
"We have great mutual respect," she says. "It's just that somehow this communication broke down and I felt really blindsided by this decision and that, somehow, we are just not operating as an effective team."
Calderwood says she'll stay on until the county finds a suitable replacement for her. But she's also exhausted. Many rural public health officers like her work second jobs as physicians at local medical clinics. Plus the public health department was dealing with veiled threats coming in from some locals.
"They were vague but they were always things like, There will be consequences for what you've done,'" says Tiffany Webber, a contact tracing nurse for the department. "It's enough to make you step back and take a different view of what's happening around you. You're just shocked."
Both Webber and Calderwood understand where this anger is coming from. Ravalli County, like many rural communities across the Mountain West, is a deeply conservative place that celebrates individual freedom and limited government. But during a pandemic, Webber says, "we can't focus on a person's rights or individual feelings. We have to focus on the bigger picture."
Webber grew up in Hamilton, the seat of Ravalli County, and wishes she could bottle up the pain she sees from those infected by the virus and show it to the skeptics.
"You know this person," she says. "You've seen her at the grocery store. You've seen them at the brewfest and the Ravalli County fair. You've seen them. They're a person, too. And now they're sick."
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.