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Communicating COVID and Public Health in Idaho

David Pate

Dr. David Pate is the immediate past president and chief executive officer of St. Luke’s Health System in Boise, Idaho. A noted thought leader, Dr. Pate is an author, teacher and sought-after lecturer.

He received his bachelor’s degree from Rice University, his medical degree from Baylor College of Medicine and his law degree cum laude from the University of Houston Law Center. He completed his residency training at Baylor College of Medicine and is board-certified in internal medicine.

For further reading on the topic of communicating about COVID, click here to read “Big COVID, Red State: The Value of Over-Communication in a Public Health Crisis” by Blue Review co-editor Dr. Jen Schneider 

A Conversation with Dr. David Pate

In fall 2020, our co-editor Jen Schneider conducted a full-length, 90-minute interview with Dr. David Pate, former CEO of St. Luke’s Health System and member of Governor Little’s Coronavirus Working Group, about his strategies for communicating about the Coronavirus pandemic. We’ve edited that interview for clarity and brevity and are publishing an excerpt as part of our COVID-19 series. This interview formed the basis of a case study that is forthcoming in the journal Frontiers Science and Environmental Communication. You can follow Dr. Pate on twitter.


Describe in broad strokes who you are, and how you came to be a sort of informal spokesperson on COVID and public health in Idaho.

Well, my background is that I’m a physician who specializes in internal medicine. I had a private practice for about 10 years in the Texas Medical Center. So COVID certainly falls within my area of special specialty. Now, obviously there are other people who have more specialization on COVID, such as virologists or immunologists or infectious disease, but it’s certainly been typical of my area of specialty to be the one on the front lines, taking care of these kinds of patients.

Following my practice, I was in hospital administration and became the CEO of the St. Luke’s Episcopal Health System Texas Medical Center’s flagship hospital. Then I was recruited here to Idaho to take on the role as president and CEO of the St. Luke’s Health System. My interest in coming to Idaho was that I have been interested in health care reform ever since the Clintons were in office. That was what actually precipitated me to go to law school, too. And I saw an amazing opportunity here to actually transform healthcare. I was the President and CEO for almost ten and a half years.

I retired on January 31, 2020.  I entered into retirement with all kinds of wonderful plans and none of them were able to come to fruition. I had about two weeks of leisure when I made the mistake of answering a phone call from the Governor, who asked if I would serve on his Coronavirus Work Group.

You’ve become a frequent communicator on COVID, and a trusted source of information for many. How did that begin?

When I was CEO, and driving the organization through so much change, what I found is you just have to communicate, communicate, communicate, because people don’t like change. And if you’re going to bring them with you, they have to understand, “Why do I have to change? And how long can I take to change?” You have to create urgency, and you have to create the case for change.

So, I did lots of different things [as CEO]: in-person recordings, teleconferences, written communications. But I also started a blog, and I thought I would just kind of chronicle our journey. And I got onto social media, which was very new for me.

Then, if you think back to March 2020, when the pandemic began, we had fairly little guidance. This was a new organism, a new infection, and we didn’t know how it behaved. The CDC and others were trying to put out guidance, but back at that time the guidance was very high-level, not very specific. It was great to have that guidance, but businesses and individuals had no idea how to apply that guidance to their daily lives.

So, I was spending eight hours a day on the phone. Businesses were calling me—all kinds of schools, gymnasiums, other businesses—asking, “Hey, what should we do? Do we need to close down or can we operate safely?” Of course, we didn’t know a lot of the answers, but I took what little we did know at the time, plus the guidance, and then I helped them think through, okay, given the fact that we don’t know all the answers, here’s how I would apply what we do know to your business to make it safer.

I also had individuals calling me. I remember a particularly impactful call by a woman in her eighties who was asking me, “What do I do about the maid who comes and helps me with the house? What do I do about my kids who want to come and visit me?” We had to talk about these things. It’s a matter of how much risk are you willing to take.

Obviously, for a woman in her eighties, there’s going to be a significant amount of risk. At the end of our conversation, she said, so do I just need to stay in my house for the rest of my life? That really impacted me. I said, no. We’ll get through this. We’ll help you. The thing is, let’s keep you safe for now. And then you will return and be able to do the kinds of things you want to do.

The problem was, at the time, the state public health office and local public health boards were totally overwhelmed. People who couldn’t get answers from the state or the public health departments were then calling me, and I was on the phone eight hours a day. So I decided to start putting out information on my social media about coronavirus to help all these people out there.

What I didn’t realize at first was how many journalists were following me on Twitter. I think because they were trying to understand what’s going on. Before long I was doing one or two or three interviews in a day for a period of time. Things snowballed from there.

You’ve talked about your communication philosophy, which is to “over-communicate.” Why is it important to over-communicate, especially during a crisis?

I’m not a communication expert, and I have no formal training in communication. I just have my own experiences and my own impressions. But the first reason I think communication is so important is that the vacuum will get filled if you don’t communicate. The only thing worse than going through a scary time is going through a scary time without information. And what people will do in the absence of information is they will fill in those gaps [with misinformation].

Especially in a social media age, if you’re not communicating, you’re now relegating that to others to do it for you, and they might be more effective at communication and dissemination than you are. Now you’re just having to respond to everything, which is not a good place to be.

You’re a long-time Republican, and a member of Governor Little’s Coronavirus Work Group. Yet you’ve been critical of federal, state, and local Republican lawmakers who have spread misinformation about the pandemic, or who haven’t acted in line with public health guidance. Has there been any hesitation on your part to talk politics, given that you’re a trusted source of information in the community?

I’ve really wrestled with this. If you looked at my Twitter feed from when I was CEO, obviously I was very guarded about a lot of my personal views on religion, politics, and those kinds of things. It was certainly my intention going into the pandemic to do the same. The thing that changed my mind is that I never would have imagined that we would have a public health crisis that would be politicized. The majority of my adulthood, I’ve been a Republican. I tend to align most closely to Republican values. But I’m most interested in our country being successful.

I do think that people have to stand up for what’s right and wrong, for what’s true information and not true. And let’s give people facts. Maybe you’ll put that through your political filter—I hope you won’t, because facts should be fixed—but at least I’m going to tell you, here’s the facts. They’re the facts for Republicans, they’re the facts for Democrats, they’re the facts for Independents. They’re the same facts.

I get frustrated when facts get spun based on politics. That’s not good. Let’s have a common set of facts. For example, we have had as a fact that there’s an opioid epidemic. Now, Republicans have different ideas about how to deal with that than Democrats do. Perfect.  But let us not choose our facts based on which party we are.

With the pandemic, though, I felt almost backed into a corner. I didn’t want the pandemic to be political and I certainly don’t want to contribute to it being political. But when you’re going through a crisis, it comes down to trust. I felt like in order for people to trust me, a few things had to happen. One, I had to be transparent about my politics. And then some religious groups were manipulating the facts about COVID, so I had to come out too on religion, because some religious leaders were advocating for some very irresponsible and dangerous things.

When you’re dealing with science and medicine, you really want to keep politics and religion out of it to the best you can. But we [in the U.S.] just haven’t been able to do it. So there have been times where I’ve had to come out and say, look, I’m not criticizing this religious leader because of religion. I’m a Christian, I’m very devoted. I want you to know I’m not criticizing this view because I’m an atheist or I don’t think religion is important.

I really regret that these things have come into the conversation. But it’s important I tell people because it’s important for the trust. My medical and scientific information can’t be heard unless they know that.

Early on when you were writing COVID posts on your blog, you mentioned that it wouldn’t be necessarily helpful to wear masks as protection against COVID. We learned quickly how important masks are, and you changed your views. How do you explain that evolution to people?

It gets back to trust again. We’re not perfect. Sometimes we get it wrong. Some people believe that just because somebody said something back in March that was wrong, then we shouldn’t listen to what they’re saying now. I think it’s completely the opposite. If you’re listening to somebody who says, I’ve had this right all along, I’ve called every shot correctly, that’s why you should pay attention to me…you should tune them out, because nobody gets it right all the time.

When I give advice to people or tell people something, they should challenge me. They should seek other authoritative sources to see if they’re in a disagreement with me, and I should have to defend that. What we need to reward is those leaders, those people who will come out and said, I was wrong in March, but I’ve learned differently, and I’ve applied that now. That’s the kind of leader we want.

Some things I thought early on have been proven not true. Some things I thought early on proved to be true. But I’m giving the best advice I have today based on what I know today, realizing I will know more next week and then more next year. Some of these things will change. But all of us should want to live our lives today with the best knowledge that we have, even though it’s imperfect.

You’re having a pretty remarkable retirement.

My wife is not quite convinced that I’m retired! It’s more than I’d like to be doing right now, but on the other hand, what a gratifying position to be in, to know that I’ve developed some unique experiences and expertise, and now here’s a way that I can give back and I can help. I can help my state. I can help our schools. I can help others. I’m actually getting to still have an impact and make a difference. That’s pretty rewarding.