How are you?
“Oh boy, that is a great question,” Dr. Danny Avula replies.
Nothing has been simple in 2020, neither questions nor answers.
With its first confirmed case in Virginia on March 7, COVID-19 and the virus that causes it, SARS-CoV-2, tore through communities and separated loved ones. It wreaked uncertainty and unknowns, masks and mandates, loneliness, fear, anger, exhaustion and mourning.
The new coronavirus has affected every person, every day, in almost every way: careers, finances, education, nutrition, housing, faith, business, politics, travel, family and relationships. It’s changed how people connect with the world and each other. It has upended priorities.
Early on, it seemed like preparing for a Richmond snow day. We hustled to the grocery store. We made runs for toilet paper and hand sanitizer. We brought children home from school, temporarily. But that scenario gave way to the realization that a pandemic was bearing down.
We didn’t need a meteorologist. We needed the epidemiologist.
We needed the nurses, doctors, paramedics, pharmacists and other front-line responders. We relied on local hospitals, assisted living centers and home health workers – and wanted to protect them. We yearned for familiar faces, experts who intimately understood our community.
We needed a public health leader like Avula, a physician and director of the Richmond city and Henrico County health districts. Fortunately, he was ready for us.
Avula’s been a “superstar,” Henrico County Manager John Vithoulkas says. “He is one of the people who defines our region and what is possible.”
Vithoulkas marvels about what he’s witnessed of the public health director and his departments, which hired an additional 120 people in five months, growing to about 350 employees across the two localities.
“The sheer volume of work and the emotion that must be involved in treating folks, and talking to people, and giving advice, and going from a nursing home to a governmental office – I don’t know how he’s done it,” Vithoulkas says. “And he’s provided probably the best example of what the local response to the pandemic has been.”
For taking care of the community, representing front-line health workers, providing transparency and reassurance, inspiring his teams and advocating for the most vulnerable, Dr. Danny TK Avula is Style Weekly’s 2020 Richmonder of the Year.
Avula laid groundwork that proved prescient, opened eyes to what ties people together, and translated a complex global situation into local, actionable advice. Fortunately for us, he was in the right place at the right time. But more than that, he was the right person.
Santa is seeing children by appointment at Regency Square on a recent Saturday morning. Cars fill parking lots and line up for the Starbucks drive-thru. Shoppers walk through 39-degree air and into the mall, which is under renovation.
In a typical year, leading into Christmas, this is where the scene might end. But on the southwest side of Regency today, there are different lines of cars. They’re here for the free coronavirus testing from the Richmond and Henrico health districts.
There’s a rhythm to this by now, our ninth month in. People in safety-yellow vests direct drivers to one of four testing stations set apart on the sidewalk. Teams of two stand ready at each table wearing blue protective clothing, gloves, head coverings and face shields. Testing takes about two to three minutes. Health workers sanitize and reset after the driver pulls away. Results will be sent later.
The local districts fall under the Virginia Department of Health, a state agency. Like their counterparts across the country, public health officials kept their eyes on alerts about the virus in January. The World Health Organization reported its first “disease outbreak news” Jan. 5. President Donald Trump’s Coronavirus Task Force began meeting daily Jan. 27.
Avula recalls how the situation intensified in February, turning from a “distant potential threat going on in China” to massive outbreaks in other countries. The patterns of a pandemic emerged. He says he thought, “This is a matter of when, not if.”
The World Health Organization called it a pandemic March 11. Gov. Ralph Northam declared a state of emergency March 12, citing the coronavirus as “a communicable disease of public health threat.” A day later, the governor closed schools for at least two weeks. Then students were dismissed for the rest of the school year.
The biggest challenge was the unknown. Information was scarce and advice was less than definitive, with scientists working to unravel the threat. “Things changed on a dime,” Avula says. For doctors accustomed to diagnosing patients and answering questions, frustration was easy.
“We’re expected to know, right?” Avula says. “It is a completely different and foreign space to be in.”
Avula, 42, also a practicing pediatrician, worked to educate himself while keeping up with changing headlines and new reports in national news outlets. He knew he “had to become a trusted and credible source of information about this serious threat,” he says.
By early March, immunologist Dr. Anthony Fauci, a member of the president’s task force, was becoming a regular presence in news conferences and on television news. Avula watched him become a visible and consistent voice, sharing information with the public.
“For me, something clicked,” Avula says: “You know what? We need that locally too.”
Avula says he committed to following Fauci’s lead, and in one way or another engaged with local media daily. He also knew how shifting advice could undermine public confidence – “already when there’s low levels of trust in government.”
Quarantine? Wipe down groceries? Wear masks or save them for health care workers?
Avula says his strategy was to be forthcoming: “What I tried to do personally was just be super transparent and say, ‘Hey, this is a constantly changing environment. We are learning more about this virus every week.’”
Born in India, Avula grew up in Northern Virginia. His parents, federal government employees, encouraged a career as a doctor. There’s a reality among young people from India who can immigrate to the United States, he says – the allure of opportunity, stability and stature that a medical career here can provide. His brother also became a doctor and works at Bon Secours. His brother’s wife, too, is a physician.
Avula attended the University of Virginia, where he says his eyes opened to issues of race and class, and the multitude of factors that contribute to someone’s health. Starting then, he says, “there was an awakening that happened.”
He also met his future wife, Mary Kay. They have five children and settled in Church Hill, a decision they made with college friends to help support a diverse, city neighborhood. It was another way to contribute, to live in the community they serve. They opened their home to people in need. Avula helped neighbors navigate Medicare. It all aligned with his interests in the social determinants of health.
After Avula graduated from U.Va. at 19, he taught high-school math for a couple of years and started medical school at Virginia Commonwealth University. During medical rotations in his third year, he came to the realization, “Man, there’s a lot I don’t know about the world.”
He relates an experience talking with low-income patients, advising a mother to work on an exercise program for her child, and to cook more healthy meals and rely less on fast food.
But such choices, situations, opportunities and privileges aren’t readily available to everyone. “They were not a part of her reality at all,” Avula says. “There was this deep conviction that my efficacy as a clinician was going to be pretty limited if I wasn’t going to be thinking of the things outside of health that were impacting this family.”
Was he where he needed to be? Could he make a difference? His wife coached him through what he calls a “freakout moment” when he wondered if this was what he wanted to do. She encouraged him to finish his degree and figure it out later.
During his fourth year of med school, Avula worked in a program with Bon Secours, which had received a grant to study asthma. He connected the dots between the health system and community organizations, he says, and saw underlying drivers of health take effect, such as income, education and housing stability.
A rotation with local health departments deepened his interest in public health, including discussions with Dr. Thomas Franck, director of the Chickahominy Health District in Hanover County – with whom he now serves on the Central Virginia All Hazards Incident Management Team.
Avula continued his education at Johns Hopkins University in Baltimore, earning his master’s degree in public health. Out of that second residency, he was hired in 2009 as deputy director of the Richmond Health District. By October 2010, he was named to Style’s Top 40 Under 40, which in part cited his work bolstering community health centers in public-housing developments.
That work continued, with eight mini-clinics established, offering new clinical access points for the Health Department. The efforts laid the groundwork years in advance for the fight against the coronavirus, which has affected low-income neighborhoods disproportionately, Avula says. “It was so stark early on,” he says of the caseload in Black and brown communities, though that has leveled off somewhat.
The health centers helped establish connections and build creditability within the neighborhoods. The department hired residents as community health workers, Avula says, because they better understood their communities.
In April and May, the health districts also realized they needed to expand their outreach to the Spanish-speaking community. But overcoming the language barrier wasn’t the only challenge. They needed people who were bicultural, he says – workers who also had immigrated, having to navigate government systems and understood how to develop trust.
In addition to a grant from the Centers for Disease Control and Prevention, nonprofit organizations played a significant role in the health response, Avula says. Some financial support went toward quarantine and isolation needs of the non-English-speaking community. The Central Virginia COVID-19 Response Fund, set up by the Community Foundation and the Emergency Management Alliance of Central Virginia, awarded $6.5 million in grants through Dec. 20.
Avula also advocated for more widespread testing at nursing homes, which proved to be hot spots, along with helping them adopt additional protective measures.
Inevitably, working with others means stepping amid competing interests – and in an election year, increasingly heightened politics.
Avula works for elected leaders. His bosses work alongside a governor. He stood at news conferences with Mayor Levar Stoney. He was called upon to answer questions in meetings with regional leaders. He offered guidance in Richmond School Board meetings.
He was in the spotlight when elected leaders grappled over decisions about school closings, businesses faced restrictions and political parties leveled criticism at each other.
“It’s my role to provide good information,” Avula says. “To help people understand the context so they can make the decision.” Ultimately, those decisions may be different from one locality to another, but it must be made within the context of that community.
“I feel like the institution of public health has had to do a lot of de-politicizing,” Avula says. It isn’t about political power: “This is about real people and real lives and real health.”
One idea to emerge stronger is a sense of connectedness, he says – that your choices, your behaviors, have a real-life potential to transmit to someone else.
Avula’s role as a dual health director for Henrico County and Richmond underscores that connectedness. After he became health director for the city in 2016, he took an interim role to help Henrico while it searched for its next director.
When recruitments didn’t pan out, Vithoulkas says he told Avula in a joking way, “Why don’t you come to work for us?”
“My heart is in the city,” he recalls Avula saying.
But they discussed the potential benefits, too, meeting with Stoney and the Virginia Department of Health. Local leaders held a news conference in November 2018 to announce that they were unifying the two departments under Avula to strengthen public health efforts.
The strategy has paid off during the pandemic response.
“We had no idea,” Vithoulkas says. “But ultimately that decision to consolidate the leadership led to a much more unified and effective approach at the ground level.”
The vaccine and its rollout are the next challenge.
And how is Dr. Avula?
His family and teams encouraged him to step away after nearly nine nonstop months of 100-hour weeks. In early December, he prepared to take two to three weeks off during the holidays to unplug. To address his own well-being.
“I need a brain break because I think this next phase of vaccinations is going to be super intense for us,” he says Dec. 4, the day the Virginia Department of Health announces details on the state’s initial vaccine delivery and priorities.
The long hours have been wearing, Avula says. “But it was an adrenaline rush too,” he says, to be able to make a difference in a time of crisis. To figure out where help was needed most. And it was “amazing to watch the team.”
“The work of public health is so much more nuanced and layered” than traditional work as a physician, Avula says. “There’s a part of me that is drawn to that – knowing that we’re not going to have all the answers, and the answers are complex, and we’re going to have to work with a bunch of people to figure it out together.”