Last Sunday morning, Dr. Mark Wilson took out the trash. He cooked his own breakfast. That afternoon, he strolled his Highland Park neighborhood.

It had been a long time since the 58-year-old Jefferson County health officer had done any of those things— a few weeks, in fact. Not since COVID-19.

Wilson dropped everything that occupied his mind, time, and especially, his heart. Once (and still) urgent issues like the opioid crisis, the state’s tragically high infant mortality rates, racial disparities throughout healthcare, addiction, violence as a public health issue, and health-related components of poverty and homelessness.

“All those things were keeping me extremely busy,” Wilson shared by telephone during his Sunday walk. “Three months ago, I had to back out of some things because I was overloaded. I was trying to do a lot around vaping and get two bills passed by the state legislature.

“I’m not thinking about any of those things now. Not a single one.”

Now, Wilson is the most vital voice in our region—perhaps in the state—on all things coronavirus, the voice guiding policies and practices he hopes will save lives. When he talks, people listen.

On Monday, March 16, during a conference call that included mayors, county commissioners, city council members and other leaders throughout Jefferson County—a call that now seems light years ago—Wilson and other health officials shared their perspectives on COVID-19, the coronavirus. It was already a national plague in China, Italy and a few other European nations, and just beginning to infest, and kill, in American cities like Seattle and New York.

“The mayors all said, give us a message and we’ll deliver it,” Wilson recalled. “We decided on a message: Stay home. It was not a policy or an order, but it is a strong message.”

The message has since gotten stronger, of course. More emphatic as the spread of the coronavirus threatened to suffocate our healthcare system, debilitate its heroic workers and, most frighteningly, force them to make decisions none of them want to make.

“I’m not an expert at anything, or the one crunching numbers and looking at projections,” he said. “I just know the projection told to me by the head of the [Alabama] Hospital Association: It looks like we do not have enough ventilators in Alabama for people who won’t be able to breathe on their own. That’s Italy, that’s rationing ventilators—taking some patients off them and putting them on others whom they feel have a better chance.

“Those are things we don’t do here,” he added. “They’re unheard of.”

Wilson paused. He is a devout man of faith, a man comfortable and open with his emotions. His voice cracked as he talked about two of his daughters: Laura Coker, an inpatient nurse at Shelby Baptist Medical Center; and Anne Wagstaff, an internal medicine second-year resident at UAB

“I don’t want my daughters to face that decision,” he said, haltingly. “Deciding that someone’s grandmother has to be left in line and given comfort care instead of a ventilator.”

He apologized, unnecessarily, for the tears. “I’ve cried a lot,” Wilson said. “Less now than I was two weeks ago. It’s normal for what all is going on.”

A COMPASSIONATE WORKAHOLIC

Wilson calls himself a compassionate workaholic—meshing traits inherited from his mother and father, Mercer and Elizabeth. He’s the youngest of their five children, by six-and-a-half years, (“I think I was a ‘whoops’ baby.”) The family lived in Charlotte, North Carolina, in the 1960s, and young Mark was shaped by experiences of that transformational time.

During summers, Elizabeth, a pre-school and Head Start teacher, worked with Anita Stroud, an African American woman who for more than half a century ran after-school programs and summer camps for children living in Charlotte’s low-income, public housing communities. “I have vague memories of being at the summer camp with my brothers and sisters,” Wilson says, “and the black children playing with my hair.”

Also in the summers, Mark and siblings took the train to Decatur, Georgia to spend a week with their maternal grandparents. They were “pretty bigoted,” Wilson recalls. The couple lived in what he calls a “white flight” neighborhood in the city about six miles north of Atlanta. Over time, African American families moved to the city, and it was soon predominantly black. “I played with the black kids,” Wilson said.

Wilson’s grandfather was also deeply religious. His grandfather “was always reading the Bible to me and made me memorize the Ten Commandments. One day, though, the man pulled him aside. “He said I shouldn’t be playing those [black] kids,” Wilson recalls. “I didn’t understand and got angry.”

Back in Charlotte, Wilson’s mother ran a pre-school program for low-income black children in their church, situated in their all-white neighborhood. Until the church told her to shut it down. “Mom got upset with the Deacons and quit going to church,” Wilson recalls. “We didn’t go to church for a long time.”

“She was a saint,” he says. “That’s where I inherited compassion.”

Mercer, in his own youth, used to steal watermelons and later picked cotton in the summers while growing up on a farm in Coffee County, Alabama. Born in 1919, he had a “depression-era mentality,” Mark said. “The most important things he wanted me to learn were hard work and self-sufficiency.” Their pantry, Wilson added, was always stocked with canned goods.

“Definitely inherited my work ethic from him.”

Mark’s father and two older brothers attended Georgia Tech, so no surprise he ended up there, too. He knew he wanted to go into medicine—and, at least initially, do missionary work. His father, though, told him to study engineering. “If I majored in biology, he said I’d end up waiting tables,” Wilson said, “which happened to my sister.”

Wilson chose civil engineering and joined the campus ministry, which was all-white. (Like almost every institution during the dawn of the civil-rights era, the campus ministries were racially separate and likely unequal.) At one juncture, two black students joined the no-longer-all-white. “They were dynamic, campus leaders,” Wilson said, “so overnight we became integrated and soon majority black. It was wonderful, a taste of heaven.”

A MARRIAGE MADE IN “A TASTE OF HEAVEN”

Indeed, too, because it is where he met Marian Cooper. She grew up in a secular family in Athens, Georgia, yet woke up one morning, Wilson said, “with a desire to read the Bible.” She came to Georgia Tech and worked for the campus ministry. “I had to get permission to date her because she was on staff,” he confessed.

They married right after Wilson graduated.

Wilson’s medical journey began at the University of North Carolina, Chapel Hill School of Medicine. During his fourth year, he did a clinical rotation in substance abuse and another rotation at a clinic in Washington, D.C. that was affiliated with the Church of the Nazarene, and in a low-income neighborhood. “That helped me decide on internal medicine as a specialty,” he said. “And in urban areas.”

A residency at Grady Memorial Hospital in Atlanta offered the diverse, urban, community-focused vibe Wilson craved, but the demanding schedule, being a self-confessed “slow, detailed-oriented workaholic” and having a baby “was not good for us,” Wilson said.

So, while her husband was working, Marian, Wilson says, found him a residency in Charlotte, close to family and with housing provided by the hospital. “If I wasn’t on call, they had supper with me,” he says. “And my parents loved having their new grandbaby in town.”

By the time Wilson finished his residency, he was clear about his desire to serve in an urban setting. And about the cost thus far to his family. “I was so mission-minded,” he said, “I was failing to love my wife.”

“She has propped me up all my life,” he said. “I’ve always been able to focus on work. I’ve been blessed in that way.”

Mark and Marian have been married for 35 years now, and in Birmingham since 1991 when Wilson arrived at the nudge of former medical school classmate Christine Ritchie, then chief resident at UAB Hospital. He joined the staff at Cooper Green as an internist. It was supposed to be a short-term gig until he could team with Dr. Tom Siler in a practice serving Fairfield’s predominantly low-income residents.

Wilson remained at Cooper Green for two decades. “The [Fairfield] practice didn’t make it because it was underfunded,” he said.

TAKING CARE OF REALLY SICK PEOPLE

Wilson embraced his role in primary care because it mirrored his long-held desire to provide missionary-like care to those who could least afford it. “We didn’t turn people away, he said. “And it was very gratifying. I had tons of patients who thanked me; it made me feel good.”

“I love the challenge of taking care of sick people who had problems related to poverty, whose biggest concerns may be, how much does it cost, and will be able to get the procedure if you can’t refer me to a specialty?” Wilson said. “I learned to become a good doctor. In all my time at Cooper Green, I saw a well patient maybe once or twice. When a well patient said, ‘I’m just here for a checkup.’ I almost didn’t know what to do."

“I got lots of practice taking care of really sick people.”

Still, Wilson didn’t think he was qualified (a recurring career theme) when Cooper Green CEO Dr. Max Michael III asked him to assume the role of medical director. Michael lived near Wilson and had watched his colleague meticulously and diligently tear down and rebuild the porch on his home over about a year. “If you can build a porch,” Michael told him, “you can do this.”

He did, and for almost two decades worked every other weekend until becoming chief of staff. In 2008, he was elected to the board of directors of the Jefferson County Department of Public Health. There, his passion for improving the health of those whose conditions are often affected by poverty evolved into creating and supporting policies that might impact those communities.

“We worked hard at Cooper Green to fix systemic problems,” he said. “Being at the health department allowed me to impact the broader health picture."

In early 2011, Health Officer Michael Fleenor announced he would retire after 10 years. Wilson attended a JCDH board meeting featuring a heated exchange between Fleenor and Jefferson County Commissioner David Carrington over tax revenue and earmarked funding for the JCHD vs. the Jefferson County government, which was entering into bankruptcy.

“It got a little testy,” Wilson remembered. When the debate cooled, he jumped in with questions for Carrington. “They were challenging, but he didn’t take them as antagonistic.”

Once Wilson finished, a colleague whispered to him: “You ought to take the job.”

Again, Wilson did not think he was qualified. “I don’t have the skillset,” he replied. “I’m a good doctor and have been a leader since I was an Eagle Scout, but…”

“Don’t worry, we’ll help you,” the colleague interrupted.

“It almost makes you cry,” Wilson said.

THE COMING OF COVID-19

It was a Friday in January when Wilson first turned an eye towards the new virus ravaging China. He saw the numbers of infected double by Saturday, then double again by Sunday. Then he noticed the deaths and began calculating the virus’s mortality rate on his phone: around 2.2%.

“I started thinking, wow, this is behaving a lot like the flu,” he said. “A lot of people die from the flu, which I preach every year and people don’t pay attention. But this looks like a mortality rate 10 to 20 times that of the flu. So, it spreads fast and is 20 times the rate of the flu. Wow. I thought, Oh, my God, this is scary.”

It hardly seems like it was just three weeks ago when there was still so much uncertainty about the wildfire that was just beginning to smolder in the United States. On Wednesday, March 11, with the number of infected globally at 18,000 and the dying reaching 4,000, the World Health Organization declared COVID-19 a pandemic, saying it had touched every continent except Antarctica.

Wilson was on his way to Montgomery to address the state senate health care committee in support of a bill that would get clean needles in the hands of drug users. His phone rang. On the line was an official from the NCAA asking if it was safe to hold its Divison II Men’s and Women’s Track & Field Championships at the Birmingham Crossplex that weekend.

“I said, ‘If you’re gonna do this, limit the number of people who come, maybe family only and have hand sanitizers and everything you can available,” Wilson recalled. “Then I put them in touch with our disease control people.”

The next day, the NCAA announced the cancellation of all spring sports and winter championships, which included the track meet.

At about the same time, Cher also canceled a concert scheduled for the BJCC and the NBA postponed its 2019-20 season after its first player tested positive for the coronavirus.

Also scheduled for that Saturday was the annual UNCF Mayor’s Masked Ball, which generates hundreds of thousands for the United Negro College Fund. Birmingham Mayor Randall Woodfin called Wilson to discuss whether to cancel or postpone the event, which was slated to attract about 1,400 people from throughout the South, and beyond.

The discussion sparked a conflict between Wilson’s compassion and pragmatic sides and tugged at his affinity for African American causes. “I hated the thought of canceling it,” Wilson said. “Sometimes I risk not making the right decision because I am a people pleaser, too.”

The mayor asked, Tell me what you think we ought to do?

“It was like a stun gun hit me,” Wilson said. “But I said, ‘Mayor, I think you have to cancel it.’ That was hard to say to the mayor of Birmingham, who was trying to do something for a really good cause.”

On Thursday, the postponement was announced.

Soon after the conversation with Woodfin, Wilson conferred with a tight circle of infectious disease specialists, including Dr. Jeanne M. Marrazzo of UAB. There were still, mind you, no cases of coronavirus yet confirmed in Alabama. “I had a good hunch, I said, that we have the disease in our community,” Wilson said. “At this point, we need to start taking some steps.”

Call it the Paleolithic era of COVID-19—just three weeks ago, remember. “Social distancing” was still not part of our vernacular. The concern was about crowds. How big? At that time, no one knew.

During a meeting, Wilson said: “I need to make a strong recommendation to cancel all events with more than this number. But what should it be? One thousand? Five hundred? Two-fifty? A hundred? Jeanne said: ‘Pick a number and start to get everyone in the mindset to make changes. We need to pay attention.’"

“... A TOTAL TRAVESTY...”

“We picked 500. It was somewhat arbitrary, but it was a starting point.”

A starting point that fell. Precipitously.

Wilson knows he has not been perfect since. Far from it.

Most particularly there was March 19 press conference to announce his second order outlining business closures. “We wanted to do a remote news conference to practice social distancing,” he said. “This was new for the JCDH.” The department had to borrow video equipment from City Hall to ensure quality. Wilson didn’t have time to solicit input, so he spoke from the compassionate heart he inherited from his mother.

The first part of Wilson’s remarks referred to the challenge facing citizens, utilizing a World War II analogy. In the later part, "I wanted to tell the public it was really painful to do this, that it hurts me to have to do this, that it breaks my heart,” he said, “I thought it was important to say that. I want you to know my heart.

“In between was the order. I didn’t have time to figure out what I wanted to say. I needed to be brief. I tried to summarize and define essential and non-essential businesses and support it with policy. Things needed to close because of social interaction, which was not essential for survival. That’s what I said.”

It was a disaster. Among the criticisms that flooded the JCHD’s Facebook page was that even he was not practicing social distancing, with the interpreter just a couple of feet away to his left and public relations coordinator on his right holding a cellphone so he could hear questions from the media.

“It was a total travesty,” he said. “What I didn’t recognize was there were tens of thousands of people watching simply waiting to know if they had a job the next day and I didn’t say anything about that.”

Particularly egregious, in hindsight is what Wilson calls his “lapse in judgment” in not initially providing clarity about whether closures included beauty salons and barbershops—businesses, he knew, were the bedrock of the black community, in many ways.

“I was weighing the economic part,” he began “They are a relatively big part of the local economy in places like Ensley. I was also thinking about African American women and hair and understanding that I would be a white man taking that away—not just the cosmetic part, also the psychological, emotional parts.

“I should have issued the order to shut them down when we shut down other things. But I had a lapse in judgment. I had an order saying other businesses have to abide by the six-feet-apart rule, as reasonably as possible. It was ridiculous to not include cutting or styling hair. That is an intimate action that lasts a long time. It didn’t make sense.”

On Sunday, March 22, Wilson issued a statement shutting non-essential retail stores. “We were already behind the eight-ball,” he said. “There was a sense of urgency to clarify the order and shut down retail altogether. We had not done that.”

That happened two days later, on March 24, when the Birmingham City Council voted unanimously to approve Woodfin’s recommendation for a shelter-in-place ordinance, which unequivocally shut down most retailers in the city and empowered law enforcement to break up instances where people appeared to be ignoring his warnings. It also carried a potential $500 fine for violations.

“We needed to do something about the basketball courts,” Wilson said. “Let’s say you have 10 guys playing. One of them is infected but has no symptoms. Now, every one of them is infected due to the contact. Each one goes home and may be living with an older person. Suppose they all get someone infected. Two of those older persons will end up in the hospital. One will die, all because some guys not meaning to do any harm were playing basketball.”

Wilson said he’s “still very concerned” and asked the police for cities throughout Jefferson County to “gently remind” people not to linger in large groups. “I don’t want them to arrest anyone because we don’t want any more people to be in jail. One of my concerns now is prisoners and jail workers.”

Even now, as some projections estimate the worst is yet to come, that Alabama could see as many as 1,700 coronavirus deaths by the end of the summer, Wilson holds his faith.

THE GOOD FROM THIS

“I hope we can get back to normal as much as possible,” he said. “I don’t want to make light of the tragedies happening in peoples’ lives, but I do see a lot of good things happen. Every person I see has a renewed sense of gratitude and a deeper appreciation of the preciousness of life.

“The simplest routines become more appreciated—like just taking the kids outside or enjoying a spin around the park on a bike."

Or cooking your own breakfast on a Sunday morning.

“We’re learning some very important lessons,” he added. “Maybe some new systems-related policies will finally be put in place. Maybe we will see more corporate innovation around working remotely. Maybe there will be fewer business trips. I even wonder if this will give us some boost on climate change.

“I’m hoping a lot of good comes out of this.”

For now, though, it remains hard for Wilson because he hurts when people hurt. And there will undoubtedly be more pain. For people like his daughters.

“It’s gonna be tough, particularly on health-care workers,” he said. “Not so much the physical but emotional toll it could take if we, like in Italy, they have to make really hard decisions.

“I’m afraid we’re headed towards that. That’s why I’m fighting so hard.”

While trying to cry a little bit less every day.

A voice for what’s right and wrong in Birmingham, Alabama (and beyond), Roy’s column appears in The Birmingham News and AL.com, as well as in the Huntsville Times, the Mobile Register. Reach him at rjohnson@al.com and follow him at twitter.com/roysj