PROVIDENCE, Rhode Island (AP) — Vilified, threatened with violence and in some cases suffering from burnout, dozens of state and local public health officials around the US have resigned or have been fired amid the coronavirus outbreak, a testament to how politically combustible masks, lockdowns and infection data have become.

The latest departure came Sunday, when California’s public health director, Dr Sonia Angell, quit without explanation following a technical glitch that caused a delay in reporting virus test results — information used to make decisions about reopening businesses and schools.

Last week, New York City’s health commissioner was replaced after months of friction with the Police Department and City Hall.

A review by the Kaiser Health News service and The Associated Press finds at least 48 state and local public health leaders have resigned, retired or been fired since April across 23 states. The list has grown by more than 20 people since the AP and KHN started keeping track in June.

The departures are making a bad situation worse, at a time when the US needs good public health leadership the most, said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.

“We’re moving at breakneck speed here to stop a pandemic, and you can’t afford to hit the pause button and say, ‘We’re going to change the leadership around here and we’ll get back to you after we hire somebody,'” Freeman said.

As of Monday, confirmed infections in the United States stood at over 5 million, with deaths topping 163,000, the highest in the world, according to the count kept by Johns Hopkins University.

Many of the firings and resignations have to do with conflicts over mask orders or social distancing shutdowns, Freeman said. Many politicians and ordinary Americans have argued that such measures are not needed, contrary to the scientific evidence and the advice of public health experts.

“It’s not a health divide; it’s a political divide,” Freeman said.

Some health officials said they were leaving for family reasons, others had planned to retire, and some left for jobs at other health agencies, such as the US Centres for Disease Control and Prevention. Still, many left amid a pressure-cooker environment.