TABLE 2. Explanation, Example Quotes, and Frequencies of the 15 Most Frequent Themes Identified in Qualitative Coding of Open-Ended Responses to PH WINS 2021 (N = 4371).

Theme	Explanation/Uses of Theme	Example Quote(s)	n (%)
Pride in public health Work/Mission	Sense of pride in the work and/or pride in having helped the public health mission	“We have tried diligently to respond appropriately to COVID in our clinic, even with tireless hours and tears shed. I cannot speak for the entire health department, but our clinic spearheaded the response and continues to do so with our heads held high.”	909 (20.8)
Leadership	Subtheme— Leadership Issues Lack of faith in leaders, perception of no leadership, opinions about how leadership should be, opinions about leadership not supporting the staff, etc (n = 426 or 9.7%)	“I have never worked under administrations that treat staff as terribly as this one. I have had many successes and won multiple awards ... during my career for my work and have worked for many other administrations in 2 states that valued my work, but these people I am working for now care about no one but themselves and how to make their own lives easier.”	756 (17.2)
		“Our leadership seems to be undermining our efforts to keep the community safe. I feel that our main leadership is angling for re-election rather than community support”
	Subtheme—Leadership Support Opinions about leadership supporting the staff, examples of ways leaders are doing a good job (n = 330 or 7.5%)	“Our agency was very well-organized and clear in its communication and training strategies! I felt very well-supported and confident in my assignment throughout this response. Also, once additional contract personnel were brought on, roles were more well-organized and more easily executed. I feel our health department delivered a strong response during such a difficult and at stressful time!”
Burnout/Overwhelmed	Sense of too much work to the point of discontent with the job, extreme stress, etc	“Stressful—very difficult to manage, especially when you have a family at home. There came a time when I felt resentful for all the hours I was working and the lack of opportunity for rest.”	613 (14.0)
Communication	Subtheme—Internal communication Discussion of internal organizational communication; sharing internal response/updates (n = 315 or 7.2%)	“Communication has been horrible. Everything I learn about COVID comes from Facebook and the news before I hear it from my own organization.”	512 (11.7)
	Subtheme—External communication Comments about communication with the community, external partners, media, etc (n = 197 or 4.5%)	“The challenge in aligning messaging with current facts and political structures, along with finding a way to speak that made sense to the public, was a huge challenge. Silos and limitations made it much harder.”
Overtime/Extra work	Indications of being busy, having extra work, working overtime, etc	“Doing all that I was doing alone was challenging. I needed more help and better pay.”	424 (9.7)
Compensation	Wanting to be paid for extra work, wanting raises, salary complaints in the context of the response	“Although I have not participated in the COVID-19 response, I do know that DHEC has compensated employees who have for both additional work and additional duties. I am thankful that my coworkers who are doing extra work are being compensated for it.” (Record #74)	365 (8.4)
		“I was unable to earn comp or extra pay for the extra hours worked because of my role as a supervisor.”
Emergency response protocols	Discussion/issues with emergency response protocols such as not knowing what to do in the emergency response or how to do it; comments about the success of emergency response protocols	“I wish the organization provided better guidance in the form of a plan/protocol for handling an emergency on a large scale that is specific to laboratory services. For example, personnel allocation, set scheduling, handling the large influx of supplies, scaling up non-pandemic processes to adequately respond to pandemics.”	340 (7.8)
Staff shortages	Comments about not having enough workers or being shorthanded	“We desperately need staff. I am the sole Emergency Preparedness Coordinator and I have been at the helm of the response work since March 2020. Not having additional backup or staff that are planning oriented severely hinders our agency's ability to lean forward and get ahead of issues. We were always reactionary.”	325 (7.4)
Teamwork	Expressing a sense of strong peer support, sense of community in workforce	“I have enormous respect for the employees and leadership at the Department of Health. I feel that the public does not value them enough. Too many people see their role in this pandemic as self-serving when it is the opposite.”	314 (7.2)
Employee wellness	Comments about employee health not being prioritized or about employee health/wellness/ill health	“We all got COVID at the same time in our office in June of 2020 and the agency really did nothing to protect us prior to that barely after.”	308 (7.0)
Disappointment with community's sense of responsibility/Trust in science	Expressions of discontent/disappointment with how the community reacted to guidance, disregarded recommendations, etc	“It was fine when there was a goal to achieve (waiting for the vaccine) but with all the misinformation and denial from the public and the unwillingness of leadership in the Health Department and government to actively combat and denounce it, it makes it feel like it was all a waste of time.”	300 (6.9)
Strain on core responsibilities of public health	Strain on routine or core public health activities and work (Women Infants and Children [WIC], lead, inspections, etc)	“It was at times very long hours and most of my regular work was put on hold to assist with the clinics.”	259 (5.9)
		“We have struggled to find a balance between our main lines of business—First Steps, WIC, Dental, Family Planning and Primary Care clinical services—and pandemic response.”
Telework	Comments about remote work or telework	“COVID didn't affect me professionally, except that it gave me the wonderful opportunity to work remotely for a year. Then my agency insisted that we all come back to the office, even though we were not vaccinated.”	256 (5.9)
		“Some roles within our office can have the capability to work from home and there were some staff in management who were working from home. It was not fair that the entire team was not given the option.”
Politicization	Comments about politics; influence of politics on community or agency; politics in the context of community discontent with public health guidance, etc	“It has been difficult to navigate when politics are leading the effort and not science. Information changes so rapidly and is inconsistent. Employees are scared to voice their concerns.”	256 (5.9)
Unappreciated	Not feeling appreciated by leadership/the agency or by the community	“...we were never thanked, acknowledged, or supported (seemingly) from anyone else besides our direct division including leadership/management, our board, our department at large, and definitely not community entities and the public”	250 (5.7)