At least 48 local and state-level public health leaders have retired, resigned or been fired across 23 states since April, according to a review by the AP and Kaiser Health News.

Driving the news: California public health director Dr. Sonia Angell resigned on Sunday without explanation, a few days after the state fixed a delay in reporting coronavirus test results that had affected reopenings for schools and businesses, AP reports.

• New York City health commissioner Oxiris Barbot also resigned last week, citing "deep disappointment" that Mayor Bill de Blasio did not use the full extent of available disease control expertise to handle the pandemic.
• Ohio health director Amy Acton, who helped shape Gov. Mike DeWine's (R) stringent response to the pandemic, resigned in June and said the demands of the job were not a "sustainable thing." Republican lawmakers attempted to strip her of the authority to issue lasting state health orders in May and protesters picketed outside of her home on multiple occasions.
• West Virginia Public Health Commissioner Cathy Slemp was forced to resign in June after Gov. Jim Justice (R) openly criticized her at a press conference for allegedly overreporting the number of active coronavirus cases in the state.

Why it matters: The U.S. is reporting the most coronavirus cases and deaths in the world and has still not controlled the outbreak. The country's day-to-day response has largely been guided by local leaders — governors, mayors, and the health officials they rely on for recommendations.

Between the lines: "Public health leaders from Dr. Anthony Fauci down to officials in small communities have reported death threats, intimidation and personal attacks on themselves or their families," per AP.

• Many of the resignations and firings are related to conflicts over shutting down businesses to enforce social distancing or issuing statewide face covering mandates, the CEO of the National Association of County and City Health Officials told AP.
• Fauci said last week that his daughters and other members of his family were receiving death threats and harassment, telling CNN that he wouldn't have imagined in his "wildest dreams" that people would threaten officials over "pure public health principals."