Dr. Mandy Cohen, secretary of the North Carolina Department of Health and Human Services, made a mantra of her three w’s of pandemic advice: Wear a mask, wait six feet apart and wash your hands frequently.

On Tuesday, she appeared to add an unspoken fourth w about fighting COVID – weary.

Cohen, an internal medicine physician whose resume includes three Ivy League degrees and experience in the Obama administration, announced that she will be stepping down at the end of December. She headed DHHS for five years and for the past 20 months directed North Carolina’s public health response to the COVID pandemic.

In describing her decision, Cohen turned to metaphors of an exhausted runner

“Certainly the last two years have been quite a marathon, and I’m so proud of all the work that we’ve been able to accomplish,” she said. “I felt like I was able to now step back and pass the baton.”

Trying to keep up with an elusive and persistent virus is draining enough. But Cohen – like Dr. Antony Fauci on the national level and many state health directors elsewhere – had her work needlessly complicated by those who politicized efforts to stem the virus. Too many people, serving a warped idea of individual freedom, or in opposition to the Democratic president, refuse to wear masks, avoid gatherings or get vaccinated. Twenty eight percent of North Carolina residents 18 and older yet to get a shot.

Despite that, Cohen built a strong record. Her push to contain the virus – along with Gov. Roy Cooper’s use of his emergency powers and his mandating vaccinations for state workers – has helped keep North Carolina among the South’s leaders in holding down cases and building up vaccinations. As Cooper said Tuesday, Cohen’s leadership has “saved countless lives.”

Yet, after all that effort, Cohen was there on Tuesday warning about the emergence of yet a new and perhaps more dangerous COVID variant – omicron. And even before the new variant’s arrival, COVID tests are showing a rising COVID infection rate as colder weather moves people indoors and holiday gatherings increase.

On the day Cohen announced her departure, the relentless virus remained. Her department reported 1,755 new COVID-19 infections, 26 coronavirus-related deaths, 1,131 people hospitalized and 288 COVID patients in intensive care.

At Tuesday’s news conference, Cooper hinted at his frustration with the resistance to vaccinations, especially by those frightened by social media misinformation about vaccines. He said the vaccines “are saving lives. If you don’t believe it, get off the internet and on the phone with your doctor.”

Cohen did not say what she will do next. She may well return to Washington, where she served in the Obama administration as chief of staff at the Centers for Medicare & Medicaid Services. It’s not hard to see why she might have had enough of state government. Between the anti-vaxxers and Republican lawmakers who won’t expand Medicaid or adequately support social services, North Carolina is a hard place to make progress on public health.

That demanding work is now likely to fall to Kody Kinsley, deputy secretary of DHHS. Cooper has nominated Kinsley as Cohen’s successor, pending state Senate approval. Kinsley is not a medical doctor, but he has a talent for logistics. That’s important in a state where advancing public health requires getting around obstacles.

Cohen would have preferred to have COVID leave before she did, but she nonetheless departs on a high note. She brought a rare mix of expertise, patience and charm to a hard job that was made unnecessarily more difficult.

Dr. Mandy Cohen has more than earned a rest, a change and North Carolina’s gratitude.