ON BECOMING STATE HEALTH OFFICER IN THE MIDDLE OF A PANDEMIC I come on the heels of Dr. Jimmy Guidry, who dedicated about 35 years of service to the state, so I have big shoes to fill. I had been working for the Department of Health for about two years as the Medical Director for Region 1, which includes the New Orleans region, and as the Assistant State Health Officer under Dr. Guidry. So, it was a natural progression. I look around at my colleagues in the Health Department and while it’s a lot of work with COVID, and people are stretched quite thin, I think there is a common sense that this is really what we are trained to do. I think people are finding themselves rewarded in that they are able to provide for the community more now than they ever have, and that’s a pretty powerful sentiment to hold—even though these have been the most challenging 12 months that anyone could ever imagine. ON 12 MONTHS IN We’re exactly 12months in. We had our first case diagnosed in Louisiana on March 9, 2020. We have recently hit the anniversary of that. I think some things have gone as fairly as we expected. Some things certainly have not. That said, I feel that we are in a new phase now, and we can clearly see how the pandemic ends. We can see the goal line, if you will, and now it’s just a matter of holding strong until we get there. Right now, we have about 16% of the population of Louisiana that has at least initiated the vaccine series now. That’s not an insubstantial number. That’s not herd immunity, but it’s a really good base to build on, and the vaccine supply is only going to pick up. It really is exciting to think that in two or three months, we’re going to have substantially more vaccine coverage than now. We’re going to be on much better footing. The challenge is to be able to get there intact and to be able to keep transmission down until we get there, especially with these variants circulating.
ON VACCINES AND VARIANTS It is possible that we will need a booster shot. I don’t think that will happen in the next few months, but I think that’s something that could come at the end of this year, perhaps sometime next year. It’s certainly possible. One of the attributes of these Messenger RNA (mRNA) vaccines is that it is relatively easy to create alterations in the vaccine to accommodate a booster to provide protection against the new variants. Taking a step back from that, if COVID transitions from a pandemic to an endemic, it is something that will be with us but not in a way to significantly alter life the way it is now. If we can keep it minimized by taking a booster every year or every two years, that’s okay. That’s how we do it with the flu and other viruses. It’s much better than living under a pandemic. It’s still a win.
I think it’s very important to remain grounded like that. For me, personally, it’s important to never give up the practice of medicine because it’s something I hold dear and is a privilege. ON BEING IN NEW ORLEANS AS COVID EVOLVED Well, I’m takingmyself back tomid-March and April 2020, in my mind. It was a scary time. Clinically, in a sense, we were flying blind because we didn’t have a great understanding of how to treat COVID patients yet. At that point, we thought it was advantageous to intubate early. That turned out not to be true. All of those things were challenges. You are humbled very quickly when you get thrown something in medicine you have never seen before. That was certainly applicable then. I have never been prouder of my physician colleagues, as well as, nurse colleagues and other support staff than I have throughout COVID. They all stepped up, and their primary goal was to care for patients and save lives, and they did so under risk to their own bodies. The conditions in which clinicians had to work under, particularly during those early days of COVID were austere, to say the least. I have very vivid memories of reusing N-95 masks days and weeks on end; wiping down plastic gowns – which are intended to be single-use and disposable – multiple times throughout a day’s work. My colleagues have really shown what drives them, which is to provide care, no matter how difficult circumstances are. The public did a good job of thanking us, and it was nice that they saw it and said it. I think most clinicians thought so, too, but the real sentiment was… it’s nice to be thanked, but just get us PPE. ON PPE It took some time, but it is there now. It’s humbling and off-putting at the same time to think how a country as rich as the United States can be put in such a situation, to be so ill-prepared and scrounging around for PPE to keep their doctors safe. It really is not something that a lot of people thought would have been possible. This has been a humbling experience, and I hope we can come out of this better prepared for the next time. ON BEING PREPARED NEXT TIME I think we invest. We invest in preparedness. We invest in public health. We listen to physicians and nurses about what vulnerabilities are there. It was no secret that the US was vulnerable to the pandemic. It had been spoken about many times. There was a disconnect that recognized vulnerability and thewillingness of policymakers to directly appropriate resources. But if you talk to the infectious disease colleagues, for example, it was no secret or surprise
IT’S HUMBLING AND OFF-PUTTING AT THE SAME TIME TO THINK HOW A COUNTRY AS RICH AS THE UNITED STATES CAN BE PUT IN SUCH A SITUATION....
at all. It was just a matter of when. I hope we take some lessons from this and learn to listen to the medical and public health community about what vulnerabilities exist, and as a community, decide that it’s worth the money to invest ahead of time. ON THE LONG-TERM IMPACT TO THE PRACTICE OF MEDICINE That’s a really great question, and I don’t know the answer. I do think we will be more conscientious about infection- control practices. I think we will be more conscientious about slowing the transmission of whatever the infectious agents may be, but I don’t think we really know yet what all the impacts will be. ON TELEMEDICINE GROWTH AND USE Telemedicine played a huge role and grew more than anyonecouldhaveexpected.Without question, it continues as an adjunct, not as a replacement. Going virtual doesn’t just apply to medicine – I think all types of industries and businesses are now recognizing the potential of virtual work and thinking about how to integrate it into post- COVID life. Medicine should be no different. Telemedicine is a tool that can augment clinical care. It can overcome some of the barriers that exist, such as individuals who are rural, individualswho are homebound, or individualswho require frequent checkups, and it can help clinicians reach patients in a way that they haven’t been able to before. However, it certainly does not and will not ever suffice for the in- person visit. It’s an addition. I’m actually pretty excited about finding new ways to integrate it. It really is going to be a significant tool, so I think people shouldn’t shy away from it. It’s going be with us from here on out, and it’s going to be on us as physicians to figure out how to make it worthwhile. ON HOWWE MANAGE SOCIAL MEDIA There is a great deal of information and misinformation shared through social media. The one part in all of this that gives me comfort is that when people rank the most
ON BEING AN ER PHYSICIAN AND CONTINUING TO WORK IN THE ER
It’s important to me to understand what the challenges are on the ground level. It’s especially important to me to maintain my clinical skills and acumen and to have a first-hand understanding of how policies that are instituted through the Health Department actually pan out in people’s lives. The emergency room is a great laboratory for that because all items that fall through the cracks of society or that don’t get adequately addressed show up in the ER. Whether it is addiction, domestic violence, homelessness, or any other issues that the Department of Health seeks to address, you really see the fallout of that first-hand in the ER from a policy perspective. It helps keep me grounded. It helps give perspective on what’s working, what’s not working, and where the Department of Health needs to focus energy.
IT’S IMPORTANT TO ME TO UNDERSTAND WHAT THE CHALLENGES ARE ON THE GROUND LEVEL.
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J LA MED SOC | VOL 173 | SPRING 2021
J LA MED SOC | VOL 173 | SPRING 2021
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