Do you think we have seen our peak here in east Alabama?

We expected our peak last week and that is what exactly happened. We feel a little better this week, but as we continue to learn about COVID-19, we cannot forget that we still have other non-COVID situations we see on a daily basis that we have to be prepared for, including some seriously ill patients who need special, complex care. COVID-19 is not going anywhere, and as a community, we should keep our foot on the pedal in terms of social distancing. We still need to buy some time and can easily get overwhelmed if we make bad decisions.

Since reaching a high of 78 COVID positive and pending hospitalized patients at EAMC and EAMC-Lanier last Friday, the number has dropped each day. Can you share why?

Many things have likely contributed to the decline. Area schools, including Auburn University and Southern Union, closed about a month ago. This was followed by the stay-at home order in our state on April 4. Overall, I think people are understanding more and more everyday about the seriousness of the situation. I know some people were very skeptical about the seriousness of this pandemic, but they eventually realized what is going on locally and in other places like Albany, Georgia and New York City. The awareness level has reached even the most skeptical person. This is probably happening in the whole country and people have started doing the right things to flatten the curve.

You expressed a concern with families gathering for Easter. How soon before we know if that holiday will cause a spike in cases?

The average incubation period is six (6) days. Therefore, we should start seeing some new cases this week and going for the next couple of weeks.

Other than Easter, what concerns you in the weeks and months ahead?

It depends on what people do. Summer break trips and pool usage as well as school-aged students and college students visiting family members who are at high risk could bring some cases to hospitals.

Describe what you have seen at EAMC over the past 2 months.

We have been working tirelessly since January as we knew this was coming our way and we expected being one of the first in the state given the incredible diversity of our community. The month of February was really a preparation month. The challenge was clear: to prepare for something we have never seen and not much to learn from published medical literature. My first job was to help our clinicians on how to recognize these patients by symptoms and certain labs, especially with the limited testing we had.

We had to learn how to treat these patients at every level, especially those critically ill, as there was no effective proven treatment. We had to interpret, and judiciously select, some of the unproven treatments that other places were using like Washington state and countries like China and Italy. We had to develop protocols quickly and change them as we learned more about COVID-19.

The challenges of how to protect ourselves with the shortage of personal protective equipment (PPE) was also important. We had to make sure our nurses, physicians, respiratory therapists and other staff members were protected while caring for these patients, and thankfully we were successful in keeping our frontline heroes healthy.

Other than an early spring break, early testing and the cluster of patients from churches, do you have any other reasons for why our area was a “hot spot” for Covid-19?

We have a lot of diversity in our community brought by Auburn University and several manufacturing plants that have international employees. Also, our proximity to the Atlanta airport could have been an important factor. For a variety of reasons, we have a significant number of air travelers in our community that do it for work or leisure.

How do you envision church, sports, concerts and other crowd activities changing as we move past this initial wave of COVID-19?

We must understand how COVID-19 is transmitted and who is at risk to get very sick to avoid a large second wave of cases. Crowd activities could potentially cause the same or worst damage than what we saw three (3) weeks ago here. Sports will likely be postponed some and/or likely need to be played in empty stadiums or arenas at the beginning. I can see masks, social distancing (6 feet or more) and touch-free interaction between people (no handshakes or hugs) as measures we will need to do for a long time. There has been talk about identifying those who are already immune to the virus, so we can let them go outside and have a normal life first, including going to concerts and stadiums, but we are not there yet. This will need a very reliable and widely available test, which will probably not be available as soon as we all want.

How common will it be to see people still wearing masks in public a year from now?

Very common, and that is something we will need to get used to quickly. China has gone through other outbreaks and are used to it. They have already learned it does slow down transmission.

In what other ways do you think life will be different going forward?

We do not know exactly how life will be in the long term as we are not sure what this virus is going to do, but I see people wearing masks for a long time. I also think people will perform hand hygiene more than before COVID-19. The elderly and at-risk population will have to be careful and avoid dangerous situations. And the young and healthy will have to protect those populations so that when they (the young and healthy) get sick—which appears unavoidable in the long term—at least we have the ability to diagnose them (the elderly and at-risk) quickly, and have the right personnel who can take care of them with more knowledge than a month ago. That is why flattening the curve is STILL the best thing to do, especially for those at high risk for severe disease. Hugs and handshakes outside of our cohort of people should be avoided. Hand hygiene with hand sanitizers will be common practice especially in public areas. Restaurants will have to change their routines and even physical barriers between tables will be common as well as waiters wearing masks. 

Also, people have asked if we need to start doing contact tracing, where we specifically look at everyone who a COVID-19 patient has been in contact with so as to prevent the virus spreading. That is something we would be doing once the number of cases gets extremely low. Right now, there are still too many confirmed cases, and I’m sure there are still plenty of mild cases in the community that don’t reach the threshold of being tested.
In the long term, as we get out of this pandemic, we will unfortunately need to acknowledge we are at the mercy of nature and novel viruses causing outbreaks will likely happen again. Our long-term plan should include always being ready for a new pandemic.

How have you managed as the only Infectious Diseases specialist at EAMC?

Infectious Diseases specialists like myself have trained all of our professional careers to be able to respond to situations like this, however this is not a one-man fight. Selflessness is key and I have the privilege to work for an organization where teamwork is just who we are. EAMC is a family and I have been amazed at how many people have joined the ID (infectious diseases) team and the leadership team to fight against COVID-19. So many employees, and many physicians of other specialties, have played a very important role. I have never seen anything like COVID-19 in my 30-year career and have never seen the amazing response of a community hospital that have so much pride in what we do.
Physicians like myself, who got on this virus early, woke up one day in a sprint race. Now we are having to change to a marathon without a break. This is an all hands-on-deck situation for ID physicians and their hospitals, but this is our mission and we will continue to do what we do. But we need the help of many in our hospital and also the help of every single citizen of our community to beat COVID-19.