Friday, February 21, 2020

In the event of an emergency ...

By BOB JOHANNESSEN | Bureau of Community Preparedness Communications Consultant, LDH Office of Public Health

As COVID-19, a relatively new coronavirus, spreads throughout China, it has the attention of world, U.S. and local health officials, as well as around-the-clock news coverage. We recently sat down with Dr. Frank Welch, medical director for emergency preparedness at the Louisiana Department of Health, who directs and coordinates all aspects of infectious disease planning and response activities for Louisiana.

We asked Dr. Welch about the planning and response to COVID-19 at a time when Dr. Welch’s team was also responding to five concurrent outbreaks of infectious diseases: seasonal flu, hepatitis A, mumps, norovirus and chicken pox.

Is it unusual to have so many outbreaks under investigation at the same time?

Dr. Frank Welch
It’s not unusual to have outbreaks and there is no relation between the ones Louisiana is experiencing. The fact they are all occurring at once is coincidental. Interestingly, though, several of the outbreaks we are seeing today have unique features.

Hepatitis A, for example, is a disease that that we usually only see a few cases of a year, typically confined to specific people or to food. It is uncommon that we have been seeing so many cases for more than a year, reaching epidemic proportions in a very specific population. For context, over the past 10 years, an average of nine cases are reported each year. Today’s ongoing outbreak is almost 800 cases.

With mumps, the vaccine is about 90% effective, so we typically see only a case or two a year. In the past, outbreaks have been rare, but today, we are regularly seeing mumps outbreaks on college campuses.

Norovirus behaves like other new and unique outbreaks like SARS and N1H1 (swine flu). For these outbreaks, anytime there are a lot of people in close spaces, and someone is sick, an infectious disease can spread pretty quickly.

From a preparedness standpoint, can the Department devote, or have enough resources to adequately address all of these outbreaks at one time?

Yes, and no.

Yes, we have been preparing for about 20 years to be ready to respond to many hazards and emergencies, not just for infectious diseases. Over this time, we have built a strong emergency response infrastructure. This means that when it comes to a new disease such as COVID-19, we are not starting from scratch. Instead, we only have to build upon the existing structure for the new, specific issue.

No, because building upon the existing structure can sometimes be challenging because it requires human resources and additional funding. There is a limit to what we can do ourselves, but the federal government has always been there to assist. In the past, the feds have recognized there is additional work and added costs, and they have provided us and other states more money for the response.

How do you prioritize resources?

Within the Office of Public Health, we have a continuity of operations plan that lets us identify essential, critical operations that we need to do, and the responsibilities that we can put off or place to the side for a while. For this planning, we follow the federal guidelines for continuity of operations. This is important to our ability to respond to an emergency, recover afterwards and then catch up when the crisis is over.

Of the recent outbreaks, which one should we be most worried about? And, why?

We should be most worried about the flu. This really is the severe, contagious illness that needs to be taken seriously. Millions of people get the flu every year — about 20% of the population.

According to the CDC, the flu has already caused more than 2,000 deaths this season, and Louisiana has seen heightened flu activity every week since flu season started last fall. But, the flu is vaccine-preventable, vaccine-mutable. From my perspective, we need to focus on the diseases that are most serious, while still having the ability to respond to other concerns like COVID-19.

How dangerous is COVID-19 compared to the flu or to other viruses?

We aren’t yet sure how quickly COVID-19 can spread. However, it appears that for every person who becomes infected, they can spread it to three other people. For comparison, every person who gets norovirus can spread it to 9 to 10 other people. By this measure, norovirus spreads three times as much as COVID-19.

My prediction for COVID-19 is that it will mutate itself out, or fail to adapt to new environments, like SARS, an earlier coronavirus. Or, it might eventually slowly spread throughout the global populations. The strategy of health officials is to slow the time it takes for the virus to enter the U.S., allowing time for effective treatments and vaccines — in other words, allowing time for more tools to be developed to fight it.

As an example, H1N1 started in the U.S., migrated globally, but is now part of the common flu.

How worried should the general public be about COVID-19?

If and when the virus gets to the U.S., the best strategy to keep from getting sick are the same strategies to prevent getting the flu: wash your hands frequently and keep your distance from others.

Given how rapidly norovirus recently spread through Southwest Louisiana, can we expect the same from COVID-19?

This depends on several things. First, the ability of the virus to spread. Remember, it appears that one-person sick with COVID-19 can spread it to three other people.

The second thing is the sick person must be in close proximity to someone else.

In China, the city of Wuhan is small in area but has 11 million people. There are a lot of people living and working very close to one another. This has allowed the virus to spread rapidly. You should also remember that it started during the Chinese New Year when there were large crowds of people. This is probably why it spread so quickly.

It is different in Louisiana where we are not nearly so crowded. We have lots of wide open spaces, and to find a crowd of people, you have to actively seek out the crowd. This makes it unlikely that we’d see the same rate of transmission in Louisiana as we’re seeing in Wuhan.

If you could advise the general public to do only one thing to protect themselves, what would that be?

As I said earlier, you need to keep your hands clean and keep your distance from others. Infectious diseases such as the flu, norovirus and COVID-19 all spread person to person. So, the best things to do are to stay away from sick people, cover your mouth, wash your hands and stay home if you are sick. This is the best prevention for any infectious disease. You should also call your doctor if you are sick and follow your doctor’s advice.

Why do some people seem to worry about COVID-19 more than they worry about the flu?

Anything that is new and different captures media attention, as well as the attention of the CDC and the world health organizations. All of this attention elevates the idea that this is something new and different and more dangerous.

In fact, a recent article in the New York Times said this illustrates an unconscious bias in how humans think about risk … we are conditioned to focus heavily on new threats, looking for any cause for alarm. We might obsess over the scariest reports and worst-case scenarios, making the danger seem bigger than it actually is. Where COVID-19 is new and different, the flu, in comparison, is seen as old and somewhat boring. It doesn’t capture the 24-hour news cycle, and, therefore, it is not as glamorous.

Anything that is seen as new and different gets an elevated public profile. It might not be all that serious, it’s just different. 

Friday, February 14, 2020

Coronavirus, 2019-nCoV, COVID-19: Separating fact from fiction


By DR. ALEX BILLIOUX | Assistant Secretary, LDH Office of Public Health

In its short lifetime, the disease most recently spreading fear across the globe has gone through several names: novel coronavirus, 2019-nCoV and now, finally and officially, COVID-19. By now, you’ve heard all about it online, in the newspapers and on television. With so many sources of information, it can be easy for falsehoods to spread like wildfire and be taken for the gospel truth. Before looking at why some of these falsehoods are wrong, let’s get educated about this disease.

About COVID-19

Source: CDC's Public Health Image Library
COVID-19, or coronavirus, is a virus that causes respiratory illness in people and can spread from person to person. It was first identified in Wuhan, China, where an outbreak of pneumonia-like illness of an unknown cause began in December 2019. The coronavirus name refers to the crown-like spikes on its surface, and “corona” means “halo” or “crown” in Latin.


The virus has been spreading from person to person in China and, through travelers, limited spread in some countries outside China, including the United States. As of February 13, the U.S. has just 15 cases of COVID-19 and the threat to the general public remains very low.

COVID-10 is similar to flu in that it is most often spread from person to person within 6 feet, mainly through the respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of nearby people who then inhale the virus into their lungs.

Reported illnesses among people who are confirmed to be infected have ranged from little to no symptoms, to severe illness and death. Symptoms include fever, cough and shortness of breath/difficulty breathing. These symptoms may appear within as few as two days or as long as 14 days after exposure.

Now that the basics are covered, let’s stamp out some misinformation.

Myth busters

MYTH: Coronaviruses are new.
REALITY: COVID-19, which is currently circulating, is a new strain derived from an ancient family of coronaviruses that were first identified back in the 1960s. Think of it as a new branch suddenly growing on a very old tree. The tree has been there for years and years, but that new branch only sprouted recently.

MYTH: COVID-19 is currently the top public health threat in Louisiana.
REALITY: There are no confirmed cases of COVID-19 in Louisiana. You are far more likely to get the flu than COVID-19. Louisiana’s flu season began way back in August, hitting particularly hard, and shows no signs of stopping anytime soon. We are still seeing widespread flu activity across the state and are 6.7% above the national baseline.


Help prevent respiratory viruses like flu and COVID-19 with these simple everyday actions:
  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose and mouth with unwashed hands.
  • Wash your hands often with soap and water for at least 20 seconds.
  • Use an alcohol-based hand sanitizer that contains at least 60% alcohol in addition to washing with soap and water.

One more preventive measure: Get your flu shot. It doesn’t protect against COVID-19 but it’s still really important to get one, and here’s why: If you didn’t get a flu shot and then you got the flu, which is a respiratory illness, your body would be more vulnerable to other respiratory illnesses such as COVID-19. So, get that flu shot. They’re available at no cost at any parish health unit. Local pharmacies, clinics, doctors’ offices and federally qualified (community) health centers also have flu shots available. To find a flu shot provider near you or for more flu information, click here.

MYTH: Ordering or buying products shipped from China will make a person sick.
REALITY: It’s totally safe to receive packages from China because coronaviruses such as COVID-19 do not survive long on objects, including letters and packages. This also means food and clothing cannot spread COVID-19.

MYTH: Pets can spread COVID-19.
REALITY: There’s no evidence that pets can be infected with COVID-19. However, keep in mind that you should always wash your hands with soap and water after having contact with pets. Hand washing will protect you against E. coli and salmonella, which can be passed from pets to humans.

MYTH: Drinking Corona beer will cure COVID-19.
REALITY: Nope. Just, nope. Having one or two might help you relax, but always drink safely and in moderation.

The bottom line

As a public health official, a doctor, a husband and a father, I understand the worries out there around COVID-19. Just remember these three things:
  • The threat to Louisiana is very low.
  • Practice everyday actions like hand washing.
  • Get your flu shot.

And, should COVID-19 show up in Louisiana, the Office of Public Health in coordination with the Governor’s Office has planned extensively in advance. We’re ready to spring into immediate action, dedicated to keeping you safe and healthy.

Thursday, February 13, 2020

The Louisiana Department of Health celebrates Black History Month 2020

Each year, the Louisiana Department of Health uses Black History Month as a time to look back and reflect on the contributions of black pioneers in medicine and the impact they've left on the industry and the country as a whole.

This year, the Department is focusing on pioneers born in or who have spent the majority of their lives and careers in Louisiana.

Vivien Thomas

The life of Vivien Thomas is an inspiring story of an African-American pioneer who overcame the barriers imposed by a segregated society. With no formal medical training, he developed techniques and tools that would lead to today's modern heart surgery. In operating rooms all over the world, great surgeons who received their training from Vivien Thomas are performing life-saving surgical procedures.

Read more here (Source: Morehouse School of Medicine).


Dr. Sandra L. Robinson

Dr. Sandra L. Robinson served as the secretary and state public health officer of the Louisiana Department of Health, then known as the Louisiana Department of Health and Human Resources, from 1984 to 1988. Appointed by Governor Edwin W. Edwards, she was one of the first two black women to serve as a cabinet secretary in Louisiana.

Friday, February 7, 2020

Mardi Gras isn't the only thing on a roll during flu season


By DR. FRANK WELCH | LDH Immunization Program Director

It’s Louisiana, and it’s February. You know what that means: laissez les bon temps rouler. When you’re reaching your hands to the sky on those Mardi Gras parade routes, which would you rather catch: those prized throws and beads … or the flu?

Louisiana is still deep into flu season, which began all the way back in August, and those big Mardi Gras crowds provide ideal conditions for flu to spread. Flu activity in the state has increased over the previous week and remains more than double that of the regional baseline. About a quarter of tests reported by clinical laboratories in Louisiana are positive for flu.

Every year, there are about 500 deaths and nearly 3,000 hospitalizations in Louisiana due to the flu. Many are preventable simply by getting a flu shot.


Catch beads, not the flu

The flu shot takes about two weeks to go into full effect, so now is the time to get yours, to make sure you’re catching beads instead of the flu this Mardi Gras. The flu shot reduces the severity of illness and complications, meaning there’s less chance a person with the flu would be hospitalized, or if hospitalized less chance that a person would go to the ICU. The vaccine also protects those around you, including young children and older adults who are at higher risk of developing severe flu illness or even death.

The flu shot is especially recommended for babies and young children, pregnant women, people with chronic health conditions and people 65 years and older — essentially, everyone 6 months and older except those with a medical reason not to be vaccinated.

The flu vaccine isn’t a perfect defense and is the target of plenty of falsehoods; you can read accurate information about these myths here. It is true that some people who get a flu shot may still get the flu, but the good news is that the flu shot lessens the symptoms. The fact remains that the flu shot is your best defense against getting and spreading the flu.

Symptoms and treatment

The flu shows up abruptly, with these symptoms:
  • Fever
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Body aches
  • Headaches
  • Chills
  • Fatigue
  • Diarrhea
  • Vomiting

Most people recover from the flu on their own with plenty of fluids, rest and over-the-counter medications or antiviral drugs, if prescribed. If you have had the flu, stay home for at least 24 hours after the symptoms subside, unless you’re very sick and in need of medical care. If you or a family member may have the flu, call your doctor immediately.

Stop the spread of flu
  • Avoid close contact with people who are sick.
  • If you have cold symptoms or have fever greater than 100.3, stay away from others until you have not had a fever for 24 hours.
  • Call your doctor immediately to see if an antiviral medication is appropriate for you.
  • If you are sick, do not visit vulnerable loved ones who may be receiving care in a hospital, nursing home, cancer center or other setting.
  • If you are sick, do not kiss babies, pregnant women, grandparents and others who may be at a higher risk of getting sick.
  • Cover your cough and sneeze.
  • Try not to touch your eyes, nose and mouth.
  • Wash your hands frequently.
  • Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

Learn more about how to fight the flu here.

Flu shots are available at no cost at any parish health unit. Local pharmacies, clinics, doctors’ offices and federally qualified (community) health centers also have flu shots available. To find a flu shot provider near you or for more information about flu, visit ldh.la.gov/fighttheflu.

Now, let the (flu-free) good times roll!

Friday, January 31, 2020

Your annual Mardi Gras reminder to not drink and drive


By DR. DAVID J. HOLCOMBE | LDH Region 6 Medical Director

Alcohol-related accidents took the lives of more than 10,000 people in the U.S. in 2018. (In the same period in the European Union (EU), that figure was closer to 6,000.) That same year in Louisiana alone, there were more than 200 alcohol-related deaths. In December 2018, more than 800 people died in the U.S., 285 of them during the holiday season. This most recent year’s totals have yet to be compiled. It is estimated that drunk driving accidents cost $132 billion each year, at least half of that in cost related to lives lost.

The legal blood alcohol concentration (BAC) in the U.S. is 0.08%, while in the EU BAC levels vary. Malta and the United Kingdom match the U.S., while most of the other European countries have lower levels closer to 0.05%. In Scandinavia, the BAC level drops to only 0.02%. Contrast those countries with the Czech Republic (one of the heaviest consumers of alcohol per capita), Hungary, Slovakia and Romania, where the BAC is zero.

Drunk driving obviously results in avoidable accidents, injuries and death. Although prevention is the best medicine, American law and order hopes deterrence with stiffer consequences also plays a role. Most states in the U.S. — and most countries in Europe — have sharply increased penalties for BAC levels exceeding the minimum level. This also occurs in Louisiana, where fines and penalties increase after a BAC of 0.15% and rise even higher at or above 0.2%. This results from data showing increased consequences for accidents as BAC levels increase any place in the world.  

Efforts to address this issue have resulted in significant drops in alcohol-related deaths over the last decade, both in the U.S. and the EU (around 40%), yet much progress remains. While a 0.00% blood alcohol threshold level seems unlikely in the U.S., there may be some movement in that direction with incremental decreases. Use of designated drivers, ride sharing or public transportation, and community vigilance through reporting all prove helpful. If you see something, say something.

Sobriety checks and zero-tolerance policy for drunk drivers always ramp up during holiday seasons, including Mardi Gras. Everyone should be aware of Louisiana’s Drive Sober or Get Pulled Over campaign. Like the U.S., the EU has addressed the problem by reducing the threshold for penalties in numerous countries while also increasing enforcement, public awareness-raising, mandating alcohol rehab programs and the use of alcohol interlocks.

If you are walking at any time but especially during Mardi Gras:
  • Remain hyper-vigilant.
  • Use sidewalks if possible.
  • Walk facing traffic.
  • Always cross at crosswalks.
  • Wear light or reflective clothing.
  • Don’t use your cellphone while walking. Distracted pedestrians are at higher risk, just as distracted drivers, especially if alcohol or other substance use is involved.

A holiday without alcohol is never the end of the world, but a holiday with excessive alcohol — mixed with driving or even walking — might well be just that, this year or next.