Q&A with the RMDs: Dr. Tina Stefanski

To respond to the daily public health needs of Louisianans, the Louisiana Department of Health has divided the state into nine regions. Each of these regions is led by a regional medical director (RMD) or administrator who oversees the parish health units in their region. Regional medical directors are in constant contact with state health leadership and local leaders to help guide Louisianans through the COVID-19 pandemic, particularly among key demographics.

In this Q&A blog series, these public health leaders will be answering many of the same questions, and together they will paint a statewide perspective of the COVID-19 pandemic and their communities’ response. Today, you’ll hear from Region 4’s Dr. Tina Stefanski, Regional Medical Director for the parishes of Acadia, Evangeline, Iberia, Lafayette, St. Landry, St. Martin and Vermilion.

The most common questions now are about the transition back to schools and how they will open again, safely, for teachers and students. We have been assisting public and private schools with their plans to open, reviewing our guidance with local school officials and answering their questions.

These are not just pre-opening conversations, as I fully expect to be having these discussions and addressing questions over the next several months. You have to remember: There is no playbook for this. We must be ready to deal with each new situation as it comes up. Although this will be challenging, we are committed to having schools reopen safely.

What safeguards will be put into place to limit the spread of the virus on school campuses? What is the notification process if a child or faculty does become ill? What are the triggers for quarantining students and, potentially, classes?

It is not just a school-to-parent communication. We need parents to be fully transparent and notify the school if their child is ill and if they have or may have COVID-19. This information will help us and the schools determine if there were any possible exposures in the school setting.

Earlier on, I think people did not fully understand the reasoning behind the wearing of a mask. All of that seems to be improving. It has been great to see the increase in compliance with mask wearing in our Acadiana area since the Governor’s mandate. The people of Acadiana really have responded to this preventive measure, which is encouraging.

When it comes to large gatherings, the news isn’t the same. We still see people gathering in large groups and not maintaining physical distance, especially at social events like weddings and dinner parties. We’ve had more than one report of a guest who becomes ill shortly after attending a wedding. They were contagious at the wedding and inadvertently exposed other people, who then became ill.   

Changing behavior is hard. We have a very friendly, outgoing culture here in Acadiana. The idea of social distancing is very new for all of us, but it is such a critically important piece to slowing down transmission, flattening the curve and, ultimately, saving lives.

When people test positive, feel ill or were a close contact of someone with COVID-19, they must stay home. We really need to do a better job of protecting our friends, family and community. 

A big challenge is getting the message across about the role of asymptomatic spread: people who have COVID but no symptoms, or their symptoms are very mild. They are still contagious. When people don’t feel so bad, they are often reluctant to stay home. Or, they think that their symptoms might be related to something other than COVID. With this virus, there is such a wide range of symptoms and the clinical picture is quite diverse — it really is challenging. Some people may have only a sore throat, mild headache and fatigue. Others, a cough and fever. Still others might only lose their sense of taste or smell.

When you live in a community with such a high level of viral activity — as we have now — you have to suspect COVID when you have any of these atypical symptoms. Then, stay home and monitor your symptoms. If they persist or progress, seek medical attention and testing. But, please remember to stay home while you await your test results.

While staying at home, be sure to avoid close contact with people who have high-risk conditions such as high blood pressure, heart disease, diabetes, obesity or lung problems, or those who are older than 65. Older people are more at risk of becoming severely ill or dying from infection with this virus.

It’s uplifting to hear the stories of people who have had severe cases and are fortunate enough to survive, but it’s also hard to hear of their lingering health problems.

The most upsetting thing has been the loss of life in our communities.

This is ultimately what we, as a community, need to pull together to prevent. We don’t want any other person or their family members to suffer from these sad outcomes.

On a very positive note, we have a tremendous healthcare community in Acadiana. The medical care delivered through our outpatient clinics and hospitals is top-notch. We are incredibly fortunate to the have the resources that we have here in Acadiana.

We have been busy with community-based testing. Our goal is to direct testing to the places where we are seeing higher numbers of cases, elevated positivity and hospitalizations, and to communities where access to testing may be limited. I am still concerned about the slow turnaround times, but they are improving. This is another hopeful sign.

We also remain very focused on nursing homes. As a state, we have implemented routine facility-wide testing. This helps identify cases early on and limit the spread of infection. Nursing home residents are the most vulnerable of us. We are committed to doing all that we can to protect them.

We continue to work with our public officials, medical professionals, community leaders, non-profit organizations and the general public. We are sharing information and answering questions so we all have the tools we need to protect the health of our families and communities. 

We are fortunate to have multiple, active workgroups and healthcare coalitions, well established and extremely helpful communication networks between hospitals, physicians, public health and public officials. This remains a rapidly evolving pandemic — guidance is updated, situations change — and we communicate well and often through these networks.

Q&A with the RMDs: Jeff Toms

To respond to the daily public health needs of Louisianans, the Louisiana Department of Health has divided the state into nine regions. Each of these regions is led by a regional medical director (RMD) or administrator who oversees the parish health units in their region. These public health leaders are in constant contact with state health officials and local leaders to help guide Louisianans through the COVID-19 pandemic, particularly among key demographics.

In this Q&A blog series, these public health leaders will be answering the same questions, and together they will paint a statewide perspective of the COVID-19 pandemic and their communities’ response. Today, you’ll hear from Region 8’s Jeff Toms, Regional Administrator for the parishes of Caldwell, East Carroll, Franklin, Lincoln, Jackson, Madison, Morehouse, Ouachita, Richland, Tensas, Union and West Carroll.

People have been hearing about the importance of testing so most of the questions I have been getting are about that: Who needs to get tested? Do I need to get tested? How much does it cost to get a test? Where can I get a test? Someone I work with tested positive — what do I need to do?

Relatedly, another question is about the guidance on self-quarantining and when they can return to work after staying at home.  

I do not feel that people fully understand the importance of wearing a mask or social distancing. I hear many people say there are conflicting messages about wearing a mask and the effectiveness of masks. They say they hear different things, even from respectable organizations and trusted leaders.

This is concerning because there really needs to be a consistent message from leaders, whether in public health, business or at the local or state level — study after study shows wearing a mask, especially when done while staying 6 feet away from others and washing your hands often, works.

Personally, I am seeing a decline in both the wearing of masks and in practicing social distancing. It seems there was a drop in following these public health recommendations as restrictions were eased and people began to go out in public.

In the places where people are going more often, they do not seem to be as concerned now, compared to their behavior a month ago, about using a mask or keeping their distance from others.

People either do not know the guidelines, are forgetting to follow the guidelines or are ignoring the guidance altogether. Another challenge is businesses not having the supplies they need, such as masks and gloves, to provide to their employees and to the public. 

Businesses want to accommodate the public, but do so while maintaining social distancing in their businesses, shops and restaurants. This is a challenge as they attempt to operate successfully and safely.

This new normal is frustrating people, based on what I am seeing. The new normal varies for different people and groups. For example, families of a nursing home resident have a different normal than someone who is frustrated because they are missing going to a sporting event. Many of us get frustrated when we can’t express friendliness through a handshake or a hug. And, almost everyone is having to adjust to wearing a mask.

Even though it seems many people are frustrated, it also is encouraging seeing so many people who are doing their part to try to slow the spread of this virus. 

There are too many stories to share. I don’t do social media but my wife does — so during this time I have frequented her Facebook page to read all the encouraging stories of our health heroes in our community. At the same time, there are many, many other stories of people and families who are struggling because of the drastic changes in their lives brought on by this virus. 

I have been so encouraged by the teamwork and partnerships I have seen in this response. So many of our community partners have joined together for this effort.

These partners include the hospitals, clinics, community health centers, nursing homes, parish governments, emergency response agencies at the local and state level, local and state officials, the National Guard, area businesses and so many more who are working together in an inspiring way.

Q&A with the RMDs: Dr. Martha Whyte

To respond to the daily public health needs of Louisianans, the Louisiana Department of Health has divided the state into nine regions. Each of these regions is led by a regional medical director (RMD) or administrator who oversees the parish health units in their region. Regional medical directors are in constant contact with state health leadership and local leaders to help guide Louisianans through the COVID-19 pandemic, particularly among key demographics.

In this Q&A blog series, these public health leaders will be answering the same questions, and together they will paint a statewide perspective of the COVID-19 pandemic and their communities’ response. Today, you’ll hear from Region 7’s Dr. Martha Whyte, Regional Medical Director for the parishes of Bienville, Bossier, Caddo, Claiborne, DeSoto, Natchitoches, Red River, Sabine and Webster.

The questions people are asking have to do with: “When will this be over?” They ask about the increase in the number of new cases and why we are seeing these increases. They really thought we were past this — that COVID had ended.

Then, when they hear the news about cases going up, they ask why aren’t people doing more, why aren’t they wearing a mask and why are they crowding into restaurants, stores and bars? They also want to know why so many places allow so many people in at one time. They know to avoid crowds but are looking for someone to enforce the restrictions on the number of people allowed in one place at one time.

And now with the increase in cases, people are asking where to go to get tested. All of a sudden, almost everyone wants a test.

People understand that they are supposed to be wearing a mask, but the act of wearing a mask has become very political. Many people are trying to make a statement by wearing or not wearing a mask.

The requirement to wear a mask when in public is based on recommendations from doctors and experts both in our state and around the world. It is not about politics. Experts have said over and over that wearing a mask and staying 6 feet away from others when in public are actions we can all take to stay safe and help end this pandemic.

It is crazy that some people view something as simple as wearing a mask — while there is an ongoing health risk — as a political statement. I hope that we can get to the point where we all understand that wearing a mask is a small inconvenience that we all can do. It is a selfless act that benefits our loved ones, coworkers and communities. 

I understand that people are tired and ready to get out again and interact with friends and family. However, we need to be smart, and too many people see some businesses reopening as an indication that we are free of the virus.

We need to remember that just because we succeeded in flattening the curve early on does not mean the virus went away. It is still here, it is highly contagious and it is especially dangerous for older people and people of all ages with conditions like diabetes, obesity and hypertension.

It concerns me when I see or hear of people going to crowded places and standing shoulder to shoulder. Close contact is especially dangerous. Not wearing a mask in public is dangerous. Because some of our residents did not follow these precautions, we are seeing a dramatic increase in new cases throughout the state. This is not at all surprising given what we know about how easily this virus spreads.

In our region, it remains a challenge to get people to really understand the current situation — that the virus is still around and it is still dangerous. How do we get people to act on this information and do the right thing when they are so anxious to get out of the house and resume their normal activities?

I find that older people tend to heed public health advice more so than younger people. Those who know they have health issues are cautious about when they go out and where they go. Younger people, perhaps seeing themselves as invincible, or hearing that their peers are not getting too sick, are willing to take a bigger risk.

Of course, this is not unique to COVID. It is part of the mindset of young people when it comes to many things — because they do not think they will get sick, or if they do, it will not be a big deal. The reality is that most of our recent cases are among young people. We also see some young people experiencing serious complications, and what makes that especially troubling is we really don’t know the long-term complications of the virus yet. 

One of my younger friends told me a story about going to a birthday party. When she got to the party, she saw that the place was packed. She looked for a way to judge the airflow, believing it would be safer if there was air movement. Ultimately, she left the party because she didn’t feel comfortable and decided it wasn’t worth it. She did the right thing.

Other people have told me the same thing: places jammed with people shoulder to shoulder, talking loud and laughing. Many restaurants have not removed tables or spaced them farther apart or marked off some areas to limit seating. In some places, even the staff are not all wearing masks.

Businesses are required to protect employees and staff by limiting occupancy, ensuring 6 feet of distance between parties and requiring employees and customers to wear masks, among other measures. If you are concerned or have questions about these requirements, you can 211.

From individuals to businesses to local leaders, we all have to do our part. If we can all do what is needed, we can reduce the number of cases, reduce the number of deaths and better protect everyone’s health. 

I was very saddened to hear about a couple who recently got married. No one wore a mask and the guests were all close to each other. Both the husband and wife got the virus and they had to cancel their honeymoon. That’s how they started their new life together. What should have been the best time of their lives instead started with each of them being sick.

We have all read the stories about other families where one person gets sick and dies. Too often, the person didn’t even have the risk factors. People think that because they are healthy, they won’t get sick.

My husband was sick from the virus and was in the hospital for almost two months. He was in isolation, but he could see whenever someone in the hospital died and their body was rolled out past his room. He was dismayed and saddened each time he saw this. 

Our biggest challenge is how to re-engage people, how to convince them that we’re not out of the woods. I don’t know the answer, but we are developing public service announcements using prominent voices from our communities, hoping that people will respond and wear a mask when it is being promoted by people they know or trust.

I am also concerned about our rural areas. We don’t have many cases in these less-populated areas, but we are seeing some cases. I worry that people who live farther away from one another are not as aware of the risks as they need to be.

Q&A with the RMDs: Dr. Lacey Cavanaugh

To respond to the daily public health needs of Louisianans, the Louisiana Department of Health has divided the state into nine regions. Each of these regions is led by a regional medical director (RMD) or administrator who oversees the parish health units in their region. Regional medical directors are in constant contact with state health leadership and local leaders to help guide Louisianans through the COVID-19 pandemic, particularly among key demographics.

In this Q&A blog series, these public health leaders will be answering the same questions, and together they will paint a statewide perspective of the COVID-19 pandemic and their communities’ response. Today, you’ll hear from Region 5’s Dr. Lacey Cavanaugh, Regional Medical Director for the parishes of Allen, Beauregard, Calcasieu, Cameron and Jefferson Davis.

I receive lots of questions regarding testing. Who should be tested? When should they be tested? What type of test should be used? What does the result of that test mean? The challenge here is that this area has rapidly changed since the onset of the pandemic, with new test types becoming available and new sets of people being tested as supply changed. In addition to guidance changes, people receive mixed messages. I usually recommend that people consult with their individual doctors to determine what test is appropriate based on the situation, and always consult CDC or LDH guidance because it is ever changing. However, in general, PCR testing (the nasal swab) is what tells us if you have the virus RIGHT NOW. PCR testing takes a few days to become positive, so if you were exposed yesterday and get a PCR test today, that’s not very useful. Antibody testing (fingerpick or blood draw) tells us if you have been exposed to the virus in the past — but it can take weeks after exposure to turn positive. We also don’t know that this means you are immune, so these test types are more for curiosity than for serving a medical purpose right now. They should definitely not be used to justify return to the workplace.

I think many people do understand the importance and want to follow guidance. I see people being more understanding during times when the number of cases locally is high, and I have seen increases in mask wearing and social distancing since our cases started to increase. There are also those people who choose not to follow guidance for a variety of reasons. My advice is to follow guidance from reputable sources — many of the reasons cited for not wearing masks come from social media and are not backed by science. Just as with anything else, people should be really cautious in receiving advice from social media.

I have seen challenges in social distancing and mask wearing. It’s hot outside. Masks are uncomfortable. People are tired of COVID. These are all real challenges. I do think that people in Southwest Louisiana care deeply about our community and want to do the right thing. I think we can continue to improve here, and I am seeing some improvement since our cases started to rise.

One of our biggest challenges is our culture. In Southwest Louisiana, we are a small town at heart. Friends and family, gatherings, food, parties and festivals are part of our core sense of identity. We are proud of our roots and social culture, and this makes it difficult to properly socially distance. It’s hard to change community norms when gatherings are such an important part of our lives. The longer COVID is with us, the more difficult this has become. I encourage us to find new and safer ways to gather and celebrate. I don’t think social distancing and celebrating are incompatible, but I do think we will need to find different ways to do both simultaneously in the near term.

It strikes me that this virus has gotten so personal. It’s hard to even go into the grocery store without seeing people I know who have been impacted by COVID in some way. Everyone has had a different challenge, but COVID has challenged everyone in some different way. There isn’t a person I know untouched by the far-reaching effects of this virus. People are handling it as best they can and trying to stay positive, and are understanding that we have a long way to go before recovery.

One situation that really made me smile is the medical community coming together and stepping up to the plate to organize a drive-thru testing site. It took coordination and cooperation from several local hospitals, the Office of Public Health, parish leadership, local labs, the Louisiana Army National Guard, EMS and many others. I am proud that we could all work together as a community to accomplish standing up that site with limited supplies, limited PPE and limited time. It was a true testament to the power of strength in numbers and working together.

Stay strong, SWLA! I know it’s hard, but I have confidence that we will get through this.

Q&A with the RMDs: Dr. William 'Chip' Riggins

To respond to the daily public health needs of Louisianans, the Louisiana Department of Health has divided the state into nine regions. Each of these regions is led by a regional medical director (RMD) or administrator who oversees the parish health units in their region. Regional medical directors are in constant contact with state health leadership and local leaders to help guide Louisianans through the COVID-19 pandemic, particularly among key demographics.

In this Q&A blog series, these public health leaders will be answering the same questions, and together they will paint a statewide perspective of the COVID-19 pandemic and their communities’ response. Today, you’ll hear from Region 3’s Dr. William “Chip” Riggins, Regional Medical Director for the parishes of Assumption, Lafourche, St. Charles, St. James, St. John, St. Mary and Terrebonne.

I get questions about the number of cases in the community from many folks I meet. I always refer them to the OPH Dashboard but they are most interested in the experience in their specific neighborhood. I remind them about the need for confidentiality and how easily that can be broken when we get too far down and the numbers are low. For most purposes, I think parish-level data is really sufficient to make decisions around our daily lives. If it’s in the parish, it’s not very far away — especially since the majority of our region’s land mass is swamp or marsh.

I think folks are aware of the recommendation but they may be confused by the differences, even when subtle, in the messages they are hearing and the examples they are seeing. Those who have personally had COVID-19 disease or know someone who has been ill or died are the most clear on the importance of social distancing and masks.* That is always the case.

Old habits are hard to break, and I see a lot of effort to create safe spaces with signage and markings on the floor, with sanitizer, wipes and masks, sometimes being observed and sometimes being overlooked. The trend I’m seeing is that while everyone struggled to safely be open or re-open, the larger facilities and chains have come the farthest in terms of their adjustments — not surprising. The smaller businesses and unaffiliated organizations like churches have wider variation in their plans and processes but I have seen some really innovative things in smaller spaces, too.

I think one of the biggest challenges is overcoming the expectation, that as a community, we have to be either fully open or fully closed. I see our new normal as a balancing act between opening up until the data shows the disease is spreading again and then slowing down or even backing up in our reopening if necessary until the disease slows. Fighting COVID-19 reminds me of riding a unicycle: it requires a lot of minor adjustments, and that means a lot of minor changes to our recommendations. It’s not as easy to follow constantly changing recommendations, but that’s what’s going to help us flatten the curve over the months ahead until we get a vaccine. I am afraid that if we all don’t commit to constantly watching our community’s data, and making the minor changes and respecting the limitations in each of the phases of reopening, we could see much larger swings in disease rates again — and no one wants to see that.

We are proud of our friendliness as a community here down the bayou, and there is a reluctance to correct others or address issues like social distancing and masks with each other. I think we maybe we are going to have to all try to thank the folks we see doing it well and use our friendliness to emphasize the positive.

On one of our early regional ESF-8 calls, the nursing home rep reported that many residents were distressed (and depressed) by not being able to leave their rooms and even walk a little. Within a week or so our social services representative had linked seamstresses in the region to the mission, and each and every nursing home resident in this region was provided a cloth mask of their own — amazing!

Our region has the fewest hospital and ICU beds and ventilators per capita in Louisiana. That means that our region is more vulnerable to having this virus overwhelm our emergency rooms, hospitals and healthcare system. Flattening the curve in our region truly means saving more lives than just the victims of COVID-19 — it means having the capacity to help those with other disease and injuries and saving those lives as well.

*According to the LSU Manship School Survey of Public Reactions to Coronavirus in Louisiana (June 2020), those with personal experience are the most risk adverse/compliant with social distancing and wearing masks.