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.