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

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.

Friday, January 24, 2020

Lean Six Sigma: Louisiana Department of Health's quality improvement quest

By KEVIN LITTEN | LDH Communications Specialist

For the Louisiana Department of Health’s Mendy Richard, a passion for quality began at the State Police Crime Lab in 2010, where there was a massive backlog of DNA tests that waited as long as 260 days for analysis.

Richard was given a challenge: eliminate the 1,700-case backlog with no additional staffing and no outsourcing. She and her team did it in a matter of months, using a conveyor belt-type process using strict standards for the pace of all activities. The project cut the turnaround time to 14 days.

While the project was a lot of work, Richard said, it was made easier using a process first perfected in the manufacturing sector called Lean Six Sigma. This process aims to eliminate waste while accepting no defects.

Mendy Richard, the deputy assistant secretary of the Office of Public Health,
holds a box of green and yellow karate belts. The belts are awarded to
trainees who successfully complete different levels of training in the Lean Six
Sigma quality improvement program.
Now Richard, the deputy assistant secretary of the Office of Public Health’s Center for Community Preparedness and Health Protection, is deploying Lean Six Sigma across the Louisiana Department of Health with advanced training for team members. The training empowers its participants to lead their own teams, finding solutions to problems in their bureaus. The 14 advanced Lean Six Sigma graduates are now using their skills to reorganize processes, eliminate rework and rethink how Department of Health team members do their jobs.

Continuous quality improvement

The “Six Sigma” system was first developed at Motorola to ensure quality of products, and “Lean” was developed at Toyota to reduce waste. After the State Crime Lab experience, Richard realized that the Lean Six Sigma methodology, which had been combined into a single improvement program, could apply to government as well.

Richard landed at the Louisiana Department of Health after completing improvement projects across state government, and began using the same methodology for new challenges that had some pretty serious consequences: The Office of Public Health was at risk of rejecting many of the specimens it was receiving from across the state because of tightened federal standards around temperatures in specimen storage and transport.

Federal authorities were holding Public Health officials accountable for keeping specimens within their prescribed storage temperatures, with some ranges between 2 and 6 degrees Celsius. If the temperature went higher or lower during transport to the lab, the specimens weren’t valid.

With those specimens being driven across the state in courier vehicles, Richard quickly realized that she needed to use Lean Six Sigma and let the data drive the improvements. In the midst of the search for the perfect procedure, she and the team launched a search for the ideal ice chest. In the end, Richard discovered that the most reliable and affordable ice chest to travel across the state — sometimes in blindingly hot temperatures — plugs into a cigarette lighter.

The discovery allowed Richard and her team to reduce rejections from 15% to less than 3% within a few months.

Richard is certified as a Master Black Belt in Lean Six Sigma, which allows her to successfully execute projects and oversee a quality improvement training program that can be used throughout the Department.

The push for continuous quality improvement is coming from the highest levels — particularly Department of Health Secretary Dr. Rebekah Gee and Deputy Secretary Mark Thomas. Gee said she has long wanted to create a culture of continuous quality improvement, but said it can’t really be done without leadership being fully on board.

Mendy Richard works with a human resource team to identify process steps
to understand where bottlenecks occur and where the greatest delay happens.
“What’s different about continuous quality improvement is that it’s strategic action versus strategic planning,” Gee said. “People are used to planning and coming up with our objectives and key goals, but what a lot of organizations don’t do is act.” 

MendyThe Department wanted to implement a more formal process that would improve efficiency and streamline processes: “Lean Six Sigma is a methodology that has been used in both the public and private sectors very successfully,” Thomas said.

Department leaders selected 14 Department of Health team members to begin what’s known as Green Belt training, a course that teaches how to define a problem and how to collect data and measure progress as possible solutions are worked out. The course also schools trainees in how to analyze various parts of the problem and to design a solution in response.

Following training, each Green Belt team member took on their own project and put together a team that helped analyze and implement solutions.

Problems and solutions

Clara Hudson, a quality assurance program monitor in the Department’s Office of Aging and Adult Services, took on a project that looked at why the Department was missing goals for approving Medicaid applications for people entering nursing homes across the state. The end goal was to ensure that people who apply for Medicaid to cover long-term care get a timely decision.

Hudson said her team was able to identify the problem fairly quickly: Application decisions depend on paperwork being scanned into the Department’s system, and scanning takes time — sometimes a couple of hours per application. But rather than hire more staff to mitigate that problem, Hudson said the team wanted to think more creatively, so it came up with a pilot program to bypass the need to hire more people.

“We created a partnership with some Medicaid analysts and a small group of nursing facilities that allowed the facilities to tell the analyst which application needed to be worked,” Hudson said. The analyst would become the single point of contact for the nursing home, and if the facility needed a decision on a patient more quickly, it could call the analyst directly and have that application located and scanned.

A key step in the process was identified as taking too long: 91% of the time, that step wasn’t being completed in five days or less. After the team completed the pilot program, that step only missed the five-day goal 5% of the time.

Christina Bolton, the quality management and improvement director at Pinecrest Supports and Services Center in Pineville, helped lead a project to improve talent recruitment and retention at the Department of Health. The Department had noted high turnover among nursing and direct care employees, and leaders knew that it was “very important to hire and maintain the right employees to improve quality and continuity of care.”

Bolton’s team created a tool that rated the quality of applications and then examined how the posting was written when there were a greater number of high-quality applications. The team found that because of nuances in the way that job postings were being presented online, some of the job titles were “vague and non-descript,” and other postings were not clear enough about required certifications.

Natalie Istre, a program manager in the Bureau of Nutrition Services at the
Louisiana Department of Health, goes over a plan for a pilot program that
was designed to improve quality in the Women, Infants & Children program.
The team decided to sculpt a new way for departmental leaders to advertise job postings by using a “working job title.” For example, if the Civil Service required a technical job title such as “Sanitarian I,” a manager could add something more descriptive in the title in parentheses, like “health inspector.”

They also improved the quality of job postings around certifications, linking potential applicants to ways they could receive a required certification.

“We wrote the job posting to appear more user-friendly to applicants: We show the required job qualifications and then let them know what steps to follow in order to become qualified if they are not already qualified,” Bolton said. ”We also worked with the Louisiana Civil Service Commission on improving how we are identifying the most effective job recruitment strategies.”

The strategy has been working, and by the end of the year, Bolton said her team projects its can scale up the pilot program to the point where it can train human resources staff to do what the team is doing with job postings. The results are projected to shave hours of time off the application-filtering duty of a hiring manager.

A transformative process

Both Bolton and Hudson said Lean Six Sigma training has transformed how they see things in everyday life as well as in their regular day-to-day work. Bolton said she’s even been doing housework differently according to principles learned in Lean Six Sigma.

“You begin to readily identify and avoid rework mishaps by properly sequencing steps,” Bolton said.
Richard said that while Lean Six Sigma stresses goals that can be applied throughout the Department — accept no defects is a common mantra, for example — the Department also sees the program as an important retention tool for retaining employees.

“Dr. Gee and Mark Thomas have whole-heartedly supported building this culture of quality,” Richard said. “It takes courageous leaders to invest in, engage in and promote this approach. Quite simply, having top-down support is the difference between mediocre and excellence in effective, sustainable improvements.”

Friday, January 17, 2020

The ‘State of the State’ of healthcare in Louisiana

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

Recently, I had the opportunity to speak before the Rotary Club of Baton Rouge on the state of healthcare in Louisiana, looking back on our accomplishments while keeping our eyes on the future. I’d like to share some of those achievements here with you.

The success of Medicaid expansion in Louisiana is something to be proud of. It is truly making a difference in the lives of some of our most vulnerable residents. We are proud of Governor John Bel Edwards and the progress this administration has made when it comes to Medicaid expansion and improving access to healthcare.

The reality is Medicaid expansion in Louisiana has been a great success. Bringing federal tax dollars home to Louisiana has allowed the state to solve a budget deficit, keep the TOPS scholarship program in place, and support roads and other infrastructure.

In addition to expansion, and under the leadership of Governor Edwards and outgoing Secretary Dr. Rebekah Gee, the Department of Health has seen many other improvements to our healthcare landscape.

Because of the work of the Department of Health, FQHCs and other providers and community partners, in July we announced that fewer people have been diagnosed with an HIV infection in the past year than in any of the previous 10 years. In 2018, there were under a thousand — 989 people newly diagnosed with HIV — for the first time in a decade.

The CDC’s national STD rankings show Louisiana’s prevention efforts are paying off. Louisiana’s case rates of primary and secondary syphilis, congenital syphilis and gonorrhea improved from 2017 to 2018:

  • Primary and secondary syphilis: #7, down from #3
  • Congenital syphilis: #3, down from #1
  • Gonorrhea: #5, down from #3
Improvements such as these take time, and show that increased screening, education and prevention efforts are making a difference.

We are leading the nation on a new model to expand access to hepatitis C treatment. Our agreement with Asegua Therapeutics provides unlimited access of Asegua’s authorized generic of Epclusa to Louisiana Medicaid recipients and Louisiana Department of Corrections inmates while capping the state’s annual expenditures. We want this life-saving treatment to reach everyone in the state over the next five years.

Since medications became available on July 15, more than 2,400 people have been treated so far. Our ambitious public health strategy to screen and treat as many people as possible prioritizes educating the public, encourages screenings to determine one's status, links individuals living with hepatitis C into care and extends the cure to as many Louisianans as possible. We’ve also launched a partnership with Wal-Mart to offer free screening in 10 stores across the state.

Through this work, we are aiming to be the first state in the nation to eliminate the deadliest infectious disease in the country.

Medicaid re-entry program

Our work for hepatitis C represents our strong partnership with the Department of Corrections, which is rare nationally. Another great partnership are proud of is our Medicaid re-entry program for prisoners, which ensures people who have served their time will have Medicaid when they are released. This means they will have access to mental health services, medications and primary care. We have had more than 10,000 applications for this program.

KickStart pilot

In Monroe, we are running a pilot program called KickStart that connects Medicaid recipients to job training, helping them reach financial independence through work. We are hearing early success stories: A son who was already enrolled in a training program began studying alongside his mom when KickStart became available. The mom who always put her child's needs before her own has now completed training as a forklift driver.

Sixteen Louisiana Department of Health employees have earned their Lean Six Sigma Green Belts.
Continuous quality improvement

Beyond these programs, the Department of Health is also very focused on always striving to be more efficient and do more with the state and federal dollars we are entrusted with. Our goal is to ensure we are effective and eliminating waste. So, under the Secretary’s leadership, we started training our employees on a program called Lean Six Sigma, which empowers employees to fix problems. Nearly 50 leaders across the agency have completed the initial yellow belt training and another 16 have trained on the next-level green belt segment that allows them to oversee their own projects.

These employees have become the bridge between different offices who have identified problems, reduced excess steps in our processes and provided better services. We are already seeing the benefits of their initial projects, and more importantly a culture of continuous quality improvement is taking hold and spreading across the Department.

Maternal mortality

This focus on outcomes and quality improvement also extends to our approach to improving health. One example is the Louisiana Perinatal Quality Collaborative, a collaborative that is focused on reducing the number of women who die or are seriously injured related to childbirth. No woman should die giving life.

Through training programs, staff support and the sharing of best practices, we've set an ambitious goal to reduce maternal morbidity by 20% by this Mother's Day. We have already seen some early wins: Since 2016, we’ve seen a 32% drop in the severe health consequences of bleeding in moms who are giving birth.

Eliminating waiting lists

We have also been successful in eliminating a waiting list for services for people with developmental disabilities — there were over 10,000 people on that waiting list, which has existed for 25 years. That list has been eliminated and now the needs of the people with developmental disabilities are being met.

We want to replicate this success for our older adult community and we are working to drastically reduce the waiting list for home and community-based health services for older adults.

Nursing home quality improvement

Many of our state’s older adults are also benefiting from improved quality in our nursing homes. A training program to reduce the incidence of pressure ulcers in Louisiana nursing facilities has resulted in some dramatic improvements. The state has moved from 50th in the United States in 2016 to 45th in the first quarter of 2018. We have more work to do but we are making progress.

Dr. Alexander Billioux speaks to the Rotary Club of Baton Rouge.
Call to action

We at the Department of Health are optimistic about the future, but we know that we did not get here without hard work, and this improvement will not continue without even more effort and focus on our ultimate goal: improving the health of ALL Louisianans everywhere.

We know that achieving this will take more than increasing access to healthcare — though that is critical — it will mean that we must also work to improve the efficiency and impact of the healthcare system our citizens are accessing. Ultimately, it means working to improve health upstream to reduce the amount of preventable healthcare our citizens need in the first place. We want to make bold moves, and I know Louisianans have the spirit to take up that challenge!

Tuesday, January 14, 2020

Can you dig it? New Orleans Blastoff kicks off 2020 Governor’s Games

Every year, sports enthusiasts across the state have the opportunity to showcase their athleticism in the Louisiana Governor’s Games. The 2020 Governor’s Games get underway this weekend with the New Orleans Blastoff, a girls’ volleyball competition Saturday, January 18 and Sunday, January 19.

The Blastoff features 4,000 participants from 266 teams competing in two venues: the Ernest N. Morial Convention Center, Halls C and D, 900 Convention Center Blvd. and The Health Club by Hilton at the Hilton New Orleans Riverside, 2 Poydras St. Admission is $10 for adults and $1 for ages 12 and younger. Saturday action begins at 8 a.m. for 12s, 16s, 17s and 18s, and at 2:30 p.m. for 10s, 13s, 14s and 15s.

If you can’t make it to the Blastoff, you’ll have another 35 chances to see Louisianans of all ages, skill levels and economic demographics participate in fitness competitions during the Governor’s Games. Over the next six months, competitions including basketball, volleyball, gymnastics, boxing, tennis, golf, track and field, girls’ softball, youth baseball and more will be held in cities all around Louisiana.

Uniquely Louisiana

The Louisiana Governor’s Games began in 1997, replacing the previous Louisiana State Games and expanding to offer more sports. They are coordinated by Durand “Rudy” Macklin, director of the Governor’s Council on Physical Fitness and Sports, former NBA player and one of four LSU men’s basketball players to have his jersey retired by the school.

In true Louisiana fashion, the Governor’s Games are one of a kind. Other states hold their state games in one location at one time every year. But, in Louisiana, the Governor’s Games are spread out all around the state over half the year.

Why has Louisiana chosen such a unique approach? When the games are held in a single location, as other states do, the economic impact stays in that single location. However, by scheduling different events around the state, like Louisiana does, the economic impact spreads to areas that can then benefit from the money athletes, coaches and fans will spend at local businesses like hotels, restaurants and service stations.

It’s also a way for people living in underserved areas to receive exposure to sports they may not otherwise have the opportunity to participate in, to develop an interest in a new sport or even just get inspired to get moving. That spark of inspiration may inspire a sedentary person to take up daily walking, or a spectator at a bodybuilding competition to start building muscle.

Fitness is a key step in lowering the obesity rates in our state. Louisiana consistently ranks among the top 10 states with the highest obesity rates for both adults and children, and nearly one of out of four adult Louisianans is considered obese. Physical activity doesn’t just affect obesity, though: it can cut down on the risk of heart disease, Type 2 diabetes and certain cancers, as well as other health benefits.

What’s next?

Dates and locations for other competitions will be posted online at the Louisiana Governor’s Games website. Competitions scheduled so far include:
  • Gymnastics
    • Boys State Championships: March 13-15 at Acadia Gymnastics, Lafayette
    • Girls State Championships: Lower Level, March 20-22 at Louisiana Tech Intramural Center, Ruston and Upper Level, March 27-29 at Alario Center, Westwego
  • Elementary State Championship Fitness Meet: April 25 at Alexandria Senior High School, Alexandria
  • Youth Golf: June 6-7 at Le Triomphe Community Center, Broussard

If you’re interested in competing in the Louisiana State Games, registration is open now. Sign-up for adults is available through local recreation departments and sports leagues, or advertisements and public service announcements made through media partners. For children, sign-up is available through local schools and physical education teachers.

If you’re not interested in competing, consider attending and cheering on our amateur athletes as they share in the spirit of competition. See you at the Governor’s Games!

Friday, January 3, 2020

Vaping injuries and deaths cloud alleged safety of tobacco alternative

By DR. REBEKAH GEE | Secretary, Louisiana Department of Health

Louisiana in November 2019 gained the unfortunate distinction of joining the states that have recorded deaths tied to vaping devices and the lung injuries they cause.

There have been questions about the safety of vaping since the devices, including e-cigarettes, were introduced to the U.S. in 2006. Conventional wisdom among the industry and those who use vaping products is that vaping is a safer alternative to smoking because vaping products do not contain the dangerous, harmful tar found in cigarettes. However, the Louisiana Department of Health and the Centers for Disease Control and Prevention (CDC) believe that vaping is not safe.

The absence of tar in vaping products does not make vaping safe. Again, vaping is not safe, and Louisiana’s two deaths and more than 30 people severely sickened by vaping products serve to highlight that fact.

While we do not yet have long-term studies to understand how vaping devices affect long-term health, the vaping injuries we are seeing are very serious. Nationwide, 95% of those patients with lung injury, also known as EVALI, were hospitalized.

Stop vaping

Vaping-related lung injuries are having an impact on families in the state. That’s why the Department of Health is recommending people stop using all vaping products — especially those being sold on the street or that have had substances added after their manufacture. The CDC has found what it’s calling a “chemical of concern” that may be the source of the deaths and injuries: Vitamin E acetate. It’s often used as a thickening agent in vaping devices that deliver THC, the active ingredient in marijuana. The chemical is also found in some nicotine products.

People who continue to vape should seek medical attention if they experience symptoms of EVALI, including cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, fatigue, fever and weight loss.

The Department of Health is asking healthcare providers to ask their patients who have used vaping devices within the past 90 days if they’ve had any of those symptoms. Providers who suspect their patients may have lung injury should report those cases to the Department.

Young people

One of our major concerns about the rise in vaping use is its popularity among young people.

Between 2011 and 2013, the CDC reported the use of vaping devices doubled among people ages 18 to 24 nationwide. In Louisiana, vaping among middle and high school students doubled since 2017 and tripled since 2015.

CDC data also shows how much vaping-related injuries have affected young people. About three-quarters of those with vaping-related lung injury were under the age of 35.

The troubling rise among youth using vaping devices and people who have never smoked before could be tied to the perception that vaping devices are safer than traditional tobacco products. That’s why it’s important not only to highlight the safety concerns, but also to remind the public that vaping devices are a nicotine delivery device, and that nicotine is one of the most addictive substances currently known.

The presence of nicotine may make vaping devices appear attractive as a less-harmful replacement to smoking, but the safety concerns around vaping should emphasize the importance of quitting nicotine use altogether. Smoking cessation aids are widely available to help users quit smoking and vaping, with nicotine patches, gum and lozenges all available over the counter.  Inhalers and nasal spray are also available with a doctor’s prescription.

E-cigarette users and smokers interested in quitting can find free, confidential help by calling 1-800-QUIT-NOW or visiting Let’s Geaux Tobacco Free, Louisiana!