Tuesday, June 30, 2020

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.

Wednesday, June 24, 2020

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.

Monday, June 22, 2020

You can have a great summer and still be COVID-safe

(With Memorial Day serving as the unofficial first day of summer, and with the official first day this week, people will be tempted to go to the pool, the beach or take a vacation. Recognizing that we are still experiencing the COVID-19 pandemic, we asked Dr. Joe Kanter, assistant state health officer, if traditional summertime activities can happen during a pandemic and, if so, are there any special precautions that individuals and families should take?)

Is it safe to go swimming?
We don’t believe the virus can spread very easily through the water, whether it is salt water or chlorinated, swimming pool water. The virus isn’t going to move across the water from one person to another. The risk, however, is getting too close to others while in the pool. That’s the same risk as if you are not in a pool; COVID-19 spreads easiest by breathing, speaking, coughing, singing or laughing when in close proximity to another person, whether in or out of the pool.

What about going to summer camps or large get-togethers like family barbecues?
Camping, fishing and barbecuing are all low-risk activities. Families should get outside. To be safe, identify who is in your close group — know who they are because that contributes to your exposure risk. And, if there are members of your close group who are at a higher risk … such as over 65 or who have underlying health conditions. What is riskier, are the things you have to do to get to the campsite or the fishing site. This includes stopping at a gas station or going shopping for supplies. This is where you really need to take the precautions: wear masks, use hand sanitizer and keep your distance from others.

Are there any activities that people should avoid altogether?
You should avoid anything that involves a crowd. When you are real close to others, your or someone else’s respiratory droplets can spread the virus. The same distance requirements apply whether indoors or outside.

What other considerations are important?
You should always try to decrease your risks. If the restaurant offers outdoor seating, use that option because eating outside is safer. You should also judge the establishment to get a sense as to how seriously they take these precautions. If you see a whole bunch of people crowding around one another, that’s not a place you want to go to. It’s not worth the risk.

What responsibilities do business owners have?
We’re looking to businesses to take the necessary steps to protect their employees and their patrons. As customers, we should vote with our feet and go to places where they exhibit concern for safety. That’s good business practices right now.

What about hotels and vacation homes? What precautions should we take when renting a room or another place to stay?
Make sure that wherever go stay, that the business — Airbnb, hotel and condo operator — should thoroughly clean and wipe down between guests. This includes cleaning hard surfaces, door handles, bathrooms.

And, we should do that wiping down ourselves, as well, with a clean, sanitized cloth rag. The biggest risk is when you are in the lobby when you are checking in or leaving. Be sure to keep distance between yourself and others. You want to make sure you are wearing your mask and that other people are wearing their masks. That will increase your safety.

Is there anything that we should keep in mind while traveling this summer?
When traveling by plane, use your mask on the flight and while in the airport. This will go a long way to prevent the spread of the virus. People should be aware of all hard surfaces they touch. Limit the amount that you touch countertops, door handles, handrails, escalator rails. Use hand sanitizer after touching these surfaces.

Also, do what you can to avoid lines. If you see a line forming, just hang back and wait until that line gets shorter. Be cognizant of the people around you. And, if possible, avoid situations where you would be within 6 feet of others.

Is it possible to have a safe summer vacation?
Yes, it is possible to be safe on a summer vacation. But, families may want to reevaluate where they want to go. Today, driving a few hours is a more appealing option than getting on a plane because it’s a lot simpler.

And, you should watch the news to see what’s going on in the locations that you are considering as a destination. If I was planning a trip to a place where they are experiencing a growing outbreak, I would reconsider and go someplace else. Families should take this all into consideration.

Any final thoughts on reducing your risk this summer?
Anytime you travel, there are risks. There are things families can do to mitigate their risks because you can’t eliminate all risks. You have to look at your family situation, take into account who is in your family — do you have older family members or do some members have underlying conditions — take those into account and make a responsible decision.

For information on COVID-19 from the Louisiana Department of Health, click here.

Saturday, June 6, 2020

Together, we will adjust to the ‘new normal’

By DR. COURTNEY N. PHILLIPS | Louisiana Department of Health Secretary

These past few months have seen us all adjusting to a steadily evolving “new normal.”

Our state all but shut down during March and April as most Louisianans took to heart Governor John Bel Edwards’ Stay at Home order. I know it has been challenging to not be able to hug our friends or our high-risk loved ones through all of this, to homeschool, to work from home, to continue to work at physical locations where the rules of operation continue to change, or to be unexpectedly out of work as a result of the COVID-19 pandemic.

Dr. Courtney N. Phillips,
While keeping us apart physically, in many ways the pandemic has brought us closer through frequent phone calls, texts and video chats with our loved ones. We have looked out for one another through acts of kindness, such as delivering groceries to a vulnerable neighbor who must stay indoors for their own safety. Let’s continue to nurture that spirit of community and togetherness as our state gradually reopens and we cautiously venture into the world once more.

I thank everyone who took the Stay at Home order seriously, flattening the curve and stemming the spread of the virus. We grieve those lost to COVID-19 — our neighbors, our loved ones, our colleagues — but we celebrate the many lives saved thanks to your cooperation.

The road ahead

Louisiana began a gradual, safety-driven reopening in mid-May under Governor Edwards’ leadership. This phased reopening, called Roadmap to a Resilient Louisiana, lifts some restrictions and allows businesses to resume operations based on COVID-like illness, case growth and hospitalizations. These declines did not just happen on their own. We together made this happen — by wearing masks, staying 6 feet away from others, minimizing how often we go out, and washing our hands and not touching our faces. This Louisiana spirit is what keeps us moving forward.

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On June 5, we entered Phase 2 of Roadmap to a Resilient Louisiana, but what does this mean? For many Louisianans, it means the sudden opportunity to dine out, shop, get a tattoo or massage, or get married with more than 10 people present. It also means many people may believe we can relax.

With the reopening of more businesses and increased capacity at already-reopened businesses, we may advise against it but people will begin to venture out in greater numbers. However, just because businesses and leisure activities are open does not mean there isn’t risk involved.

Businesses will continue to open gradually, but not the same as we’re used to. They will have to operate under strict requirements including limited occupancy with social distancing, masks for public-facing employees and increased sanitization. We are also strongly recommending good practices including offering temperature checks before a person can enter, posting the symptoms of COVID-19 outside with a request that symptomatic individuals not enter and posting signs thanking guests for wearing a mask.

We have control over our own preventive actions, such as wearing a mask and putting 6 feet of space between ourselves and others, but we cannot control the actions of others. Before making plans to go out, we encourage everyone to reduce the risk of exposure by considering the factors of Time - Space - People - Place, an assessment of risk developed by Ohio State University epidemiologist Dr. William Miller. To put it simply:
  • Time: The more time you spend with other people, the greater the risk.
  • Space: The closer you are to other people, the greater the risk.
  • People: The more people you interact with, the greater the risk.
  • Place: Indoor activities are riskier than outdoor activities.
Here are some tips for considering Time - Space - People - Place:

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During Phase 2, we encourage high-risk individuals to continue staying at home for their safety. This includes individuals ages 65 and older, long-term care facility residents, and vulnerable individuals such as those who are immunocompromised or have one or more of the following health conditions with poor control:
  • High blood pressure
  • Diabetes
  • Obesity
  • Chronic kidney disease
  • Heart disease
Remember that everyone is still safer at home. With the easing of restrictions comes the possibility we could see what other countries and states are seeing: a spike in COVID-19 case growth. We do not want to slide backward, so we must all do our part to continue moving forward. This includes contact tracing, testing and mitigation measures such as those below, but it takes all of us doing our part to prevent a new spike in cases.

Defending against COVID-19

As we continue to adjust to the new normal and avoid a new wave of infections, it’s vitally important that we all continue to wear masks and stay 6 feet away from others when in public.

Face masks or face coverings should be worn anytime when you are near others who are not in your immediate household. The only exceptions are children under the age of 2 and people with severe breathing issues. I wear my mask every day whether I’m at the Governor’s Office of Homeland Security and Emergency Preparedness (GOHSEP), LDH headquarters or the Capitol — and I am thankful to see others doing the same. I wear my mask to protect you, and you should wear your mask to protect me. It’s being a good neighbor to everyone around you.

I know that it can feel strange to breathe and even talk while wearing a mask but it is for all of our health and safety. I am confident we can all get comfortable in our masks and make wearing them as normal as getting dressed in the morning.

Along with masking up, social distancing is one of our most reliable tactics to prevent the spread of the novel coronavirus. Social distancing means maintaining a physical space of 6 feet between yourself and people from outside your household, something which does not come easily to Louisianans.

As a daughter of Louisiana, born and raised in Plaquemines Parish, I know firsthand that the need to be friendly and to congregate is instilled in us at birth. We thrive in one another’s company, which we can enjoy so long as we do so safely — 6 feet apart and masked. Yes, it is different from the social gatherings we are used to, but so long as we are together we will shoulder through these challenging times.

Along with masking up and observing social distancing, to help keep everyone healthy:
  • Wash your hands often and thoroughly with soap and water for at least 20 seconds, or use hand sanitizer containing at least 60% alcohol if soap and water are unavailable.
  • Clean high-touch surfaces and high-traffic areas frequently.
  • Avoid touching your face.
  • Sneeze and cough into a tissue, elbow or mask.
  • Stay home if you are sick, especially if you have a fever greater than 100 degrees Fahrenheit. Isolate yourself from others in the household and contact your medical provider. Staying home when sick saves lives.
This is our new normal until we have a vaccine. Take care of yourselves and your neighbors, and once again the bonds of Louisiana spirit will see us through.

We frequently update our website with helpful information to help keep you safe during this pandemic. Visit http://ldh.la.gov/Coronavirus.