Friday, August 21, 2020

Q&A with the RMDs: Dr. Joe Kanter

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 1’s Dr. Joe Kanter, Regional Medical Director for the parishes of Jefferson, Orleans, Plaquemines and St. Bernard. He is also the Assistant State Health Officer for the Louisiana Department of Health.

Note: A different version of this post originally appeared on Pages 38-39 of the July/August 2020 Healthcare Journal of New Orleans.

The concerns of the people of this region have changed since the pandemic began. In the early days of our outbreak in Louisiana, what now seems like a distant memory, Louisiana was home to the fastest-growing COVID-19 outbreak in the world, and, by all rational expectations, was headed toward absolute disaster. Late March projections from within LDH, as well as outside experts, forecasted an early April surge of hospital-level COVID-19 patients exceeding existing acute care bed availability by approximately 2,000.

But now, as we are in Phase 2 of our reopening, people are slowly reacquainting themselves with vestiges of their pre-COVID lives. They are venturing back out, but doing so with patience and caution. For example, although they complain, people are wearing masks, not forming crowds in the French Quarter and generally keeping a safe distance from others.

If you recall back to March, April and May, we had thousands of COVID patients who required mechanical ventilation to breathe. In fact, we were projected to exceed ventilator supply by a factor of 2-3. Crisis standards of care were discussed in a manner not seen since Hurricane Katrina. Few of us have ever had ever doubted that quality acute medical care would not be available to us at all times, for any reason.

Yet we watched the experience of Northern Italy — hospitals overfull and turning away patients, long lines of ambulances queued to drop off patients like parents at elementary school — and had every reason to believe we would be there, too.

That, of course, did not happen. Immediate resources were directed toward the rapid expansion of acute care capacity, including the addition of surge capacity within existing hospitals, quick procurement of crucial supplies like mechanical ventilators, and the erection of alternative care facilities like the medical monitoring station at the Ernest N. Morial Convention Center.

This facility was a great example of our ability to be prepared. Luckily, we never had to use it to its full capacity. Today, it is much smaller, but is still serving as a place to care for patients as the need arises.

Early on, our elected leaders made difficult decisions to cancel public events, order aggressive but necessary social distancing measures, and issue calls for the public to stay at home to limit the virus’s spread. Most notably, the people of the greater New Orleans area heeded those calls.

As evidence, highway traffic data and aggregate mobile device location information pointed to widespread adherence to social distancing measures during the peak weeks of the outbreak.

By embracing these recommendations, we were able to flatten the curve and keep hospitals from becoming overwhelmed. This was remarkable, but it was far from a foregone conclusion. Now a national best-practice model, the dramatic change in trajectory in our statewide outbreak was due to data-driven public health measures, good governance, and widespread public cooperation.

Louisiana’s robust emergency preparedness infrastructure proved invaluable to our ability to monitor the outbreak and quickly respond. Significant investment and training in the years since Katrina have yielded several important changes that have enhanced our emergency readiness. These include:

  • A national best-practice hospital tracking system and registry of people who are most at risk,

  • Dedicated medical special needs sheltering plans that can be quickly adapted to a variety of emergency settings, and

  • Well-identified communication pathways between the private sector, municipal and parish governments, and state authorities.

For the pandemic, we were able to build upon this position of strength and preparedness. However, the pandemic also laid bare deep-seated racial inequities in our community.

The racial inequities throughout our region show up in the disparate prevalence of comorbid medical conditions. This results, in part, from the wide variance of social determinants of health across racial lines, and decades of severely limited access to care for marginalized communities. It remains a challenge and a partial explanation of why black Louisianans, less than one-third of Louisiana’s population, constitute nearly 50% of COVID-related deaths.

Widely unequal exposure risks tell more of the story. Black Americans are more likely to be employed in a job considered essential, are less likely to be afforded the ability to perform their job remotely, and are more likely to lack the ability to safely isolate from other family members in their own home.

We have learned from prior disasters that vulnerable people are vulnerable, and our COVID-19 experience is no different. Systemic racism in Louisiana and elsewhere certainly predates COVID-19. We have seen attention drawn to it in the widespread and spontaneous protests demanding accountability for the murder of George Floyd, and the longstanding institutional racism which has allowed for select instances of police brutality to go unaccounted for. We must recognize that poorer outcomes from COVID-19 and poorer outcomes within our societal structure are branches of the same trash tree. It is only by recognizing this as a challenge that we can work together to find solutions.

We can be proud of our COVID-19 response to date in Louisiana and still commit ourselves to working harder, working smarter and addressing longstanding long-standing problems such as racial inequities. 

Of course, we are all working on the issue to the day — such as safely getting children back in learning environments — but we must, step by step, commit ourselves to the hard work of ending the disparate treatment of our fellow citizens. Our communities and our patients demand this of us as healthcare and public health professionals, and it is our obligation to rise to the challenge.

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