HJAR Nov/Dec 2020

DIALOGUE 12 NOV / DEC 2020 I  HEALTHCARE JOURNAL OF ARKANSAS   Romero I would liken that to chicken pox parties. Are you so young that you don’t know what a chicken pox party is? Editor I haven’t been to one, thank good- ness. I had a large family; we all got it at once. But, I know what they are. Romero These were considered a good idea at one point. That shows you how bad the idea was that it was accepted. If somebody had chickenpox they’d invite the neighbor- hood over, so everybody would get infected. Well, that wasn’t such a good idea, because you could die from chicken pox. You can die, because the virus can cause infection in your brain. You can die, because the chicken pox themselves can get infected with strep and then you would die of sepsis. So, we squashed that idea decades ago, and hope- fully it’s not being done anymore. I think the same is true with COVID. COVID is not a benign disease. [With] COVID, even if you are young and healthy, you can die. We also now know that recovery from COVID, even if you’re young and healthy can be prolonged. There’s an example, and I don’t know her name, but there’s a reporter who’s an avid runner, a long-distance run- ner, who acquired COVID, and to this day has had a terrible time recovering and going back to running. So, I don’t think it’s a good idea to have COVID parties. I think that for every COVID party you can probably cal- culate howmany deaths there will be, and I think that’s foolish to go ahead and get your- self exposed on purpose so that nothing bad will happen to you later on. Editor Will you please speak to contact tracing? How many folks has the depart- ment hired, and how is it being perceived by the individuals who received the call? Romero We have over 700 individuals dedi- cated to contact tracing. We ramped up sig- nificantly. We have two organizations that are providing us individuals to do that. We also have the University of Arkansas Col- lege of Public Health engaged in this as well as a group in northwest Arkansas. So, at this time, we have a robust system for contact tracing. I think that it is generally well received. There are individuals that do not appreciate us contacting them and talk- ing to them and trying to determine their contacts or issuing recommendations for either isolation or quarantine. That’s the unfortunate nature of any type of activity like this, but we try to talk with them. We try to explain why it is important that you adhere to these recommendations for isola- tion or quarantine, because that is the way we mitigate spread. I’ve unfortunately heard stories about our poor contact tracers being verbally abused by the people that they’re contacting. They are simply trying to do their job. They are simply trying to bring this virus under con- trol, and I wish people would understand that. They mean no harm, no disrespect; they’re not getting in their business for the sake of getting into their business. They just need to try to bring this virus under control. Editor Do you see other operational roles in the department emerging because of the pandemic? Romero We’ve had a public health lab here for many decades, and we have expanded on the capacity of the public health labora- tory to test. We realized early on that com- mercial laboratories were not going to be able to meet our needs, because they were being overwhelmed by hotspots across this country and by states that have populations that were much larger than ours. We took it upon ourselves, and really under Dr. Nate Smith, to expand our role. We went from being able to process only 20 specimens a day to now being able to process up to 2,700 specimens a day from PCR [polymerase chain reaction]. And, we are going to have, within the next week, another machine, which will allow us to do somewhere close to 3,200 specimens every 24 hours. So, we have these processing machines, we have nine thermocyclers and we now test 24/7. We’re open every day of the week, and we process throughout the week and we enter throughout the night. I’m proud to say that the capacity we have to process clini- cal specimens equals a small commercial laboratory. Editor Our nursing homes and assisted care facilities have been hard hit by the virus. What is your advice for those in leadership there, and what can loved ones do to make sure their elderly are OK during this time of isolation? Romero Yes, you are correct. The elderly, especially those living in congregate liv- ing facilities, nursing homes if you will, are at risk for acquisition of the virus (and for adverse outcomes simply because of their age) if it enters that community. The major- ity is over 65, and many have comorbid con- ditions that place them at higher risk for morbidity and mortality. And, because they live in a very close environment, there is the ample opportunity for transmission within that environment. So, what should we tell the administration of these institutions? The Arkansas Department of Health has issued recommendations for mitigat- ing or decreasing the risk of introduction of viruses into that community, and that means that workers should be free from symptoms of COVID. Workers should also realize that, because they are the ones that will bring this virus in. Remember, most of the individuals who live there don’t get out into the community and don’t get COVID from the community. They get it from the healthcare workers or the caregivers that bring it in. The caregivers have a responsi- bility for the safety of those housed in the congregate living center, and they need to take that into account when they make deci- sions to attend public functions. They need to take use the masks, the social distancing and washing of hands in order to prevent the introduction into those communities. With regard to family members, it’s extremely difficult for family members not to see their loved ones. I get many emails asking that the regulations for visitation be