HJAR Nov/Dec 2020

DIALOGUE 14 NOV / DEC 2020 I  HEALTHCARE JOURNAL OF ARKANSAS   Romero You are correct that an N95 mask properly used protects the wearer and those around the wearer. Now, let me say that those of us who use N95 masks (and I mentioned that I’m the TB physician for the state of Arkansas, and I’ve been the CDC’s physician for my previous state, which is Nebraska) are fitted for the N95 mask, that is that we go through a procedure to make sure that the mask fits us, that we’re using the right size mask and that the mask cov- ers our face completely. That includes a pro- cedure in which something like saccharin is blown in our faces to see if we taste it, because saccharin has a very bitter taste. So, if it’s getting through the mask, you’ll taste it. The problem with getting an N95 mask to the public is that it may not protect them, because it’s not being fitted for that individual. That is the downside of having it for the public. The other issue is that the N95 mask is a necessity for a healthcare provider giving care to someone with COVID, and as you know and heard, during the earlier part of this year, that was a major problem—that healthcare providers in hot zones didn’t have enough of the masks to protect them— and so that’s the other reason why we don’t recommend it for use outside of the health- care system. Did I answer your question? Editor It seems like more of a manufactur- ing issue. Romero There is a manufacturing issue. I think that there are enough N95 masks for the healthcare providers. It’s more complex to make an N95 mask than a regular mask. But, remember that if we all use a mask, we would protect those around us and would decrease the spread of the virus signifi- cantly. There is that report from the CDC that I use (and many of us use) to convince people that the regular, everyday mask is a good idea, and that’s the one where the two beauticians or stylists who had COVID saw 135 clients, and none of the clients became infected. Why? Because the cosmetologists were wearing their masks—that’s really the important part. Wear the mask, and wear the mask properly. Let me just add a little bit to that. I saw a cartoon that showed an individual with their mask on their chin. It said, “The face mask is not a chin guard.” It needs to go over the nose and mouth, and there’re just different ways of showing that it’s wrong. I frequently see individuals in retail stores with a mask down around their mouth but still open in their nose. They’re expelling air through their nose and therefore can infect some- one. The mask has to be worn correctly— that is, covering the nose and covering the mouth, and really it would be nice to have it under the chin so that you’re completely covered. That’s really what’s going to pre- vent the spread. Editor Other than COVID-19, what are some of the big issues in Arkansas that you’re facing or focusing on? Romero We have spent so much time and diverted so much of our efforts to COVID. We do need to get back to the issues that were there before COVID—the issue of HIV/ AIDS. HIV/AIDS can be eliminated in this country. The southern states (ours is one of them), the rural states are at high risk, higher prevalence for the disease than other states. Prior to this COVID epidemic, there was a plan to begin to mitigate and to get rid of HIV in the state and across the southern United States. We need to get back to that. That’s an important issue. Because I’m an infectious disease person, you’re going to hear a lot about what I think are important issues in infectious disease. I think the Hepatitis C epidemic needs to be brought under control and eliminated. Before the COVID outbreak, we were seeing increased numbers of individuals infected with Hepatitis C. We were seeing women of childbearing age increasing in number that were infected by Hepatitis C. They them- selves can transmit to children. It is an erad- icable disease; we can get rid of this disease if we put our minds to it. That is one of the things that I will target during whatever life span I have as secretary of health. We have to get back to our issue of obe- sity. The obesity rate in this state is very high, and we need to address that. With that come the other problems associated with obesity: diabetes, hypertension, heart dis- ease—all those things we need to focus back on. There will be other small outbreaks or epidemics. Before COVID, we had an out- break of Hepatitis A we had to deal with, and before that there was an outbreak of mumps. Our programs for maternal fetal health, maternal infant health, for chronic illnesses need to be again reactivated and brought to their full activity. I can only hope to begin to get them back to where they were. If I’m in this position long enough, I hope to fol- low through all the way, but it may be the responsibility of the next secretary of health to take this to the next level. Editor What initiatives has the Arkansas Department of Health contemplated or is planning to do to address the health dis- parities around our state? Romero It’s been said many times, by others more eloquently than I’ll be able to state, that unfortunately, COVID has really shown a very bright light on these health disparities that have existed for decades. I have been hearing about howwe are going to mitigate and deal with them since I was a resident in the ‘80s, and we really haven’t done a good job on it. We have now the tools in place to begin to deal with that—video visits with your doctor, telephone visits with your doc- tor. Those are ways now that we can move forward in getting our patients seen more often. I can tell you as a practicing physician, I use telephone consult very frequently now to reach out to my patients [and their par- ents] who live two or three hours away. I’d love to see them, but I understand that for [their parents] to take the whole day off from work and drive here to be seen by me for 30 or 45 minutes and then drive home again is a burden. And that burden can be