HJAR Nov/Dec 2020

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2020 9 Dianne Hartley, Editor What made you want to be an MD? José R. Romero, MD This is going to sound very corny. Because I grew up in the 60s, I thought it would be really cool to be an astronaut. What I realized was that I was interested in science, and there were lots of options. I thought of being an oceanog- rapher, and I think some of that had to do with the Jacques Cousteau thing that was going on back in that time. But, I think that the issue that sort of gelled in my decision was that I enjoyed helping people. I enjoyed science, and I thought that this would be something interesting to do. And I was one of those lucky guys, lucky kids who knew very early on what he wanted to do. I went to a four-year high school, four-year prep, knowing what I wanted to do—I wanted to study medicine. So, for me it was something that was a goal very early on. Editor You stepped into the role of sec- retary of the Department of Health dur- ing a pandemic. That must have been an interesting time to do so. What have you found to be some of the biggest surprises or challenges that you as secretary and the department have faced during this pandemic? Romero This has been a significant shift in my career. I think I should probably tell you the genesis and then tell you what these issues are. I had a conversation withmy pre- decessor, Dr. Nate Smith, in November or December of last year. We were actually going to talk about tuberculosis, because I’m a pediatric TB physician for the State of Arkansas, and I wanted to talk to him about some issues. The conversation drifted to the fact that he was looking for someone to become the chief medical officer state epi- demiologist, and did he know of anybody who was interested in doing that? That turned to a question of: would I be interested in doing it? I had no formal epi- demiologic training, and so I was a little reluctant to consider the job. I’m a believer that you have to have some knowledge of what you’re doing in order to take on the job. But, when we talked, it became obvious that I was interested in becoming the chief medical officer—that I felt I had all the skills to do so. And so, my foray into the health department really began in December/Jan- uary, and by February, we had decided that I would transition over to the health depart- ment frommy previous role, which was the section chief of pediatric infectious diseases at UAMS (University of Arkansas for Medi- cal Sciences) and Children’s Hospital, in June of this year. It would be a part-time, 25 to 50 percent effort as a chief medical officer. As I began to prepare for that, my idea was to spend time volunteering here in the health department over the period before July 1. I actually started inMarch with a col- league of mine who works here, Dr. Gary Wheeler, and shadowed him. Well, it turned out that the first day I followed himhere was the day that we had our first COVID patient, and pretty much from then forward, I began to spend a lot of time here, including sit- ting in on meetings and assisting the group here in addition to my job as a chief of infec- tious diseases at the other institution. And, because of the need for someone with my skillset, my appointment was moved for- ward so that onApril 1 of this year, I became the chief medical officer. Forty or 45 percent of my time was dedicated to this. Then, Dr. Nate Smith was offered a posi- tion at the CDC, and I was approached regarding whether I would be interested in filling in as an interim secretary of health, which I found very flattering and quite shocking that they would think I was capa- ble of doing that after having been here only a few months. I took that on, and in June, I moved over here so that approximately 90 percent of my time was spent over here in the health department and 10 percent at the university. Then eventually, in August, I believe, I was offered the permanent appointment. That’s the genesis. So, what have I learned about this? Well, I’ve learned a lot. Everything that I’m doing here is relatively novel to me. It is a far cry from what I did as a section chief and as a clinician, because I’m not taking care of patients directly for the most part, so I’m learning a lot. I’m learning that, whereas in my previ- ous role I was the one who had to initiate the process and move the process forward in order to make the change (lead by exam- ple, if you will), here, I am surrounded by people who know much more than I could ever hope to know about epidemiology, about statistical analysis, about public pol- icy, and, with their input and help, I learn what the essential issues are, and I gather information that allows me to make a deci- sion as we move forward. I work through an entire institution in order to get informa- tion and then come to a decision on what to do. I rely very heavily on my advisers. There are areas that I certainly am very studied in (for example, vaccinology, the scientific process). Those are things that I know very well from my past life, and so I can rely on myself. But when it comes to other issues, I really rely very much on [my team]. There is an interface between public health and government, and that interface did not exist in my previous job. Learn- ing that interface—learning to interact and work with government officials—has been an interesting aspect of this job, and I think unless you do this all the time, you don’t realize how much there is an interplay between the government and public health. Editor What do you know now about SARS- CoV-2 or COVID-19 that we didn’t know at the onset? Romero That’s a question that you can answer by saying, ‘everything.’ Quite liter- ally, I mean this is an exciting time for me to be involved in this both medically and sci- entifically and public health-wise, because this is a brand-new virus. It is a virus that is not acting like anything we’ve known before. It’s a respiratory virus that affects not just the respiratory system but the entire body. We know it causes heart problems—it can cause myocarditis. We know it causes kidney problems—it can cause the kidney to shut down. In addition to the primary target, which is the lung disease, we know it can cause problems with clotting in the blood. We know it can cause problems with