Doctor provides update on COVID-19 battle, what is needed to reopen community

Published 2:47 pm Monday, April 20, 2020

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Editor’s note: The Natchez Democrat asked Dr. Blane Mire, a physician and partner at Internal Medicine Associates and on the front lines of the Miss-Lou battle with COVID-19, to update our community on where we stand with overcoming this crisis.

Question: What do we know right now? How do we interpret the information from the national COVID-19 conversation as it relates to our situation in Natchez?

Dr. Mire: From the national level, we are seeing an overall plateau or leveling off of cases and deaths, and some areas of the country have started to see consistent reductions of cases. These states, like Louisiana, were way ahead of us on cases due to the New Orleans outbreak after Mardi Gras and started strong mitigation strategies early on. They reached their peak numbers about a week ago and have seen a decline while they have maintained their stay-at-home measures. I hear that some areas of the state are working on strategies to start opening back up very gradually and with strict guidelines.

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Mississippi is not expected to reach our peak for another four to five days. We have seen numbers of daily cases of the virus push higher for several days in a row. Our daily death totals have bounced up and down, probably related to some delays in reporting, but have remained at the higher end of the curve as well. We definitely have not reached that plateau.

I’m referring to one of the main data-driven models being used to follow the crisis. The University of Washington model collects world, national and local data on a daily basis and adjusts its predicted projections. Our peak day for death rates has been extended to April 24. Though only a prediction, our numbers have followed the trajectory along with the model.

Thankfully, due to the stay at home orders and the overall cooperation of our state and local community, the model’s curve has flattened significantly, meaning that death rates have not reached early projections and the model has adjusted accordingly. It projects out a recovery and gradual reduction of deaths over the next several weeks extending into late May.

The key to that is the continued adherence to social distancing and other mitigation strategies. In other words, it’s up to us. We control this curve. Beginning to open up our community too quickly and without a clear and functional plan could easily lead to another bump in cases. The current thought is that the curve needs to be in at least a 14-day continuous decline before we can have any confidence that we are headed toward recovery.

I think of Natchez and our surrounding area as having our own epidemic within this pandemic. What I mean by that is we must use our local data, not relying on national or state data only, to make our determination as to when to safely move forward into a new normal.

Here in Adams County, we were at just 20 cases just over two weeks ago with only one death. We have been under our stay at home orders since that time. Since then, as of today, we are up over 80 cases and seven deaths — four of those in just the last week. Two of our nursing homes have suffered from outbreaks. Who’s to say where those numbers would be without the preventive actions and the cooperation of our community.

Our hospital — Merit Health Natchez — has been really prepared, and our medical staff has stepped up big time. Patients who require hospitalization for this aggressive virus are usually very sick and require an incredible amount of effort, skill and commitment to provide the care they need. Several patients are still in the hospital fighting to recover.

Question: So much focus is on COVID-19 right now. Where does that leave your other patients?

Dr. Mire: My focus has been on outpatient management of this crisis. Our clinic, Internal Medicine Associates, has transformed into a telehealth and COVID-19 outreach clinic. Dr. Daly, Dr. Stubbs, our staff and myself connect to more than 100 patients a day. We want all of our patients to know we have not abandoned them just because they can’t get out.

It is also really important for our patients with chronic medical conditions to maintain their meds and report any issues about their health to us. Of course, we also discuss how this crisis has impacted them and why it is so important to maintain their commitment to self-isolation and hygiene. I know that many other physicians in town are busy doing the same for their patients.

In addition to normal urgent care issues, the Natchez After Hours Clinic is also our COVID-19 testing location. We have tested well over 200 patients and have seen close to 30 cases to this point. We have treated most of these folks at home by monitoring them closely. Symptoms have been as mild as low-grade fever and sore throat to full-blown flu-like symptoms, high fever and increasing shortness of breath.

Yes, we have utilized the combination of Zpack/hydroxychloroquine in several patients and some have reported improvement in symptoms, especially when shortness of breath has been the main complaint. In the last week or so, there has been an increase in patients presenting with gastro-intestinal symptoms like diarrhea with fever and testing positive. We just want everyone to know and watch for these symptoms and consider COVID-19 in order to take appropriate precautions and contact their doctor for advice.

Question: When we reach the decline in cases, how do you see the reopening of our community playing out?

Dr. Mire: Let’s just start with the next two weeks. That brings us to the peak and hopefully the beginning of the decline. Locally, you’re going to hear that the hospital is planning to open back up for diagnostic services and elective procedures. Let me be clear, that in no way means we are getting back to normal. The hospital has safety protocols for everything and will be utilizing personal protective equipment, social distancing and controlling the amount of cases. This is a gradual but essential move for the health care of our community. They will also be viral testing for active infection as part of the preadmission workup. The hospital staff is prepared and well trained to take on all of these measures effectively and safely.

For the rest of the community, the most important step is to keep our foot on the pedal when it comes to social distancing, masking and hand hygiene. We have seen more widespread cooperation throughout our community and the essential businesses in the last several days that were limited at first.

But, most businesses were and still are not fully equipped and trained to protect their employees and patrons from this invasion of our daily lives. This has gone from just an inconvenience for some to the reality that it is here and it is very dangerous. Asymptomatic, healthy individuals can unknowingly pass it to those at high risk. No one wants to be on either side of that transaction. Our community, unified with these mitigation strategies, has to stay the course to reduce the curve more rapidly and effectively. It’s frustrating and restrictive to live like this, but the virus does not care how we feel about that.

Our local medical, government and business leaders have to pull together to create the right mitigation strategy for our situation here in the Natchez area to get our city up and running safely.

Following directives and strategies from The National COVID-19 Task Force, national and state public health experts, CDC, OSHA and others will provide the framework. There will not just be a day on the calendar where we just go back to normal. We can only move forward to some kind of new normal that we should expect to incorporate into our daily lives for at least the foreseeable future.

With vaccines over a year away and no clear, curative medicine at this time, we must be prepared for everyday life with the risk of COVID-19. We hopefully get to June and the summer heat to find out that the virus acts like other seasonal viruses and goes away for a while. Even if it does, experts still expect a second wave in the late fall and we need to be prepared.

Question: What will this strategic plan involve?

Dr. Mire: Here’s what I think.

  1. Continue preventive measures to minimize exposure risk, promote everyday safety actions, and protect high risks individuals (aged, pre-existing conditions, healthcare, first responders).
  2. Gradual return to the New Normal – provide enough time to educate and provide training resources to businesses so they will be empowered to implement recommended actions tailored to their particular situation. Balance safety with minimizing the disruptions in our daily lives.
  3. Isolation of infected individuals and contact tracing. This step will rely on more funding for our local public health departments to aggressively monitor patients and contacts. This will provide for the ability to break the chain of spread more quickly. This will be important to identify those individuals who will benefit from testing strategies.
  4. Mass testing: Current testing by our clinics and hospital are genetic tests that identify the virus RNA within the patient’s nasal passages. This test tells us if someone has active infection. The test usually goes positive from start of symptoms to resolution which can be up to 14 days or so. We are seeing 24 hour or less turnaround times in the clinic for results now and the hospital is seeing same day results for some of their patients.

We hope to be able to offer rapid testing from Abbott in the very near future. This will be a major improvement for monitoring because the test is done in the clinic with results in less than 15 minutes. This test also measures the viral RNA that would indicate active infection.

An additional test we will be using is the IgM/IgG Antibody test. It is very important to know how this test will help us. It is not to be used and is unreliable to identify someone with active infection. The test identifies antibodies in the blood. If the patient had been infected with SarsCoV2 virus previously, they would begin making antibodies using their own immune system. IgM is produced first but is not identifiable until late in the acute infection or in early recovery. IgM only stays around in our immune systems for a few weeks. IgG levels start to rise 2-3 weeks after recovery and is the antibody that provides long term immunity, though we are unclear how long it will protect us since this is a new virus. To be clear, this test is not a valid way to identify active infection and we don’t want anyone to use it for those purposes.

We should be able to utilize the IgM/IgG Antibody test for another important reason in our strategic plan. We know there are a lot of people in our community that have been exposed to the SarsCoV2 virus but were either asymptomatic or symptoms were not serious enough to seek medical attention or testing.

Most likely, these individuals will have some immunity to the virus for an extended period of time and therefore would also be a very low risk to transfer it to others. This information can be very helpful in getting our workforce back safely, especially in healthcare/nursing homes, restaurants and other businesses where it is more difficult to adequately social distance.

Using the tests in the school systems for teachers and students may give us good data for decisions about returning to school this fall. These tests will become available to us very soon and will be an integral part of the strategic plan. (Note there have been issues with some companies that have sold unreliable test kits produced in China. We are working with our sources for kits with emergency use authorization from the FDA and produced in the USA.)

Overall, we need our community to stay vigilant for the next 30 days. Please do not relax our mitigation strategies too quickly. Working together, we can avoid a second bump, implement an effective strategic plan to get back to our lives and begin mass testing to provide valuable tools to facilitate ongoing infection control and obtain community immunity data.