BONUS: Fighting the Next COVID-19 Wave

ROBERT JOHNSON:
This is Public Health Review. I'm Robert Johnson.

On this special episode: fighting the spread of the Delta variant; public health officials talk about vaccines, mask mandates, and sending kids back to school.

Welcome to a special bonus edition of Public Health Review, a podcast brought to you by the Association of State and Territorial Health Officials.

Today: voices from the front lines; public health officials battling a surging COVID variant; looking for ways to build trust in vaccines; answering questions about mask wearing; and explaining the value of both to parents with kids about to head back to school.

On Thursday, three state public health officials met in a virtual news conference with national and local journalists to discuss these issues.

Dr. Nirav Shah is president of ASTHO and director of the Maine Center for Disease Control and Prevention.

Dr. Karyl Rattay is director of the division of public health at the Delaware Department of Health and Social Services.

Dr. Joseph Kanter is the state health officer for the Louisiana Department of Public Health.

Up first, Dr. Shah.

DR. NIRAV SHAH:
Historians of the pandemic will look back on where we are now and compare it against one year ago, and what they will see when they look at the present is an inflection point, a fork in the road.

In both time periods, then and now, cases had increased or were increasing and concern was literally in the air. Now, a year ago, masks were the coin of the realm and variants were the stuff of virologists' nightmares. Researchers were talking about variants, but the public wasn't.

JOHNSON:
Of course, everyone is talking about variants today, but they're also talking about vaccines—three formulas that could end the pandemic.

SHAH:
If only we could convince the remaining 30% or so of the population to take them. The movable middle that we've all been talking about for the past few weeks is moving, but it's moving more slowly than it did a few months ago. And the principal risk right now is that the variants will get to those folks before a vaccine does.

JOHNSON:
Dr. Joseph Kanter is Louisiana state health officer and a practicing emergency room physician. He's dealing with the policy and the people in his office and the ER.

DR. JOSEPH KANTER:
It's as bad now in Louisiana as it has ever been at any point during this pandemic—and I say that still with some degree of shock that we're back here.

A lot of us, myself included, did not think we should be back here, even with the vaccination coverage being relatively low. We did not get this far in to the pandemic to think be we would be right here. It feels like we never even left, unfortunately.

JOHNSON:
Kanter wants people across the country to learn from his state's recent and worrisome experience.

KANTER:
For the past four weeks, we have increased our hospitalization COVID census by a factor of six. Almost every hospital in the state now is canceling or postponing elective and non-emergent procedures.

The majority of hospitals that I spoke to today are on diversion, which means that critical patients—COVID or non-COVID—in smaller hospitals that don't have the resources or expertise to treat them, cannot be transferred in. It's very hard to get patients transferred in.

And there are real morbidity and mortality consequences to that—even just canceling or postponing non-emergent procedures. Most procedures that are non-emergent are only such for so long, and then they become emergent. And that's what we saw during the first wave when there was such disruption in healthcare.

Louisiana is leading the country in new cases. And even more concerning than the actual number now is the trajectory—and we have gone pretty straight up when you look at our graphs, both for hospitalizations, COVID-like illness presenting in emergency department, and new cases over the past three weeks.

JOHNSON:
The surge is being driven by the Delta variant, a strain that's far more contagious than the earlier iterations of the virus. Shaw calls it wily; Kanter says it's a big unknown.

KANTER:
Nobody really knows how to model Delta appropriately, so it's difficult to put how high we're gonna get and how long we are going to be in this. It's not a comforting place to be.

JOHNSON:
As a policymaker, Dr. Karyl Rattay has her eye on the new school year, thinking about the kids who have not been vaccinated and ways to keep them safe.

DR. KARYL RATTAY:
Both the CDC and the AAP recommend universal indoor masking for all staff, students, and visitors to K-12 schools, regardless of vaccination status.

This, again, is because the large portion of students are not eligible to be vaccinated or have not yet been vaccinated. And also because the Delta variant is more contagious. In addition, schools may lack the resources to monitor vaccine status or enforce mass policies based on vaccine status.

JOHNSON:
As a mom, Rattay says her kids have adjusted to wearing masks in class.

RATTAY:
I can tell you, having two kids myself in school—they don't care. They just wear them. They wear them when they need to, and it really doesn't impact them.

If we want to have kids in school this fall, and as many kids as we possibly can get into school, masks are a key component to getting kids back into school.

JOHNSON:
Although the Delta variant is more aggressive, Shah, Rattay, and Kanter remained convinced that vaccines and masks are the best defense against infection.

When asked whether mandates could help chip away at the group of Americans not yet protected, Shah in Maine says they could help drive a decision—at least among some of the holdouts.

SHAH:
There are probably two groups there—there are those who haven't yet been vaccinated by choice, and those who have not yet been vaccinated by chance—and mandates help both.

For those who have not yet been vaccinated by chance, they've been busy, they haven't had the ability to find the vaccine spot. Making it mandated or a condition of employment coupled with easy access helps that.

And then, for those who have not yet done so by choice, it puts the decision right in front of them. Some fraction will opt out, but I'm heartened by the fact that, for example, Methodist Hospital, which went in this direction in Houston, saw vanishingly few people ultimately say no.

JOHNSON:
Rattay from Delaware says offering frequent testing to hesitant people might still help improve vaccination numbers.

RATTAY:
Maybe somebody comes in for a weekly test, three, four weeks in a row, and talks to a nurse there, develops a relationship with them, and, finally, on the fourth visit, they're like, "All right, here's my arm."

JOHNSON:
The bottom line? For Kanter, people need to get their shots to stop the virus before it mutates again.

KANTER:
We have excellent protections against the worst consequences that even Delta can bring. There's no guarantee that future variants will provide us that opportunity. Despite all the transmission dynamics, this vaccine remains a good match for Delta, it remains good protection against severe disease.

And I think the more we can continue on this push and remind our stakeholders that we are not out of the woods yet—even if you think you can see daylight, we're still in the same thing—I think it will pay dividends in and save some lives down the road.

JOHNSON:
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This show is a production of the Association of State and Territorial Health Officials.

For Public Health Review, I'm Robert Johnson. Be well.