LEILA FADEL, HOST:
The coronavirus pandemic continues to wreak havoc in nearly every part of the country. Just yesterday, the U.S. reported more than 177,000 new confirmed coronavirus cases and over 1,400 deaths. For days now, the number of new daily cases has been in the six-figure range, and the data suggests things will likely get worse. That's because there's a general lag between a rise in cases and a rise in hospitalizations and deaths. This comes amid a busy holiday travel season, which has public health officials worried about more surges and overwhelmed hospitals.
But the numbers only tell part of the story. We wanted to get a sense of what the surge looks like for the doctors and public health officials who are battling it, so we've called on three to share their experiences. Joining me now are Comilla Sasson. She spent the last few weeks traveling through the Midwest helping hospitals deal with COVID-19 surges.
Welcome.
COMILLA SASSON: Thanks so much for having me.
FADEL: Ivan Melendez is the health authority for Hidalgo County. That's in Southern Texas on the U.S.-Mexico border. And it's one of the hardest-hit areas in Texas.
Dr. Melendez, nice to have you.
IVAN MELENDEZ: Thank you so much.
FADEL: And Dr. Lynn Paxton. She's the district health director for Fulton County in Georgia. That's the district that serves most of Atlanta and some surrounding suburbs.
Dr. Paxton, welcome to you as well.
LYNN PAXTON: Thanks for including me in the conversation.
FADEL: So we're going to start with Dr. Sasson. You're just getting back from a few weeks on the road. You were in the Dakotas, Montana, Oklahoma - those states among the hardest hit right now. As briefly as you can, tell us what you were doing in those places and what you saw.
SASSON: I was actually leading a COVID crisis response team that was going out to critical-access hospitals and trying to help them prepare for the surge. Oftentimes, we would come one or two days or maybe a week before the surge actually hit - so just really getting folks to understand what their capabilities are, how to treat high volumes of patients and higher acuity patients than they're used to.
But most importantly, I think, just really dusting off the plans that many folks had had in March and April, but, you know, we had that lag time where everything kind of looked good, like we were going to be having everything under control, and so just really kind of reigniting hopefully those plans that people had put into place.
I think the hardest part was, is that once we got there, you know, our case positivity rate in one of our communities went from 3% to 42% within...
FADEL: Wow.
SASSON: ...Just a few days. And so the volume of patients that we're seeing in those communities is massive. And then the lack of ability to transfer out, I think, is what was really the most difficult thing for folks to comprehend.
FADEL: Transfer out to the larger hospitals.
SASSON: Yep, exactly. And, you know, a lot of these hospitals are used to saying, hey, look, if we've got sick patients, at any time, we can transfer them to a higher level of care. And when we were in the Dakotas, when we were in Montana, there really was no place to send those folks.
You know, I personally spent hours on the phone - 16 hospitals I called, and not a single one could take our patient, so we ended up having to keep that patient at our hospital. And so it's just a huge mind-shift, culture change, for the workers there, because I think, again, no one really knew what to expect until we started hearing - seeing those real surge volumes.
FADEL: Wow. Dr. Melendez, your area - also really hard hit on the Southern border with Mexico. Texas recently surpassed 1 million cases, so we're talking about a lot of people getting sick. Can you tell us what you're seeing in the hospital and what the surge looks like where you are?
MELENDEZ: It's better than it was in July, but it's up about 20% from about three weeks ago. So we're also seeing after the holiday season, the opening of the schools, the reopening of the bars and restaurants, the winter visitors coming from the North, from the Midwest - and, of course, our porous border along the Rio Grande River - the numbers again increasing in the last several weeks.
FADEL: Dr. Paxton, how about you? Your county has a lot of people - over a million residents. And in your role, you oversee a number of hospitals and clinics. Can you tell us about what you're seeing where you are? Is there something from this past week that sticks out to you?
PAXTON: Daily numbers of reported cases are going from somewhere around 70, maybe about two to three weeks ago, steadily increasing to about 150. We got - then we had - like, yesterday, I think we had about 340 or so. So we are seeing an - you know, an almost exponential rise in cases in Fulton County.
FADEL: You all represent such different clinical and geographic settings, and so you have really unique perspectives on just how bad this pandemic has gotten. And you're seeing, quite honestly, what most Americans aren't able to see. So before we let you go, what's the one thing you think needs to happen now? If you could advise President Trump or President-elect Biden to do one thing based on what you've witnessed, what would it be? And, Dr. Sasson, let's start with you.
SASSON: So the one intervention that I think could absolutely change the way in which we have folks access care is to really quantify for people what it means to be sick with COVID-19 and when you need to seek care. I think we've done a lot of public education saying, don't come to the hospital, don't overwhelm us until you're really sick. And I think what we've needed to do now is shift the conversation and really talk about, hey, look, here's when you do need to come to the hospital and get care.
And that's what we've done in our - primarily in our Native American communities. And we've shifted that conversation to say, hey, look, if you've got COVID-19, you're going to get worse sometime between day five and day 11. If you get to the point where you can't walk to the bathroom, or you're feeling very winded even after walking for just one minute, can't sing your ABCs, then come see us.
And so we get these people in much, much sooner. And what we've been able to do is to stop that hyperactive immune response. And we've been able to treat them with steroids and other medications to help them get better - and most importantly, give them oxygen because that's really most of the reason that a lot of people get very, very sick.
So to me, that's the No. 1 intervention we can do - is to tell people not to not come access the health care system, but when to access the health care system and make sure that we're quantifying in a way that makes sense.
FADEL: Yeah. Dr. Melendez, your thoughts?
MELENDEZ: You know, even though our population is 1.2 million people, I've lived here the majority of my life, and so I've intubated previous school teachers. I've played messages from family members who have passed away, essentially corpses of my neighbors, my mom's best friend, my uncle. So it's become a very personal thing for us here. We've had over five physicians die, over 20 nurses die, and very personal.
And so when you see the people in the community continuing to act in ways that are not helping mitigation, despite being fatigued from COVID physically for nine months, it's also an emotional and a spiritual kick because you ask yourself, what are these sacrifices worth?
In the Rio Grande Valley of Texas, on the border, we are traditionally the No. 1 or No. 2 area in the entire country in diabetes mellitus, obesity, hypertension, use of hemodialysis, poverty. Forty to 45% of our people are uninsured or underinsured. Our average age is 29 years of age, where people believe they're just indestructible, infallible. And most of our admissions that we're seeing are twosies (ph) and threesies (ph), which means mom and sister, grandparent and grandson. So our No. 1 mode of our 40,000 people transmission have been family.
So I asked myself, why do we have the highest mortality rate? Is it because we're the sickest? And the answer is, yeah, because we're the sickest. And then I ask myself, what about other ethnic similar demographic populations all along the border, and I guess Native Americans, et cetera? Why did we - why were we the worst among the worst? And it hit me - hit me - is that we were ill-prepared as a community standard baseline state of health.
Getting the baseline of the population to be not as obese and have better control of diabetes would have placed our population in a much better starting point to, you know, fend off this pandemic. So I would recommend strongly and I would elicit from those public servants that we elected to refocus some of our resources into having access to primary care for the majority of the population so that we could be in a much better baseline state of health and avoid starting way behind the line when the next pandemic or the next wave comes along.
FADEL: Wow. Dr. Paxton, what about your final thoughts?
PAXTON: This pandemic has basically just laid bare all of the long-standing discrepancies and inequities that have been existing in our public health system for decades. We want to think beyond COVID because at some point, COVID will be in our rearview mirror. But then again, something else is going to come along.
But we all know that these basic discrepancies, the high rates of high blood pressure and diabetes and heart disease and obesity that, you know, are affecting so many of the people in our community - they're still going to be there, and we still need to work on that. So we're trying to capitalize on some of the resources that we have now as a direct result of COVID and thinking forward to, how can we use these to help bring down these high rates of other illnesses that are having such a devastating but hidden, more hidden, effect on our communities?
I mean, COVID can - has been rather dramatic. But, you know, heart disease and diabetes have been killing people in our communities for decades. And we have an opportunity to really, really address that. But we need the political will to do that.
FADEL: That was Dr. Lynn Paxton, district health director for Fulton County, GA., Dr. Comilla Sasson, emergency medicine physician in Colorado, and Dr. Ivan Melendez, the health authority for Hidalgo County, Texas.
Thank you all so much for joining us today.
PAXTON: Thanks very much for having us.
SASSON: Thanks so much.
MELENDEZ: Thank you so much, guys. Keep your heads up. We're all in it together.
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