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Monday, Aug. 10, 2020

We Are All In This Together

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Louisiana cannot afford another stay-at-home order

The COVID-19 virus has changed everyone’s world. For many, health and career have been impacted. Others have experienced the crush of change from mental, spiritual and other health concerns to caring for our children and aging parents. The last few months have been a time of personal disruption and transition.

The COVID-19 pandemic is a dual health and economic crisis. The crises are connected, and so are the solutions. We have to consider both lives and livelihoods as we resolve to prevent overwhelming our health systems, limit the complications of the virus, and preserve our economy. We are all in this together.

Like March and April, our hospital capacity is currently being threatened by an increased number of patients with COVID-19. We ask our friends and neighbors to redouble efforts to participate in common sense prevention strategies of physical distancing, facial covering, checking temperature, frequent handwashing and staying at home when ill. At the same time, support us by supporting this community as a whole – our small businesses, our schools and people returning to work. Strong health-care systems require strong communities.

The advantage of today over March and April is the ongoing scientific discovery of the past few months. We are learning – filling in gaps of knowledge every day in this pandemic. This added knowledge gives us the confidence required to successfully navigate the dual crisis. It is confidence borne from knowledge – not false bravado and unrealistic expectations. We can’t predict tomorrow, but we do know our community and health systems can and will adapt.

We know the community prevention strategies of physical distancing, face-covering and staying at home when ill are effective. Because of the reduction in transmission of the virus from these prevention steps, our hospitals weathered the original wave of COVID-19. We are now better prepared to respond to the current spike in cases and hospitalizations in our community, but it will require the same intensified work and sacrifice from health-care workers as in the spring. We are all in this together.

We have learned that the incidence of major complications of COVID-19 are predominantly in the elderly with chronic problems such as obesity, diabetes, COPD and heart disease. Upward of 50% of deaths have been in nursing home patients, 30% in people over 65 and not in nursing homes, and the other 20% in the rest of the population. We also learned there is much higher prevalence of the virus in lower socioeconomic neighborhoods. As health-care workers, we have appreciated our community’s efforts to protect the vulnerable. We join with you to step up these efforts in the face of our current increase in hospitalizations. We are all in this together.

We have learned about the exponential impact of large gatherings and super spreading events on the rapid transmission of the virus. Japan has been able to avoid the worst effects of the pandemic without mandatory lockdowns by concentrating on avoiding highrisk situations defined by the three C’s: closed spaces, crowded places and close-contact settings. We should do the same.

This means understanding the potential of exponential spread in crowded places. In our community, it means limiting large gatherings where distancing is not realistic – Mardi Gras, festivals, concerts, bars, funerals, political rallies, large family reunions and stadiums full of people at sporting events.

There is a reason ventilator usage and rates of death have been less impacted despite a significant increase in the number of cases and hospitalizations. This reflects the evolution of improved treatment of COVID-19 patients. Physicians across the globe have learned and shared their knowledge with each other. Scientific discovery is an ongoing process.

The management of fluids and ventilators in COVID-19 patients has evolved. Remdesivir has been shown in a large study to have a significant positive impact. Hydroxychloroquine has demonstrated a positive impact on mortality in one large study. Dexamethasone has improved outcomes of the most ill patients with COVID-19. Fulldose anticoagulation has been used to reduce blood clot complications. Convalescent plasma and other experimental therapies have helped many and await study results to be used in nonexperimental settings. The focus on multiple treatments is key to living with the virus more on our own terms – even if vaccines are not yet available.

We underestimated the negative impact of stay-at-home, lockdown and school closure strategies. No one predicted a sixweek lockdown would convert a record low unemployment rate to Great Depression-like joblessness and business failures. No one predicted the impact of loss in education opportunities, social and emotional strain, and the impact on employment with the closure of schools. The impact of these economic and social issues add exponentially to the dual crisis threat – especially on the issue of overwhelming our health systems.

Louisiana simply cannot afford to lock down again. We already face the economic consequences of loss of tourism, adverse turns in the energy sector, and trade issues that impact all our ports. Another lockdown would be the culmination of the perfect storm that would likely set our state back for years. We must work together to do everything in our power to both reduce health complications and to prevent the inevitable economic complications of another stay-athome order.

So what do we do now as we move forward? First, we accept the inevitable tension of different perspectives. We continue social distancing, facial covering and handwashing at work and school. We concentrate on prevention efforts for the vulnerable population in our nursing homes and “hot spots” within our community. We continue limits on large indoor gatherings and outdoor gatherings where distancing cannot be easily accomplished.

We concentrate on monitoring the most important metrics of hospitalizations, hospital capacity and mortality rates. We send our children back to school. We do everything in our power to avoid lockdowns by staying focused on doing what needs to be done to flatten the curve to protect our health systems.

We are all in this together is no trite statement when connected with the COVID-19 viral pandemic. Implementing community prevention strategies of physical distancing, masks and staying home when ill requires all of us. So does limiting large gatherings. So does protecting the most vulnerable. So does supporting our local businesses and schools. So does flattening the curve to protect our health systems.

The lack of realistic expectations and the law of unintended consequences have surfaced many times with this pandemic. Fear of the unknown can be paralyzing. However, as we continue to learn and lessen the unknown, we gain confidence and hope. It is what we are doing as we learn more about COVID-19.

This past Sunday, I witnessed the baptism of a young lady at my church. It reminded me of the gift of God’s grace and the manifestations of that grace through love. It was a reminder hope and faith trumps fear and anxiety. Isaiah 41:10 reads, “So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you. I will uphold you with my righteous hand.” We have to continue to remember these truths and those from scientific discovery as we make our way out of this pandemic. We are all in this together.

Dr. Phillip Rozeman is a practicing cardiologist. He is past board chair of the Greater Shreveport Chamber of Commerce, Shreveport Medical Society and Blueprint Louisiana, and a former chief of staff at Willis-Knighton Health System.

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