Coronavirus in Context: Georgia: The Road to Reopening and What We've Learned

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You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. Today I'm joined by two guests, Dr. Colleen Kraft, she's the Associate Chief Medical Officer of Emory University Hospital. And Dr. Carlos Del Rio, he is the Executive Associate Dean of Emory University School of Medicine. Thanks for joining me today.

Thank you.

Good to meet with you, John.

You know, Atlanta was the first major city to reopen, uh, during the pandemic. I'd like to understand what you all are seeing. Dr. Kraft, what are your impressions of what's been going on since the reopening?

Yes. So the city of Atlanta and also the state of Georgia were the-- were the first to reopen. We have not seen a huge surge, uh, that we thought we were going to be seeing. I think, um, mostly because many individuals, at least in the metro Atlanta area, are still really trying to focus on doing, um, social distancing, wearing masks in public, and being very tentative about, um, being in large crowds and being in public places, such as restaurants.

And so I think, even though there was a relaxing of the shelter in place statewide, I would say that it's been very slow in getting to-- I mean, we're nowhere near sort of what it was pre-COVID.

Dr. Del Rio, has anything surprised you about that?

No. I think Dr. Kraft is absolutely right. I mean, I think just because, you know, one thing is policies and political decisions, and the other thing is individual decisions. And what we need to understand is that it's really individual decisions that are going to impact what this pandemic does and what-- what direction it takes.

It's our own-- own individual decision. So we continue practicing social distancing, if we continue wearing masks, doing the right things, not only are we not going to get infected, but we're going to prevent others from getting infected. So the reality is, we need to remember that this virus has not gone away and that we need to continue doing those things.

Having said that, there are clear evidence that we're seeing some impacts of those-- of those easing of restrictions. And we're seeing some people, you know, sort of thinking that the virus is gone and not wearing masks. And we're seeing, uh, people in other places.

And we are beginning to see an uptick in the number of patients being admitted and the number of cases. Now, we need to be aware that cases are going to increase. What we need to be sure is we don't have these outbreaks. We need to contain cases so they don't become big outbreaks.

And Dr. Kraft, are we looking at the right data? You know, we tend to look at total number of cases and the aggregate. Um, we may not always focus as much on-- on local communities. You know, we don't hear as much about hospitalization and death rates. Do-- do we have the right data points to really assess what's working and what's not?

I think we do have the right data points. I tend to look at three main sources of truth. One of them is the Johns Hopkins Center for Global Health Security, and that gives you a real global perspective, which I think is important to think about, um, the number of global cases seems staggering compared to just a few months ago.

And so I think that's a place to start. I look at the CDC website for our national data. So what, uh, Dr. Del Rio was alluding to earlier, thinking about what's happening in other states. But then I spent a lot of time looking, and I know Dr. Del Rio does too, at-- at our Department of Public Health Georgia website.

And so while you can see spikes in various counties, I really spend a lot of time looking at the top five counties, um, in Georgia to sort of see if there's a change, and one county being higher than in another in terms of cases. So to me, it's all about looking at the microcosm that you may be living in, and then what area you're serving, either as a clinician, or a hospital administrator, or a public health individual.

I will just add to what Dr. Kraft said. I think she's absolutely right in the-- in the source of data she looks at. One additional one that I would add here in Atlanta is with the mayor's office, we put together a website called atlantastrong.org.

And there's a dashboard there that I think is, again, looking at dashboards is very useful, because the dashboard really tells you what cases are doing, what deaths are doing, what hospital admissions are doing, what ICU capacity is, what testing is. So there's a lot of data points that are helpful to know what you need to do.

And Dr. Del Rio, I wanted to follow up on your point about, um, you know, in some ways, there is this quarantine fatigue, and people are out and about. And, you know, they may not be hearing about the, you know, number of cases. And they see people, you know, in restaurants without masks and walking around. How do we keep people vigilant, uh, and recognize that the virus is still around and they need to still have these safeguards?

I-- I think that the-- the quarantine fatigue is true. But the reality is, is this is an epidemic. This is a pandemic. This is serious. This is unprecedented. I mean, the reality is, I've never lived through anything like this.

Hospitals across the United States, primarily in the Northeast in New York and other places, got overwhelmed very rapidly to the point-- you know, I remember a colleague at Cornell saying, we have 125, you know 500 people hospitalized with COVID, 170 who need ICU care, and we only have 100 ICU beds.

It is-- it is scary. I mean, that level of overwhelming of hospitals, those images should scare anybody. And if they don't scare somebody, I think it's-- it's-- it's-- we need to do a better job communicating this. Because the reality is, is this virus still with us.

Now, we're learning a lot about it and we're learning how transmission occurs, how to avoid it. So as we learn this things, we need to communicate that to people because we can-- can, in fact, decrease transmission. And we have to be particularly careful with our vulnerable populations.

I think we really need to protect our-- our people over the age of 65, people that have chronic conditions. Because those are the ones that they happen to get sick, are going to get very sick. They're going to get in the hospital, and they may actually need ICU care and even die.

I want to talk about the impact on different populations. What has been, um, the disproportionate impact on minority populations? Are we seeing even a greater impact with reopening, um, or has that leveled out?

We do have, especially in Atlanta where we have a very wonderful diverse community, we are seeing that the impact on, um, persons of color and minority are-- are disproportionately higher. I think it's too early to tell if it's happening as a result of the release of shelter in place. We just know that it's sort of happening already at baseline.

You know, I think, initially, we saw a big number of cases among African Americans, among nursing home residents. I think we are continuing to see, here at Grady Hospital, we continue to see a disproportionate impact on African Americans. But we're also seeing, across the city, an increase in the number of cases among Hispanics.

And again, many of these people, I think what they all have in common is they're frontline workers. They're-- you know, they're the people serving. They're disproportionately in those positions and those jobs that require you to be in front of people, that require that-- there's a lot of crowding. Think about the-- the meatpacking industries, et cetera.

And there's also, quite frankly, many of them live in conditions. You know, shelter in place is a privilege. You know, I've talked to many of our patients and they say, well, you know, I was talking to a young 23-year-old man infected the other day and Hispanic. And he said, well, I live in an apartment with 15 other people in two-- in a two bedroom apartment.

I rent not a room, but I rent a bed there. Well, when people live in those kind of conditions, transmission is going to happen. So I think we need to remember that it is-- it's living conditions, it's poverty, it's the fact that you're a frontline worker, it's the fact that you need to take public transportation that puts minorities at a-- at a much greater risk than those of us who have the luxury of being able to shelter in place, who have the luxury of being able to telework, to telecommute, et cetera, et cetera.

Now, having been a month plus in terms of reopening, what would each of you have done differently that other states and cities can learn from?

Uh, I think in terms of the state, uh, even though there was a lot of concern about us opening early, I think what Dr. Del Rio really eloquently said it earlier, which was, even though there was a policy that was made and-- and then revoked, meaning that the shelter in place, is that it's our personal responsibility to take care of ourselves.

And so while we can blame sort of lots of other aspects of what's going on, we still have within our control to be able to protect ourselves. And I think I want to continue that message. Whether or not the state is open, the city is open, you have to return to work, you don't have to return to work, you can telecommute or, um, telework, I think we still need to realize that we have the ability, with hand sanitizer, masks, and good surface and face hygiene, to be able to protect ourselves against this virus. And we should be taking it seriously.

I would just add to that. We have-- we-- we have the ability to-- and to protect ourselves. And we also have the ability to protect others. I mean, the reason we wear masks in public is not to protect me, but it's to protect others.

And if everybody in public wear a mask, you can decrease transmission at the population level by about 40%. So the reality is, we all have the responsibility to take care of ourselves. We all have the responsibility to take care of others. And if we do that, we can actually decrease transmission by not doing a bunch of things.

I mean, it's not like we need to stay inside and never go out again. But when we go out, we have to wear a mask. We have to do hand hygiene. There's certain things we have to do.

Well, that's very good advice. And I want to thank you both for joining us.

Happy to be with you.

Thank you for the opportunity.

And I want to thank you for watching Coronavirus in Context.