HJNO Jul/Aug 2020

HEALTHCARE JOURNAL OF NEW ORLEANS I  JUL / AUG 2020 39 Joseph Kanter, MD Assistant State Health Officer Louisiana Department of Health AS WE BEGIN Phase 2 of our reopen- ing, and slowly reacquaint ourselves with vestiges of our pre-COVID lives, the early days of our outbreak in Louisiana seem a distant memory. Lest we forget: In the early weeks, Louisiana was home to the fastest-growing COVID-19 outbreak in the world, and, by all rational expectations, was headed toward absolute disaster. Late March projections from within LDH, as well as outside experts, forecasted an ear- ly April surge of hospital-level COVID-19 patients exceeding existing acute care bed availability by approximately 2,000. Patients requiring mechanical ventilation were projected to exceed ventilator supply by a factor of 2-3. Crisis standards of care were discussed in a manner not seen since Hurricane Katrina. Few of us have ever had to doubt quality acute medical care would be available to us at all times, for any reason. Yet we watched the experience of Northern Italy—hospitals overfull and turning away patients, long lines of ambu- lances queued to drop off patients like par- ents at elementary school—and had every reason to believe we would be there too. That, of course, did not happen. Imme- diate resources were directed toward the rapid expansion of acute care capacity, including the addition of surge capaci- ty within existing Tier 1 hospitals, quick procurement of crucial supplies like me- chanical ventilators, and the erection of alternative care facilities like the medical monitoring station at the Ernest N. Morial Convention Center. Elected leaders made difficult decisions to cancel public events, order aggressive but necessary social dis- tancing measures, and issue calls for the public to stay at home to limit the virus’s spread. And most notably, Louisianans heeded those calls. Highway traffic data and aggregate mobile device location in- formation pointed to widespread adher- ence to social distancing measures during the peak weeks of the outbreak. Our flat- tening of the curve was remarkable, but it was far from a foregone conclusion. Now a national best-practice model, the dramatic change in trajectory in our statewide out- break was due to data-driven public health measures, good governance, and wide- spread public cooperation. Additionally, Louisiana’s robust emer- gency preparedness infrastructure proved invaluable to our ability to monitor the outbreak and respond expeditiously. Sig- nificant investment and training in the years since Katrina have yielded a national best-practice hospital tracking system and at-risk registry, dedicated medical special needs sheltering plans that can be quickly adapted to a variety of emergent settings, and well-identified communication path- ways between the private sector, munici- pal and parish governments, and state au- thorities. We were fortunate to build from this position of strength in our COVID-19 response. However, the pandemic also laid bare deep-seated racial inequities in our com- munity. Disparate prevalence of comor- bid medical conditions—in part resulting from the wide variance of social deter- minants of health across racial lines, and decades of severely limited access to care for marginalized communities—provide a partial explanation of why black Lou- isianans, less than one-third of Louisi- ana’s population, constitute well over 50 percent of COVID-related deaths. Widely unequal exposure risks tell more of the story. Black Americans are more likely to be employed in a job considered essential, are less likely to be afforded the ability to perform their job remotely, and are more likely to lack the ability to safely isolate from other family members in their own home. We have learned from prior disas- ters that vulnerable people are vulnerable, and our COVID-19 experience is no differ- ent. Systemic racism in Louisiana and else- where certainly predates COVID-19, but the widespread and spontaneous protests we have seen demanding accountability for the murder of George Floyd, and the longstanding institutional racism which has allowed for select instances of police brutality to go unaccounted for, demand recognition that poorer outcomes from COVID-19 and poorer outcomes within our societal structure are branches of the same trash tree. We can be proud of our COVID-19 re- sponse to date in Louisiana, and still com- mit ourselves to working harder, working smarter, and addressing longstanding inequities. Our communities and our pa- tients demand this of us as healthcare and public health professionals, and it is our obligation to rise to the challenge. n DR. JOSEPH KANTER serves as assistant state health officer of the Louisiana Department of Health. He is also a clinical assistant professor of medicine at LSU Health Sciences Center, adjunct assistant professor of medicine at Tulane University School of Medicine, and a practicing emergency physician.