HJNO Sep/Oct 2021

HEALTHCARE JOURNAL OF NEW ORLEANS I  SEP / OCT 2021 23 McKenna We investigate all suicides, drug overdoses, homicides, accidental deaths or any suspicious circumstances. What are you seeing as the leading causes of deaths that your office is involved in assisting? Preston Still far and away the most common cause of death in the parish is natural. That is, somebody has significant medical prob- lems such as heart disease, diabetes or can- cer, and they succumb to that underlying disease process. There has been an increase in accidental overdose deaths. I don’t think this is related to the pandemic as much as to the emergence of very toxic opiates such as fentanyl and its analogues being mixed with heroin or being administered as a sole poison. Accidental overdose climbed from 93 in 2019 to 126 in 2020. My impression is that this has more to do with the lethal sub- stances involved in the overdoses, although I certainly couldn’t exclude pressure from the pandemic as a contributory factor. Cvitanovich Most of the cases we handle turn out to be natural, followed by accident and homicide. McKenna Right now, there are a large num- ber of drug overdoses and homicides. What do you think is the leading reasons for homicides in your area, and do you see an effective solution to preventing them? Preston We are very blessed in St. Tam- many Parish that we do not have a par- ticularly high homicide rate. We had a total of 11 in 2019 and 17 in 2020. Some of these homicides involved domestic vio- lence, some were related to drug activity. I don’t believe that the government can insinuate itself between the mind and the actions of an individual. Having said that, perhaps expanded mental health treatment opportunities and treatment for substance use disorder might temper these numbers. How has the COVID-19 pandemic impacted your office? Preston The COVID-19 pandemic has not particularly stressed our office, because most COVID-19 deaths are considered nat- ural deaths and are therefore not coroner cases. Having said that, my role as the chief medical officer of St. Tammany Parish has become more active, requiring my partic- ipation in prevention messaging initially through handwashing, social distancing and wearing facemasks and now in trying to promote the message that the vaccine is safe and effective. I do spend quite a bit of time addressing misinformation from social media that is contributing to vaccine hesi- tancy, which is driving the current fourth spike of this pandemic. There has been talk nationally that COVID-19 deaths are inflated, because underlying causes are not listed as the primary cause of death. So, while a decedent may have tested positive or been assumed positive for COVID-19, the death was actually due to an underlying condition but listed as a COVID-19 death. How has that worked in your parish? Preston The notion that the COVID-19 deaths are being inflated is just patently wrong. As I indicated, most of these deaths are natural deaths, and so they are being signed out by a private attending physi- cian, not the corners office. In my opinion, if anything, COVID deaths may be under- reported, because a patient may die from a delayed complication due to a thrombo- sis that is related to COVID-19, but because the infection was remote, COVID-19 was not implicated in the death certificate. The most important message I would want your read- ers to have is that nothing about this pan- demic is being inflated. The case rates are real, the long-term morbidity is something people all over this nation, and the world for that matter, are dealing with and will continue to deal with for a very long time. I continue to work diligently with our parish government to try and direct people to reli- able sources of information so that they are not putting their health and the health of all of those around them in jeopardy. I think we are at a critical juncture in our fight against coronavirus, and if there is not swift and widespread embracing of vaccina- tion and mitigation, our local and national economies will be jeopardized. This is very much a national security issue. If individual Americans don’t step up to do their part to stop the spread of COVID, this surge can become the most crippling event in our nation’s history. The same folks who resist vaccinations and facemasks are the folks who will be outraged when President Biden passes another multitrillion-dollar recovery package. To save lives, to protect our econ- omy and to protect our national security, the choices are simple: be part of the solution by becoming vaccinated and wearing a mask, or contribute to the catastrophe by failing to stop the spread of the virus. At the coroner’s office, we have increased our infection control measures, treating every scene as if the family members are COVID-positive. We are trying to conduct interviews outside instead of in closed spaces and liberally use N95 or above respi- ratory protection. Speak to us about what your parish is experiencing in overdose cases. Preston I think St. Tammany Parish is expe- riencing overdoses that mirror what is hap- pening throughout the state and the coun- try. It is the introduction of fentanyl and fentanyl analogues, which are so much more potent than traditional opiates; we are literally finding people with needles in their arm from these lethal injections. In St. Tammany Parish, parish government, through the leadership of Parish President Michael Cooper, and our fire districts have partnered to distribute Narcan to the pub- lic who may have a family member at risk for lethal overdose. I’ve been very active in