HJNO Jan/Feb 2026

DIALOGUE 10 JAN / FEB 2026 I  HEALTHCARE JOURNAL OF NEW ORLEANS there were so few knowns at that point. The best modeling we had in those early days told us that if we did nothing, no mitigation, we would have about a 7% mortality rate. That is huge. When you’re facing those numbers, you have to be prepared for anything. All we could look to was what was happening in China where they were being overrun and they were setting up field hospitals like that. That’s the nature of being prepared: It’s preparing for the worst and hoping for the best. We know — especially in New Orleans — we knew from Katrina that you can’t just not have a plan because a lot more people die when you don’t have a plan. And so yes, I do see it as a success. I think a hallmark of emergency preparedness is mobilizing the assets and then hoping that you never need to use them. Editor The politization of science and public health is making my head spin; I’m sure yours as well. Avegno Indeed. Editor During COVID, many Americans say they didn’t trust CDC, and now former CDC scientists and medical societies are saying similar things, but for entirely different reasons. What do you think is the root of the discord? And how do you lead in a moment when trust is collapsing from both ends? Avegno Yeah, I think that there is some validity to that. I think that we all know that even before the pandemic, trust in traditional American institutions was waning. And that’s medical science, that’s Congress, that’s a variety of hallmarks. When you have such an unprecedented, completely unknown event like a global pandemic which disrupts all of the social norms that everybody has grown up with for 100 years, there’s a tremendous amount of fear and confusion. And what people want most is certainty. And unfortunately, that’s the thing that often you have least. my radar, although I would say emergency medicine, you see a lot of public health in its clinical expression. If a pandemic’s going to show up, it’s going to show up in the emer- gency department and things like that. But I applied to be the health director for the city and, somewhat to my surprise, was selected in 2018. My goal was to tackle some of the biggest health issues in our community, which have in many cases been intractable for years — like most American urban cities — things like maternal child health, behavioral health, system inequality, and violence. So I began to work with our fabulous team here at the health department, and then we had a pan- demic, two pandemics, actually, and several natural disasters. Although I think that’s how most people know the NewOrleans Health Department best is for our work in COVID, we’ve been around for almost 130 years working on the really tough problems. And I think we have some real opportunities to make some foundational gains in improv- ing health outcomes for all NewOrleanians. Editor You’ve led the New Orleans Department of Health since 2018, as you mentioned, and guided it through a century-defining public health crisis, with New Orleans emerging as an early epicenter. What was that experience like from where you sat? Avegno It’s hard to describe. I guess I’m eternally grateful for having the training as an emergency physician because for 20 years, I’ve learned how to be in crisis mode pretty much all the time, how to make deci- sions quickly with as much information as is available at the time, how to communi- cate clearly to people who are in distress, and how to deliver bad news. Once we were launched into the pandemic with such force as New Orleans was, I really drew on that training, and I hope it served us well. It was making decisions based on incredibly lim- ited information for an entire community, not just one patient, and understanding that it was going to be impossible to get every- thing right, but knowing that if I could back up what I was doing with the information I had at the time and communicate that to the public and be able to say, “Here’s what we know and here’s what we don’t know. Here’s what we think the best path forward is,”that that hopefully was going to serve us well. And so those early days were a lot of sleepless nights, trying to figure out what the best path was for our city and under- standing that our city was unlike most other cities at the time. It was just us and NewYork City and maybe up in Seattle, but most other places were, so they thought, unaffected by this, and we were getting absolutely ham- mered. It was impossible if you lived in the city of New Orleans not to be affected by COVID. We had to make some pretty early deci- sions, and I think they set us on the right tra- jectory. We had a lot of deaths fromCOVID, but the vast majority of them came in that early period [when] we didn’t really know what was happening, didn’t have great tools to diagnose it — certainly didn’t have many mitigation measures or a vaccine — and so we had to act pretty quickly. Once we got control of the epidemic as much as anyone could, then I think we started to see much less morbidity and mortality compared to many places around the country and other places around the state who didn’t mitigate in the same way that we did. I’m really proud of our team. They’re not ER doctors; they’re public health professionals, but they were able to pivot really quickly and meet the moment. And so I think we came out bet- ter than we could have, I’ll say it that way. Editor There was some criticism from state legislators about the funds spent on the makeshift hospital that wasn’t heavily utilized. To me, that is complaining about a public health success rather than a failure. Avegno Yeah, I think so. I think the state really did the right thing, because again,