May 16, 2022

With 2nd anniversary looming, LA County’s COVID future may be about staying nimble – and humble

View Original Notice ? With 2nd anniversary looming, LA County’s COVID future may be about staying nimble – and humble

Embrace and harness the growing pool of data. Adapt based on what we learn. Improve the messaging. And stay humble.

With a somber second anniversary of the first coronavirus case in Los Angeles County just days away on Jan. 26, they are the elements of a shifting mindset in the battle against the disease.

Even as they face the staggering omicron-propelled surge of the coronavirus, medical professionals in the region are bracing for a long-term future of treating, managing and responding to the virus.

There’s a sense that it’s no longer about “beating” or “eliminating” COVID-19. It’s not about “Zero COVID.”

Don’t get them wrong, no one is giving ground. Leaders and front-liners alike still speak in terms of “changing the trajectory of the disease,” and “turning the tide.”

But many acknowledge that the future will very likely be about managing the virus for years to come — with vaccines and medicine, but also with humility and adaptability.

Prevention strategies and treatments will be adapted and refined. And it’s essential, expects say, that the way COVID strategies are communicated to the public improve as the same time.

For Dr. Thomas Yadegar, a pulmonologist and medical director of intensive-care unit at Providence Cedars-Sinai Tarzana Medical Center, the realization that a long-range battle lay ahead became acute during last summer ‘s surge — as the then-ubiquitous delta variant exploded.

“I had my suspicions before that that we weren’t going to beat it, but we had that summer surge with delta, and we had more patients in the hospitals… That made it very evident we are not going to eradicate this virus,” he said this week, stepping away from a morning treating a new group of patients.

This week, Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases, seemed to be echoing Yadegar.

“When you look at the history of infectious diseases, we’ve only eradicated one disease in the history of man, that’s small pox. That’s not going to happen with this virus,” Fauci told Bloomberg.

Mike Oliti swabs his nose for a free COVID-19 test hosted by Reliant Health Services at the Betty Ainsworth Sports Center, parking lot, in Hawthorne on Tuesday, January 18, 2022. Each participant took a rapid test and a PCR test. (Photo by Brittany Murray, Press-Telegram/SCNG)

Locally, Supervisor Holly Mitchell this week reflected on a future where mask-wearing could be more commonplace, where there’s more robust funding for public health and where the design of congregate-living facilities accounts for the need to isolate.  Supervisor Hilda Solis spoke of “a future with widespread testing and therapeutics,” “not far off,” “entirely within our control,” with vaccines and safety measures.

At the federal level, a year later, a group of former advisors to President Biden are urging his administration to pivot to a new domestic coronavirus strategy — one not caught off-guard by variants, where there are thresholds and benchmarks for when emergency measures should be taken to quell future surges, and where vaccines are continually updated.

It’s a future that Dr. Sue Chung, chair of medicine/rheumatology at Facey Medical Group, has seen coming, virtually since the beginning of the pandemic. She is not surprised at a more sobering tone about the future of the virus.

“I think it’s been on all of our minds,” she said. “From the onset, I don’t think we’ve seen any signs we’re beating the virus,” Chung said, also noting this disease’s ability to change, keeping researchers and healthcare professionals on their heels.”

Chung added: “It’s unlikely we’ll see it disappear. Our hopes are it will eventually end up like the flu.”

Chung leans on history as a guide to that future. In particular, she cited the Spanish Flu. After it rampaged through the world’s population from 1918 to 1920, infecting 500 million people (one third of the population at the time), it lost steam. A third wave of the virus triggered by the end of WWI started to subside. By 1920, the pandemic had ended and moved into an endemic stage, after infecting so many people. Clusters were found only in certain regions and cases spiked seasonally.

The 1918 pandemic never disappeared completely; it continued to survive by becoming less virulent, and today, modern flu strains still contain ancestral links to the pandemic that happened more than 100 years ago. As Chung notes, we never really absolved ourselves of it.

Welcome to the cusp of a “new normal.” This is the world where a new approach to thinking about a COVID-19 future sees governments recognizing that coronavirus is just one of several currently circulating respiratory viruses, from influenza to respiratory syncytial virus.

“I think we’ll see a similar type of pattern with COVID in the future, where we may find that variants arise from time to time and we may need to tweak our vaccines to include those variants each year as this becomes more of an endemic disease, one that has a constant baseline in society similar to influenza,” said Dr. Richard Kim-Farley, who studies the eradication of disease at UCLA Fielding School of Public Health.

Holding the hand of a staff member a nine-year-old foster child anticipates being vaccinated for COVID-19 by Carina Umana, an RN with Carbon Health, at Five Acres in Altadena on Thursday, November 18, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

“Getting out my crystal ball, we will see a world in which we have effective vaccines,” Kim-Farley said, “where we have sufficient capacity to be able to be able to manufacture them.”

They’ll be distributed across the world, and tweaked when needed, he said.

The group of former Biden advisors envision a “manage-COVID” future where the public health infrastructure is built on four goals:

  • Establish a digital data infrastructure for public health to more precisely monitor disease spread and beef up surveillance and projections for the disease;
  • Beef up a public health agency–based community health worker system and expanded school nurse system able to expand and contract based on surge capacity and  respond to emergencies;
  • Improve the flow of medical services — including licensing, billing and telemedicine waivers — across regions and state lines, improving the flow of medical services to severely affected regions; and
  • Rebuild trust in public health.

In some respects, the future is already here. Medical practitioners in L.A. County point to a kind of ad-hoc community of “COVID specialists,” from medical technicians to doctors to ER staffers, who have treated scores of infected patients throughout the pandemic, learning what works and what doesn’t work and why. Many, like Yadegar, are building on expertise in pulmonary medicine.

“I think everybody, no matter what field you are in, are becoming specialists,” Chung said.

Already, there are signs of a reset in the way government and public health agencies have appeared to hold back from sweeping revisions to health orders, akin to the early days of the virus. They are striving to keep schools open; businesses, too. Another sign: The recent CDC recommendation brought the isolation period for people with COVID from 10 to five days.

Experts say the ability to rebuild trust, communication and unity in a “minimize-the-virus” world versus a “zero-COVID” world is a top priority.

The discussion has started, from medical schools to public health scholars: How do physicians deal with patients who don’t trust vaccines or treatments? How to deal with lack of trust, and how to foster it? How to cope with medical issues that morph into political divisions?

“We need to do, all of us a better job, of communicating the science,” said Kim-Farley. “Societal factors need to be brought to bear to be able to have a unified and common approach to keeping the virus under control.”

Kim-Farley laments public-health messaging that has not always adequately primed the public for the need to adapt as more was learned about the virus. The lack of such messaging has confused and at times divided the public, from masking to quarantine guidance.

“I don’t think these are being well-articulated to help people understand that ‘OK, I get it, Yeah, it’s ideal we did a 10-day quarantine, but given the fact that people aren’t doing the 10 days, it’s better that we find something that is a compromise here and at least more people are doing it, and helps reduce transmission as compared to completely trying to stop transmission through quarantine,” Kim-Farley said.

For Dr. Marianne Gausche-Hill, the biggest challenge facing her field amid the ubiquity of the coronavirus has nothing to do with medicine: It’s about how people process information and about how public health officials communicate what they know.

LAUSD interim Superintendent Megan Reilly holds students’ hands as they head to get their COVID-19 shots at Arleta High School on Nov. 8, 2021. Sunday is the deadline for students 12 and older to receive their first coronavirus vaccine dose to comply with a district vaccination mandate. (Photo by David Crane, Los Angeles Daily News/SCNG)

“Reliable sources of information will be important,” said the medical director for L.A. County Emergency Services. “As we move forward, it’s important we convey a sense of social consciousness, that we’re all part of a society.”

There will be other viruses, she said, and other challenges in the future. And, we all have to build resilience to change and adaptability.

“It’s important to have a sensibility about the dynamic nature of public health,” said Gausche-Hill. “There’s information that’s true today that is not true tomorrow and that doesn’t mean anybody lied. We’re just taking in new data to make better decisions.”

Changes — and adapting to them — make communicating effectively tougher. Gausche-Hill said the challenge for messengers will be to communicate the uncertainty of what is known while also conveying the need to adapt to new knowledge as it arrives.

For now, though, most time and energy is caught up in the moment, dealing with the relentless winter 2022 surge.

“We haven’t fully gotten ourselves out of the pandemic world to fully articulate what the post pandemic world will look like,” Kim-Farley said.

For public health officials, facing constant “curve balls” from the virus, fully committing to a strategy that treats COVID like other managed illness requires a capacity to respond and treat people that has yet to be attained consistently.

L.A. County Public Health Director Barbara Ferrer spoke last week about three areas to focus on to make a future “minimizing-the-harm” strategy work:

  • Better and more broadly available therapeutics: “We’re just starting to see the distribution of the oral antivirals, one of which is highly effective, but of super limited supply. So you can’t really have scarcity in your therapeutics and talk about minimizing harm,” Ferrer said.  That’s particularly the case for patients who may live in remote areas, with little access to healthcare, minimal medical insurance and few clinical options, she added.
Providence Holy Cross Chief Executive Bernard Klein talks to the press about how the pandemic is impacting the northeast San Fernando Valley and the Mission Hills hospital on Tuesday, December 22, 2020. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)
  • Widely available testing:  While testing sites are sprinkled throughout the county, Ferrer said, only this week has the federal government started distributing free tests to American households to they can more easily do tests themselves.
  • Growing healthcare staffing:  “Even with lower numbers of people in the hospitals this go around, our hospitals are overtaxed and under enormous strain,” Ferrer said, adding that we must deal with such issues as pay equity, consistent availability of  adequate personal protection and staving off burnout.

And perhaps most important will be the ability to stay nimble, experts say.

For Dr. Bernard Klein, chief executive at  Providence Holy Cross in Mission Hills, that reality set in during the omicron surge.

“What this tells me is that this virus will continue to mutate. As long as it does mutate, it’s going to be a challenge to eradicate it,” he said.

His colleagues echoed that point.

“This is something where as time as has gone on, it’s something we’ll need to manage. And I think we always need to be aware there will always be a variant down the road,” said Dr. Rex Hoffman, chief medical officer at Holy Cross.

If history is a guide, it will take vigilance, too.

In their push for a new strategy, Dr. Ezekiel J. Emanuel; Michael Osterholm, a leading epidemiologist; and Dr. Celine R. Gounder, wrote:  “After previous infectious disease threats, the U.S. quickly forgot and failed to institute necessary reforms. That pattern must change with the COVID-19 pandemic.”

Underlying a future strategy? A dose of “humility,” they wrote.

Staff writer Lisa Jacobs and the Boston Herald’s Alexi Cohan contributed to this story.

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