Doctors from the Rio Grande Valley, New York City, California and Houston agreed that another wave of COVID-19 cases is inevitable and on Wednesday talked about what they’ve learned so far about dealing with the pandemic.
The discussion, hosted by the University of Texas Rio Grande Valley, gathered doctors from those areas to share insights about their experiences.
The talk was organized by U.S. Rep. Vicente Gonzalez, D-McAllen, and U.S. Rep. Adriano Espaillat, D-New York City. It was moderated by Dr. John H. Krouse, the dean of the UTRGV School of Medicine.
The panelists included Dr. Ramon Tallaj, board chairman for SOMOS Community Care, a network of nearly 2,500 healthcare providers in the Bronx, Queens, Manhattan and Brooklyn.
It also included Dr. R. Graham Barr — an epidemiologist and chief of the general medicine division at New York-Presbyterian/Columbia University Irving Medical Center — Dr. Andrew Phillips — an intensive care unit physician in Fremont, California — and Dr. Joseph Varon from United Memorial Medical Center in Houston.
Locally based speakers included Dr. Robert Martinez, the chief medical officer of DHR Health in Edinburg, and Dr. Ivan Melendez, the Hidalgo County health authority.
“The disease spreads, as we know, very simply, often asymptomatically, often like a cold and goes through the population and then weeks later, starts killing people,” said Dr. Barr, adding that at the hospital, they went from one case on March 1 to 1,000 cases six weeks later.
“When the governor shut down the city, which was obviously a dramatic move, it took three weeks for things to stabilize and then we hit a peak and only then did we start to drop,” Barr said. “We went from 1,000 patients to 200 patients with COVID in the hospital in three weeks.”
He said that showed how effective straightforward public health interventions like masks and social distancing made a difference.
Dr. Tallaj said that for the future, he believed it was important to create simulations at all levels — school, city and state — to practice how to respond to a resurgence of this virus or to the appearance of a new one.
“We should be ready,” Tallaj said.
“We should create institutions like ours,” he added. “SOMOS Community Care is a physician-led organization in the community; we are not a hospital.”
Tallaj said he hoped that legislators in Washington would understand that organizations SOMOS were needed and provide just enough to keep them open so they could react when public health crises hit.
For Dr. Martinez at DHR Health, the pandemic showed that people had to be selfless.
“I think that was the biggest thing — to get people to realize, with this disease in particular which we were learning from and we continue to learn from every day — that we needed to adapt quickly and we needed to think about others and not just ourselves or our immediate group,” Martinez said.
He added that here in the Valley, healthcare providers collaborated with and learned from people in New York and California through video discussions.
Martinez also noted how significant testing was when hospitalization began to surge.
“We had no rapid tests so turnaround time was seven days, seven to 10 days. You can imagine what that does to capacity,” Martinez said. “If somebody’s sick, you have to keep them because we’re fearing that they’re going to go home and get everybody sick.”
But collaboration, he emphasized, was important with learning how to deal with this disease.
When the first cases of the novel coronavirus began popping up in the United States earlier this year, doctors and researchers had to deal with the constant and continually changing flow of information.
“When this first started, I would read something in the morning and there would be new information, something different by the evening,” Dr. Phillips said. “It’s not that that information was wrong but that the information was becoming more refined.”
“What we’re learning right now and what we’re now starting to put the emphasis on is that outpatient side and the long-term effects,” Phillips added. “It’s hard for people to say what happens years later, well we don’t have a years later. No one knows what happens to people a year out from having COVID-19 because no one has had it for a full year.”
In Houston, Dr. Varon said they had developed methods to effectively treat the illness.
“I’m not talking about remdesivir and Regeneron,” Varon said. “I’m talking about understanding the basic point that these patients die because of inflammation and coagulation.”
Varon said he and four of his colleagues developed what’s called the Math+ protocol in which they administer Methylprednisolone, Vitamin C, Thiamine and Heparin.
“And with that, my hospital in Houston has a 95% success rate, just with a simple control of those things,” Varon said.
But to prevent infection, Varon said face masks and social distancing were the most effective methods.
“I concur with some of my colleagues and even with you guys — we’re in for another wave, I have no question about it,” Varon said. “We’re not going to be any different than other countries in the world and if we don’t listen, we’re going to be hit really hard.”
With the novelty of the virus, Dr. Melendez said no one could call themselves an expert on it, but what he is an expert on, he said, is Hidalgo County.
With a 4-5% death rate, Hidalgo County was hit harder than other areas with similar demographics such as Laredo, Brownsville, Corpus Christi, El Paso and Eagle Pass.
“I believe that the reason that our area was hit the hardest is because our patients, our community, was sicker than most,” Melendez said.
And the reason behind that, he said, is because about 40% of the population is uninsured or underinsured.
The county has three free clinics for about 1.2 million people, and the people who went there, according to Melendez, weren’t going to see a doctor unless their health situation was a crisis.
“And so when the pandemic hit us, we had a very, very, very sick group of community members,” he said.
For the future, he said officials in the area needed to focus on remedying that.
“We need to focus more on being able to get our community, in general, healthier so that when we have a recycle or when we have another pandemic that we’re better prepared to handle these diseases,” he said. “We need to establish more primary care so that when it comes, we’re best prepared for it.”
At the conclusion of the discussion, Gonzalez said it was “sad” that the use of masks had become politicized.
“But it’s something that we need to keep communicating to our people, our country that this is not a political issue,” Gonzalez said. “And this is a medical recommendation from physicians and healthcare experts.”
To prepare for a possible spike in cases and hospitalizations, Gonzalez urged the importance of having sufficient testing and contact tracing.
“I hope that just as we prepare for war, we prepare for a virus like this or a future event,” he said. “We need to have the same level of preparation and if we want to prepare our people for a war, we should also have the same level of healthcare arsenals to protect us from a pandemic.”