VDH: "The Moment To Band Together Is Now"
As the number of cases of COVID-19 increases in the Commonwealth, staff at the Virginia Department of Health perhaps face the biggest challenge of their careers. WHRV's Gina Gambony spoke with Dr. Laurie Forlano, Deputy Commissioner for Population Health, to get an update about what the agency is doing now. This conversation took place Friday, March 13.
Gina Gambony: Thank you, Dr. Forlano for taking a few minutes to be with us.
Laurie Forlano: Sure, thank you.
GG: Can you tell me, what is your job with VDH?
LF: My day job, my current role is I serve as the Deputy Commissioner for Population Health at the Virginia Department of Health. And what that role entails is that I provide guidance and oversight to three pretty large functions at the health department, including our office of epidemiology, which is our communicable disease and prevention control arm. I also oversee the office of Family Health Services and the office of Health Equity during an all-hands-on-deck response like this, I'm also serving in the leadership team at the Virginia Department of Health and in the state level or inter-agency levels task force and helping to lead the operation.
GG: So, there's a lot of activity going on in ways that the general people on the street, we don't know what's going on up there at the health department or how decisions are being made. What we do know, like today, we see the numbers of course are going up steadily, across the United States and in Virginia. The number of people who tested positive for COVID-19, or presumptive positive, as of today is thirty, and ten people hospitalized. And that's the biggest jump in a day that we've seen so far. But you know, it's hard to interpret what that means. Can you put that number into context for us? What does that mean, that it jumped more than it has yet?
LF: I would say that this trending upward is to be expected in situations like this, and I would expect cases to continue to increase in the coming days and potentially weeks, as we've seen in other areas of the world. As providers test patients and public health test patients, we would see those cases go up. Public Health does investigations when we find known cases to try to identify those contacts to those individuals. And in some instances, if those people become sick, they would be tested. So it's expected that we'll start to see cases increase around the Commonwealth.
GG: I know that you look at people who have caught the virus from being overseas versus catching it in the community. Of these 30 cases, do we know if they are from a community contact?
LF: The majority of our cases are associated with travel to areas of the world with travel advisories or areas with known community spread, or in people who have had contact with those travelers. Some investigations are still underway. So we don't have full clarity on the presence of community spread yet in Virginia. But I anticipate that clarity will come pretty shortly.
GG: As you're looking at things from a completely different perspective than the rest of us, is there a feeling about--well, we have 30 people who have tested positive. Is there another number where it's like, well, we expect that about X number of people are carrying the virus right now in Virginia?
LF: That's a great question, and it's something that a lot of public health scientists think about, what we call modeling. We can use data and math to determine, well, how many people actually have the condition of interest. Not sure we're there yet here in Virginia, but it's something we're starting to build now. I'm not able to fully answer that right now. But it's likely that as with any kind of disease surveillance or when we count diseases, we almost never are able to count every case, even with just general communicable diseases. And surveillance is used to give us a good picture of the burden in a community or a state.
GG: Is there a moment, and I think this is the moment everyone's grasping for--is there a moment when we're supposed to say, okay, things are serious now. Or are we already at that moment?
LF: I think the moment to band together as communities and as a Commonwealth and a country and frankly the world, is to take responsibility right now. And there's a lot of, obviously a lot of messaging out there about what individuals can do, washing their hands, staying home if you're sick. It's messages we actually say all the time. But now is the time to really pay attention and to really employ them. And I know communities are starting to make really hard decisions about canceling events or employers are having to make decisions about their workforce and who can come to work or who shouldn't come to work. So, right now is definitely the time to practice good prevention, wash your hands, stay home if you're sick, stay away from people if you're sick. And if you're an individual who may have more serious complications if you do contract COVID-19, keep your distance in general right now. Try to practice good social distancing and good hygiene in general. And hand-washing.
GG: I've heard that universities have closed, not because we're that worried about the university-age students, the general population of students that live on campus particularly. We're not necessarily worried about their health, but we are worried about how they could contract it, then carry it to people who would be at a higher risk of having more complications if they caught COVID-19. Is that true?
LF: I think the decisions that the leaders of our universities and colleges are having to make here in Virginia and around the country are really complex. I can say with a lot of confidence that they want to do the right thing to protect public health. And I think what you just described is, is mostly correct. You know, universities, especially universities where students live there, are just a unique situation. They're living in congregate settings, they're sharing meals. There's a lot of, you know, close contact with recreation and other kinds of events. So I think they're trying to get ahead of the situation. And also practicality and logistics are important things that those leaders need to consider when they're making decisions. And they do it very much in consult with local and state public health.
GG: And I understand that governor Ralph Northam just announced that all Virginia schools, K-12 schools will close for two weeks.
LF: Yes. I'm aware that the governor has made that decision.
GG: Do you know what prompted that decision on his part? I know that some school districts in Virginia were really struggling with making that decision on their own.
LF: I'd advise talking to the governor's office about their decision making.
GG: Do they receive advice from the Health Department?
LF: Absolutely. We have daily, if not more, interaction with the governor's office and his cabinet staff. And then we have more formal convenings as well with our state task force and unified command. I spent several hours today, for example, with members of the state leadership.
GG: Dr. Forlano, let me ask you, is this the most challenging situation you have experienced in your time with the Virginia Department of Health?
LF: Yeah, that's a great question. I've been a public health practitioner and epidemiologist for over a decade. I previously served as Virginia state epidemiologist. And I can say that this is definitely one of the most complex, if not the most complex situations I've ever faced in my career. And I do think this is something that will be in the, in the history books. I am really heartened though. The support that I'm seeing, even my personal life, for people reaching out to their neighbors and their colleagues is really nice to see. This is a really complex time for a lot of people and I'm feeling confident that Virginians will take care of each other and we will adhere to public health guidance and recommendations as much as we can as a large community.
GG: And I guess it kind of does come down to, you can't just come up with a solution and then disperse that solution. It really depends a lot on the population, and the population's cooperation.
LF: Yeah, one of the most important, if not the most important partner in all of this is the public. And we are so reliant upon everyone's commitment together, shared commitment as communities and individuals to listen to the recommendations, get your information from trusted sources. If you're told to stay home, please do so. If you need help, please reach out for help. So yes, the public is definitely very much a partner in all of this, both for information sharing and for public health prevention.
GG: Is there a concern about whether we have enough space in our hospitals? Are our hospitals ready for COVID-19?
LF: So, I'll use the term "medical surge planning." Surge planning is definitely part of our response and our planning and our action right now. I personally am not the lead on that group. My colleague here at the Health Department is convening partners, our hospital association, leaders in the clinical community, emergency planners to really put a plan in place for how we will deal with the anticipated surge on our medical care system. Very, very much part of what we do here at the Health Department in partnership with our clinical community.
GG: Is that one of the most important aspects that you're planning for right now?
LF: I do think it is an extremely important component of this response. We don't want to overburden the medical system unnecessarily. We also fully appreciate the fact that people need access to care. So balancing that is important. Making sure our healthcare workforce is sustained and we keep them healthy and we keep their well-being in mind as well. It's really humbling to see my colleagues in the clinical sector work so hard during times like this and we're really grateful for their partnership.
GG: Governor Ralph Northam said that there were enough COVID-19 test kits in Virginia as of yesterday, he said that. I'm not sure if he said anything about it today. We know that other states are saying they have shortages. Northam said that Virginia is developing its own test kits. How is our situation with test kits now, today, and looking forward? Are we able now and are we going to be able to test the number of people we need to be testing to manage the outbreak in Virginia?
LF: So, questions regarding specific development of actual lab tests and things I would direct to my colleagues at the Division of Consolidated Laboratory Services, DCLS. As far as capacity is concerned, that's something we're definitely working on on a daily basis. We do have some capacity at state public health labs and those tests are currently are reserved for individuals that meet our public health testing criteria. For individuals that do not meet that testing criteria, we encourage clinicians to use their best judgment to determine whether a patient needs to be tested, and if so, they would work with a private laboratory to obtain that testing. The capacity is expected to increase with time and we're working hard to ensure that happens.
GG: For people who meet the guidelines to be tested, is that having been to a location where there was an outbreak?
LF: So there are three general categories, yes. Includes travel you know, a travel history that would place someone at risk. If you have been a contact, a close contact with someone who has confirmed to have COVID-19. There's also a category of testing reserved for residents of nursing homes or longterm care facilities. And there are other kinds of criteria for that certain population because that population has been shown to be quite vulnerable in other parts of the country and the world. And there are exceptions at times to those criteria based on our epidemiological investigations and judgment. So we always build flexibility in. We don't want to be overly restrictive, but for right now, we are balancing the need to keep our capacity for people who are most at risk.
GG: Thank you for taking time with us today.
LF: Thanks for the opportunity.
This is a transcript of a live conversation.