As the head of Cobb and Douglas Public Health, Janet Memark has dealt with outbreaks of infectious disease before, including hepatitis A and the measles.
But neither that nor her experience as a physician could have prepared her for the novel coronavirus, which has already killed more than 500 people in Georgia and left millions isolated at home under shelter-in-place orders.
Memark spoke with the Atlanta Journal-Constitution this week by phone to discuss what needs to happen before the strictest social distancing measures can be lifted, and which ones will likely remain in place until a vaccine is widely available. This interview has been edited for length and clarity.
AJC: Can we see the impact of social distancing in Cobb’s numbers yet? What would that look like?
We feel like we are seeing some impact and of course that could change. One of the things that we’re looking at is the rate of new cases and it seems like it has slowed down a little, but there’s a delay of one to three weeks to see the results of any intervention. Right now, we’re seeing the impact of the closure of the schools [on March 16]. We’re hoping that this is a sustained decline in the rate and so we will continue to watch that.
AJC: Is there a specific infection rate that must be sustained over a specific number of days?
I don’t think there’s any magic number … [We look at] the hospitals as well and how they’re doing with admissions ... We’re not quite there yet.
AJC: Has anything changed in the past week in terms of testing capacity?
We have been working with Georgia Department of Public Health on this. This week is when we’re expecting that to take off. We’ve added another vendor to help us out. We’re expecting that we’ll be able to broaden our testing capability a lot more ... we’re able to get people in quicker and we should be getting quicker results, too ... we have not gotten an official number [of tests per day], but we will be able to meet our needs.
AJC: Can you provide any specific data points about how close we are to reaching healthcare facility capacity in Cobb? ICU beds, ventilators?
The numbers change by the hour. We have two hospitals in Cobb ... We definitely see more of a need for ICU capabilities and ventilator capabilities ... One of the hospitals is a little bit close to their capacity but they haven’t done their expansion yet.
AJC: I know you are hesitant to give numbers because things change, but would you say they are at or above 80 percent capacity?
One is and one is not.
AJC: Many members of the public and officials, including the White House, appear to be relying at least in part on the model published by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington to plan for the pandemic’s peak. Another model out of Vanderbilt University projected different scenarios. Do any of these models line up with what you’re seeing in Georgia and Cobb? How useful are these types of models?
They’re mostly kind of a guide… I don’t rely on any of the models but it gives us a really good idea of what has been seen in the past and what needs to happen to prevent the worst case scenario. If we do nothing, we’re going to have a huge number of deaths ... most of our hospitals run at high capacity anyway. Adding this on was really a disaster waiting to happen ... If we put in these shelter-in-place orders, we know that in one to three weeks we will see the results of that. That’s what these models show you.
AJC: Can you say yet when the shelter in place might be lifted? What needs to happen to start ‘reopening’ the county? How long does the ‘plateau’ need to last before we can call it such?
You need to have a good sense that you’re not getting sustained transmission in your community ... We need to have our testing capabilities in place so that if we have new outbreaks or clusters we’re able to identify those. Right now, because we’re near the peak, it’s really hard for us to identify individual cases that are popping up. We need to get to a place where we can say, ‘Ok, we have a cluster here, we have an outbreak going on,’ then we can do contact tracing and say ‘Who were you in contact with?’ ... Those are the pieces we need to have in place before we can do any sort of lifting.
AJC: We’ve heard about two kinds of tests: One to determine if someone has the virus, and another antibody test to see if someone has already had it and might be immune. Where does antibody testing fit in?
This week is the week that a lot of antibody tests will be coming online … it depends on which tests that they have and if it’s just showing past infection or whether that’s going to confer immunity or not. These are very valuable questions and those questions have to be answered ... hopefully we’ll be able to say, ‘You’ve been exposed and you’ve had some immunity to COVID-19.’ That’s the hope. But it’s a new virus so they need more data. The vaccine is one of the ultimate things that we need as well to really be able to feel comfortable ... All of these are things that we’ll have to use as they come out and figure out their use in the whole plan.
AJC: You mentioned the importance of finding a vaccine. I understand that’s at least 12 to 18 months away, at the earliest. When can life return to ‘normal’?
I’m thinking it will be a different kind of life. Unless, when we do all this testing, we show that we have had high levels of exposure in our community, which I’m not getting a feeling that that is happening, you’re still going to have a lot of people that are unexposed ... if you open up too quickly without having some protective measures in place, you still have the risk of having another 80 percent of people getting hit at the same time, and that will put us back to where we started. I think it will be a modified normal that we will go back to. Hand washing will still be part of it, modified learning, face masks--everything is just going to be a little different. I think we’re going to see a lot of those things stay in place until we’re able to have mass vaccination.
AJC: What has been the biggest challenge in your job during the pandemic?
I think it’s been balancing everything. We have a good group of people who are working nonstop on this, so just balancing keeping them intact as well as the other jobs that I have and reassuring a lot of people, and protecting as many people as I can ... It’s a marathon and we’re trying to sustain ourselves and keep the stamina and keep going to the end of this.
AJC: As a physician and public health expert, when did you personally realize this, the coronavirus, was going to be your full time job?
I think when we started seeing the spread outside of China ... that’s when my light-bulbs went on ... It’s someone else’s problem until it kind of hits your shores. We’re so connected now as a world that it’s so different. It’s just too easy to spread things, so when I saw that it was spreading, I knew that we would have to have some response. I knew it was coming here.
AJC: What do you want the public to know right now?
I know social distancing is really hard, but it’s making a difference. It’s flattening the curve a little bit ... As we test more, we’re going to see more cases and that doesn’t mean there’s a surge ... I just want to thank everyone for everything they’ve done because it’s making our jobs that much easier.
About the Author
