2020 Vision

New Mexico announced its first four COVID-19 cases on March 11, 2020, all involving travel. Flash forward nearly a year later, the state has had—as of press time—more than 180,000 cases and over 3,500 deaths. From the get-go, Human Services Secretary Dr. David Scrase was a familiar presence at what became weekly COVID-19 updates with Gov. Michelle Lujan Grisham, providing regular epidemiology and medical updates and explanations to the press and the public. SFR caught up with Scrase as New Mexico nears its one-year anniversary to talk about what we've learned and what comes next. The interview has been edited for space and clarity.

SFR: Can you take us behind the scenes in terms of what you were doing when news of COVID-19 began?

David Scrase: In January when we had our first cabinet meeting…I knew I was the only physician there but didn't know what that might mean. When the pandemic started up…I was immediately pulled in to help in whatever way I could. The Medical Advisory Team really works to support the Department of Health, so I spent a lot of time supporting that. But in the very first couple of weeks, the whole government was focused on making sure—and I give the governor credit for this—we had the data systems in place to keep track and report and analyze trends. Epidemiology had a system for doing that, but connecting that to the public had never happened. Because I'm a data person…I knew the best way I could help was by supporting those data efforts and interpreting the data when it came out.

You’ve ended up the face of the science and medical efforts in the state, but you’re also the Human Services Department Secretary. Can you talk about where those roles intersected?

I really love the Human Services Department, and it's why I came to state government. I think that my sense of responsibility, along the Human Services line…was doubled by the pandemic because what we didn't know then with numbers, but we knew intuitively, was that low-income people—people who have 10 people living in the same household, folks in rural areas who didn't have access to food and water—were going to be much more severely impacted by the pandemic. So, I'm…proud of the work that my team did…in getting new benefits for Medicaid waivers for [the Supplemental Nutrition Assistance Program]; dramatically increasing the amount of dollars that went into food for families who have low incomes; providing what will end up being 100,000 or more additional people, either with new Medicaid coverage or sustaining that coverage throughout the pandemic. When we look at the pandemic, we think of the number of cases and hospitalizations and all that, but I think mainly of the fact that people in high-income census tracts had one quarter the chance of getting COVID as people in low-income census tracts. So, I felt like being in an insider of the DOH side…helped inform me and my department of what we could be doing and where we could be going.

New Mexico has been particularly vulnerable to the pandemic because of those vulnerable populations, as well as relative lack of medical resources. Can you talk a bit about the HSD plan to grow the Graduate Medical Education Expansion Program?

We know that primary care is a national…problem. Not as many people go into primary care for a variety of reasons. So that idea of turning out 46 new primary care doctors and…keeping them on our state [means] 100,000 more people per year who would have a primary care physician, which would really get us caught up in four or five years. You have more primary care docs, there'll be more referrals—that grows the specialty community in a rural area. I think the word is out that we are really focused on primary care. We're [also] really focused on behavioral health needs. We've seen huge growth…I feel like we've actually maintained behavioral services or even significantly increased them during the pandemic.

You’re a practicing geriatrician and COVID-19 has hit the elderly population particularly hard. Have you lost patients during the pandemic?

Oh, yes.

How have you handled that?

It's hard. You know, I feel like every doctor every time they lose a patient goes through this. I wonder if I could have done anything differently. And I wonder if there was something I missed. And then I have a whole other layer…which is like, 'Gee, I wonder if there's something I could have done at the state level regarding policy?' I think we've been pretty all over the issues related to higher rates of infection in nursing homes and in the elderly. 'My people,' as I call them, who aren't in nursing facilities or assisted living facilities, have done a great job protecting themselves staying at home. And you know, some of my favorite patients have kind of succumbed to the virus…there were others, who clearly had not yet come to their time. A vibrant woman with a major organ transplant, who was just an absolute light, who got exposed, got COVID and died within…a couple of weeks. So, yeah, it's hard. But at the same time, it kind of brings home and refreshes my sense of urgency at the state level.

I know you’re not Nostradamus, but I wonder if you have a stance on whether this pandemic has changed New Mexico and the rest of the country in permanent ways?

With these variants [the South African and UK versions]…there's a worst case scenario version, where we start over, except instead of having zero cases, we have, like, 300 we're building on top of and, even worse, maybe the vaccine won't be effective for one or more of those strains. We know that [bamlanivimab] and other monoclonal antibodies aren't as effective for a couple of those strains. And so, I don't have to be Nostradamus: I'm just worrying about what's going to happen next month. But I do think at the same time that…it will be really interesting to see how [not having a flu season] affects society and how we think about wearing masks in the winter, for example. I think we'll relax more than maybe it makes sense and then we'll learn something from that and tighten up.

What are you most looking forward to doing when it feels safe?

Flying to visit grandkids.