Last week, the state Health Department switched up its weekly COVID-19 news conference, shortening it in length, and requiring reporters to send questions ahead of time, which were then selected and read by Transportation Department Communications Director Marisa Maez and answered by Acting Health Secretary and Human Services Secretary Dr. David Scrase. That format has already changed after some criticism from journalists and Scrase will be meeting with reporters at 1 pm Wednesday, Jan. 26 (the news conference will post afterward on the health department’s Facebook page).
We couldn’t quite wait, though, and had a backlog of questions, so we snagged an interview with Scrase where we talked about, of course, COVID-19, the state of hospitals, forthcoming improvements to accessing therapeutics and a whole lot more. The interview has been edited for clarity, concision and style.
SFR: Thousands of New Mexicans are testing positive for COVID-19 right now. Most of them won’t need to go to the hospital, but presumably some of them won’t feel well. What’s your doctor’s advice for how people should take care of themselves when they have COVID?
Acting Health Secretary Dr. David Scrase: Can we start with the assumption that they had a positive test and they have the results back?
Remember, we have a new motto: Don’t wait, isolate. The next step is: Do they have risk factors for serious COVID disease? And we are modifying our criteria. I haven’t talked about this with any reporters yet, but we’re going to make it easier, I think starting today, sometime today, to get both [the oral treatment] Paxlovid, [out-patient antiviral medication] Remdesivir…and [the monoclonal antibody treatment] Sotrovimab and make it really a lot easier to get [the oral treatment] Molnupiravir…Any risk factor whatsoever, we’re going to work to get a better supply of the drug and make it easier for people to get.
If you have risk factors…over 64, obese, any underlying condition, then you really ought to seek out treatment still. I’ve talked to people who had a condition, but really weren’t that sick, and when they talked it through, they were like, ‘I don’t feel like I need treatment.’ I think you can use your own judgement. We’re seeing a confirmed two weeks of a trend in much lower ratios of intubation to hospitalizations. You remember the days of 25%? We’re running 11% or 12% for two weeks now, a steady decline of intubation; unfortunately, an uptick in hospitalizations but we’re also seeing lower hospitalization rates for people who have COVID. So, a little more leeway there, but isolation for five days and then you can leave home with a mask on for another five days.
My mother had a breakthrough case after Christmas and her doctor said she should get a home oxygen monitor.
All my patients are over 75 and I encourage them, if they can afford it, to get an oximeter at home. Anyone with significant lung disease probably ought to have [an oximeter] as well because your oxygen saturation can drop significantly before you start feeling short of breath. So that’s a good guideline for older people in particular and [ones with] pulmonary disease. If you’re having significant pulmonary symptoms, bad cough or fever and cough, that’s not a bad idea too. And the main reason is it might cause people to seek treatment earlier and avoid complications.
And otherwise, just treat it like you have a cold?
Rest. Drink plenty of fluids; take Tylenol for the muscle aches; if you have GI symptoms, more toward a clear liquid diet until solid food until it clears up. But, I think the main thing by far is isolate. Cause otherwise we have five people who have the same problem as you do.
On Jan. 24, the Food and Drug Administration revised the authorizations for two monoclonal antibody treatments – bamlanivimab and etesevimab (administered together) and REGEN-COV (casirivimab and imdevimab), limiting their use because they aren’t effective for Omicron infections. You talked about the state doing that last week.
We don’t like to brag when we make important decisions two weeks before the federal government…so I’ll just leave it at that. But we were on record and pulled them from the supply chain a little more than two weeks ago. And there was a debate about, ‘isn’t it better than nothing, even if 5% don’t have Omicron, wouldn’t it be better than nothing?” And we…felt like, ‘no it’s not better than nothing and you’re invoking all the hazards of than ineffective treatment.’
But you expect more supply of the treatments that are working against Omicron?
I’m working with the governor on that and our channels in Washington. What I’ve read is that in April we’ll start to see an uptick in the supply. I would have liked to see the end of January or early February, so it’s longer than I really want to wait, and then ample supply by June. So, I think the feds are pumping up the supply chain the best they can, but it is more of a delay than I’d like to see. The other thing about Paxlovid is, it’s kind of ideally for the highest-risk people to prevent hospitalizations and death, and the problem is the higher risk you have, the more meds you’re on, and there’s a lot of interactions between Paxlovid and relatively common drugs. So, it’s sort of kind of a Catch-22 there. But Sotrovimab doesn’t present that problem.
I’ve shared with you before the New Yorker dispatches by Clayton Dalton, who is an emergency room in a rural hospital here. His recent one paints a very dire picture and you have also described “dismal” conditions. My question is, really, have hospitals and health care been changed forever in ways that are going to require a big reckoning and big moves assuming we ever move past this moment in time?
Can I give you three answers at the caregiver level, the hospital level and the state view of our hospital capacity?
I think at the caregiver level, people will be changed forever. One of my mottos is I never made an important change in my life as a result of everything going just great. So, the…significant traumatic experiences of really working long hours. For doctors, [it’s] very duplicative of our internships, which for most of us were fairly wonderful opportunities to learn amidst the trauma.
So, I think that everyone is changed. You can’t be in health care in a hospital right now and not be changed. I think the jury is still out…we’ve seen an initial increase in retirements and turnover, but it will be interesting to see what evolves among the people who have stayed and are potentially, paradoxically more resilient. I feel like I’m more resilient as a result of going through this just because of all the extra exercise and stuff I’ve had to do to keep up with the demands of the job. I’ve heard of people who’ve decided they want to go into health care because of the pandemic, know a few. That was pretty gratifying to me that would folks would see ‘maybe I can help on a broader level.’ Of course, everyone now practically in New Mexico—if not by now, by the end of January—will have had someone in their family with COVID and will have seen that happen and we’ve had over 5,000 people die.
On the hospital level, I think it’s going to stimulate a desire to expand resources in hospitals to be prepared in the future. I don’t know exactly how hospitals are going to rationalize that, I do feel like today with the [Medical Advisory Team], there is some optimism. Seeing that drop in ICU patients on ventilators is a big deal. They are still completely oversubscribed; hospitalizations are probably going to hit a new record…One thing I think you’ll appreciate: You know how we’ve been talking about this two-week delay between cases and hospitalizations forever? It’s a week now; it’s seven days. So the good news is, whenever we do hit the peak, which we’re anticipating in the next seven days, we won’t have to wait two more weeks for hospitalizations to start to drop, just a week.
Is that because Omicron has a shorter intubation period?
Yeah…I don’t know. We talked about a lot of things. It could be people getting tested at home and not really reporting it and then getting really sick so they just go to the hospital, and then they get a positive test that does get reported so all of a sudden the hospitalization and test are zero days apart. It could be some activity in the way the virus works. Some people have postulated, somewhere else, and we saw this with Delta, that more younger people getting it are being hospitalized sooner in the course of their illness. I need to read more about that. We don’t know yet.
So, I think you’re going to see hospitals better prepared and holding on to larger supplies of N95 masks. At the state level, there’s a bill out now that the governor’s sponsoring to create a fund to help rural areas that don’t have hospitals to set them up and rural areas with hospitals to expand them. From a DOH point of view, [we have] some budget requests for expanded trauma capacity, and having more than just one level-one trauma center: That’s a learning from the pandemic.
I’ve been reading a lot about the Great Resignation and how workers don’t necessarily want to return to normal in-office hours and want to preserve the flexibility of remote work. I had heard that some HSD employees weren’t happy about having to be back in the office two days a week, that it had lowered their productivity and job satisfaction. What’s your reaction to that?
I’ve been doing the two days at work minimum since August. The challenge we have at state government is how can we tell teachers to go back to school and be in the classroom to keep schools open and not have our state employees doing the same? It’s not the same pandemic as it was 21 months ago: We have vaccines, we have availability of masks, we’ve send out those masks to HSD employees, and we’re coming up with a state strategy to send them out to everyone. For me, it’s just so much part of being a doctor: Of course I deal with sick people. Would I rather stay at home on the couch in a reclining position with a fake clip-on tie giving people medical advice? Maybe. Probably not. It’s public service. Police officers have risks in public service, all the health care workers in public service have risk. It’s just new for employees who didn’t imagine being a public servant could involve risk. So I just think it takes time for people to get used to it.
This is a question about equity. I had requested and received the 79 ZIP codes the health department used to identify places on the Social Vulnerability Index to send tests. I noticed Rio Arriba County wasn’t on there and I knew it was because their SVI data was missing and I received a very thorough explanation from DOH, which did in fact send tests to Rio Arriba County. But it made me wonder about the long-haul questions surrounding equity and masks, tests and therapeutics. What do you envision the state doing in the long-term? Does federal data work for equity? Was Rio Arriba County an outlier?
I think the Rio Arriba thing is an outlier and the data is good. [Deputy Health Secretary Dr.] Laura Parajon and I are kind of becoming militant about this issue. The current mask and testing supply stuff we’re doing as a state is, one, designed to fill the gap between reality and when you get your test in the mail. But after that…I think the SVI of New Mexico is probably twice as high as the mean SVI, which means we need a second layer to this layer cake as long as the pandemic lasts.
So, one way is to supply it all ourselves and the other is to ensure that other routes that are equity based open up. Making sure the [Indian Health Services] is getting their full supplies of mask, testing and treatment. Making sure the [Federally Qualified Health Centers] are getting their fully supply. I asked them to check on it and we only have one non-Native FQHC getting anything, and they got 20 doses of Paxlovid and 100 doses, I think, of Molnupiravi, and that’s not even a rounding error in the equity issue. So, I think pushing harder on expanding channels that the government ostensibly already has set up to do this, which I don’t think are functioning as completely as they could be. Working with [the federal government] and governor herself to make it really clear that that second layer of the cake is a national responsibility for every low-income person. And third is I like the federal system: I like you can go online and order. We’re working on a collaboration between HSD and DOH—we were able to get the two secretaries of those two agencies together—to try to set up something for HSD customers, which are a [1,051,755] New Mexicans, to get that second layer of the cake, to direct order. So, that’s going to take some weeks to roll that out. But rather that focusing on SVI ZIP codes, which is a great strategy, why not focus on SVI individuals. To me it seems like if we could hit some of that at the federal level and do a really good job at the state level, I think it would be good.
Are you thinking about retiring at any point? Or hiring another health secretary?
I’m not the one who thinks about hiring a health secretary.
Is anyone thinking about it?
That would be a question for the governor. I have no idea what everyone else is thinking about. I think we’re making great progress at DOH. I like what I’m doing. I have lots of energy. I debate most days on the way home from work about which team I enjoy more: DOH or HSD, it’s kind of a tie. They’re both phenomenal. I’m a public servant and sometimes being a public servant means having to deal with COVID-positive patients. Sometimes it means having two or three jobs. I’ll probably wait on the substitute teaching just a little bit longer, but eventually I bet I’ll show up in a classroom. Hopefully it’s biology and not art.
So you didn’t not want to talk to us directly at last week’s press conference because you’re just sick of it all, you’ve just had it?
No. I think what we’re trying to do, the press of Omicron is so severe we were trying to optimize everyone’s time. It’s good to try different things and find out whether they work or not. I think the press has been an incredibly important partner and we’re really anxious to have you have your voice, and I think we’re doing that tomorrow. We’re just trying some dials, nothing’s permanent.
Then I will leave my other questions for tomorrow.