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Post-Mask Mortem

Acting Health Secretary Dr. David Scrase talks masks, data and a new phase with COVID-19

On Feb. 9, during the weekly COVID-19 update, Acting Health Secretary Dr. David Scrase said New Mexico wasn’t quite ready to end its indoor mask mandate given the ongoing pressure on hospitals. “It’s just too soon today,” he said.

The following week, on the morning of Feb. 16, the health department canceled its regular Wednesday afternoon news briefing, citing conflicts with the Legislature. The following day, in a post-legislative briefing, Gov. Michelle Lujan Grisham ended the mask mandate, effective immediately.

Scrase and state Epidemiologist Dr. Christine Ross then met with several news media members, including SFR, via Zoom, on the afternoon of Feb. 18 to discuss potential changes to the daily delivery of COVID-19 data points (for instance, as of this week, DOH is no longer including daily COVID-19 case totals from long-term care facilities, but says the New Mexico Aging and Long-Term Services Department continues to track that data).

And on Saturday morning, Scrase spoke one-on-one with SFR regarding all of the aforementioned events and the state’s forthcoming campaign to provide resources to immunocompromised residents. Scrase is expected to also discuss these topics at a 1 pm weekly COVID-19 update this afternoon, Feb. 23, which will stream live on the health department’s Facebook page.

The following interview has been edited for clarity, concision and style.

SFR: You’ve spoken recently about shifting COVID-19 data reporting to have less emphasis on case counts. What should the average person pay attention to in terms of data?

Dr. David Scrase: I have a spreadsheet that I’ve set up since the pandemic started that has in the left column different…outdoor temperature ranges like zero to 5; 5 to 10; all the way up to 65 to 70, and then I have this grid of all the different clothes that I wear. So, today was 25 to 30 [degrees]: I wore my regular gym shorts, gym shirt, socks, long pants, another long-sleeved shirt on top of it, my little puffy jacket and then heavy gloves and a hat. And so, I think what we all need to get used to doing is dressing for the weather of COVID and being more aware of what’s going on in our vicinity. If I were going to pick one number, it would be the number of people in the hospital. There [also is] a weekly report from the [Medical Advisory Team]…with the self-scoring of the hospitals about their capacity. I think that would be a good thing to look at and give people a good sense of what hospitals are feeling. [viewable at https://cvmodeling.nmhealth.org/medical-advisory-team].

You mentioned on Feb. 9 that one criteria for removing the mask mandate was having New Mexico hospitals less reliant on outside help. Has that happened?

We are currently winding those contracts down and not renewing them where they exist. We didn’t just pull people back immediately. We had some conversations this week…there is probably still going to be a need for some extra help, particularly in hospitals like [University of New Mexico Health], where they are still running 120% capacity.

Do you expect cases to go up with the mask mandate rescinded or have we just basically run out of people to infect?

I do expect the numbers to go up, but I don’t think we’ll notice them because we’re in such a meteoric descent.

Are there places you plan to still wear a mask?

Number one: I’m sure I’ll wear a mask the rest of my life on airplanes. I’m just not going to give that up now because I always used to get the flu or a cold or something. When I’m in a large place where there’s a lot of people indoors, I’ll still wear a mask and, of course, with patient care. I’m looking forward to going back and dining indoors, but I will probably be more selective about the places I go; if a restaurant says no one needs to wear a mask, servers don’t need to wear a mask, I might be more cautious. I’m always running to my nearest big box store, and I’ll probably wear a mask in there for quite a while longer.

Several groups remain particularly vulnerable to COVID-19. Are we entering a time where some people will feel safe to live their lives without masks and some will feel less safe as a result?

I think that’s probably true. If I were an immunosuppressed person, I’d be more careful. We’re going to do…a campaign for immunosuppressed individuals. There are special treatments for them, the [AstraZeneca’s Evusheld] treatment is a new one for immunosuppressed people. It’s sort of a long-acting monoclonal antibody type treatment. The Department of Health wants to do something in particular to reach out and make sure we connect the most vulnerable people with new resources we have that we didn’t have last summer.

Did you know before you canceled the weekly COVID update last week the governor would end the mask mandate the following day?

No, I did not. If you go online and review the video of the House floor on [Feb. 16] you’ll see me show up there a little after 1 pm [1:58 pm] to help [state Rep.] Daymon Ely [D-Corrales] get a bill [SB40] passed…for funding for nursing homes…The governor and I had been talking about removing the mask mandate…since November, but we were waiting for case counts to drop and things to ease up in the hospitals . I mean, I knew it was coming but it didn’t have anything to do with the presser last week, that’s for sure.

You’ve said a few times the jury is still out on long-COVID. But it seems indisputable some people who have had COVID are experiencing long-term health issues. What are your thoughts for those people?

I think we know somewhere between 10% and 20% of people experience symptoms of COVID beyond 30 days. When I’m talking about, ‘we don’t exactly know what long-COVID is,’ I’m speaking very specifically as a physician. I don’t have diagnostic criteria [such as with rheumatoid arthritis or lupus]. We don’t have that taxonomy yet for long-COVID and, because we don’t have that, it’s hard to engineer a clinical trial…and that’s what I’m really hoping to see in the next few months. I have friends that treat people with long-COVID and they just describe a set of symptoms that are mainly related to fatigue… sometimes persistent respiratory symptoms like shortness of breath. The other thing about it that I think is particularly terrifying [is] even back in 2020, these reports came out…there was one where they took MRIs on 100 people with regular COVID-pneumonia and something like 50% of them…had lesions in their hearts. So, we shouldn’t be surprised that there’s longer recovery in people…like, at all.

The Institute for Health Metrics and Evaluation said recently it expects Omicron—in the absence of a new variant—to return in the winter of 2022, and the emphasis should be on antivirals; persuading the unvaccinated to get vaccinated; and careful consideration about when a fourth dose of vaccine should be given. Does that jibe with your thoughts?

Except the premise. I think that’s widely optimistic to predict Omicron will come back in the winter. We’ve seen…every six months, it seems, we get a new variant. I’m expecting a new variant in July. But I think we’re going to get a little break here; I’m excited about that. But then once we get that variant, I hope [most] New Mexicans who get a strain of COVID in the future will be able to test at home; if positive, be able to isolate themselves at home; call their contacts on the phone or use the NM Notify app; and have those people get tested. Have the person who has COVID call their provider and be seen or, if they’re sick, get [treatment].

How does learning to live with COVID and its aftermath translate at the Health and the Human Services departments?

We’ve had discussions at HSD and DOH in the past day about masking and how we’re going to do that, and people are going to have the right not to wear a mask. I think society will be in a little bit of turmoil probably for the next six weeks as really conservative school boards find out that half of the parents want everyone masked at school, and really liberal school boards find out half the parents want their kids unmasked. I think the state has provided air cover for a lot of employers and schools and departments in state governments, but I think those discussions are going to be really exciting, fruitful, contentious, eye-opening, and I think we’ll work through them and figure it out.

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