Catching up on COVID

SFR talks with Acting Health Secretary Dr. David Scrase on the latest pandemic developments

New Mexico’s Department of Health held its last weekly COVID-19 news conference on March 11, the two-year anniversary of the pandemic. Since then, the state has curtailed its daily case reporting to include only statewide cases, hospitalizations and deaths, while continuing to provide weekly reports on vaccinations, transmission and other relevant data points.

Nonetheless, between the state renewing its public health order last week, a federal judge this week striking down mask requirements on airplanes and the rising instances of the contagious Omicron subvariant BA.2 across the country, the not-yet-over COVID-19 pandemic still prompts plenty of questions.

SFR caught up with DOH Acting Secretary and Human Services Secretary Dr. David Scrase for a short interview today and asked a few of them. The interview has been edited for clarity, style and concision.

You told me the last time we spoke you would wear a mask on airplanes for the rest of your life. Is that still true and do you, on behalf of the health department, have any statement about the overturning of the mask mandate on planes this week?

I’m still alive so that means I’m still going to wear a mask on airplanes. I have a trip to Chicago next week. I have my N95 in my briefcase and I’ll bring some wrap-around eye protection as well. I think what is happening is we’re moving to a world where instead of having the government make decisions for individuals, individuals are starting to make more decisions for themselves. And, understanding the dynamics that when other people don’t wear a mask that might put me more at risk, I still feel pretty good about the fact that I can choose to do what I want to do. I’ve been talking about dressing for the weather; if it’s 90 degrees out, you can wear shorts and a T-shirt, but if it’s 10 below, you’d be in trouble. Case counts are low right now [New Mexico reported 120 new cases today] but I still have some risk factors, so I want to be careful. I wear a mask full time pretty much when I’m around other people five days before I start seeing patients, just to make sure I’m not bringing something to the clinic with me. So, I’m still doing what I said I would do.

How much increased risk is there for the person wearing a mask when other people aren’t?

Well, you know, there’s a little graphic from the [Centers for Disease Control and Prevention], I don’t remember the exact numbers, but a good N95 Mask reduces your risk by 85% [it appears to actually be 83%, according to the CDC]. I suppose if no one else wears a mask around you, then the best you could do is 85%. Certainly if the other folks are wearing masks, then you get that they work together to reduce your risk. But I guess I sort of feel like life’s too short to really spend a lot of time worrying what decisions are being made by other people and just focus on those things I can manage, which are my own decisions.

You renewed the public health order last week through May 16 and in a news release said you anticipate increasing cases of BA.2 here in the next few weeks. Based on the last few years of the pandemic, I am assuming we will see an increase in the next couple of weeks based on the numbers right now on the East Coast. Can you set expectations about what people should expect? I don’t know if there’s still modeling going on—it’s not being posted if there is.

[Scrase gets on phone] Let me just take care of that. We still do modeling. I’m surprised it’s not up.

The last one posted was Feb. 8.

Sorry about that. I don’t know what happened there. I think we’re anticipating seeing some sort of peak. We don’t know what to expect, though. Case counts on the East Coast and West Coast are going up. I think we’re 23% higher than we were last week nationally. One [location] in their Omicron BA.1 peak went way up and then their BA.2 is about half that height. If that was our experience that would be 3,000 cases a day, but we seem to have a really slow evolution here to BA.2. And part of the problem with that is any data that we have is a minimum of two to four weeks old, and we get it every two weeks, so it’s like three to four weeks old. We think though that we are probably well above 50% now. But other than [BA.2] being resistant to [the monoclonal antibody treatment] Sotrovimab, it doesn’t seem to have much difference in terms of infectiousness so far; hospitalizations, deaths, resistance to vaccines. So, it’s kind of more of the same, but hopefully a lot less.

I’ve been reporting regularly, based on the state epidemiology report on breakthrough cases, that the number of cases, hospitalizations and deaths all are rising among those who are vaccinated and boosted. Your epidemiology department has already given me a list of reasons why this is the case…but how do you simply encourage people to get vaccinated and boosted when they see those figures? *

I’ve also noticed the vaccination dashboard hasn’t really budged in ages and DOH isn’t reporting on second boosters, so I don’t have a clear assessment of the state of vaccination. **

[Gets back on phone] I thought it was going to update on Monday. I think what happened at the beginning of the pandemic is we all got our first vaccines to prevent us from getting COVID. But now I think the purpose of vaccines is more to prevent us from being hospitalized and dying, particularly if we have risk factors. So some of that is a mindset shift. Second point, though, to be totally honest, is I just got my fourth shot 10 days ago of a vaccine that was made to fight the virus that we had in 2020, which is like three major variants ago. So, I would expect that the longer we keep trying to put the same exact formulation in my arm, the less effective it’ll be for preventing just the infection.

But we still are getting benefit from severe disease. There was an Israel study that showed that…the second booster worked but didn’t last quite as long; it kind of peaked at six weeks of protection, and then kind of came back down, but still a dramatic sustained reduction in hospitalizations and deaths. So I think: One, change your way of thinking about the vaccine to make it more about preventing serious illness; and two, I think we need to have a new vaccine, you know, that is either more directed at current variants or a different part of the virus that doesn’t tend to vary as much. And there is a dilemma about that, if you want to hear about that.


OK. So here’s my macro-economic theory of why we’re not seeing more diversity in vaccine development. If you remember the first vaccine it took about nine months to get to market. You know, we had COVID in February, and we started putting shots in people in December, so nine or 10 months. But what we’ve seen with the variants over the past 18 months, Alpha in January of last year, Delta in July of last year, Omicron, at least here, January of this year. So, the variants are shifting every six months, but we’ve got a nine-to-10 month development cycle for the vaccine. So, if you’re a major pharmaceutical company, how do you manage the risk of developing that vaccine when it might be obsolete before it comes out with a new variant? Things like high blood pressure don’t go away suddenly; diabetes just doesn’t go away. And so any investments you make in those kinds of drugs help. Another option would be to go over more to the flu shot model, where every year we just pick the three variants that we believe will be most prominent and give everybody that shot. I would tell your friends who are 50 or older or have any risk factors that they’d be smart to continue to get the boosters, but they shouldn’t expect that it’s going to keep them from having a milder case of COVID.

The CDC’s COVID-19 data tracker includes information from its National Wastewater Surveillance System. For New Mexico right now, Los Alamos and Bernalillo counties are the only participants. Will this increase? Does the state think it’s useful?

Absolutely. We’re working really hard on that right now. The state Laboratory Division will be running the samples. We’re working now with all sorts of municipal water folks to get them to do the sampling and send it. So it’s going to sort of be an independent surveying mechanism. One of the people who worked at the environment department…is moving to DOH and he did all the wastewater testing [at the environment department]. He’s not doing that at DOH but he has all the connections. So our team is out there working with various municipalities to get them on board to start submitting samples May 1, and we are getting generous support from the CDC on that, as well.

[Updated: A DOH spokesperson tells SFR that according to state Epidemiologist Dr. Christine Ross, the CDC started working with Santa Fe on wastewater surveillance through a contractor and eventually, the health department will take over this work with the City of Santa Fe. According to the city’s Communications Director Dave Herndon, via email: “The City does not currently test wastewater for COVID-19 virus. Through the pandemic we have monitored some of the work being done around the country regarding testing wastewater for the COVID-19 virus. We have had discussions with State of New Mexico officials and national consultants regarding this process,  including conducting a pilot in 2021.” Herndon included samples of the pilot. “The Santa Fe sanitary sewer collection system does not lend itself to producing representative samples and quality data,” he wrote. “Testing in our facility inlet is representative of the entire City and County (Espanola to Edgewood), and therefore not geographically specific to the City. Most samples are grab samples, which produce a snapshot of a larger volume coming in, not a portrait.”

Philadelphia recently renewed its indoor mask mandate [which is now being legally challenged]. It sounds like you just don’t see that happening here—that we’re in a hands-off situation at this point in terms of the government.

I think we kept the public health order pretty much as it was. We made a subtle change in lab reporting to conform to the CDC, but the feeling was what we do have in terms of high-risk settings for masking and vaccine requirements is a good backstop to work from as opposed to taking everything away completely. I do think we’re in the midst of an international/national/ state and even local transition from government responsibility in the beginning when it was really needed to to more individual responsibility now, and that’s reflected in it as well.

There’s a lot of vulnerable people who rely on the state for different benefits. Is the state going to be facing a real decrease in federal support for any of the programs that help support people with COVID? In terms of masks, treatments, tests, etc?

Yeah. We’ve gotten notice from [the Federal Emergency Management Agency], that in all likelihood their 100% support for the emergency disaster declaration will go away on July 1. It might go to 90/10. So, the state puts in $10 to get $90 from FEMA, but we don’t have money in our budget for the $10 part right now. So, there will be some changes and we’re trying to move almost everything over to a world…where insurance pays for testing and insurance pays for treatment and insurance pays for, you know, your masks, maybe. Vaccines, of course and all the treatments which are going to be really important, particularly [the oral treatment] Paxlovid. And then the public health emergency, with respect to Medicaid and [the Supplemental Nutrition Assistance Program], you know, with my HSD hat, we’re thinking will probably not extend any later than July 16. We will know for sure, though, if you want to check with us on May 16, we’ll know if it’s gonna go beyond that or not, but I think not. And so we’ll be transitioning. You know, we’re gonna have to go through and re-certify almost a million people on Medicaid, almost 550,000 for SNAP and so all at once, we are going through that and trying to figure that out and there will be people, many people in SNAP, the majority, will get less money for their groceries and food every month than they did before. And about 85,000 people we’re thinking will no longer be eligible for Medicaid when the public health emergency ends. We’re working to move those to the health insurance exchange.

It seems like there’s enough things happening on COVID that one could imagine a news conference. Do you think there will be another COVID news conference again?

I don’t know. I certainly have a lot of stuff I have to do at HSD and DOH that isn’t COVID. The strategy right now is not to do the press conferences but to make myself available… to answer questions…keep people up to date. I think we’re going to adjust to what’s going on.

Are you under any political pressure to keep COVID off the front page?

I’m not political. Sometimes I experience what some people might think are political pressure and I’m just not sure that’s something I should do. I work for the governor and work at her pleasure. She’s not giving me any orders about press conferences. I’m just trying to make the best use of my time that I can to help New Mexicans.

* On April 7, SFR reported a response from DOH regarding increasing breakthrough cases, hospitalizations and deaths among those who have been vaccinated and boosted. According to Health Equity Communications Manager Katy Diffendorfer, who replied via email with a response from the department’s epidemiology department, the data “does not tell us the effectiveness of the booster vaccine.” Rather, she wrote, “as more and more people get the primary series and booster we expect them to test positive as the vaccine does not protect people 100% of the time. We also believe people who are getting the booster doses are more likely to be engaged with healthcare and have conditions that place them at higher-risk for severe outcomes. We also recognize that the results reported to us tend to be in people with access to testing and are likely more vulnerable than those not getting tested. So when you have a highly transmissible virus (Omicron) that causes less severe disease overall, testing will be biased to the population most likely to be sick enough to request testing and be boosted.”

** Following SFR’s discussion with Scrase, the state’s vaccination dashboard updated. Currently, 91.3% percent of adults 18 years and older have had at least one dose of a COVID-19 vaccine and 78% have completed their primary series; 46.6% of adults 18 years and older have had a booster shot; 12-17-year-old age group: 71.1% of people have had at least one dose and 61.7% have completed their primary series; Children ages 5-11: 39.3% have had at least one dose of the Pfizer vaccine and 31.5% have completed their primary. Santa Fe County: 99% of people 18 and older have had at least one dose and 87.8% have completed their primary series.

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