Interview with Talbot County Health Officer, Dr. Fredia Wadley
This interview has been edited for length and clarity.
EEDC: Right now, everyone wants to know when we can go back to normal life. How can this happen?
Dr. Wadley: The number one thing is cases decreasing for 14 days. Keep in mind that not every place may be reopening at the same time. The second thing is robust testing. The third one is robust contact tracing capability. And then the fourth one is that you know your hospitals can meet the demand, not only with staffing but having personal protective equipment as well as ventilators and anything else that a hospital may need.
EEDC: What about testing?
Dr. Wadley: Our testing got off to a slow start, and it has never caught up. They should be many fold what has been done. In Talbot County, we’ve got 14 confirmed cases, by tests. In no way do we think that that’s all the COVID19 infections, we’ve got in Talbot County, I think it’s a lot larger than that. And here’s why it’s so important. One of the first things you’re taught in public health, the very basics of controlling infectious disease, especially when you have no treatment, is you identify those infected. Once you do that, you identify all the contacts that they have had in that incubation period or contagious period. So, for COVID19, that could be two to 14 days before they ever had a symptom and then all the days that they had symptoms.
EEDC: Contact tracing?
Dr. Wadley: Yes. If a person started today on their symptoms, I want to trace what he’s done 14 days back, at least. Has he traveled? Has he been around anybody sick? Has he been to New York where there’s been a lot of cases? Since you know it can take 14 days, for this individual to actually have symptoms, then you got to go back at least 14 days to see who that person has been in contact with. You isolate the one that’s infected and you quarantine those with a solid contact that you know. For example, if you lived with somebody right around them all the time, that’s a definite contact. If you walk past them in an airport not a definite contact. That’s the way you keep it from spreading in the community
What we’re looking at here in Talbot County is we’re going to train all of our nurses, not just the one in infectious diseases, but all of them, on contact tracing.
Everybody wants to get back to some level of normalcy and business because the economy has been affected so much. We want to be ready when the cases start down, so there’s not a delay in being able to do the other stuff.
EEDC: So, you feel that the testing for the virus is more important than doing the antibody tests?
Dr. Wadley: Yes, at this stage of the game. The antibody test doesn’t help us much going forward. We want to know who’s got it and not take so long to get that test result back. So, we can get to isolating and quarantining.
But I think it got to be understood that this is a new virus and they’re trying to do as much research as rapidly as possible. We get a lot of questions, and when we say we can’t answer them, I think some people think that we’re trying to hide something. No, we just don’t have all the answers on COVID19 yet. We’re having to learn about the virus as we’re having to try to also control it.
EEDC: You’ve changed your focus on the virus, if I’m not mistaken. I remember reading a couple of months ago that you were hoping that it wasn’t going to be quite as bad.
Dr. Wadley: Yes, we did. If you looked at some of the countries, then you thought, ‘well, wait a minute, the numbers didn’t seem all that bad.’ I don’t think they knew how many were being affected, but what became clear with a little time was how this was affecting the people that really got ill. You don’t have this many people having to be on a ventilator, during the average flu season, but you do with this virus. What was unknown then was how much damage it can do to a lung, and what we’re learning about the damage that it can do to other organs, like the heart and the kidney. We still can’t say how lethal it is compared to your average flu case. Until it’s over and you have more testing, it’s more guesswork.
EEDC: It seems like we’re getting all sorts of different recommendations and directives and advice almost daily, sometimes it’s hard to know what we need to be doing.
Dr. Wadley: So yes, the information that’s come along with this virus has made for a lot of changes and even different recommendations. That in itself has been very confusing to the public. And I understand that. We get different recommendations from the CDC, and as they learn a little bit more, they change recommendations. Some of them may be a little bit too quickly. Still, there will probably be some changes even as we learn some more about exactly how long a person that is asymptomatic can transmit the virus or how long you can carry this virus in your throat or your respiratory system. That will take at least this season. Maybe another one. Hopefully, it won’t be like this season.
EEDC: I’m wondering how do you envision life being different on the Eastern Shore when we finally ‘reopen?’
Dr. Wadley: We’re lucky on the Shore because we’re not densely populated, and that gives us an advantage. But it’s not like everybody is wearing a mask or trying to keep 6 feet away from people. I think they’re doing better now than they did initially. But when you try to say, okay, it’s looking better, so let’s phase things in a little at a time, you can see the reluctance of people who want to go from locked down and stay at home to everybody’s out in the open and socializing again.
EEDC: Lately, I’m hearing from people who wonder where they can go to be tested if they think they’ve been infected.
Dr. Wadley: Here’s the thing about the test, it’s more complicated than going up to LabCorp, rolling up your sleeves and they draw blood. To do the COVID19 test, the person administering it needs to get in personal protective equipment and not every doctor’s office has all of that. They may have a surgical mask, but that’s not enough. To get a really good specimen, you have to take it from way back of the throat causing the person to gag choke and cough. When we hear a person say that it was the worst test they’ve ever had, then we know we got a good sample.
So, you can’t go to your local physician and necessarily get the test. You had to go to the hospital, and they couldn’t handle the load. Five of the health offices got together to set up drive-by testing at the Chesapeake Community College. Private physicians would write a prescription, and the patient would bring it, and, with our nurses all geared up and in protective equipment while they were still sitting in the car, they could get the smear. We started with just enough tests between all of us to do maybe a week: Monday, Wednesday, and Friday. And every time we think we can’t open another day, we’ve been able to get enough tests for another two or three days.
EEDC: What about getting the results back from the lab?
Dr. Wadley: With the increase in testing, we are seeing a backup at the labs. Now that’s almost not helpful, okay. Because you want to be making a decision, and you have to isolate people before you even got the result. And if you got the result in two to three days, that’s not bad. But if it took you ten days to get the result, that’s really bad.
If, for example, right now we have any suspect in a nursing home, that doesn’t go to a private lab, it goes to the state lab because we know we can get it back in 24 to 48 hours. So the state hasn’t had a backlog because it has kept this capacity to 500 tests a day, and that’s not nearly what we need. And then the labs, private labs have helped a great deal, but literally, we should have done ten times the testing that we’ve done, easily.
EEDC: Do you think we’ll be able to get more tests?
Dr. Wadley: They’re gradually increasing all the time. It’s just not meeting the need. Everybody and maybe they thought we could have unlimited testing. Nope, you still got to get the cartridges, the testing stuff for that machine. And it’s not easy to get, there’s just not enough of it yet. And you still have to get somebody to take the specimen, and you have to have the personal protective equipment to allow that person to take the specimen. So, we have about three chokepoints on testing, and therein lies the problem. Until you can get greater capacity at every one of those points, they’re not going to have robust testing.
EEDC: So, what can the average person do to keep from getting the virus?
Dr. Wadley: I think it’s difficult for this country—it’s difficult for me—it’s difficult for us to know we have the most expensive healthcare system in the world and technology we are very proud of. I think it just hard for not only the health providers but the public to say, ‘what do you mean we don’t have treatment? We don’t have a vaccine? We don’t have a good testing capability in this country with our health care system?’ I think they’re astounded by that. And yet we were warned about this for years. That pandemic of a virus that just mutated is the biggest concern that we had.
What makes it more difficult is when I tell people the two things you’ve got to protect you are ‘old school’ before we had antibiotics: frequent hand washing and staying six feet away from people. You can do a great deal of controlling an infection without having a treatment, but you got to take those old things seriously. Don’t get around sick people. And when you don’t know, who has it (and people can be asymptomatic), you really have to close yourself off to everyone until it sort of dies down. And we just can’t get our minds around that.