Adam Interviews Monroe County Health Commissioner Dr. Michael Mendoza

Adam Interviews

Dr. Mendoza talks about hospital readiness and offers social distancing advice

ROCHESTER, N.Y. (WROC) — To promote social distancing amid the COVID-19 outbreak, Monroe County officials will no longer be holding in-person news conferences.

Instead, Monroe County Executive Adam Belo and Health Commissioner Dr. Michael Mendoza will be available for one sit-down interview per day.

Dr. Mendoza met with News 8 in his office, the same same that Monroe County witnessed its first COVID-19 related death.

Dr. Mendoza emphasized the need for social distancing so the surge expected at hospitals in the coming weeks doesn’t overwhelm resources. On the issue of Resources, we asked if the Health Department and hospitals are building any makeshift ICU facilities. That and much more in this wide-ranging interview.

Adam Chodak: Thank you for talking with me.This is has been a very chaotic couple of weeks, three weeks, how are you holding up?

Dr. Michael Mendoza: I have a wonderful team. Not that anybody wishes this upon ourselves, but I have a wonderful team and we’ve been working hard. We prepare. we practice, that’s not to say we could predict everything that could come our way, but I will say practice has given us at least a structure to address these complex problems, that we’ve developed good working relationships across our departments has been invaluable so while I’d be lying to you if I said I’m getting lots of sleep, the reality is we’re really very fortunate, we’ve got a great team here.

AC: Some of the steps some people are taking to help them social distance, I think they have questions about. If they get Instacart or they get something delivered to their house and they touch the package with their hand, where does that stand?

MM: So let’s remember the facts and the facts are that this virus we believe to be transmitted by respiratory droplets and so you’ve got to have that proximity with another person who is coughing or breathing or sneezing in such a way that the droplets would land on a surface that you would either touch or would land directly on your mouth or nose or lips. So if somebody would come to your door to drop off a package of whatever and they were to walk away and you were to come upon that package, that would be safe.

AC: It wouldn’t live on the cardboard necessarily?

MM: Surfaces that we think of as smooth surfaces, metal or plastic, so it’s always good before you eat to wash your hands and so forth, but I wouldn’t view those surfaces as high risk.

AC: We now have restaurants who are providing takeout or delivery only meals. We have drive-thrus. Is everything when it comes to that safe at this point?

MM: Yes, as long as we take appropriate precautions. If people who are working on the side of the food service establishment are washing their hands and taking all the precautions that we work on with them and customers are doing the same, I do think these are different times and we’ve got to be a little bit more attentive to these changes, I think we can take appropriate precautions.

AC: Play dates?

MM: Those are tough. I get it. People, kids they want to do something, we are social beings by our nature and at the same time we have reevaluate those habits. I think the play dates is a tough one. The one saving grace perhaps is that we believe that this virus has spared kids for some reason that we don’t totally understand. We’re not seeing the degree of illness in kids that we might expect from other respiratory illness, influenza for example affects kids at a higher rate. This is not to reassure the public. Whenever you have a play date you have adults there as well, I think that’s the number one risk and quite frankly even though we haven’t been testing kids in very high numbers, the belief is that kids may be carrying this and for whatever reason aren’t building that reaction, those symptoms that trigger that desire to test and think through the contacts and all that so I think play dates while tempting, but they’re not safe.

AC: Once you have it, I’ve heard cases in which patients have been infected again. Is that risk low, though, once you’ve had it?

MM: To be honest, I don’t think we know. If we can borrow from knowledge we have of other viruses, we don’t think so but the issue of mutation, the issue of milder reinfection I think those are questions that have yet to be answered. I think the better part of caution should be that until this thing is over we ought to be taking precautions the whole way along because the last thing we want is to kick this and then to have another surge and we see that with influenza, we have different strains of influenza in a season and I think 3 or 4 years ago we had 2 spikes of influenza and so again if we can borrow from what we know from other viruses, I think we ought to be cautious and so until we get through this let’s keep our guard up.

AC: Social distancing is, what you’re saying, perhaps the most important thing we can do perhaps even more important than anything that can be done in the hospitals.

MM: Once you’re in the hospital we’ll take care of you, we’ll provide supportive care, all of the things that we need, but prevention is really what we need here. Prevention is good so a) we keep people out of the hospital and b) because we know certain people are going to be at higher risk. People who are older or have chronic illnesses to no fault of their own are more likely to be hospitalized and we want to retain that capacity at the hospital so that we can provide that care for them and help them get through this.

AC: Speaking of beds, how many do you have in our community to handle COVID patients?

MM: Even under the best of circumstances, capacity is always a struggle. We always look at bed management. We have a whole lot of people looking at bed management in our hospitals. I can’t give you the exact number, I don’t know the exact number, I do know there’s some flexibility in that. As you’ve heard hospitals can cancel elective cases, we have ways of creating additional capacity, up to a point. If we threw our hands up and completely gave up on social distancing there’s no way any hospital in the country would be able to withstand the surge that would result as a result of that. So I think we need to do these community measures while the hospitals are planning and creating that capacity, you know, getting people who have influenza out of the hospital is step one, that’ll take some time, you know, but not that much time because flu season is coming to an end. We also have a need for post-hospital care and we have to make sure the capacity where we have long-term care placement, that we loosen up that area too, so it’s a whole chain of events that, people focus on hospitals, which makes sense but that’s only part of the chain.

AC: Is the county with local hospitals building right now any facilities, ICU facilities outside of the general buildings that we’re used to?

MM: I haven’t been down Elmwood lately, but I understand there is a facility that is being built outside of Strong Hospital right now that I believe is intended to be a triage center, I know Rochester Regional is working on that also, but that is not meant to supplement the ICU, to have an ICU, you need a substantial amount of equipment, personnel and so forth. We want to nip it earlier than ICU capacity needs so we’re looking at way even before the hospital are we able identify people in their homes who might be at low risk whether they need testing or not to provide them guidance either by testing or phone, through telemedicine or FaceTime, so we can keep them in their homes, maintain that social distancing and prevent anything from escalating from that point.

AC: Speaking of escalation, ventilators should only be needed in the more severe stages of this disease. Is there any worry that we don’t have enough ventilators should their be a surge?

MM: We have the ability locally as all counties do to tap into state and federal assets for ventilators and so part of our job is to be looking ahead and anticipate the demand and manage that demand to the extent possible but if we need to expand capacity there are avenues for that which does mean that if we’re not prepared we will run out of capacity so the goal here is to be prepared, to plan ahead and identify those needs in advance and work with our partners in the state to get them..

AC: But of course if the outbreak is severe statewide, it might place a burden on you to get them?

MM: That’s why this is a partnership. And working across the states and across the borders to figure out how we can prevent all of this from hitting anybody.

AC: Are you recruiting doctors from retirement, trying to get more doctors, more manpower in right now?

MM: I have to say I’ve been very grateful for a lot of offers of support from doctors, from nurses, from social workers, you name it, this community has come together to really identify a need and want to work together, just yesterday we learned Villa of Hope would be willing to manage some of our telephone demand and a great partner in that because many of the questions are coming from people who have worries and anxiety and mental health is so important particularly for someone going through quarantine and just this stressful time in general. That community has been exceedingly great to work with.

AC: Has the medical community been able to take those offers from retired nurses and doctors, medical students, are they’re able to bring them into the fold?

MM: We have medical students downstairs right now who are entering data, making some phone calls, we want to reserve the work that we believe we do best for us. Calling an individual who has just been exposed to this is not something we would just throw a volunteer into, but when it comes to calling people who now need to be in quarantine, people who we identify as relatively low risk, who we’re going to be sending educational material to and so forth, those are perfect instances where we can capitalize on retired nurses and doctors. I mean, nurses are educators. I can’t think of a better group of people more so than even doctors who would be willing to call a person on the phone and check in with them.

AC: So we’re going to see more people come in for educational purposes?

MM: Right, public health is really about education, getting information to the community in a way that’s acceptable and understandable and reasonable and I think nurses are great with that.

AC: At this point do we have a general idea of how many people have been tested for COVID-19?

MM: In the department we know how many we have tested and I can get that number for you. Both Rochester Regional Health and UR Medicine are also testing, we don’t yet have a good system coordinating all of that. Coming this Monday the center for community health and prevention who helps us with our influenza surveillance, we’re going to try to have something in place to be able to measure the COVID surveillance. It’s complicated because the data come in from various places, even at the at of the day when we’re trying to figure out how many cases we have, it is a little bit of a coordination game right now to get information from Erie County’s lab, from regional labs, from UofR labs so that is the thing, that is important because at the end of the day I want to go back and say what was the surveillance here, what the prevalence, what was the fatality rate, all those statistics that we want in any epidemic. We’re early enough now that we don’t have a lot of those things in place, but absolutely a priority.

AC: Do we know the percentage of cases tests that were positive?

MM: High, right now because we are identifying people who are at higher risk from a pre-test standpoint. And so that’s good. If our initial testing was low that would cause us to question the criteria that we were using to test so right now it’s relatively high because we’re testing the right people.

AC: Those who have survived, what type of symptoms did they have?

MM: Variable actually. Fever, cough, shortness of breath, but people who are older or have chronic medical conditions don’t follow the recipe for illness so some of them will find themselves in an ICU setting with very severe respiratory symptoms requiring ventilator support, some of them will have cardiac issues because the pulmonary stress is enough to have a cardiac event so it’s highly variable when you look at it with the intensive care side of things, there is no one path toward wellness here. I think that’s where we rely on the hospitals to deploy the ICU-level of care that is looking every organ system and trying to pull things back together.

AC: One of the main problems we’ve seen in Italy is a type of pneumonia and you’re going to have to help me with the name, but when it gets to that stage how difficult does it become to treat especially someone who’s elderly?

MM: All pneumonia are difficult to treat particularly in older adults. You know this is a viral pneumonia so therefore there are no antibiotics and for this particular viral pneumonia there is no anti-viral. For people with influenza pneumonia there are anti-viral treatments specific to that virus but we don’t have that here so we’re deploying primarily supportive care which is helping them to breathe, paying attention to all the other complications which will arise from having difficulty breathing, making sure people don’t develop a secondary infection, so people with a viral pneumonia are at risk for other types of bacterial infections, bacterial pneumonia on top of that so you could have two different pneumonia at play, which, as you can imagine is a serious threat to the lungs and so forth, but again there’s no one path and medicine at that level is very complicated.

AC: I’m going to have you walk me through your best base scenario and worst case scenario.

MM: I think the best case scenario if you assume that COVID-19 is here, that the vast majority of us will come into contact with it, potentially become symptomatic with it, the best case scenario is that we identify and recognize that a vast majority of people who contract this disease will have little to mild symptoms. That that group of people can accept that just like we do for influenza or the common cold although those are different things, that there’s going to be some level of community infection that can be managed, that we don’t enter this panic situation from those individuals because what we really want to pay attention to are people who are risk of serious illness so my worst case scenario is that whatever we do around the healthy and the relatively well, my worst fear is that distracts us and depletes the resources and otherwise prevents people who are at most risk from the care they need and deserve. And those tend to be older individuals who are by definition going to have more challenges accessing healthcare because of all the complexities that go around being older with a medical condition so as a community I think we have think very heavily about how we help people who are most at risk and I think that’s the perspective that I think is still hard and still evolving in that community.

AC: So it sounds to me what you’re saying is that a lot of us are going to get exposed to this but employing social distancing will make sure that infection rate is spread out over period of time and allows for capacity…

MM: Pacing ourselves so to speak. So if you’re looking at a team of people in a particular work place not everybody gets sick all at once, we take our turn so to speak and in that way, teams, families, groups can continue to function and not have to manage everybody being out all at once. You know, when you look at the community that’s the same idea. We don’t want everybody out all at once. We want to be able to anticipate so we can have all of our resources deployed more over time and retain them again for the people who need them the most.

AC: When I was watching the news conference with you over the weekend you had gotten up to the podium and you had said there are consequences to closing schools, there are going to be serious ramifications in our society because of this and Greece Central Schools close down then all school close down. I have to admit, there was part of me that wondering if you were on the fence about doing that.

MM: I wouldn’t be doing my job if I didn’t think about what the fence looks like because in all of these decisions it’s not simple. There are unintended consequences to literally everything we would consider and I understand the desire to want to have an answer, I get that, we want to have structure, simplicity, that from a cognitive standpoint is much more comforting but these are uncomfortable times and when you think through the notion of a school closure, this is foreign territory and while it’s tempting to say lock down the schools, if that answer to that, the solution to that is everybody goes home and grandma and grandpa come over and provide daycare we might not be solving the problem so thinking through those dimensions, I think people do that in time, but when we’re thinking with emotion and anger and reacting so forth we don’t allow ourselves to think through those steps in a thoughtful way and I think when we’re navigating these uncertain times it’s not that we have the luxury of time because we want to be decisive, but at the same time we have to be thoughtful, we have to pause a little bit and ask ourselves what are the consequences of everything we’re about to undertake and I think that’s the conversation I want to encourage people to have.

AC: So do you think that conversation will be had as we decide moving forward whether to open school up again?

MM: Absolutely. As we look at the decision of whether to reopen schools, we’re going to be looking at community prevalence, we’re going to be looking at all sorts of data that we’re going to have to develop but again I don’t want to just open the doors and let the kids run in because a) the parents need to think through what is the consequence of all of that, what are the arrangements that they’ve had, what’s the reentry plan for both school and work and so forth, that will require a conversation so we’re meeting regularly with the superintendents group, I’ve known a lot of them in passing and so forth, but I’ve gotten to know them as a group lately and they’re a thoughtful group and they understand that there is no one answer to a lot of this and I look forward to having that conversation in the weeks to come.

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