Observercast Episode 12: Where Are The Voices Of Public Health?
I'm Oklahoma Observer Editor Arnold Hamilton. And I'm Marianne Martin. This is observer cast your weekly deep dive and Oklahoma politics and policy powered by the Oklahoma Observer. Democracy Foundation worldwide. There are over three million confirmed cases of Kovic nineteen in the United States. We are hovering near one million cases. We have long ago. Surpassed numbers the worst hit countries in Europe including Italy in Spain. According to the Oklahoma State Department of Health website dedicated Covet nineteen pandemic. There are three thousand two hundred eighty cases of the virus in Oklahoma up. Twenty seven or zero point eight percent over the past twenty four hours one hundred ninety seven. Oklahoma have died from the virus to in the past day. And according to the John Hopkins University covered nineteen tracker. The state of Oklahoma has a five point. Nine percent fatality rate governor Kevin instead of now staple twenty second that a phased in reopening the state would begin starting with restaurant dining rooms movie theaters. And gyms this announcement came in spite of the Oklahoma Hospital Association critique against allowing elective surgeries to begin again with Osha President. Patty Davis saying in a statement but hospitals did not have access to adequate personal protective equipment to resume elective surgeries Oklahoma State Medical Association President. Dr George Monks said reopening. The state was quote hasty at best this past weekend on Fox News when Chris Wallace asked the governor about Dr monks concern stood. Said he didn't even know who monks was Jane. Nelson of the Oklahoma Nurses Association also voiced concern in an Oklahoma. Watch story saying her organization has reports of nurses being asked to reuse. Pp and that no one really knows how transferable viruses mayors across the state have been forced to rethink their stay at home. Orders with Tulsa Oklahoma City deciding against extending due due to competing messages from surrounding suburbs. That would undermine the efficacy of orders in their city limits. Meanwhile are Oklahoma. The Homa city reports that eighty percent of the staff at a metro nursing home tested positive for the virus but returned to work anyways this while nursing home operator statewide report. An inability to access P P. E. TO PROTECT staff governors was famously slowed any restrictions in place here in our state even hedging his orders with phrases like safer at home and stripping any Modicum of collective awareness to flatten the Kerr with his insistence on Oklahoma and sense of personal responsibility notably missing from this in our state however is a voice from public health experts. Yes we have. Two of the governor's cabinet members next to him at every press conference but his secretary of Health and mental health comes from oil and energy and has zero background in either of these areas and his Secretary of Science and innovation leads always use medical school. She's well respected airfield but neither is biologists nor epidemiologist. Public Health is the field that specializes not only in tracking disease but also in communicating about in ways that change behaviors and perceptions given the governor's erratic messaging and inconsistent communication about the nature of Cub. In nineteen in its prevalence in our state we thought an actual public health expert might shine a light on key information that were missing right now. I found Dr Rainy Hue Bach. He works at Oklahoma State Department of Rural Health with a background in infectious diseases and behavioral science. He agreed to talk with us about the states. Response to the virus and what we can do to protect a homeless. My Name Is Randolph. Humor and I associate professor of Rural Health at Oklahoma State University at the Center for Health Sciences. My background is in a public health specifically looking as a behavioral scientists at the behaviors that individuals do and why they do it how can modify them and particularly I'm interested communicable diseases so each AIDS STI is Hepatitis C. But other infectious disease agents at the same time this kind of has built off my experience before going to academia I worked at County Health Department as a communicable disease investigator going out. Doing contract tracing Also looking at disease outbreaks in the like and that experience kind of helped motivate me to go into this more on a academic research room. So where were you before Oklahoma? So I'm originally from California is working here at Oklahoma State University. Like to say that the America's Bright Orange is actually the sun sets off the beach in California and then I did my doctoral degree at Indiana University in Bloomington Indiana of public health. I The backstory here is You know on twitter. I just noticed you know you were a randy. Just kind of talking about the pandemic response and so I was curious and we we try and add a level of interpretation in a depth of information for the podcast like Arnold said typically missing from mainstream news. Although I don't think we totally throw our journalist colleagues under the bus because I think the coverage specifically Condemning has been lights out here in the state but But we we really wanted some information on You know assessment of the states response to the pandemic because Let's just say it concerns me right though I harbour daughter who compromised But just as a citizen of the state you know What what should we be looking for in terms of a response to the pandemic? Are we following a good time line you know is? Is the trajectory really going down? I mean these. These are my big question and I think as a citizen Oklahoma. We should all be concerned. One of the biggest things that we're looking for is leadership at our state in our federal level in as a public health researcher and practitioner with concerns me. The most is that lack of leadership or leadership. That's focused more on the economic impact of Cova than actually the public health Impact in reality. What I'm Moore's concern is we need individuals that are interested in the public's health and so from a Oklahoma perspective. We were very slow to the game. And I would say we haven't even got to the game The governor With his advisors are advisors have really have looked at a policies for safer place. But I don't think most Oklahomans understand that even this type of policies focused on individuals who are sixty five and older or have some underlying health condition so we never really pulled the trigger a trigger for a true shelter in place which was required and recommended By other entities and what was implemented by other states so we can look at California as a model an Oklahoma. It's might say well you know we don't have the same characteristics California demographic Looks different but when it comes to basic public-health Karma says the idea that governor some actually pulled that trigger early to go ahead and shelter in place following the mayor of San Francisco and some of those other counties in the mayor of Los Angeles. They have seen a relatively low incidence of the virus and lower death rates. In comparison to other metropolitan core areas in so that type of leadership really has helped keep those that burden down in Oklahoma. We have kind of a unique as situation here. So I think the mayor's of Tulsa and Oklahoma City have been a little bit more and Going ahead to address this issue more head on. Definitely the Mayor of Norman in that area as well have been kind of the defacto leaders within this this discussion and what we're kind of missing here is from the State is public health messaging. That's gonNA reach all Oklahomans and so if we think about disease burden within our state we've had this dialogue about raw cases the raw number of cases. We hear this with a New York. We hear this. We heard this within Seattle. We have these many cases up to ten thousand. Were Up to twenty thousand rupture thirty thousand. Now we've had these many deaths. We've focused on those rock aces as a metric. But we really haven't looked at. What is that disease burden within that specific area so here in Oklahoma? What we're starting to see is a disproportionate burden within a rural counties. And I WANNA give you an example that I think will resonate with people in our state Greer county so out in southwest Oklahoma. The mob relation about six thousand individuals within that county. That's about they've had so far as of yesterday. Sixty three cases so that rate is one thousand sixty individuals per hundred thousand people. That's the same rate that we're seeing in New York in the surrounding counties around your in New Jersey and the like Holy Smokes. It's extremely high and so we have stable. What's going on there? Resort to look at a Washington County Which is having A rate which is lower. It's about four hundred per hundred thousand but that's what we're seeing some metro areas in other smaller states as well. Texas County Rogers Delaware County aid air. And the like that. We have these high number of incidents within our metro areas. But we really haven't looked at. What is this disease burden on row communities where we have hospital closures We have local leadership that might not taking more practical approaches and we might have a general kind of just John Wayne mentality of if we pull our bootstraps up. This is something that we can deal with. That are on our own. We really don't need guidance from other levels so these are the things that start to concern me more. So he'll find for us at disease burden Help us understand that term a little bit. Because I propping eye-popping statistic on Moore County rate. Wake me right it is. It is rural it is very rural so talk about disease burden so as an epidemiologist won the the basic measures that we start to look at his idea of incidents rate so per thousand ten thousand eight hundred thousand individuals. What how many individuals are being diagnosed with this condition so within covered nineteen we look at. How many who have been diagnosed the population of that county and so we can start to look at that raw numbers there but we want to be able to make comparisons of what's unique between greer county in Payne County are versus Oklahoma Tulsa County. And the way that we can do that is by turning it into a rate so this makes everything look equal. So now I can compare county to other counties It's essentially taking into account. The population of that area is a disease burden. I'm looking at. How much disease is prevalent within that area? This isn't looking at the financial or medical. And this is just how much disease is present and especially for a communicable disease becomes important of because we're only take into account here. How many individuals are known in diagnosed? So this is the minimum number that we could expect in this county right now and that's another conversation we have to have is. What is testing looking Mike in our state in anything? That's an issue in you know what I've talked to Oklahoma and Zita via twitter Foun Or before we were in kind of a working from home environment would have conversations with me. Is that in order to be proactive? And Start Opening things backup. We really have to ramp up our testing capabilities and I will say that the partnerships with the universities argue with an issue has allowed for that to be wrapped up somewhat. But we're still predicated on this idea that individuals can only be screened the presenting with symptoms. Or if they have come into contact who was diagnosed with kofoed but what we know about Kofin that a lot of individuals are not presenting any symptoms at all in these individuals than are passing the virus onto others so if we don't have a more thorough testing paradigm to try and capture these a symptomatic individuals by opening up the state again even small you're allowing for community transmission and it really is only a matter of time to see where we could have more widespread transmission occurring. Do you. Do you think that the messaging whether it be from the national level or from the state level and in combination brawling. I guess is the way we ought to look at. It has created a some sort of a false sense of security in rural Oklahoma that That somehow this might be more in urban problem Yeah you know. I think of almost like the OPIOID epidemic those early that we traditionally looked at avoids similarly we can think about HIV as well as that is an issue of urban spheres especially on the coast and we took that mentality for a long time with HIV. And so with you later what individuals her listening might understand. Is that Oklahoma? Last couple of years has been classified as one of seven states with the highest royal. Hiv burden within the US. In some of that came to is is that we have all these coalescing factors that come into place poverty employment education Given the fact that we don't really have sexual health education within our state that all these factors call lesson have driven itchy for example more into rural communities where we haven't had that public health or spots and so what does that mean then for Kobe. Kobe I had that same kind of mentality that we started seeing these cases popping up in Seattle and San Francisco Barrera New York means of well if we can keep it there. It's not our problem and so we didn't really have the response from states and humidity use. That weren't really on the coast but we saw within our state here is wanted became. We had our first case in Tulsa the another case in Oklahoma City. We started to have a couple more poppel pop up but he still had a the mayor of Oklahoma City in the governor. Tweeting pictures of them out to eat. Even though by then social distancing had kind of been recommended amount the federal level and so you did have a false sense. Security and with the governor's perspective of we won't essentially safer at home accounting until they have a case within that county will that creates a paradigm to where people think. Oh I don't need to worry about that because I'm living in Woodward County and we haven't had anything around us. Well we know. The disease is probably prevalent in every county here. We just haven't screened for so let's talk about the public health. Messaging to reach all Oklahomans is one thing that has really struck me. Coming from. The governor's office is As a communications practitioner. You know the idea that he said the example in the tone in that he he if if I I really feel Especially in Oklahoma that he our elected officials are ultimate opinion leaders if he and members of his administration particular were setting the tone for. This is something you know instead of just kind of hedged their language just a little bit but still set the example for This is a responsible way to conduct ourselves. I think it would have made all the difference in the state right. So what she you would be. what you said the public health messaging to reach all. Oklahoma's what would that look like? You know. I think we have to look at. Who are these popular opinion leaders in how we can get them onboard? Especially you're right. The the governor is administration. Have that voice. These are individuals that people look to but we also have what I like to call. They're not traditional participants within public health. So we might actually think of them as part of the public health system away and the governor by Default Really Kinda is within that sphere and so if we think about you know who people are looking to in times of crisis That could be faith leaders as a what has the role of faith. Leaders been in Supporting messages a public health either by closing houses of worship earlier on moving to online or these individuals that kind of have refuted the signs on this end tried to find ways to still meet in person if we start to think about the role of sport in Oklahoma and how those individuals have a high profile. We look at example recently of coach county at Osu having messaging about bringing players back and kind of then sets message of well. If coach Dungy things we should come back. Why couldn't we all come back to and so really is is finding these key individuals who do have a voice within our community to start disseminating sound science and as you kind of mentioned that are living with. They're talking about. And so if we talk about the importance of social distancing these are things that we could observe Being done we could see this within their messaging on their social media. We've seen faith leaders for wide variety of background who've had conversations about how they are still able to live their lives live their faith etc But by being at home and how they communicate that to prisoners in the like We start to see that also with people within our sports arena as well we see individuals in business who start to have these conversations that we can't just rely on the government sphere to messages of but we also have to look at the wide variety individuals within our state in one thing that I really truly appreciate has been the role of the tribal nations. That when you had Cherokee Nation Muskogee Creek owes Asian Lake Route. Start shutting down Casinos and that revenue of it then really having conversations about the importance of tribal members to stay home they think of. Cherokee nation really had this whole conversation about the role of protecting elders. Who STILL Were speakers of native language and that we need these individuals to keep our language alive that this is the type of messaging that really resonates within people those communities. So what would make people want to stay home? What are those things that we can then tap into to say? Yes that myself as a member of this community I have to do my part not only to protect my health but to protect the health of others and I think that's a message we've met a we've missed is we've talked about the importance of staying home for just us but not really the impact of how it impacts others so what. What is the message? What message does it? Send when the governor's like were opening backup because we are even even if it's in phases because we You know all our healthcare provider associations in the State Medical Association Association have put out very strong statements in the past. Couple of weeks Trying to dissuade the governor So what does it? What? What message does it? Send to Oklahomans. If the governor's like a non essential services can open back up. It's a messenger confusion. And that's what I'm hearing on the ground here even within the Tulsa area and you know what what role does what mayor bynum has said of keeping things. A shelter in place role has interact with what the governor saying? Oh no of individuals that are out in the broken arrow. A broken Arrow area wishes adopted stitz. Faizan plan a opening backup. Local business owners have started to have a conversation of what? If I'm not ready. What happens am I being socially pressured to be back open. How can I protect my staff Myself and also my Patrons in and here too is. Are we opening back up? Just because then we can get people of unemployment and that really is a message of concern to that. What happens if your business are still open back up where you're employed but you don't feel comfortable going in yet the US an individual or following the science insane. Maybe this isn't the best idea. Are you then going to be fired or laid off or not willing to come back? Does that jeopardize your unemployment as well? So instead of having a unifying message of these proactive steps that we're gonNA take try to reopen the Oklahoma economy where sewing disinformation. But we're really also something confusion of. What is this process? He's going to look like? And how is this lockstep with what we're hearing from public health medical entities in when all public agencies and medical agencies within the state on a national? You're saying hold your horses. We really got to do this. With due diligence the public's left to decipher of what's right. And what's wrong? Ernie I am. You know I I was thinking as you were saying that that the people may actually have more to say on this than the opinion leaders or the messengers. Because probably like you. I'm hearing from a number of people were saying. Well you know he can roll this out but I'm not. I'm not going back to get my nails done or I'm not going to get my haircut or I'm not going to the movie theater until I feel safe because we are in a situation with this. Where while the numbers and again this is partially because of testing but but just the way this virus seems to be working You know we don't know when it's going to flare up and and talk to an ICU type level and it just happened so quickly and can be so deadly as result that a lot of people are not willing to take that chance. And I think for the general public it say you have the internal conflict that we want to support local businesses. You know I've been telling individuals like Oh you just WanNa stay home now. I WANNA be back in my office. I WANNA be with my colleagues. I am tired of working for my guest bedroom I am ready to be back but at the same time. No it is not time to be back. It is not for my interest or the best interests of anybody else but when we think of these local communities where we've really tried to support small businesses. There's a conflict of I. WanNa support that Nells Leon. I want to support these other server services that are starting to open back up but I'm not ready to put myself or those individuals at risk yet as of that starts to be that internal conflict that we have in ultimately we might have stores and stuff that are opening. It'll be interesting to see how people are actually showing up but by gift cards or do do curbside delivery Roy. Exactly I mean. I think there are ways that we could do this. I've heard from people that Are Animal rumors where they're only going to have you know some of them. It's a family small business where they've been contact each other's maybe two of them and they're going to have a crate outside so the animal could be punch of the cray and then they will come out and get. The animal is that there really is not. You're you're still keeping social distancing other ways we can start to do things but we really haven't had that guidance of what that looks like and what has the role of lobbying been with this. Who knows to no? We've had this conversation about open gyms backup and how gyms are trying to be proactive. I don't think no matter how proctor gyms are really. Kinda to me is a recipe for disaster in the long run Just away virus transmit how can live on surfaces. Are we at the point where we should be opening those type of resources backup? I'm not sure one of the things that the governor really emphasized the other day in his press conference unveiling this phase Hin reopening of Oklahoma was the notion that we have of hospital capacity to deal with any sort of unexpected surge. That would allow us then to realistic and if we needed to do that but I wonder from where from where you sit and being a sole familiar with healthcare in rural Oklahoma in particular whether that's the case particularly when suddenly in it's to their economic benefit I supposed to do this on the one hand but on the other hand the notion of opening up a hospitals again to elective surgeries Creates a whole other set of issues or are hospitals really as prepared as just raw numbers might suggest that they are? I think it's a case. By case scenario. I mean I think there is a way to have some elective surgeries going on so I think for a lot of rural hospitals. This has been kind of their One of the larger issues for them is they're not bringing in that revenue in there already running in the red So is there a way to slowly have that opening backup? We have capacity the thing. We really haven't evaluated the various models as A. What's IT GONNA look like now that we're making changes? A lot of these models are based on a certain level testing within the community They're looking at Various metrics that will come into play and so we we started having these discussions and I think for the most part Based on the levels that we've had now we're in a good spot now if we surge you know. What does that really look like? And I think we have kind of focused on these urban centers of Tulsa Oklahoma City by having to hospitals available for Serge. But what happens if we were to be out in the panhandle area Given we have meat packing plants alike. And we're GONNA have a large number of new cases that got to the point where they needed to be hospitalized will do we really have that capacity now and so these are the questions that I think we we have to have start having And I'm not sure of local leaders have thought through this as much because we have focused much on these more urbanized fear given that. It's the the population hubs within the same area So they're really becomes a missed opportunity to start having these conversations. I don't have anything go MOJO. We really appreciate your joining us today. And and you know I mean I mean if there's other things we wanNA talk to you or anything about or long winded. I'm happy I found it. I found it riveting and do so I mean and one of the things I think it's it's interest in tune. I think this is Marva. An ethics issue nationally is that we are closing resources within communities because we want to maintain the public's health so we think about a correctional re entry programs now that we've had individuals that are being released our commute sentences commuted in the like Right the governor. Somebody's reentry services are closed if we think about harm reduction services within the state for people that are substance using or engage in high risk behaviors. Some of those programs have been either extremely whittled. Back are not open at the moment. So do how much are we vowing the public's health without without addressing the needs of everyday Oklahomans that need access harm reduction community reentry in behavioral substitute services. That might not be there when I feel like another side of that. Too is the workers that feel compelled. Go back you know Against their comfort levels against their wishes and It I think it just puts so many people in a bad place to have to choose that just I mean you're absolutely correct. This is an issue of ethics. So yeah I mean I think of you know especially the issue related to I'm being on unemployment. We had this one time stimulus check twelve hundred dollars individuals. We know that's not what does not go far. But if your company opens back up you really don't have a choice. You're going to have to go back and work because the money's not gonNA come otherwise so it's either D. fired for not working and then you lose your unemployment benefits or you're putting yourself in your family at risk. It's a lose lose situation for someone. Who's not ready to go back to? Work completely agree a terrible choice. Yeah it's a it's a tale of two perspectives. That we got going on here and you know the biggest thing I hear. Is the US our public health leaders and let's use our public health resources. For example you know the governor And others talked about using medical students to do contractor contract contact tracing within the state which we need contact tracing medical students do. That's fine but we have a whole variety of public health professional specifically their titles disease. Intervention specialists are disease invented investigation specialists. Depending on the state with these people have been trained to do contract tracing for HIV of listening hypoc communicable. Diseases. We're not using them fully. So why would we use an innovation tapping into medical students when the innovation really should be using the employees that we have? Who have the training in have the capacity in what they're doing and clough whether you realize it or not. That's kind of been the theme of our entire PODCASTS We have these resources. Why are we throwing them away? Basically letting them idle anything. That's been one of the things I've been. I've really been concerned is where where the voices of the public health leaders. Where the voices of the epidemiologist? Where are these voices when our Cabinet positions are held by individuals but not public health experience Who were a phone? Call Away to say hey. Based on similar situations here recommendations. Here's some people within our workforce that we tap into a set of students why not use our public health students graduate level were being trained to do contact tracing or about disease outbreaks. I think too often were missing true. Offered every really want innovate. There's ways to innovate in a much. More logical manner again. Thank you so much for your time. It was great to do. We hope to public in person at some point. Yes yes no definitely would love to come down and once we're able to come together maybe even coffee or something. That'd be great. Thank Dr Randy. He bought for speaking with us for today's episode. Please remember next week's observer castle drop Monday evening may fourth and once again will remind everyone to please request our absentee ballot. Now for all the coming twenty twenty elections at okay dot Gov backslash elections in. Please take time to contact your legislators. In the governor's Office are urged them to remove the requirement for impression notary signatures in the meantime. If you're interested in sponsored observer cast please give me Arnold Hamilton a coal at four zero five four seven eight eight seven zero zero or drop me an email at a Hamilton at okay. Observer Dot Org you can also support observer cast with a tax deductible donation to the Oklahoma Observer Democracy Foundation whose mission is to help create a better more informed of the home to help keep us on the air visit Okay Observer Dot Org and Click on the donate button on the upper right side of the homepage. We also urge you to subscribe to the Oklahoma Observer now in our fifty second year of comforting the afflicted and afflicting the comfortable we have a special digital subscription rate for observer cast listeners. Only a dollar ninety nine a month for the first year. That's fifty percent off the usual rate for monthly digital subscribers. Just use the Coupon Code. Observer CAST when checking out to get the discount rate and finally we. WanNa Think Norman. Stare deck for the music heard during this episode. Learn more about jared jared music dot com.