Friday will mark six months of data reporting by the Halifax County Health Department during the COVID-19 pandemic.
rrspin.com submitted a series of questions to Health Director Bruce Robistow on the novel coronavirus and two follow-up questions following his initial response.
The answers and questions are being published in this Q&A format with editing for style and typos.
rrspin: In the six months we have been living with the novel coronavirus, what are your takeaways on the disease from the negative impacts it has had to anything that can be construed as positive, whether it's on the guidelines, what your department has been doing to deal with this or the general reaction from the public to the local guidelines and measures enacted.
Robistow: The negative impacts on our population over the last six months are countless. From job loss, a disruption in education, a declining economy, to loss of life and health in a manner never before witnessed by our generation.
The challenges for providing guidance and education, the provision of care and vaccines, as well as constant and effective mitigation stem from a lack of trust in science and in government that I had not anticipated at this level.
Mitigation is hampered by noncompliance and disbelief in its effectiveness. Moving forward we need to find a way to establish more trust in our elected officials and science so that we can better navigate whatever else we may face moving forward.
The positives are many. We are making progress every day in our efforts to better control the spread of COVID-19.
Families are doing more together, and navigating many of the challenges in positive ways that they will always remember. Many people are helping those less fortunate, as Americans do so well. Our dedicated medical professionals, first responders and service industry people are all stepping up to do whatever it takes to care for each other.
Every day I witness so much good through so much turmoil, as Americans have done so many times in the past.
rrspin: What ZIP code area surprises you the most in regard to the number of positive cases? Which area has the highest percentages of positives as related to population?
Robistow: No comment.
rrspin: There is some feeling or belief that COVID-19 is no worse than the flu or a bad cold. Please explain why or why not this is or isn't the case.
Robistow: This is definitely not the case. The flu is a seasonal virus that we have a vaccine for. The volume of positive flu cases and deaths in the country are far below those of COVID-19. COVID-19 is not seasonal. There is not yet a vaccine. The negative effects on the body from COVID are far more traumatic than that of the flu.
I think people compare it to the flu because that is all they know to compare to.
It is not an apples to apples comparison.
Even with the flu, and having a vaccine, we have come to accept that a certain volume of people will contract it and even die from it. That is the new normal for flu. COVID-19, when under control, could very well have the same outcome.
rrspin: There is some confusion on the way related deaths are recorded. Our understanding is the deaths which are classified as COVID-19 related deaths have exacerbated certain underlying conditions a patient may have. Please explain.
Robistow: This is a hot topic that has fallen under a lot of scrutiny and conspiracy theory. When someone dies from a COVID-19 related cause, it simply means the ill effects of COVID, most importantly the inability to get oxygen from the lungs, into the blood. Lack of oxygen in the blood can have many different ill effects to the body such as heart attack, stroke, organ failure, etc. Should the patient have chronic issues when infected by COVID, their already compromised health is at greater risk of failure. However, a perfectly healthy person can also succumb to death, depending on the severity of the COVID and its effect on the body. So, when someone dies from one or more of the conditions mentioned — heart attack, stroke, organ failure, etc. — that is the primary cause of death but it is caused by the ill effects of COVID-19.
rrspin: We have seen, especially on social media, people who simply deny this is a real pandemic. Is this a real threat to our health? Explain what it takes to make a virus a pandemic.
Robistow: The CDC defines a pandemic as an epidemic that has spread over several countries or continents, usually affecting a large number of people. That being said, by that definition alone, this is a pandemic. And yes, this is a very real threat to our health. It does not actually have to be a virus, it can be any disease that can be spread from one person to another.
As I try to understand the denial of this being real, it appears that there is a lot of fear, frustration, and an inability to relate to the magnitude of this pandemic, just because we have not seen it before in our lifetime. Yes, it happened 102 years ago but all we can do is read about it. Very few of us experienced it. Although social media serves many positive purposes, it does enable miscommunication and disinformation which simply complicates people's understanding of what this is.
That being said, and combined with the distrust of government, trying to convince the public of the facts becomes a rather challenging task as I am not a politician, I am a public health director, as well as a longtime citizen of Halifax County. I am here to try to share information about public health and promote mitigation and prevention of public health issues. I have no other motivation other than that is my job, and I am very passionate about my responsibility.
rrspin: With flu season coming up, what role does the novel coronavirus play in that? Does this mean residents should be more guarded? What are the effects of the flu on COVID-19 and vice versa?
Robistow: The flu is a good example of a virus that we have learned to live with, expecting certain levels of illness and even death related to it. It is similar to COVID-19 in the fact that it is also a virus. However, the flu is seasonal, we have a vaccine and we can better control the flu with vaccines and education.
It does mean that residents should be more guarded as the flu season starts up, for many reasons.
It is possible to be infected by both viruses, at the same time. That in itself would be very difficult to deal with or treat.
Although COVID hospitalizations are down presently, not controlling the flu could put more people in the hospital leaving less hospital capacity for any increase in COVID patients.
Getting the flu vaccine, and continuing to follow the same 3 Ws that we promote for the mitigation of COVID, will go a long way in controlling flu cases.
rrspin: When might we see a day when this pandemic is declared over or when might we see a vaccine developed?
Robistow: The pandemic would be declared over when the infection of people no longer meets the definition of a pandemic. Declaring the pandemic as over in no way means COVID-19 is gone. Our best chance of controlling COVID-19 is through herd immunity that presently can only come close to happening with a vaccine.
There has been a lot of information being shared about the optimistic goal of having 300 million vaccines available by the beginning of 2021. When it does come available we will then face new challenges regarding vaccinating the masses. More concerning to me is the ever-increasing lack of confidence in vaccines. Both will present many challenges for vaccinating enough people to accomplish some level of herd immunity.
rrspin: In discussions with you, we have learned your staff has worked tirelessly during this pandemic. What has gone on behind the scenes other than just providing updates to the public? What are the duties of a health department during a health crisis?
Robistow: First of all, we still maintain an operational health department without compromising our original mission and programs. That in itself is a lot of work for our committed team.
COVID-19 added so much more work to that same team. From logging each and every positive case, monitoring each patient, educating them and their families, contact tracing any and all contacts, working with the school systems on planning, as well as law enforcement and all first responders, educating the public, constant research and planning, that can sometimes change daily, to our staff to do all of this all while having to live with COVID-19 like everyone else.
Our staff have families, illness, and all the other challenges that face each and every one of us and at the same time stepping up directly into this pandemic, trying to find out the best answers and promote efforts to the public. There are many heroes that have continually stepped up for this challenge, to serve our community and our health department is definitely one of them.
rrspin: What have the last six months taught you about the needs of the health department? What do you need to make your jobs more effective? How prepared was the health department for this? Should there have been action on the state or federal level sooner?
Robistow: Again, this pandemic is unprecedented in our modern times. However, public health throughout the country have prepared for such events, formulating policies, procedures, communication networks to quickly share information.
I cannot comment on state and federal action regarding initial action. I can, however, comment on how well our state has unified healthcare systems, followed the science, shares information and the greatly needed resources to our health department.
Regarding what I have learned over the last six months when it comes to the needs of the health department there is nothing actually new that I have learned about the needs. It has all just been elevated to a new level. Limited funding, challenges in communication and outreach, limited human resources have always been challenges for any health department. The challenges are just bigger. However, we have learned that collaboration with other providers is virtually limitless when you are working with the right people that have common goals to serve the public health.
To make our job more effective I would of course say that increased staff during this pandemic is the biggest need. Our health department has limited staffing that has been working so hard with such dedication, but it has been quite the challenge. We have improved processes, as well as gaining assistance from both the state, and our colleagues in the county to somewhat reduce the strain on our team.
It remains quite a bit of work however and I could not be more pleased or impressed by our team at your health department — constantly committed, caring, and professional, working together to support this county. Very impressive team.
rrspin: At last count, we believe you have only had to issue one stay at order for someone who initially refused to stay home while sick. Have there been more since last reported?
Robistow: We have only had the one. That is very impressive and I am proud of our community for that compliance. It became obvious that when COVID hit home, it was taken more seriously. I am pleased that more people have not had to confront that but at the same time the lower volumes appeared to stoke the mistrust in the magnitude of this virus.
rrspin: What are your views on the state's plan to reopen?
Robistow: As I have followed the data, the science and recommendations for mitigation, I am pleased with how the state has consistently followed the data and science in both planning and implementing the reopening phases, according to the accessible information.
I am fully aware of the challenges, frustration, confusion, fear and other extreme concerns that have arisen throughout the last six months.
If the state reacted to all of that, instead of the science, I am confident that our state would not be making the progress we have made.
Leading through a pandemic is a thankless job that requires strong leadership and commitment to a focused and measured goal. Our state has done just that.
rrspin: Are you satisfied with the school systems’ response to the pandemic?
Robistow: I am satisfied. I can confirm that each system throughout our county has worked hard to try and figure the best way to continue such a vital resource as education, all while protecting the safety of our children and staff in our schools. Each system is different from the next and therefore need individual plans that meet those differences.
All of them have followed the state guidelines, consulted with me, and each other, locally, and are continually adjusting as needed. I am so proud of everyone involved in this process.
What would help even more is the compliance of our citizens regarding the 3 Ws. This would promote improved compliance of our children, who emulate their parents and elders. This requires everyone to make it successful.
rrspin: Having recently read The Great Influenza which documents the 1918 pandemic, there are striking parallels between what went on then and what is going on now particularly in the mask debate, the business reopening debate and the mass gathering debate. What are your views on the similarities and differences?
Robistow: Fortunately, pandemics have been rare, the last being over 100 years ago. As that is fortunate in one respect, it does cause a level of disbelief, skepticism, and fear, all of which produce a level of distrust, lack of compliance, or ability to comply, and most importantly, the patience needed for a pandemic to be combatted.
It takes a lot of time to identify a disease, understand how it spreads and mutates, how to mitigate spread, and finally how to treat it, all of which make it more difficult to tolerate the personal, financial, and so many other negative effects that take place during that time of discovery.
rrspin: Explain why you believe the three Ws are an important tool in fighting this.
Robistow: Presently, and throughout this pandemic, the 3 Ws have been the primary tool for preventing the spread of COVID-19 — very simple and very effective when practiced.
The challenge however has been gaining the buy-in with our population.
If everyone would do it, we would have progressed much faster in the reopening process, fewer people would have been infected, and ultimately fewer deaths. It works folks, please, please participate.
rrspin: What has the cooperation between the health department and Vidant, the department and Rural Health and the department and the state been like during this?
Robistow: In a word, incredible. From the start, Rural Health Group, Vidant, Vidant North, and Vidant Medical Group have been vital participants in this pandemic.
We meet at least weekly to brainstorm, plan, and work together to provide the best possible solutions for our county. I could not be more proud of our health department team, as well as our strong collaborative relationship with our fellow healthcare providers throughout the county.
The state has also proven to be a tremendous asset.
We receive daily reports of every form, multiple Zoom meetings with the state and all health directors throughout the state.
This pandemic has been a moving target and changes in process, planning, strategies, etc., are virtually a daily occurrence and the state helps to ensure we are all on the same page.
The state has consistently recognized new challenges and has quickly provided resources, both financial and with contracted support to assist the local health departments with meeting the ever-changing needs in each county. We always have a resource for consultation, at any given time.
rrspin: Do you feel the county has accurate numbers on positives, recoveries and current cases?
Robistow: I feel as though the numbers are accurate, but sometimes delayed. Due to multiple entities reporting, lag times for test results, etc., the numbers as far back as a week can increase. This has been an issue all along but the increase in test numbers has amplified this issue. That is why the weekly report has proven more helpful in giving a snapshot of our progress, more so than the daily report.
Followup questions and closing comments
rrspin: What is your perception of wearing a facial covering and the compliance of the executive order for wearing masks in public places? Explain the effectiveness of masks.
Robistow: Masks have been proven extensively to be the best possible way to mitigate the spread of COVID-19 to others when you are around others.
It is most important to remember, however, that the mask does not protect you, it only prevents you from spreading the virus to others. That is why everyone should wear a mask. I wear it to protect you and you wear it to protect me — a great example of caring for each other.
It is very possible for you to be capable of spreading the virus without knowing it as you could be positive and not have any signs or symptoms. Therefore, wearing the mask whenever you are out in public, around others, it is vital at all times.
My perception of the compliance in our community in regard to the executive order for the wearing of masks is twofold:
In most healthcare facilities, doctors offices, pharmacies, etc., compliance is quite strong, and very impressive.
In many restaurants, department stores, grocery stores, and specialty shops, I see a lot of room for improvement.
As many of you do, my wife and I must venture into many of these businesses for needed food and supplies.
I do observe staff in some of these places to be compliant, but not all.
Many post signs requiring customers to wear masks but the businesses obviously do not enforce this practice.
I have noted some exceptions in salons and a few other shops but the overall compliance of businesses and public compliance can be dramatically improved.
Professionally, we do not have a day at the health department that we do not receive complaints from the public regarding the lack of mask wearing in the businesses mentioned, by staff and patrons alike.
I listen to the complaints, share my concern, but then inform the complainants that the health department does not have the authority to enforce this executive order. That responsibility lies solely with the local and/or county law enforcement, as well as the proprietors of the establishments mentioned.
I end the conversation by guiding the complainant to contact law enforcement regarding their concern.
I also ask them to please aid in communicating their concerns to everyone they know, encouraging them to wear masks and to protect each other.
I am happy to report that I have personally passed on these complaints to both local and county law enforcement with very positive results. They are working with us to remind and educate local establishments regarding the order and importance of masks — a great team effort that I am very pleased and appreciative of.
In short, we have a long way to go with compliance. This truly takes a combined effort to most effectively slow the spread of the virus. I do however remain optimistic that we as a county can do this.
rrspin: In the most recent weeks there has been a decrease in the trend with the exception of this past weekend. Please, first explain what you attribute the decrease to and then what you attribute the increase to.
Robistow: There are many factors that can influence the direction of the trend line regarding the number of positive cases.
Periods of bad weather like we have had in the past weeks has a tendency to keep more people home. This could reduce public spread, while at the same time good weather may motivate people to socialize outside where public contamination is reduced.
Now, chronic cold weather is also predicted to increase the volume of positives as people may tend to socialize inside instead of outside which can now increase community spread.
Certain popular events such as parties, holidays, etc., can be a cause of complacency and large social gatherings, causing an increase in positive cases.
However, those increases will be delayed due to the fact that it takes a few days after contamination to test positive.
For example, our recent increase over the last five days could possibly be attributed to the recent Labor Day weekend. In reality, all we can do is speculate.
The number of tests can also make a difference in the number of positive cases.
That is why we also report the percent of positive cases. For example, this past week does show an increase in positive cases. There is also an increase in the number of tests. However the percent of positives has also increased which indicates that the overall value is an increase in actual infections.
The bottom line is simple: Compliance or non-compliance with the 3 Ws, executive orders, and other recommendations will be the determinant of the number of positive cases.
rrspin: Any other comments or advice you might have for the public are certainly welcomed. Feel free to comment.
Robistow: Please know that I do understand the frustration, fear, lack of trust — to a degree — that so many people have.
I am one of you and share so many of the challenges that everyone is facing, as does the entire team at the health department. Please try to trust us.
No matter what your views of the 3 Ws are they are painless, only a little challenging, and virtually cost free. Please give it a try. You have nothing to lose and so much to gain, and give simply by following the 3 Ws
In closing, COVID-19 is not going away.
Until we can enhance herd immunity by way of a vaccine, following the 3 Ws and executive orders is the only way to reduce the spread and to protect each other.
Please promote these practices to those you know.
Please also report violations to the law enforcement in your jurisdiction.
Please also be prepared to receive the COVID-19 vaccine when it becomes available.
All this requires a complete county effort to protect our county.