COVID-19: Smart Leadership Makes the Difference

When Cathey and I returned from volunteering for a month at the Gallup Indian Medical Center (GIMC) and seeing the contrast between how the Covid-19 crisis was being handled in Arizona and New Mexico, I felt compelled to voice our impressions and concerns.

Cathey is a retired cardiopulmonary nurse and a member of the Prescott City Council. I am a retired General Surgeon. We have experience providing care in challenging situations. We spent six months at a small hospital in Kenya, and I spent two weeks in Haiti and Nepal after their earthquakes.

Early in the crisis we realized that Covid-19 was a real global threat and that not enough was being done to prepare in a coordinated way nationally or in our state. In early April scenes from NYC documented the toll the pandemic was taking on patients, their families and the healthcare system, including healthcare workers. Frustration over the lack of coordinated national effort was obvious.

I responded to Governor Cuomo’s call for volunteer healthcare workers and was assigned to a public hospital in Brooklyn, but before I was deployed their curve flattened and they needed less help. Cathey and I then reached out to the worst “hot spots” on the Navajo Nation, Tuba City and Gallup. The Gallup Indian Medical Center (GIMC) was in greater need, so we chose to serve there. When we crossed the New Mexico border at night we were greeted by an eerily lit portable sign stating “Face Masks Required in NM.” The Governor had mandated face masks on May 16 to try to reduce the spread of disease as the state started to reopen. Because of the severity of the spread of the disease, President Nez placed the reservation under lockdown and the mayor of Gallup closed the city except for essential traffic and workers. Manned road blocks were placed at all freeway ramps. GIMC was being overwhelmed with the number of patients. At peak it was transferring 10-12 seriously ill patients a day to the University Medical Center in Albuquerque. Patients were frequently separated from their families by hundreds of miles, and many didn't survive to see them again.

At GIMC Cathey was assigned to the drive-through testing center. I was assigned to the teams caring for patients at several hotels and motels recruited to provide rooms for Covid patients when the hospital was overwhelmed. With most under strict isolation or quarantine, these patients were under significant stress, both physically from the disease and mentally. They were isolated and we were their only real contact with other people, they could not leave their rooms (if they did, they could not return). They were separated from family and friends and frequently did not know the status of loved ones who were also ill, some in critical condition in other hospitals. A 19-year-old man was admitted to the motel one evening, and when we saw him the next morning on rounds we learned that his mother had died that night at hospital in Albuquerque. He was alone, and we were the only ones there to comfort and mourn with him. Many stories like this show the toll this disease was taking on patients, their families and healthcare workers. They illustrate graphically how this disease can spread rapidly, with significant consequences to the entire community, and that state and local leaders must respond aggressively to flatten the curve. That means following the CDC guidelines and requiring face masks, which has been shown to change to course of the disease, reducing both human suffering and impact on our economy, our healthcare system and healthcare providers. No one can absolutely predict the course of this disease, but we know that it will take strong leaders at all levels working together, making tough decisions based on scientific evidence, not political considerations, in consultation with health experts to achieve the best outcome. Arizona is in the midst of a significant surge in the number of infections. In my opinion we have had a failure of leadership at every level of government. But it's not too late. I also believe our medical community should to speak out publicly and make recommendations to our residents. People should know the situation in our hospitals, our ICUs, staffing issues and testing availability. Then the public can make better informed decisions on measures to reduce the spread of disease. I believe we should have instituted stronger measures prior to the July 4 celebrations, requiring face masks, as many other communities in Arizona have. Just recommending that everyone wear face masks has obviously not been adequate, as only a very small minority wore masks downtown on the Square and at the rodeo. Recent reports confirm that the virus can be spread by airborne transmission as well as by droplet transmission, and that face masks can significantly reduce the number of infections, and that distancing alone isn't enough. Costco, Walmart and other major chains are requiring face masks in their stores. This is not a personal rights issue, but one of public health and safety. You can’t smoke in bars because that risks the health of those around you. Wearing a mask is a two-way street: you protect yourself from other, and others are protected from you. By not wearing a mask you can transmit a potentially deadly disease to those around you. That is not your right, rather it infringes on the rights of others. You can go where you want and do as you normally do while wearing a mask. You can also support our local economy while wearing a mask. Our experience in Gallup showed us the extent of the impact of this disease on a community and state, and the measures we need to control it. It allowed us to contrast approaches in New Mexico and Arizona, where the Governor is deferring to local leaders and local leaders are deferring to the Governor. It highlights the importance of a coordinated effort at all levels of leadership and the willingness to make difficult decisions for the good of the people. Fortunately the course is clear: follow the CDC guidelines and in this case mandate face masks while we get this surge in infections under control. It's the right thing to do for the health and safety of our fellow citizens and our economy. Face masks: Require face masks during this surge of infections. Use well fitting, tighter face masks or face coverings. Social distancing: Limit the numbers of people in stores, restaurants, etc. Avoid larger groups and gatherings. Good hand-washing Interaction outside with social distancing is safer than indoors. Spread the word: not the virus!

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