A nationwide surge of COVID-19 cases this summer has led to increased hospitalizations throughout Louisiana, including in New Orleans. Still, the city’s in a “much better place” compared to the height of the pandemic, according to Dr. Jennifer Avegno, director of the New Orleans Health Department. She recalled thousands of hospitalizations two years ago, when she was regularly on TV giving updates on the city’s pandemic response, whereas hundreds have been hospitalized during this most recent surge.
But COVID-19 is still dangerous to high-risk populations, like those who have compromised immune systems, and there are plenty of other threats to public health in New Orleans. The city’s hottest summer on record has caused calls to the emergency medical services for heat-related emergency to triple. And some organizations say New Orleans faces a mental health crisis as well.
Avegno spoke to Verite about all three topics amid this summer’s excessive heat and what the city is doing to address them.
This interview has been edited for length and clarity.
Verite: New Orleans has had record-breaking heat — single-day records, strings of days above a certain temperature threshold — this summer. How has the record-breaking heat this summer been affecting the city’s health care system?
Avegno: I am a New Orleans native and I’m used to heat, but I don’t think any of us have have seen [it] like this. We look at our EMS data pretty much daily, and the number of calls that they’ve been getting everyday for heat has been about triple what it was this time last year. So there’s no doubt that we are seeing significant utilization of medical services. We do get data from the state. It’s not great data by parish, but it’s statewide data on hospitalizations and you can see the last several weeks — really, since June — have been much higher than the average. So that’s tough. That’s tough on our EMS, that’s tough on our hospital systems. I mean, if you’ve been in a hospital lately, you know that they still haven’t quite recovered [to] pre-pandemic [levels] in terms of staffing, and they’re having a lot of issues with crowding. So it’s a strain.
Verite: What are some of the more material ways that the health care system has been affected by the additional load from heat-related services?
Avegno: If our EMS transports and calls are tripling because of heat, those people are getting deposited at hospitals. And if hospitals are strained in their capacity just to handle the normal volume, then additional patients means longer wait times, means a lot more difficulty getting folks in beds.
I’m an emergency physician by training, so I feel this in the emergency department. I still do some shifts, like on weekends. The last time I was there, I definitely saw a few more people than I normally would, who had heat-related [conditions]. Maybe they weren’t super sick, but they had been outside in the heat and they were dehydrated, they needed medical care. And even though thankfully most people recover, that’s a bed that wouldn’t have been taken up with that three months ago. That would have been the guy waiting out in the waiting room with abdominal pain or chest pain.
Verite: And it’s extra paperwork to process.
Avegno: It’s just extra time to get folks through the system.
Verite: Speaking of strain on the system, there’s been another surge of COVID throughout the state. How has the city dealt with this latest surge?
Avegno: We’re definitely in a different place, thankfully, than when I was on TV every other day. And it’s a much better place certainly. We have a lot of immunity. Because we did have a fairly high vaccination rate.
So what we’re seeing is that … COVID is still transmitting … [but] we are not seeing the severe disease by any stretch of the imagination, as we have in previous surges.
So, Dillard [University] coming out and deciding to put a mask mandate on? That makes sense for them. They might say, “Look, we know that this is transmitting, we know that our kids are coming back to school and we want to be able to preserve classes. We want to be able to keep having classes. So this makes sense for us, given our population, given the levels that we’re seeing on the ground.”
And that’s what we’re just encouraging everybody to do. What makes sense for your institution, your family, your organization, understanding the inherent risk and everybody’s underlying status.
Verite: And you’d say that we’re far off from having to institute another mask mandate?
Avegno: Oh, yeah. The tools we have now [are] not the tools we had when we were [masking] on a regular basis for the most part, right? We’re at the point now where we want to make sure that everyone has all the tools to prevent against severe disease and hospitalization.
[But] our high-risk residents are in a different place. If you are immunocompromised, it’s still not so easy. And so [we have to be] mindful of making sure that they number one have been vaccinated and number two, if they get COVID, that they have access to Paxlovid, which can significantly reduce the likelihood that they’re going to have a severe outcome. … We don’t want to diminish the risk to our high-risk folks, because that still is sizable. But for the rest of us, staying up to date on our vaccinations and just taking precautions [is sufficient]. If you don’t feel well, don’t go out.
Verite: How does the city prevent or limit surges without the robust monitoring that had been developed at the peak of the pandemic?
Avegno: It’s just that we have shifted our focus. No longer are we getting these tremendous surges of severe disease. We’re at a point that we get to with a lot of viruses, including flu, where we know what we need to do to reduce your likelihood that you’re going to get it [and] you’re going to get it badly. And that’s basic mitigation measures, staying home when you’re sick and getting vaccinated.
Verite: Let’s shift topics. New Orleans is a city with lots of psychosocial stressors — high crime, poverty and the effects of climate change, to name a few. Some organizations in the area say New Orleans is in the middle of a mental health crisis. Do you agree? Why or why not?
Avegno: We’ve had significant mental health challenges for many years. And I don’t think there’s any sugarcoating that. Whether we’ve been at crisis levels for years and years? Maybe.
The health care system in America is very fragmented and challenging to access. I think mental health care is an elevation of that. [It’s] not that we don’t have good providers. If you look at our sheer number of providers in New Orleans, we have a pretty good ratio of mental health providers to the population when you compare us to other cities.
But just having them present doesn’t mean that access is easy. And it doesn’t mean that it’s easy to stay in treatment or to know that you need treatment or to want to have treatment. So there’s a lot that we need to do and there’s a lot of people working on this.
What we do at the health department is take a population-level approach and figure out where are the gaps that we need to fill.
Verite: Where are the gaps?
Avegno: I think access … getting folks to treatment. And by that I mean whether that’s destigmatizing [mental health care], whether it’s physically transporting people to treatment or making it possible [for people with jobs to] get to treatment and then keeping them in treatment.
It’s also prevention. How do we prevent escalating mental health [issues] throughout the lifespan? That’s one of the reasons why … we’re spending much of our American Rescue Plan Act money to partner with Children’s Hospital to do intensive mental health services in schools. So that that kid that’s having some issues in second grade doesn’t end up hospitalized in ninth grade. Because at that point, he’s been labeled, you know, bipolar, schizophrenic, because no one addressed whatever that little thing was.
We really need to think about substance use prevention and the opioid settlement money that’s coming is a really great opportunity to do that.
Verite: The health department just received $1.7 million for the Opioid Abatement Task Force. What’s going to be done with that money to address the opioid crisis?
Avegno: A lot of the things it can [be used] for are programs that we’re already operating — our Law Enforcement Assisted Diversion program, harm reduction and Naloxone distribution. We’re going to continue the things we’re doing now and hopefully expand.
There’s some practical things we need to do. We’ve been trying for years to come up with a better system of public sharps containers in areas where we know that there’s a lot of needle litter. It’s dangerous for users, it’s dangerous for neighborhoods. So this money allows us to do that.
But the first thing we’re doing with it is doing a needs assessment, getting an independent, objective contractor to come in interview all of our stakeholders [and] say, “This is what the landscape looks like in New Orleans: here’s the system you have, here’s the amount of money you have. This is what we think would be the best and most efficient ways to use it. $1.7 million is a lot. It is not a lot to treat everybody with opioid use disorder, but it’s not nothing.
Verite: What additional facilities, resources, infrastructure would be helpful in dealing with the mental health challenges that the city faces?
Avegno: I think a lot of it is less brick and mortar and more connective tissue and glue. And this is true of a lot of health care, it’s the social determinants. It’s what prevents you. Is it that you can’t get to the clinic that you need to go every month to get your shot of whatever? Or is it that you don’t have stable housing?
Roughly [80%] of what determines your health outcome has nothing to do with what’s inside your body, has nothing to do with your anatomy, your physiology, your genetics. It is the conditions in which you live.
A lot of our work … through our Community Health Improvement plan with our many, many partners across the city is: How do we fix the foundation? How do we fix the safety net? Because that’s what’s gonna give us the biggest bang for our buck.
I can do fancy programs all day long. But if we don’t fix the basics, they’re not gonna be very impactful.
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