Terri Wilder: So what is happening in Georgia In terms of COVID-19, like how many cases how many deaths has Have you seen?
Melanie Thompson: Well, Georgia is a heavily impacted state. As of today, we're reporting about 23,000 cases, and over 900 deaths. And one thing that's important to realize about this is that we have a very low level of access to testing. So Georgia has typically been in the bottom of states in terms of how much testing we're doing. And when you look at our testing, and how many are positive, what we see is that 19% of tests are positive. And what that tells us is that we're really still under testing. We're only testing primarily symptomatic people. So we have a long way to go to ramp up testing.
And I would also say that while we have a lot of cases here in metro Atlanta, really the worst outbreak in Georgia began in southwest Georgia. And that really was several months ago in February and March with two funerals. And that outbreak has killed 108 people in a single county, Dougherty County, and dozens more in surrounding counties. So, if you look at the map of Georgia, what you see is a very heavily impacted area in the southwest portion of Georgia. And this is a largely rural area with really insufficient health systems. So, we have been impacted in so many ways.
TW: As I mentioned earlier, as you know, the governor or Georgia announced the plan to reopen the state with some very specific businesses mentioned in the announcement including hair salons, nail salons, gyms and bowling alleys. Why is this happening? I mean, the, you know, the Centers for Disease Control is in Georgia, Emory with its medical schools, School of Public Health and you know, other major sources of accurate, scientifically available public health information is in Georgia. So it's a little confusing to me about why he made this announcement.
MT: Yeah, it's sort of stunning, isn't it? Exactly the businesses that you would think would be the highest risk because they are high touch [occupations]. You know, there's been a lot of joking about, “Oh, I'm gonna get my hair done and my nails done. I've got to go to the gym. I've got to go bowling and I'm going to get a tattoo on Friday.”
But aside from all the joking, I think we are all worried that what we are going to see is a real upswing in cases, hospitalizations, deaths in the near future two to three weeks down the road. Now, why this is happening, when we have so many experts right here in Georgia? I think the issue is that science is not the basis of this decision. This is a political decision. It is a decision that the governor is making, I believe wrongly, on the basis of economics. Georgia has been heavily impacted by unemployment due to the pandemic. And so the governor has chosen a path of trying to repair the economic damage when I think many of us feel that economic damage will only be repaired once we repair the public health. damage. So this is not being done based on advice from public health, certainly not CDC, or the doctors on his task force. And it's very disappointing.
TW: So you mentioned a task force, so the governor actually has a COVID-19 Task Force?
MT: He does. But there was an article after his decision that interviewed a variety of task force members and many of them were not consulted, before this decision was made. And one of them, Bernice King, daughter of Dr. Martin Luther King, said that she was considering resigning from the task force, because this was viewed as a rash decision that in particular, would adversely impact African American populations.
TW: Yeah, so I'm glad you brought that up. You know, I recently saw transgender activists, Octavia Lewis, who is also African American. She posted on her Facebook. “Why are they opening the largest Black metropolitan city in the country? Even with a rising COVID-19 cases in the state of Georgia, I'm really disappointed in Atlanta, My heart aches for my former city.”
MT: Well, I agree with Octavia and my heart aches too. But I want to clarify a little bit about the opening of Atlanta. And while the governor was very clear that mayors could not implement their own recommendations, either more or less stringent than his executive order. Our mayor, Keisha Lance Bottoms has been very vocal in encouraging people to stay home. She has spoken directly to our community, directly to African American communities within metro Atlanta to say “Please stay home, we only will get to the end of this scourge if people continue to do the kind of social distancing that is currently happening.”
And it seems that staying at home may be having an effect here in Atlanta. But I would say it remains to be seen how much of Atlanta will open up. It remains to be seen how much the state will open up. At least in Atlanta, we have leadership that is pushing back.
TW: I want to go back to this idea of this COVID-19 Task Force and that people are saying that the governor didn't consult and you know [Bernice King] is considering resigning. Is anyone with a medical or scientific background actually advising the governor? I'm assuming there's a health commissioner in Georgia. Are they somehow involved? Are there any scientists or medical professionals that you're aware of that actually do have his ear?
MT: Absolutely. We have a commissioner of public health in Georgia, Dr. Kathleen Toomey. Dr. Toomey has a long history of experience in working with HIV. She is his commissioner and she stands beside him and behind him at all of his press conferences. It's unclear what kind of behind the scenes conversations Dr. Toomey has with Governor Kemp, but he says he is listening to her. And yet he makes these kinds of decisions that really fly in the face of any sort of public health recommendations that we have heard across the nation. We haven't heard Dr. Toomey push back on that. But I do know firsthand that there are a number of public health and other physicians who have reached out to the governor.
There are individuals who have reached out. There was a letter from infectious disease doctors that went to the governor. I was involved in a letter from over 140 healthcare providers that went to the governor pushing back. Actually, even before this latest announcement, we were pushing back on some of his other decisions. So, it seems that the sorts of arguments have fallen on deaf ears about politics.
TW: So I looked at the actual order online. And you know, the order to open has a list of measures that should be taken for the opening of the business. So I think there was somewhere between like 16 and 20. And it had everything from screening, you know, in evaluating the worker who exhibit signs of illness, such as a fever over 100.4 degrees Fahrenheit, coughs, shortness of breath, to increasing physical distance between workers and customers. And I'm not actually clear on how you would increase physical distance between the worker and a customer if you were doing somebody's nails or cutting their hair, like that seems almost impossible to me.
MT: But there have been some funny memes online about that, about how you could do it: washing somebody's hair with a mop, for example. No, these are not things that can be done from distance. It is impossible to carry out the business of tattoos or nails from a distance. And yet here we are.
TW: I mean, this is very personal to me. I mean, as you know, I'm from Georgia. My family lives there. My parents are in their seventies. And when I read this, I was absolutely shocked. Shocked but then not really surprised. I think that when we look back in the history with people fighting Obamacare and the health exchanges, making sure people have access to health care. I mean, the states that fought against that in terms of their elected officials, overwhelmingly are Republican. Those particular geographic areas across our country are ripe for a double pandemic happening in the state.
MT: Well, that's right. Look at what the decision not to expand Medicaid has done to our healthcare infrastructure in the South and in Georgia. We have had numerous small hospitals and larger hospitals close since 2010 because they absolutely can't afford to be open. They are taking care of people who need care but care is uncompensated. And so the lack of Medicaid reimbursement, which would have brought so much federal money into Georgia, would have stabilized our healthcare system, would have stabilized these smaller hospitals, and would have provided additional safety net care to so many Georgians. And now we see the situation worsening, with so many people out of jobs and losing their employer provided health care, and having no safety net in Georgia at the very worst possible time. So many of us also are trying to encourage the governor to please go ahead and expand Medicaid at this point, because it will bring in money and it would help fortify our infrastructure. But that has been a very difficult ask.
TW: So you're actually an expert in HIV. Talk about how the COVID-19 pandemic has impacted your practice.
MT: I think it really caused us to rethink how we do everything. We certainly have been very diligent in rethinking all of our infection control practices in the office to make it cleaner than ever, even though I think we ran a pretty tight ship, but now we have implemented very aggressive infection control practices. We provide masks to our patients and we try to keep people from sitting in a waiting room so they are not exposed to other people.
We try to take care of our staff in that same way. There was a struggle to get the personal protective equipment that we needed, and we still have trouble getting certain items from time to time. We got in line as quickly as we could to get access to testing for the coronavirus, and that has been hit-or-miss. But probably the biggest thing that we have done is to pivot to telemedicine and that is something that happened very quickly.
I will say the fact that the Centers for Medicare and Medicaid Services changed their approach to telemedicine really did have an impact. And I really hope that is something that continues long after the pandemic has waned. It's interesting to all of a sudden be doing telemedicine with people instead of seeing them face to face. We still see people in the office who need to come in. But sometimes telemedicine is triage to try to figure out who needs to come in and who actually can be safe not coming into the office, and to be sure that they have all their meds refilled and have everything they need. Or if they need to come in the office, for a lab draw or visit, we minimize the time that they have to be in the office. So, everything has changed, actually.
TW: What is the most common question that your patients living with HIV are asking you about COVID-19?
MT: Well, a lot of questions come up. Everybody wants to know whether they are more likely to get the coronavirus because they have HIV and some people just assume that they are more likely to get it or get sick because they have HIV. And so that is an area that takes a lot of discussion. As far as we know, right now, HIV by itself isn't a risk factor for acquiring the infection or for having a more serious illness, as long as people have a strong immune system, their T-cell count is good and their viral load is suppressed. So that's usually a piece of the conversation. And then it's common that people who may have had some sort of winter illness in December or January or February will say, “Well, you know, I had this cold, I had this cough, I had this fever and it wasn't flu and could I have had COVID? And when can I get an antibody test?”
So now the second conversation really is about, what does antibody testing tell us and what does it not tell us? Right now we don't have access to antibody testing, but I think there is a lot of education that needs to be done first. And there's a lot of science that still needs to be done to really understand what these antibody tests mean before people have access to them and make their own interpretations that could be dangerous.
TW: Right. So when you do see your patients, I'm assuming that much like the rest of the country, people are losing jobs, potentially losing health care insurance. I mean, what are your patients’ greatest needs at this time?
MT: I try to always start by finding out how people are doing in general. Do they still have a job? Are they able to work from home? If they are a so-called essential worker, what do they actually do? Do they have personal protective equipment? And now it's important to know whether if people have been laid off. Do they have shelter? Do they have food? And what about a continuous supply of medications? For people living with HIV, as everybody knows, continuous HIV medications are life-saving, and they also prevent the spread of HIV. And so it's really important to figure out a way to keep people hooked in so that they can get continuous medication supplies. Those are the kinds of things that we talk about.
And I think people are hungry for information. They're hungry for real information from a medical provider, because they're so bombarded by so many things on social media and from their friends and their families. So there is this hunger for real information. I think people also want reassurance and they need to know - for them - what does this all mean? Are we going to be there for them? What do they do if they need us? I've seen a lot of people whose depression has worsened, whose anxiety is off the charts, who even are carrying around a lot of anger about this pandemic and the way it's been handled. So it's a very difficult time for, I would say, most people.
TW: I'm wondering if you can talk a little bit more about what the community is doing to address what's happening to Georgia. Is there like an official COVID-19 activist group that's working together?
MT: I'm not aware of any specific group around COVID activism. Because I work in HIV, primarily, I do think that the people who have been involved in HIV are wrapping COVID-19 into our worldview. For example, we are interfacing with HRSA and with CDC to advocate directly with the agencies, especially on behalf of those taking care of people living with HIV through the Ryan White program. What are the challenges people find in the Ryan White program and how can we address them? And I must say HRSA has been very responsive to this kind of advocacy.
At the state level, it is dispiriting that advocacy has pretty much fallen on deaf ears, but I think people are still eager to push back. But you know, people living with HIV are not new to advocacy. I think that we're not going to see people living with HIV take this lying down.
One thing that I've been very impressed with among my patients is that people do take this so seriously. There are very few of them blowing this off, as I see so many other people do. I think those of us who have been in this fight for a long time, and people who live it every day, know that you don't gain anything by withdrawing from the fight.
You have to continue to engage, even if you feel like you're not making any progress. So I think that people are still pushing back in many different ways.
TW: Yeah, I mean, I asked this question because, you know, in New York, there's actually COVID-19 New York working group that meets several times a week, of course, virtually, and it was created in the majority of the people who are involved in it are HIV activists and LGBTQ activists. So to your point, yes, these communities understand pandemics, we understand stigma. We understand how stigma perpetuates things happening or not happening. We understand broken systems, etc. So it's just kind of curious if there was something like a formal group that was meeting together. But you know, again, to your point, I think it's, you know, this community probably more than most are very aware of the consequences of broken systems and not implementing change that can benefit everyone and keep everyone safe.
MT: Well, that's right. And, you know, I think what we, as an HIV community, inject into this conversation is really around how this particular pandemic hits the most vulnerable people at the most vulnerable of times.
You know, an example in Atlanta is housing. We have a major housing crisis and it's gone on for quite a long time. It's not new, it didn't just pop up. The city of Atlanta has a long history of not managing its housing funds well from the HOPWA (Housing Opportunities for People with AIDS) program. There's now an area of activism that is not specifically about COVID but it is much more acute because of COVID because we know that people living with HIV who are not housed appropriately, not only are at higher risk for loss of viral suppression, acquiring or transmitting HIV to others getting sick or dying because of HIV, but they also are at higher risk for being in a situation that's crowded such as a shelter and thus acquiring the coronavirus.
And so, this is something that is really pulling on a lot of strings that are interconnected.
TW: Well, I really wish that this was not happening to Georgia. Like I said, it's personal for me, and I am happy to hear that you're involved or been part of some of the activism that's happened. And I just hope that at some point the governor gets some sense knocked into him.
Correct me if you have a different opinion, but I'm what I'm afraid is gonna happen is you're going to see an increase in rates of COVID-19 and death and then he'll say, “Oh, no, we know we have to close everything again.” And it'll be the consequences of somebody's life being taken away from them.
MT: We are not past the peak of this epidemic yet. If you look at the model that is guiding so many decisions from the University of Washington, it tells us that we should maintain our shelter in place until June 22. And we're a long way from that. I do fear that what we will see is an increase in cases and hospitalizations and deaths and that these will occur in the most vulnerable communities. African Americans are already disproportionately affected by cases and by deaths. I'm afraid we're in a situation where we have to continue to fight back, but we still may see a very bad outcome depending on how many people actually follow the governor's order.
Now, I do think it's important for people in Georgia to know that you don't have to follow this order. And that there are a lot of communities saying stay home safe, stay safe.