Published in Health Care

Q&A: Dr. Adam London Director, Kent County Health Department

BY Sunday, May 10, 2020 12:32pm

Over the past few weeks, the number of positive COVID-19 cases in Kent County rose sharply, roughly doubling in each week during the second half of April. Reports suggested West Michigan was a new hotspot after the early and continued devastation in Southeast Michigan. The public health director in Kent County, though, says more targeted testing in vulnerable populations was the key to helping stop the spread here. Positive cases are up, yet total deaths have grown gradually. Hospitals have not yet reached capacity. Dr. Adam London spoke with MiBiz on May 5 about the county’s effort to track COVID-19, the limitations in testing and walking “this delicate policy tightrope” between public health and the economy.

Over the past few weeks, officials have noted a large percentage increase in COVID-19 cases in Kent County and West Michigan. Are those increases concerning to you?

Dr. Adam London director, Kent County Health Department COURTESY PHOTO

No, they’re not concerning at all for me. In fact, I think they have been a little bit misrepresented. What we’ve done is approach this lately with a more aggressive strategy for testing. Where most of the state is right now, individuals who are looking to be tested are almost always symptomatic, almost always going through their primary care physician or hospital to be tested.

Here in Kent County, we recognized looking at the data in other parts of the country that we were very likely to have worst-case scenarios in places like long-term care homes and shelters for those experiencing homelessness. We decided that instead of waiting for symptomatic cases to develop in those settings, we should act more aggressively to identify positive cases in those environments before those small outbreaks become large outbreaks. We really want to break up these small clusters before they become bigger outbreaks. 

What was the planning behind the more aggressive testing, and how is it working in practice?

Within the Health Department and county team, we have a number of units including our surveillance, testing and communications teams. We have a team doing the isolation center for those who don’t have a place to stay who are positive. The surveillance team is where we’re doing all of our epidemiology. We have a team of nurses who are trained to go into the field and collect samples from those higher risk environments. We coordinate and have regular meetings with hospitals. We were doing just a few dozen tests a day in early April, late March to 1,000 now, and we’ve seen an increase in positive cases. We’re hunting for it, and finding it.

What are you hearing from hospitals? Are there concerns about reaching their capacity?

The hospitals all report they’ve seen fairly flat numbers in terms of admissions for COVID-19. While the testing has increased, most of the people diagnosed positive are mildly symptomatic or can recover at home. The actual number of people admitted at local hospitals is a little less than 100, and that number has stayed pretty flat. We have seen the curve flatten as far as hospital admissions go. 

Trying to measure the shape of the curve by testing is complicated because testing was not consistently available over the past few months. The availability has changed and it’s a really hard metric to judge actual prevalence in the community. A better measure is hospital admissions.

The number of deaths in Kent County remained in the 30s over the past week. 

What information does the county have on who is dying?

Our current number is 39 as of this morning [May 5]. That number has been fairly flat. The number we’re really watching is the rate of days it takes to double. We’re at 33 days to double our death count, and that number continues to increase. We’re putting our hospitals in a good position to provide high quality care. A majority of (patients) are recovering and having a successful outcome.

The vast majority (of deaths) have been over the age of 60, the vast majority had underlying health conditions as well. That trend has played fairly consistent with what we’ve seen elsewhere. We also see a lot of people in the 30-50 age bracket that have tested positive for COVID-19. While the most terrible outcomes have been fairly limited to the 60 and older population, we have seen hospital admissions in all age groups.

Are you seeing any concerns about tests showing false negatives?

I’m concerned about that, and a lot of things related to testing, especially as we test more asymptomatic individuals and more people who are critical infrastructure workers who think they have been exposed to someone positive. There’s a great desire among those individuals to get tested right away. In many cases, the infection hasn’t occurred to a level to be detected by a test. 

We’re also seeing problems with false positives, especially with antibodies tests they want more available. In places where they’re using antibody testing, it’s picking up an immune response to infections that have happened with other types of coronavirus, the less severe forms that have been around for decades.

What has Kent County been able to glean from the experiences in Southeast Michigan?

The No. 1 takeaway is you cannot allow your hospitals to be overwhelmed. When the hospitals can’t handle the surge in cases, that’s when you start to see the increase in the rate of death and the worst outcomes. You’ve got to keep hospitals in good shape.

We’ve also learned that communities of color and socioeconomically distressed communities suffer disproportionately from COVID-19. There’s a variety of reasons, most importantly the prevalence of other underlying conditions and lacking access to health care. We recognize that and we’re doing our best to make information available in lots of different languages, make messages culturally relevant and work with leaders in those communities to make sure our message is reaching people who need to hear it the most.

What lingering concerns do you have, and what keeps you up at night?

What keeps me up late at night is the concern that this is not going to be a short-term crisis. This virus is not going away anytime soon. We still have a huge majority of people who are susceptible to this infection. Until we have better therapies and ultimately a vaccine, we’re going to be struggling with this. 

I also know and fully recognize we need to reopen the economy. We need to get life going again in so many ways. That’s so important and so related to many other health outcomes. We have to walk this line between being mindful and cautious about COVID-19 and also mindful and cautious about the health of the economy and making sure people have jobs, can pay their mortgage, buy groceries and don’t disrupt the supply chain of so many products. We need to do both. We have to walk this delicate policy tightrope between both of them to make sure we’re not causing disaster on either side of the situation. And we will need to walk that tightrope for probably a year or so.

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