The coronavirus pandemic has exposed a uniquely unflattering side of American leadership. Desperate for good news, those in power have sought to fabricate it. The virus will “just disappear.” Cases are only up because testing is up. Bleach may provide refreshing cleanse.
These ramblings might be dismissed if the man who delivered them were not the president. But they are also emblematic of an effort to make science a political and cultural chess piece in the United States of America.
Look no further than the fact that, after being suspended from Twitter for sharing false medical information, Donald Trump Jr. decried on national news the deplatforming of those “preaching conservative values.”
And yet the strain of anti-science thought in America is less infectious than the virus it seeks to minimize. Americans, on the whole, still overwhelmingly trust the experts. Republicans, of whom two-thirds trust President Donald Trump, confide even more in medical scientists and the Centers for Disease Control (CDC).
As a result, Dr. Joseph Gastaldo has been working around the clock. Gastaldo is an Infectious Disease Specialist working for OhioHealth, the hospital system which services Columbus, Ohio, and 47 counties throughout the state.
With over 24 years of experience in the medical field, Gastaldo has been a chief resource for the public and other physicians during the pandemic. He had already done 94 TV, radio, and print interviews by the time he sat down with The Globe Post to discuss public policy on coronavirus.
The following interview has been lightly condensed and edited for length and clarity.
The Globe Post: Just for context, can you say a little bit more about your specific expertise and what you’ve been doing with the coronavirus situation?
Gastaldo: I’m a board-certified infectious disease doctor. I’m the System Medical Director for infectious diseases [at OhioHealth]. Specifically back in January or February, I was called by leadership at OhioHealth, who said, “Hey, Dr. Gastaldo. We need you at the incident command center to help us, as a system, define policies and procedures for us to follow all the mandates by the governor’s office, and to provide the highest quality and safest patient care that we could have in the setting of COVID-19.”
And we’re in a very different situation now than we were. The first barrier that was very challenging for us, as physicians: this is a brand new disease that we know nothing about, so one of the things that I had to do was stay current and learn about COVID. I still do it today, and I educate physicians and medical staff members on what’s going on with COVID treatment-wise.
The other challenging thing was testing. When COVID first was on the scene, it was very challenging to test people and really confirm that they had COVID. I’ll never forget when COVID first came out; we had to do testing on people, send it to a reference lab, and wait five, six, or seven days before we got test results back.
In late March, as a system, we were first able to do testing at OhioHealth’s lab, and we were only able to do 80 a day. We thought that was a lot – it really wasn’t – and there are still limits on our testing. But now, we are able to do about 1,400 tests a day, which is good. And having that testing capacity allows us to open up and get back to business in the safest way possible, so we can test people who come in for non-COVID-related surgeries. Now we’re seeing people who have had their healthcare delayed – cancer screening, cardiovascular screening. People had detrimental things happen to their health, but they delayed treatment because of COVID.
The Globe Post: I want to start with the big question right now, which is school. The CDC guidelines currently suggest things like sending kids in on different days, moving the desks apart, and disinfecting regularly. If we do these things, can we avoid another surge in the fall?
Gastaldo: Schools alone are not going to cause another surge. Right now, schools aren’t even in session and rates are going up even in Ohio; it has more to do with the settings that are riskier for COVID-19. We always talk about social distancing, wearing a mask, and washing your hands. All of those things need to be done in schools, but the bigger thing that I think people don’t realize – and that really trumps everything else I just mentioned – are enclosed spaces.
Specifically, enclosed spaces where there isn’t much air circulation. Crowded spaces where people talk loud. Those are things which put people more at risk of getting COVID-19, and they all describe schools. But schools alone are not going to contribute to another spike.
The Globe Post: So do you think that, if we implement all these guidelines, it’ll be safe to reopen in the fall?
Gastaldo: Well, nothing with COVID is a zero risk, but it’s easy to have guidelines. The guidelines that have come out, like those from [Ohio] Governor DeWine and the other governors, are subject to interpretation. COVID-19 has really brought out health disparities, but you’re also going to see COVID-19 school district disparities. Private schools and public schools with deeper pockets can do different things, but I think you’re going to see disparities in how schools execute their governors’ guidelines based on the financial support they get.
The Globe Post: So, if the school doesn’t have the resources to distance properly or suffers from classroom overcrowding, for example, then that could affect its ability to follow the guidelines?
Gastaldo: Yes. There are private schools versus suburban schools; in inner cities, you may be dealing with people who are in a lower socioeconomic class, and they’re more at risk for COVID anyways because healthcare disparities are working against them too. Everything is synergistic.
Are schools zero-risk? No, nothing is zero-risk. Schools can reopen safely, but there are so many different variables with school districts and how schools are. Look at a new building versus an old building; newer buildings have better ventilation. When we’re talking about closed spaces with suboptimal circulation of air, that poses more of a risk. If you’re in an overcrowded school system, how are you going to do social distancing? Look at the age of the kids; it’s more challenging to do face masks and social distancing with first-graders than it is with high-school seniors.
The Globe Post: If we move beyond schools to the general public, one of the top issues right now are the mask mandates. Right now, over 20 states have these mandates. The Columbus Dispatch just published an editorial on the front page calling on Governor DeWine to move past Ohio’s county-by-county mandate. If we assume that most people follow these mandates at a time when cases are surging, is this the only way to avoid another lockdown?
Gastaldo: Absolutely. Is wearing a mask alone going to prevent COVID-19? No. Wearing a mask is just one of the things we have in our toolbox, along with all of those other things I just mentioned – good hygiene, avoiding enclosed spaces, and social distancing as much as possible. The 6 feet rule we talk about is actually kind of arbitrary. Twelve feet is better than 8 feet, which is better than 6 feet, which is better than 4 feet. Again regarding the mandates, wearing a mask will help, but that’s just one thing we have in our toolbox in addition to all of these other things.
The Globe Post: One of the other things that we might have in our toolbox, which you’ve talked about extensively, is contact tracing. Can you explain what that is and how we go about implementing it?
Gastaldo: Contact tracing is another area that highlights financial disparities. It’s been done in public health forever. We did contact tracing for measles recently when we had an outbreak. Public health, historically, when it comes to government, is kind of like the ugly duckling. We all need it, but some things, depending on where you live, are oftentimes underfunded in less metropolitan areas.
Contact tracing is like this. Reportable diseases like COVID get reported to health departments. Health departments get the names of people with COVID, and their job is to reach out to the people who have COVID. Those people who reach out are contact tracers. Contact tracers have to be trained. There is a unique art to what they do and how they engage patients.
In general, when it comes to COVID there are four things that are very, very important. Number one is testing; we have to test people as much as possible. The second thing is isolating those who have a diagnosis of COVID-19. The third thing is contact tracing.
Contact tracers contact those who have COVID-19 to make sure they are isolated. Then they’ll say, “Go back 48 hours and, as best as you can, tell me everybody you’ve had contact with for less than 6 feet for greater than 15 minutes.” And some people may remember, some people may not remember. Some people may feel threatened and not give that information.
After that, the contact tracer will call the people who had contact with that person. They’ll make an anonymous call, and they’ll say, “This is Dr. Gastaldo from the COVID health department. I am calling to let you know that you may have been exposed. You could expose somebody to COVID, and we recommend that you be in a 14-day quarantine.” The issue with that is, if you’re in a metropolitan area, where there are too many people getting diagnosed, there aren’t enough contact tracers to do all that.
The Globe Post: Nationwide, the latest WHO numbers say that we’ve had about 45,000 to 65,000 new cases every day for the past couple of weeks. Have we already reached that point of no return where we simply don’t have enough resources to do contact tracing?
Gastaldo: Well, for example, there are counties in Ohio where they probably only get 5 or 6 new diagnoses a day, and those areas are manageable. Where diagnoses are low, they can do it. In countries in Europe – Italy, where their rates are low – they can do it there, but it depends on them having the infrastructure in place to do it. And I don’t know what public health is like in rural counties in Ohio. We could do it in Columbus, but do they have the infrastructure in place? Do they have enough contact tracers? Public health can be overwhelmed if there are too many cases, and dealing with that’s really hard to do.
The Globe Post: You mention having the infrastructure to deal with contact tracing, but if you’re talking about the hospitals in general, is COVID hindering our ability to provide healthcare to people with other health problems? Are we having to divert our resources?
Gastaldo: Well, not here in Columbus. However, when you go back in time, to March and February, when Governor DeWine did the stay-at-home order, all elective cases – elective surgeries, cardiovascular procedures – everything was put on hold.
The message we told to patients was: “Don’t go to the hospital, and don’t go to the doctor’s office unless it is urgent or life-threatening.” The reason we did that was because we were anticipating a surge of COVID patients, but because of everything being closed, everybody staying home, people not congregating in bars or restaurants – we did such a good job with not bringing people together that we stopped the curve and were able to handle the COVID cases.
Right now, in Columbus, our hospital capacity is fine, but that’s not the case in Houston, Texas. That’s not the case in Arizona. That’s not the case in Florida.
The Globe Post: Do you expect that it’s only going to get worse from here, as the weather gets colder?
Gastaldo: Yes and no. In Ohio, yes. It depends on what the governor does, but, again, the riskiest thing to do is to have a lot of people in a confined space.
Right now, we have the weather on our side because in Ohio we do things outside. Look at Arizona and Florida – super hot down there, and when it gets really hot down there a lot of people are inside because of the air conditioning.
I look at the trends every day; the Ohio Department of Health, on their website, gives you all the statistics, and the thing that I look at, most importantly, is the 21-day trend. We have a 21-day trend of newly diagnosed patients, of hospitalizations, of ICU admissions, and of deaths. And since July 1, our trend of newly diagnosed patients has gone up, and as a lagging indicator now we’re certainly seeing the trend of hospitalizations go up.
The Globe Post: Is there a dialogue between the hospitals and the state or federal government when it comes to providing enough supplies to deal with the number of patients?
Gastaldo: There is, but the leadership has really come from the governors. Each governor has different advisors and there are political overtones, of course, but there hasn’t been a really strong federal policy on it. The federal government gives guidelines, the governors give guidelines. The people in the trenches, it’s up to them to follow the guidelines that come out. And sometimes it’s very confusing. Look at the mask guidelines.
The city of Columbus has a mask guideline, and then the governor has a mask guideline, and they’re each a little bit different. So it can be hard and confusing for people to follow the mask guidelines, with all the different ones that are out there, and guess what? Who enforces the mask guidelines? The responsibility of enforcing the mask guidelines isn’t the police’s; it’s the health department’s. The health department’s not there 24/7 like the police.
The Globe Post: I remember when Columbus city officials went around and there was that picture of the bar that was publicized of all those people not distancing. The city threatened businesses in Columbus, that they could lose their license to serve alcohol. But they can only reach so far, no?
Gastaldo: Well, that was a learning curve, too. I’ll tell you this: I’ve talked to business leaders before. These guidelines came out, and a lot of business leaders didn’t really know that it was the restaurants’ responsibility to enforce the mandates from the health department. It’s their responsibility. The restaurants were under the impression that it was the people’s job to follow the rules, and that’s not the case. It’s the responsibility of the restaurants and the business owners to follow the rules.
The Globe Post: And when you combine that with COVID fatigue, as you’ve said, the situation only gets more muddled.
Gastaldo: You know, everybody’s job is affected by COVID. The things that we do in life that give us pleasure, those are all affected by COVID. COVID fatigue, you can’t get rid of it, and people either consciously or subconsciously don’t want to talk about it anymore.
The Globe Post: No, there’s a sort of collective denial going on throughout the country, or specific regions of it at least.
Last question: What’s the strangest thing anybody’s ever asked you about coronavirus?
Gastaldo: *laughs* So, I stay current on coronavirus news for medical reasons, of course, and whenever there’s a new thing that comes in the news, the local news latches on it. And I’ll never forget a suggestion – this came up in the news, and there was some Chinese publication that said it too – that coronavirus was detected in semen. I do all these news channels things, and that came up on a live news feed as a question. Someone asked if we had to worry about COVID as a sexually transmitted infection. And that caught me off guard as something I’d never heard of at all. It was one of the strangest things I’ve ever heard on live TV.
Also, people always say, “Well, the prominent way this is spread is from droplets and from micro-droplets.” This business about going to the grocery store and thinking groceries are a biohazard – that is a very, very minor way that you can get COVID-19. You remember a couple of months ago when people went to buy groceries and were so scared to buy groceries. I thought that was very much overblown in the media, when people were afraid to go out.
The craziest thing I ever saw was a woman at Kroger, back in March or February. She went into Kroger wearing a beekeeper’s outfit.
The Globe Post: A full-on covering?
Gastaldo: Yep, a full-on beekeeper’s outfit.