Ex-Arkansas surgeon general explains ACHI’s role in providing vital COVID-19 stats

A “demand and hunger for more granular data than county level data” led to the Arkansas Center for Health Improvement becoming involved in providing specific statistics about COVID-19, according to Dr. Joe Thompson, chief executive officer for ACHI and the state’s surgeon general from 2005 to 2015.

Thompson said ACHI, which is associated with the University of Arkansas for Medical Sciences and has been around more than 20 years, has found that if it could turn information into data, it could help decision-makers, starting with the mom or dad who is out buying groceries for their families all the way to the governor.

The data provided by the ACHI shows such things as regional rates of new known COVID-19 infections and “ZIP codes and school districts with the highest rates of new known infections in the local community per 10,000 residents over a 14-day period for each region,” according to the organization’s website. Its data has been used to show when school districts have had high infection rates. “It helps drive improvements and opportunities to help citizens of the state,” Thompson said. “People are hungry for information that helps them make better decisions and that’s what we try to provide.”

When the COVID-19 pandemic started, Thompson said “we were all doing our regular day jobs and the health department and the governor were putting out county level information on the increasing threat from COVID-19.” However, he said he was having conversations with school leaders and mayors who wanted deeper data than county level.

“So we approached the health department to offer some analytic and graphical search capacity and said we’ll take on the local information,” he said. “The health department was very receptive to that so that is how we started down the path.

“Originally, we began with community and then because some school districts were made up of more that one community, particularly in the rural parts of our state, we added school districts and the risk from the … populations the school districts drew from – so some of the rural school districts might have two or three communities that they represent.

“And then we got the larger schools districts that said, ‘Wait, we need zip code level data because our school districts, like the Pulaski County Special School District here, is a ring around Little Rock so they wanted to know the zip codes for Maumelle, the zip codes for west Pulaski County and the zip codes over toward

Continued on Page 11 STATE NEWS (cont.)

Lonoke.’ So we ended up being able to create different levels of reports. I think they helped local leaders make more informed decisions.”

He said the need for more specific data began with the mayors.

“We were working with the [Arkansas] Municipal League. We have been doing weekly phone calls with local leaders and the Municipal League,” Thompson said. “I have done a regular update with some of the education leaders. I was on with the Arkansas Bankers Association recently.”

The reporter asked several other questions of Thompson during the interview.

Is something like COVID19 anything you prepared for in medical school, a pandemic hitting a nation?

Thompson: “There have been many kids of discussions, preparations, dissertations but until you’re in the battle, I don’t think you can ever anticipate everything

Hopefully, this is a rare event. However, I think with international travel and the growing worldwide population and interactions, the potential is still going to be here. Not only is it important for us to learn and understand how people make informed decisions, [but] for us to mobilize

Concerning COVID-19 and students attending school, can you shed light on the nationwide conversation, if it is really safe to have all kids back in schools?

Thompson: “I think anytime you are in this public health emergency, there’s a balance of risk to benefit for which there is no black or white answer. The challenges of the school-based settings are influenced by the fact that the risk of COVID-19 transmission to schools is directly related to where the kids and adults are coming from in the community. If your community risk is very high, your school risk is very high, that is No. 1.

“No. 2, there are many kids and families who are very much dependent on the services, educational, nutritional, children with special health care needs – the support that they get from schools – so having schools be closed cuts off all those supports. Obviously every parent wants their child to be able to advance on their educational path and unfortunately, we’ve got internet access problems and also some of the parents don’t make the best teachers. The challenge there is virtual education is not easily available for every student across the state. I think it’s a balance of risks and benefit.

“Obviously in some of the larger, more urban areas of the United States, the difference between a onestory school building and a six-story building is different so some of those building risks may be different also, so again I think local leaders have to balance the risks to the benefits and make those informed decisions they best that they can.”

Doctor, can you address the topic of hesitancy when it comes to people, including employees, who either are not ready for or do not want to receive the COVID-19 vaccinations?

Thompson: “I think it’s a great question and I think any time you are in an emergency-type situation, people’s anxiety is higher and therefore their decision- making process is probably more tuned. This is a new threat. The threat is real not inly on the short term but even [a couple of weeks ago] the Journal of the American Medical Association published a study that said up to 30 percent of people that had COVID-19, not serious COVID-19, had longhauler events where they have respiratory problems or stamina problems or memory problems. I think the effects of this virus are going to be with many of us for a long time and they are not the effects that one wants to have.

“The vaccine is an important protection tool. I think its newness make people naturally at least think about it. I will tell you when I got my vaccine, I got my vaccine as a physician in the UAMS system.

There was about 60 seconds as I was driving over to get it that I was a little nervous because it was a new vaccine, but I thought through what I know is that this virus could make me have long-term cardiac

problems, memory problems or even potentially an illness that could cause me to be in the hospital and lose my life. And I said, ‘You know, they have gone through the testing process here and it’s a risk-benefit situation that I think people should accept.

“And I would spin it around, if you are not going to take the vaccine, you need to be prepared to live with the consequences should you come down with COVID.”

Thompson: “I think the staged approach with health care providers first, our nursing home residents, those over age 70, then our school teachers. I think soon we need to consider those who are incarcerated, they obviously have a high risk also. Obviously, the governor’s decision to open up it up for those 65 of age and over. It is totally dependent upon on the supply of vaccines. I think our state health department delivery strategy and our health care providers are really doing a great job putting shots in arms.”

Address for us, Doctor, herd immunity. When do you think enough people will have taken the vaccine for us to see that?

Thompson: “Herd immunity requires somewhere probably between 70 and 80 percent of a population, a community or state to have resistance to the infection so the infection can’t spread as quickly as this virus has. I think the reduction that we are seeing now is actually coming off the compounded peaks of Thanksgiving followed by Christmas and the holidays followed by New Year’s. We just had a lot of spread and a lot of people become newly infected, hospitalized and unfortunately, some of those ended up in death.

“I think we are seeing a reduction in the transmission because people are being adherent to wearing a mask and being a little more defensive. I think it’s possible that we may see even a further reduction because so many people were homebound because of the snow. I think until we get well over 50 percent of the state with immunity to COVID-19, we aren’t going to be able to approach that security and safety you get with herd immunity.”

Will COVID-19 change our habits forever as American citizens? Will we wash our hands a little better and be careful to maintain distance when we are at places like movie theaters or in church?”

Thompson: “If we can get the supply [of COVID-19 vaccine] broad enough and the uptake high enough, then COVID-19 won’t continue to be as big a threat as I think it will be for the next few months, but there will always be a threat for a new infectious virus and I do think people are going to be a little more attuned to their personal hygiene.

We may see some groups that are more likely to wear masks. We have had almost no influenza this year because people are wearing masks and we haven’t passed the flu around.

We may see in nursing homes or hybrid situations, masks are more common.

“I think the other thing we need to think about – this is long term, as we build new buildings or refurbish existing ones, schools in particular – really to think about the ventilation requirement, so we are energy-efficient but we are capable of having air recirculation when necessary during a time of a respiratory virus transmission.”

Could you reflect on a couple of lessons learned from COVID-19?

Thompson: “I think from COVID-19, this was a virus that never infected a human being a little over a year ago and I think both the scientific community and the development of a

vaccine and the clinical community in learning how to deal with this new infection will be invaluable going forward. The clinical community responded with scientific basis, with medical prowess, with an observation capability to say, ‘OK, this is not working, let’s try something different.’ “But I think we are better at treating COVID-19 now but I think also most importantly, the clinical care community and the public health protection community have been drawn back together. I think we need to figure out how we not only take care of people when they are really sick but also work harder at keeping people healthy and even physically more fit so that if they do get exposed to something that causes them to have an acute illness like COVID19, their body is more able to withstand it. The people we see who are having the most trouble are folks that have either existing chronic conditions or they are not in good physical fitness, and that’s a challenge to each and everyone of us.”

The [virus case] numbers are going down but do you have any scope of thought on when COVID19 is going to be out of here?”

Thompson: “Well, I am concerned about the [variant] strain and we are in a little bit of a race with the strain. The more vaccine we get delivered, the less the strains can propagate and move. So, there’s a little bit of an uncertainty there.

“I think COVID will be with us and we will have to guard against its resurgence next fall, just like they did with the Spanish flu. The Spanish flu hung around for three years, but I am hopeful by the Fourth of July, we can be back to some normalcy and I look forward to heading to St.

Louis to see the Cardinals play baseball before the end of the summer. I am ready to go.”