If the state of Louisiana does not keep social distancing restrictions in place through May, the state's residents could suffer from a second wave of COVID-19 infections and deaths, a top state health official who reportedly communicates regularly with Gov. John Bel Edwards says.
Dr. G.E. Ghali, Chancellor at LSU Health Shreveport, warned that a model projecting the spread of COVID-19 in Louisiana still expected demand for hospital services to exceed capacity in spite of current social distancing measures. If those measures were lifted prematurely, the consequences could be worse, according to Ghali.
“I'm afraid that if these social mitigation factors are released too early that we could be seeing a second peak, which would be a really bad deal,” Ghali told The Ouachita Citizen in an interview last week.
LSU Health Shreveport is a medical school with two teaching hospitals in Monroe and Shreveport, managed by the Ochsner LSU Health System.
In Louisiana, Gov. John Bel Edwards' social restrictions are currently in place until April 30.
Last week, President Trump unveiled guidelines for slowly reopening parts of the country through a three-phase process amid public outcry over the effect of social distancing restrictions on jobs and the economy. Some of the federal recommended guidelines include confirming a 14-day downward trend in COVID-19 cases, allowing restaurants and movie theaters to open with strict physical distancing rules, limiting gatherings to no more than 50 people among other recommendations.
Trump's plan to reopen the country does not set target dates but tasks each state's governor with deciding when to relax certain social distancing measures.
In Louisiana, Edwards has declined to say whether social distancing restrictions would continue through May, though he has suggested Louisiana is a “hot spot” for COVID-19. Hot spots for the virus would not reopen as quickly as other states, according to Edwards.
During the interview, Ghali commended Edwards, Trump and other states' governors for carefully considering how best to slowly reopen the country.
“I think it's a mistake to open too early,” Ghali said. “I don't want to speak for the governor, but I think he will have some systematic, graded way of doing it, looking at various parishes, looking at various businesses, telling people that in two to three weeks you can go back to doing some of these needed surgeries, but you have to do it under these conditions.”
Edwards is in regular communication with Ghali, according to a KTBS 3 TV news report.
“I think the governor is being very, very careful,” Ghali said. “In the next couple of weeks, we may see some relaxation of things, such as a decision through the governor's office to allow elective surgeries again. There are patients who need surgeries who aren't getting those surgeries. If there's someone with cancer, they need to be operated on within a certain amount of time to keep the cancer from spreading.”
Earlier this month, a group of 35 state lawmakers wrote a letter to Trump, asking him to lift the federal guidelines on social distancing after May 1.
The legislators' April 15 letter refers to the social distancing measures as “draconian” and “medical tyranny.” Each legislator signing the letter is a Republican. Edwards is a Democrat.
“We are not prepared to wipe out two hundred and forty-four years of liberties protected under our beloved Constitution because of a virus,” the legislators wrote. “This medical tyranny has temporarily wiped out our freedoms and fundamental way of life, has threatened our national security, and has collapsed our economy in the name of health and welfare.”
The legislators' letter also appeared to dismiss COVID-19 as “some invisible enemy.”
“Our trust is in God,” the legislators wrote. “The backbone of our success is in our ability to overcome, not in our ability to hide in our homes from some invisible enemy waiting for a cure.”
“The people are ready to go back to work and end the 'quarantine' and draconian measures that will bring our nation to its knees,” the legislators added.
Lawmakers from northern Louisiana signing the letter included Reps. Larry Bagley, Raymond Crews, Michael Echols, Dodie Horton, Danny McCormick, Jack McFarland, Alan Seabaugh, and Neil Riser as well as state Sen. Glenn Womack.
During the interview last week, Ghali referred to a COVID-19 projection model maintained by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, Washington. The IHME model also has been referred to as the “Chris Murray model” in a White House press briefing.
Under the Chris Murray model, the number of COVID-19 deaths could reach as high as 7,000 a day between now and May 1 while social distancing restrictions are in place. Nearly 1,900 deaths occurred on April 11. The Chris Murray model assumes that social distancing restrictions remain in place across the country through May.
Like Ghali, Murray has cautioned against relaxing federal guidelines on social distancing for fear that COVID-19 could “rebound.”
“That model shows that Louisiana is really dependent on social mitigation factors being in place through the end of May,” Ghali said. “I think that is the best model we have. The White House uses that model among others.”
Ghali noted that many, if not all, COVID-19 models underestimated the effect of social distancing measures on stemming the spread of the virus. That was the case because all models are only as good as the assumptions supporting them, Ghali said.
“That's why those models anticipated 2 million, adjusted them down to 1 million, and then recalibrated to 200,000 and lower,” Ghali said. “The fact is, that the total number of deaths are going down from what they predicted. The last one was about 60,000 to 70,000, which is significantly less than what models previously showed. But that's a lot better than half a million or two million. The model is not totally perfect.”
Reviewing COVID-19 data showed the virus' infection of the population in southern Louisiana likely peaked a week ago, according to Ghali.
“The peak up here in north Louisiana is a little less defined, and we're probably closer to where the peak in Arkansas or the peak in Texas is going to be, which will probably be this same time next week, or at least 10 to 14 days after the southern part of the state peaks,” Ghali said. “Most of our parishes up here are fairly rural. That is to our benefit. Likely, the virus will be further dispersed over time so it doesn't overwhelm our hospitals.”
Earlier this month, Edwards announced his plans to excuse public school students from needing to return to school campuses to complete the 2019-2020 academic year. According to Ghali, children returning to school could be asymptomatic, carrying the disease while not expressing the virus' common symptoms. The same could be true for much of the state's population, meaning the state's COVID-19 figures could be much higher.
“That's why it's important we get as many people tested as possible,” Ghali said. “We're really only testing symptomatic people because the tests are still at a premium. We need more widespread testing. In other words, some people might not look sick, but they could potentially test positive.”
Researchers at LSU Health Shreveport recently established an indirect enzyme-linked immunosorbent assay, or ELISA lab test, that could detect whether patient sample contains COVID-19 antibodies or even possibly whether that patient is immune.
LSU Health Shreveport also is working with LifeShare Blood Center to find convalescent plasma donors who have had COVID-19, recovered from the virus and still have the antibodies that might help treat patients currently struggling to fight off the infection.
"The serology lab will aid the Convalescent Plasma Therapy that is ongoing at LSU Health Shreveport. By identifying the amount of antibody in donated plasma, we can select of the most effective plasma to be used in patients," said Matthew Woolard, PhD, O'Callaghan Family Endowed Professor in Microbiology and Associate Professor in the Department of Microbiology and Immunology. "In the future, we hope to use this serology assay to better determine who has been infected and understand the scope of the COVID-19 pandemic in Northwest Louisiana."
According to Ghali, LSU Health Shreveport also is currently validating a more sensitive antibody test for COVID-19.
“The one we have would give you very reliable results,” Ghali said. “We hope to have that out by the end of this week. It doesn't do any good to get a false positive.”
An accurate antibody test also would help state official determine when people could return to work, according to Ghali.
“But we have to get that testing done. We need antibody testing, then a vaccine,” Ghali said. “There will be another virus coming, not in 100 years like the Spanish flu, but in the next couple of years. We need to drill and practice so we don't run out of ventilators, PPE, or hospital beds.”