Jackie Hendry: Each week, we check in with a South Dakota healthcare provider to learn the latest on COVID-19. Today, Dr. Wendell Hoffman joins us by phone. He's an infectious disease specialist with Sanford Health. Dr. Hoffman, welcome back to In The Moment. Thanks for being here.
Dr. Wendell Hoffman: Thanks, Jackie, very much for having me.
Jackie Hendry: So of course, kind of eclipsing the pandemic right now are the events over the past week, protests related to the death of George Floyd. And we're going to start there because, as we saw over the weekend around the state and the nation, well, it's hard to maintain six feet apart when thousands of people are gathered together. So in light of this ongoing risk with COVID-19, how dangerous is it to be in large groups outdoors? And remind us of some of the safety precautions folks can take.
Dr. Wendell Hoffman: You bet. So yeah, this is really quite an astounding development over the last week, where we arguably have had multiple potential super-spreader events occurring across the country. It would be almost like having a hundred separate long parades or a hundred gigantic sports stadium events, so forth and so on. And I don't think anybody really knows what's going to occur, but many are concerned. And I see already that you guys at NPR have featured that certainly this morning already. I think we have to go back to our knowledge about how this virus is spread. There is a rising body of scientific literature that suggests that the virus is most easily spread if you're in close proximity to another person who might be infected. And so whether it's regular speech, whether it's coughing or sneezing, loud speaking, singing, whatever you're going to call it, those are the main ways in which this virus is certainly spread. And so when you bring a lot of people together, no matter what you call the event, you're going to have that potential.
Now, that said, those activities being out-of-doors will have a potential mitigating effect. Although there's other data that suggests that the physics of air, even of wind in outdoor settings could carry those particles further out than the traditional social distancing of six feet that we've all become familiar with. So many are now calling, including, I see, the Atlanta mayor, that if you attended one of those events, that perhaps you should consider getting yourself tested or maybe you should consider undergoing a period of quarantine. If we're going to ask a bunch of party-goers to a big gathering in the Lake of the Ozarks and we're going to be concerned about that, why would we not be concerned about the events that we've seen, not just in one location, but multiple locations?
So I am, yes, very concerned about these as exacerbating the potential number of cases coming at us. And of course, that all is going to affect the most vulnerable among us. And so via these chains of transmission, potentially, where asymptomatic carriers could transmit the virus to others, who could transmit the virus to others, who might end up in the lap of your grandma at home, who maybe has some chronic underlying healthcare conditions, I think we have to be concerned and set the politics aside, and literally look at any large gathering, and try as we can to point this out to the public. This is not a political issue. This is a health issue.
And so the virus is apolitical. It doesn't care if you're Republican or Democrat. It doesn't care if you're an independent or a libertarian. It will do what it does. And if we set up the situation for transmission, primarily that being in close quarters with another person outside or inside, although the inside framework is what we're mostly concerned about, I think we may be reaping a whirlwind here.
Jackie Hendry: Of course, when the state's health systems and other authorities were looking at their projections and modeling and everything, as far as a mid June peak, potentially, in South Dakota, I doubt anyone could have predicted our current situation layered on top of the pandemic. As far as you're aware, are local health systems still confident that they have the capacity to meet the need that they anticipated?
Dr. Wendell Hoffman: I am. I think that, but again, aside from the events of last evening, where we had a very large gathering in Sioux Falls, we are not locally, at least we'll see what happens tonight and the following nights, but we have not yet been nearly as impacted as places like Minneapolis and New York City and Chicago and so forth. But I think we are prepared, to your question. I think the extraordinary planning that's undergone by our healthcare systems is just frankly, a lot of, and I think we're ... But we're going to see, because we need to track this closely.
And as you stated, I'm sure the models are kind of shredding themselves this morning after the last week, because even some of the best models, like the Penn Medicine Wharton School model, which I was going to bring up today, which actually highlights policy scenarios as well as behavioral scenarios. And I think it's one of the better short term models. And by that model, by the end of July and really prior to this last week, they were projecting that we were going to jump from currently 1.8 million cases to maybe 2.7 million cases, well, nationwide. And so you can just translate that down into the individual states, but now with all of this happening where we have these large gatherings going on, I think even the best models may be scratching their heads today.
Jackie Hendry: Right. Moving on more generally, you mentioned you had planned to outline that model, so I'll open the floor to you. What are some things that we know or are concerned about this week that we weren't on the same page with, as far as COVID-19 is concerned, even last week? What's new today?
Dr. Wendell Hoffman: Well, I think that a couple of things; I think these models are premised on, as I said, policy statements and premises of each of the individual states and then the projected behavioral changes that we could anticipate. And so what this particular model, and I believe I sent Lori the link that you guys could post, but we can anticipate that if a state like South Dakota, for instance, that has a very open policy compared to a state like New York, if we do not practice mitigation strategies here, we can anticipate a rise in cases. It's just the way this virus has been going. It's just a no-brainer, which raises the overall point is that as we shift from a state policy and we put the burden more and more on the individual, we have to depend upon our fellow citizens to see this as their obligation.
The situation really raises all kinds of interesting things politically, healthcare-wise and so forth and so on. And I have long believed that medicine and health in general is at most what we would call pure science. And at most, if not significantly more, at least half social science, because you can have the greatest protocol in the world. In this case, you can have the greatest intent where a state, for instance, might say, "We're really asking our citizens to take this seriously." If the citizens don't take it seriously, the behavioral aspects trump the policy aspects.
And so I think we really need to speak to the public and that includes small business owners, but everybody who is going out and about to try to practice what I've been trying to call blocking and tackling. We are all part of a team and the blocking and tackling, every great team does something very simple, to use the football analogy. They block very well and they tackle very well. The blocking has to go with social distancing, where you're actually blocking that virus from getting to another human being, and the use of masks, another way in which you block. The tackling has to do with hand hygiene, where you actually are taking the virus out of the game, so to speak, and then the environmental cleaning. Those are the four mitigating strategies that are so important, whether you're in New York or whether you're in South Dakota.
And so I think we need to lean on each other and somehow develop some expectations because this, again, is not political. You're not a Republican if you refuse to wear a mask. You're not a Democrat if you're going to use a mask. And yet this is the kind of absurdity that has been going on, where with the politicization of everything, even masks become political. That's just really, in my estimation, very sad and really rather juvenile on all sides. So I think we have to see that politics has now become part of the equation for healthcare delivery.
And so I encourage my physician colleagues, because we are the ones that are taking care of the patient individually and we inherit all of this stuff that's going on out there, whether it's hydroxychloroquine and the politics of that, whether it's masks and the politics of that, whether it's the coulda/shoulda/woulda blame that certain leaders should have known beforehand that this or that was going to happen and therefore that we're going to hold them accountable. And so you've got on the one hand, President Trump being blamed that on his watch, we have seen more deaths than in Vietnam, Afghanistan, and Iraq combined together. And then on the other hand, you have people like Governor Cuomo, who is being accused of sending positive COVID patients back into nursing homes and that he coulda/shoulda/woulda known that.
This is the kind of stuff that will destroy us. And this is where people of sound reason, of goodwill need to speak to both sides. We need to come out of our corners and stop fighting and begin to truly work together. But honestly, Jackie, I don't know. I don't know. We are so politicized. But the politics now is affecting the healthcare in some major ways. So I'm hoping, though, that people of goodwill, that people who exercise sound reason will see that they need to question their own presuppositions, their own biases before they criticize somebody else's. And if we're able to do that, if we're able to set this aside a little bit and to try to work for the benefit of all, because if we don't, we're going to have people at high risk.
Like for instance, look at the risks of black Americans in this COVID crisis. It's really amazing. They are a high risk group. In Chicago, more than 50% of COVID-19 patients and nearly 70% of deaths involve black individuals, although they make up only 30% of the population. And this occurred primarily just in five neighborhoods on the city's South Side. In Louisiana, 70% of deaths have occurred among black persons who represent 32% of the state's population. In Michigan, 33% of the COVID patients and 40% of deaths have occurred among black individuals, despite the fact that they represent 14% of the population. And the list goes on and on, and so we have to be very concerned about those that are at risk.
And now, what I've just raised is a very complex issue. I realize that this is a lot about how healthcare disparities are being meted out and how we're addressing them as a nation. But in the short term, we need to do both. We need to do things in the short term to try to mitigate the spread and things in the long term about addressing these kinds of significant healthcare disparities.
Jackie Hendry: Dr. Hoffman with Sanford Health. Our time is short today, but I want to thank you for highlighting the continued need for mitigations in light of the COVID-19 pandemic as our attention moves elsewhere throughout the country. Thanks for joining us today. We really appreciate your time.
Dr. Wendell Hoffman: Thank you, Jackie.