The Covid Chronicles and More

By David J. Holcombe MD

“The COVID CHRONICLES and More” is a collection on non-fiction articles related to the COVID pandemic, plus various short plays and other writings by Dr. David Holcombe. The COVID pandemic monopolized the nation and the world of public health for over two and a half years (from March 2020 to October 2022), resulted in over a million U.S. deaths. Following these published non-fiction articles gives a unique historical and scientific perspective on the events from a local public health perspective. The following plays deal with a variety of topics, including office dynamics, letter writing and teacher-student relationships in a French class. The collection ends with a few miscellaneous works, some of them more or less autobiographical. Given the diversity, there should be something for everyone ranging from the scientific to the theatrical.

• Language: English
• Publisher: AuthorHouse
• Release date: Nov 7, 2022
• ISBN: 9781665570824

David J. Holcombe MD

David J. Holcombe was born in 1949 in San Francisco, California, and raised in the East Bay in Walnut Creek. He passed a tranquil youth and adolescence, riding to school on a bicycle through pear orchards that still lined the country roads. At Las Lomas High School, his English teacher introduced their Advanced English class to creative writing, something he pursued at U.C. Davis under the tutelage of Diane Murray-Johnson (author of “Le Divorce” and “Le Mariage.”) While always attracted to art, writing and dancing, the realities of life induced him to pursue a medical career, a path that lead him to the Catholic University of Louvain in Brussels, Belgium. His knowledge of four years of high school French allowed him to excel in medical school despite the rigor of a Belgian education. Returning to a residency at a Johns-Hopkins affiliated clinic in Baltimore, he and his wife and three sons made their way to Central Louisiana in 1986 where their fourth son was born. There, in the middle of the rural South, he practiced medicine for twenty years while raising a family and resuming both painting and creative writing. After twenty years of internal medicine, he pivoted to public health and became the Regional Administrator/Medical Director of the Louisiana Office of Public Health for Central Louisiana. During his years in Alexandria, Louisiana, he self-published twelve books (all of them commercial flops) and saw a dozen of his short plays produced by Spectral Sisters Productions, a local developmental theatre group. Science and art have co-existed uneasily during his entire life. He has been called too artsy to be a good doctor and too scientific to be a good artistic. Being torn between these two conflicted poles has provided much of the tension that fueled his artistic output. While his books remain unsold, his art has had some modest success in local-regional exhibits and has found its way into a number of collections, none of national renown. He hopes that his artistic output will be discovered by generations yet unborn as an expression of a creative spirit, stuck in a most unlikely environment. When he planned on moving from Baltimore in 1986, the Residency Director at the program learned of the proposed destination, Alexandria, Louisiana. He commented at the time that “you won’t find any soul brothers there.” Those prophet words have remained with me for over 40 years. With much effort, however, there have been some glimmers of “soul” in a number of my brothers and sisters of Central Louisiana, leading me to believe that you can find kindred spirits in even the most unlikely places.

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© 2022 David J. Holcombe, MD. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse 11/03/2022

ISBN: 978-1-6655-7081-7 (sc)

ISBN: 978-1-6655-7082-4 (e)

Any people depicted in stock imagery provided by Getty Images are models,

and such images are being used for illustrative purposes only.

Certain stock imagery © Getty Images.

Cover illustration by Elizabette Kennedy

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Contents

A COVID TIMELINE

THE COVID CHRONICLES

CORONAVIRUS, SARS-CoV-2, COVID-19

COVID-19 (NOVEL CORONA VIRUS) BLASTS INTO CENLA

COVID-19 TESTING: WHAT, WHEN, WHY?

COVID-19: ASKING FOR MASKING AND SHIFTING DEMOGRAPHICS

SICK AND TIRED

COVID-19 HERE AND ELSEWHERE

BACK-TO-SCHOOL BLUES: GRANDPARENTS BEWARE!

COVID AND NURSING HOMES: A TERRIBLE TOLL

THE RACE FOR A COVID-19 VACCINE

HERD IMMUNITY: FACTS AND MYTHS

SHELTERING IN A TIME OF COVID: NON-CONGREGATE SHELTERING

A TRIP TO MARSHFIELD, WISCONSIN

COVID VACCINATION: MANY CHOICES ON THE WAY

COVID VACCINE: WHO GETS IT AND WHEN?

PANDEMIC FATIGUE (OR BURNOUT) VS. POST-COVID CHRONIC FATIGUE SYNDROME

COVID VACCINE DISTRIBUTION: PRIORITIES AND PENURY

COVID VACCINE FOR NURSING HOME RESIDENTS AND STAFF

THE LINGERING EFFECTS OF COVID-19

COVID-19 AND THE ELDERLY

COVID VACCINATION: PHASES AND TIERS

COVID VACCINE ALLOCATION AND THE ELDERLY

APPROACHING 500,000 DEATHS FROM COVID-19

COVID AND SOCIAL JUSTICE

COVID VACCINATION PROGRESS IN CENLA

VACCINATION PROGRESS IN THE ELDERLY

THREE COVID VACCINES AVAILABLE

SLOWING COVID-19 VACCINATION TRENDS IN CENLA

GET YOUR GRANDCHILDREN VACCINATED

COVID VACCINATION AND THE LAW OF DIMINISHING RETURNS

COVID GOES BACK-TO-SCHOOL

COVID-19: RIDING THE FOURTH WAVE

IVERMECTIN: NOT FOR COVID

COVID-19 VACCINATION: MANDATES ON THE WAY

MONOCLONAL ANTIBODIES: TREATMENT OF COVID INFECTIONS

COVID VACCINE BOOSTERS ON THE WAY: GET ONE TODAY

PROTECTING AND SERVING IN A TIME OF COVID

HURRICANE SHELTERING IN A TIME OF COVID. . .AGAIN

OMG, NOW IT’S OMICRON!

THE COVID PANDEMIC: LIGHT AT THE END OF THE TUNNEL?

HOW PANDEMICS END

NEW COVID-19 DEVELOPMENTS

COVID-19 AND SHORTENING LIFE EXPECTANCY

THE END OF MEDICAID CONTINUOUS COVERAGE DURING COVID

BIRD FLU: ANOTHER PATHOGENIC VIRUS

2022 AMERICA’S HEALTH RANKINGS SENIOR REPORT

COVID-19, THE SIXTH WAVE AND MORE

MONKEYPOX: ANOTHER VIRAL INVADER

A FEW SHORT PLAYS AND OTHER WRITINGS

THE LETTER

A D IN FRENCH (Version 2)

TO SEND OR NOT TO SEND

THE BEATRIX PLAYS

HUMILIATING FARCE

THE REPRIMAND

INFANT MORTALITY

THE REVOLVING DOOR

FAUX PAS

DEFENESTRATION

TELEWORKING

VOICEMAIL

MILITARY-CIVILIAN INTERFACING

THE RETIREMENT DINNER

A DIFFERENT DRUMMER

ABOUT THE AUTHOR

A COVID TIMELINE

Although COVID-19 began to rear its ugly head back in January of 2020, it did not become a daily reality until March. My personal involvement came at that time when I was deployed on March 7, 2020 with CA-4 DMAT (Disaster Medical Assistance Team from San Diego, California) to board the Grand Princess, a cruise liner held outside of San Francisco Bay because of the presence of confirmed cases of COVID-19 among passengers. Another DMAT had been previously deployed to access the number of sick patients aboard.

That first DMAT members boarded the vessel in full hazmat gear, with self-contained PAPR units. Those units had a functional time of about 8 hours or less. That team stayed on the Grand Princess, going from cabin to cabin and asking for those with symptoms, especially among residents of California. By the time our DMAT was sent out to relieve them, the former team had spent over 30 hours on the boat and were reduced to using standard N-95 masks, gowns and surgical gloves in a highly contaminated environment.

When we arrived, it was announced that the ship was allowed to enter San Francisco Bay and dock at the Oakland shipyard. After some confusion about our mission, we continued to screen passengers, but with no ship manifest and only hand-written lists from the previous team, we were forced to re-initiate the cabin-to-cabin screening process from top to bottom. Since we only had a few hours remaining before docking, we were unable to complete the process. We did discover about 10% of the passengers with some sort of symptoms (about the same percentage as the previous DMAT had recorded). Our paperwork, considered contaminated, was eventually destroyed. Both DMAT teams debarked, the former team required a subsequent 14-day quarantine, while ours was not since our PAPRs remained functional during our entire stay aboard.

After negotiations with the CDC, Health and Human Services and state officials, it was decided that all the passengers would be screened upon debarkation and those with fever or other symptoms would be sent to one facility while the others would be sent to other quarantine facilities. The laborious process of debarkation of 2,500 passengers began with Canadians and some other foreign national being repatriated by their respective countries. The U.S. citizens had their temperatures taken and those with fever or other symptoms were sent by bus to one facility while others, notably the California residents without symptoms, were loaded on buses and sent to Travis Air Force Base near Sacramento.

It took several days to debark the passengers, many of whom went to other quarantine facilities around the country, often closer to their place of residence. For those traveling to Travis Air Force Base, about two hour’s drive from Oakland, they were loaded onto packed passenger buses and transported without benefit of masks or social distancing. The notion of asymptomatic COVID positive cases had yet to be firmly established. Our DMAT team, which was billeted at a hotel in Walnut Creek, California (about an hour’s drive from Travis AFB), were transported daily to Fairfield to fulfill our duties. As an aside, I was raised in Walnut Creek, where my brother and his family still live, and I attended Las Lomas High School there before going on to the University of California at Davis, just a few miles from Fairfield many years before.

At Travis AFB, I worked with a small medical team that evaluated passengers who were in quarantine. We addressed medical issues, which sometimes required transfer to a medical facility for what was later diagnosed as COVID-19, often with various associated complications as well as non-related medical problems. Several patients died following emergency transfers to local hospitals. Each night, we returned to Walnut Creek and we continued this way until the end of our 14-day deployment.

Although the passengers had all been exposed to COVID-19, only those developing symptoms were tested. Asymptomatic passengers were only tested if they agreed and the vast majority declined to be tested. They all knew that a positive test would prolong their quarantine and delay their return home. There is no doubt that many of the passengers were positive, asymptomatic or pre-symptomatic, and disseminated COVID-19 throughout the state. On the nearly empty plane flying back to Louisiana from San Francisco, the first documented case of the disease was discovered in New Orleans, starting a long struggle with the pandemic in Louisiana.

Upon returning to Alexandria, the Regional Office of Public Health began by organizing our emergency operation center, or EOC, with those persons important to the upcoming pandemic activities. This included our PHERC (Public Health Emergency Response Coordinator), HNC (Hospital Nurse Coordinator), Immunization Supervisor, Regional Nurse Supervisor, Assistant Regional Administrator, Regional Administrative Manager, Epidemiologist, to which we added our Louisiana National Guard representatives, Community Health Workers, the COVID Coordinator, and various other individuals. This group met daily each morning in a COVID HUDDLE to coordinate testing and subsequent vaccination efforts that would last 22 months and counting.

Before vaccines became available, our first priority remained COVID testing. We developed a drive-thru site not far from the OPH Regional Office and began testing. The lack of available testing materials proved an initial, frustrating impediment. But as time went on, we tested thousands of individuals at sites all over the region. As positivity rates increased, so did availability of testing material, so we could watch, somewhat helplessly, as COVID numbers soared across the state, the nation and the world. Eventually, elements of the LANG (Louisiana National Guard) took over testing until, after months of providing that service, the numbers dropped so low that drive-thru testing could be eliminated at the Rapides Parish Coliseum, but continue at the nearby Rapides Parish Health Unit.

During this time, we assisted in aggressive testing in nursing home settings where the most vulnerable people remained in congregate settings. Eventually, of the over 18,000 deaths in Louisiana, 9,000 of them were in those 70 years old and older. It remained a state priority to identify and quarantine nursing home residents, something that required onerous weekly testing schedules of both residents and staff and draconian restrictions on visitation.

Meanwhile, the drama of masking and social distancing played out in the general public. Almost weekly television and radio appearances stressed the importance of masking while explaining the increasing number of cases. To aggravate the situation, Louisiana was struck by four hurricanes, during the Fall of 2020, the worst of them being Laura and Delta. OPH staff opened the Medical Special Needs Shelter, whose functioning was assumed by BCFS (Baptist Children and Family Services), a not-for-profit contract agency, while we continued to address medical needs of evacuees from Southwest Louisiana in the Critical Transportation Needs Shelter. Thousands of evacuees were redirected toward hotels in New Orleans and we saw over 700 for various medical problems, all in the context of the COVID-19 pandemic. Masking, social distancing, testing of symptomatic individuals with quarantining efforts all became part of our responsibilities during 76 days and nights from August 25, 2020 until closure on November 7, 2020.

In December, prior to the availability of COVID-10 vaccines, I was again deployed with our DMAT (DELTA-1, a combined Mississippi and Louisiana team) for a two-week assignment at a small regional hospital in Marshfield, Wisconsin. The hospital had requested federal assistance when 30% of their staff went out with COVID, creating an acute nursing crisis. Their COVID ward had over 70 people and, while there were enough doctors, the ancillary staff could not handle the situation. Our team arrived with several NP’s, nurses, EMTs and other medical personnel to assist. While the NPs, nurses and EMTs went straight to work on the wards, I was relegated to assisting the residency medical teams, a position with no direct patient-care responsibilities.

My attempts to integrate into the Marshfield Medical Center testing and vaccination planning efforts proved difficult because of off-site work among local administrative personnel and adequate medical staff on the wards. My advanced age of 71 also surely caused the administration to pause before throwing me into a high-risk situation. Fortunately, my medical colleagues on site allowed me considerable time to tele-command the Region 6 Office of Public Health from afar. The fact that Wisconsin and Louisiana are located on the same time zone facilitated multiple zoom meetings with my public health team by ZOOM and phone calls.

Returning to Louisiana, we continued testing and while awaiting the arrival of the much-vaunted vaccines. With the subsequent development and distribution of COVID-19 vaccines, we finally received a tool to effectively address the pandemic. Our considerable experiences with drive-thru flu clinics allowed us to set up at the Rapides Coliseum site near our Rapides Parish Health Unit without delay. The problem became, much like with testing, the initial lack of available vaccines. Since the state got limited supplies, their priorities became nursing homes, hospital personnel, first responders, followed by large clinical providers, pharmacies, FQHCs and finally, the Office of Public Health. When we eventually got vaccines, we opened up drive-thru sites in every parish and promoted the vaccine to all those who were eligible. This started with the groups listed above, including those over 70, but rapidly expanded to other groups. I received my COVID-19 vaccination in late January, to my great relief, because, despite all of my potential exposures, I had never acquired the disease.

As the eligible groups slowly opened up and vaccine supply became abundant, we reached over 2,000 shots administered per week in the beginning of March, with a second peak of about the same number in the beginning of April. Since that time, demand decreased dramatically despite more and more aggressive outreach to vulnerable communities. LANG (Louisiana National Guard) performed over 300 missions with OPH and, together, over 26,000 doses of COVID-19 vaccine were given from the beginning of March to the end of July. This represented over 25% of all COVID-19 vaccines administered in Central Louisiana, a percentage unequalled in other OPH Regions.

The Law of Diminishing Returns dictates that there will be a point at which efforts to achieve a goal will slow down and require increasing efforts of less results. Those thousands of Louisianans who wanted vaccines eventually got them and after that, it took more and more effort to achieve smaller and smaller results. As of the beginning of the summer of 2021, that point seemed to be been reached. LANG/OPH continues outreach efforts which included migrant workers at crawfish processing plants and nurseries, as well a socially vulnerable neighborhoods throughout Central Louisiana. Events were held at community gatherings, churches, schools, libraries, food banks, festivals, businesses, restaurants, in homes, prisons, rehabilitation centers, and other locations.

Dr. Holcombe and others appeared in hundreds of interviews, presentations to civic groups, school board meetings, community gatherings, professional groups, physician meetings and other locations, most pre-planned, although others spontaneous. Our Community Health Workers have done the same for countless groups, both large and small. Our Ambassadors have reached out to schools, businesses, private providers, pharmacies, hospitals and other provider locations. While Beta Land Services personnel concentrated on businesses, some of which requested on-site vaccination teams. We piloted true mobile vaccination events with LANG, working with Bring Back Louisiana canvassers from Together Louisiana, worked in socially vulnerable neighborhoods to do on-site, block by block, same-day vaccinations.

With the eminent departure of both LANG and Bring Back Louisiana in September, the work pivoted to largely health unit events and selected other activities. Since a significant segment of the Louisiana population has refused vaccination at this point, every opportunity is explored to reach those who remain hesitant. Persistent outreach efforts and the danger of COVID-10 variants may help encourage some people to accept vaccination. Other incentive programs, including the ShotAtAMillion lottery campaign offered some hope of motiving recalcitrant citizens.

At a thank you banquet at Governor Edward’s mansion, the Governor expressed appreciation for the effort of OPH/LDH leadership, including the 9 Regional Administrator/Medical Directors. When asked if he thought any of the medical directors could have done anything better or differently, he replied with a uncategorical No!

Somewhat unexpectedly, the Delta Variant plowed into Louisiana in August provoking an intense fourth wave, higher than previous waves. Case numbers and hospitalizations soared to levels higher than those of the third wave, albeit with younger, unvaccinated individuals. The fourth wave differed from earlier waves in that the majority of victims were not Black or Brown, but White. Our regional Office of Public Health resumed drive-thru testing and vaccinations, reaching levels of 500 tests and over 100 vaccinations every day for weeks. The National Guard, slated to depart in September, was prolonged through the end of year. With full FDA authorization of the Pfizer vaccine and increasing mandates for various groups, it was hoped that our lagging percent vaccinations can be improved to the elusive level of 70% for herd immunity.

To add to the turmoil, Hurricane Ida slammed into Southeast Louisiana, displacing thousands of Louisianans, many of whom ended up in the Megashelter in Alexandria. Since non-congregate sheltering was no longer possible (as had been practiced in Hurricanes Laura and Delta), evacuees had to share a common, albeit enormous, space. Testing of all evacuees was not allowed among those bussed into the shelter, but voluntary testing revealed a 10% positivity rate, the same as in the surrounding community. In the Medical Special Needs Shelter, strict pre-entry testing and regular testing thereafter, managed to keep the COVID positivity rate at zero. The co-existence of a persistent pandemic and mass sheltering proved a significant challenge, especially in a region with only just above 30% vaccination rates. While hospitalizations began dropping in September, community spread continued among the unvaccinated, principally children and young adults.

Vaccinations for children 5-11years old became available in November 2021 with hopes of vaccinating this group with a partnership of private pediatricians, school-based health clinics, and the continued efforts of the Office of Public Health and its community partners. As of this time (November 2021), OPH and LANG has given 37,000 COVID vaccines, performed 42,000 tests and given away over 2,000 cash cards for $100 for first time vaccination recipients. Although regional vaccination rates only hover around 40% (less than 20% in adolescents and 30% in young adults), we still hope to eventually achieve the illusive herd immunity. Vaccine resistance runs deep in the conservative population, largely motivated by fear: fear of the unknown, fear of long-term vaccine side effects, fear of infertility, fear of microchips, fear of government control, fear of loss of personal control. Combating such irrational fears became a theme of innumerable media presentations, printed articles and public talks, sometimes to hostile crowds.

Given the high number of unvaccinated individuals both in Central Louisiana and around the world, it came as no surprise that a new variant, Omicron, came out of South Africa and quickly established itself all over the world. Within a matter of weeks, it had established itself as the dominant variant in Louisiana and elsewhere in the United States. The vast number of mutations lead to a relative resistance to the existing vaccines. The vaccinated with boosters proved most protected, followed by the vaccinated without a booster, and last, but not least, the unvaccinated. This latter group once again became the source of the sickest individuals with by far most of the hospitalizations and deaths. The Office of Public health continued testing and vaccination as Omicron swept through the population during the end-of-year holidays in 2021. We performed over 700 tests per week with extraordinary rates of positivity between 20 and 30% during the last two weeks of December 2021 and the first two weeks of January. Our OPH/LANG vaccination totals exceeded 53,000 and our tests exceeded 63,000 as of February 2022, enormous numbers relative to total vaccines given in Central Louisiana.

Omicron peaked around January and by April, the COVID numbers has dropped to the lowest levels since the pandemic began. Although everyone hoped for an end of the pandemic, the arrival of Omicron variants and subvariants (i.e. BA2, BA2.12.1, BA4 and BA5) have ended hopes for a frank end to the pandemic. Although case numbers are on the rise, there does not appear to be a concomitant rise is hospitalizations and deaths, probably related to widespread vaccinations and large numbers of previously infected individuals. One hundred percent vaccination rates have not been achieved anyplace in the U.S. and certainly not in the South. Enthusiasm for masking and lockdowns has dwindled everywhere. So, we plod along hoping vainly that the next mutations will not be any deadlier or more contagious. As the death total surpassed 1,000,000 in May 2022, the seriousness of the past must give us pause. Of that number, at least 250,000 deaths were in unvaccinated people for whom a vaccine was available, thus preventable. In Louisiana alone, 4,000 of the 17,000 deaths were also in unvaccinated people who were not vaccinated by choice. Such senseless loss of life defies reason and rocks the world of public health to its core.

After the peaks of Delta and Omicron (fourth and fifth respectively), we experience a brief period of respite. Mask wearing and social distancing more or less disappeared and the public reveled in a return to normalcy. The virus, however, had other plans. Due to constant mutations, the Omicon developed variants and subvariants, BA.2 and others, which moved on to BA.4 and BA.5. With each iteration, the index of transmissibility (R naught) increased. The original Wuhan variant transmitted to 2 other individuals, but the time we got to Delta, that had increased to 8