Out of humility, Dr. Mouhanad Hammami laughed off our describing him as “the county’s Dr. Fauci,” but it’s a decent working analogy. The UM-Dearborn public health lecturer and former county health department director has been serving as Wayne County’s chief health strategist for its COVID-19 response, which on the whole, has been a pretty solid effort. After erupting as one of the nation’s hottest initial COVID-19 hotspots, Wayne County has significantly improved its per capita caseload. Recently, we caught up with Hammami to talk about what’s working, the strategy for coping with the pandemic’s critical next phase, and why county health departments matter more than you ever knew.
We tend to focus a lot on the national and state-level actions when we talk about the pandemic response, but I think the huge role county health departments play remains relatively opaque to most folks. Can you pull back the curtain for us?
Well, I think that’s true, and many people probably think of the health department simply as a last resort for things like a flu shot or childhood immunizations. But the health department is in fact tasked with setting a whole strategy for the communities it serves, including infectious disease control, HIV and STDs, environmental inspections, and many other things. So in a pandemic, there are specific authorities that are assigned to a local health department. For example, when the governor declared a state of emergency, that made it easier for health departments to act as one. Conversely, a few weeks ago, when the Michigan Supreme Court ruled that the governor has limits on what she can mandate, this is where the local health department can step in, which is what we’ve done. So far in Wayne County, we’ve issued two orders to fill the gaps: The first order preserved the state’s previous mandates regarding face coverings, social distancing and group gatherings. And the second related to workplace safety — which continues things like workplace health screenings and the mandate that workers who can work from home should. In addition, the state Department of Health and Human Services issued orders to preserve other mandates covered by the governor's executive orders. So this is kind of the beauty of the system — that even in the absence of a governor exercising emergency powers, our health departments have the authority to issue orders to continue a strategy.
I definitely want to talk more about what you think the strategy will be going forward, but let’s take a second to look back. Wayne County was the center of the pandemic in Michigan back in April. Now, compared to other Michigan counties, we’re doing quite well. What do you attribute that success to?
I think what worked were these health measures that were put in place by the state and local health departments. The shelter in place order, social distancing, face coverings, all of that worked to flatten the curve and reduce transmission. If we had not done those things, I would have expected to see what happened in Florida and other states where those measures were lifted too soon. Another thing that was very important was increasing our capacity for testing and contact tracing. In Wayne County, we are doing a lot of community-based testing, which includes things like weekend test events and drive-through testing. We do that for free, and we’re focusing on areas where we think barriers to testing might exist. The testing helps us with early detection, but then we’ve also increased our ability to case investigate and contact trace. Now, when someone tests positive, we reach out within the first 24 hours and ask them about who they’ve been in contact with. This is a method that is the core of communicable disease responses, and the sooner and more aggressively we do this, the more we limit the spread. In Wayne County, for example, in order to suppress the transmission, the models tell us we need to have the capacity to do 8,000 to 10,000 tests per day and the ability to do case investigation and contact tracing for positive cases.
So how close are we to that threshold? Like, how well is that system working right now?
From a testing point of view, I’d say we are getting there. In addition, we were able to use some of the CARES Act funding to hire 30 case investigators and 30 contact tracers. We also wanted to make sure we are sensitive to the diversity of Wayne County, so the emphasis is to hire contact tracers who are bilingual and can speak Arabic or Spanish or Bengali. I think what still needs to be emphasized, and we have a public awareness campaign that we’re launching around this, is that if someone calls you from the health department, it is not to shame you or tell you you’ve been reckless. So if a contact tracer calls you, please be straightforward about the fact that, for example, you were at a wedding and mingling with 200 people without a mask. We are not going to judge you. We simply want to learn who we need to alert to make sure they are aware they might have been exposed. So you asked the question, is the system working? The system is only as good as all the players who are in it, and cooperation and compliance from citizens is a must. You can have the capacity for 10,000 tests, for example, but if only 100 people are willing to go and get tested, then the system is not working.
Well, it seems pretty clear that we’re entering a new phase of the pandemic, with cases on the rise across Michigan, though the increase in Wayne County isn’t as severe as other places. What do you attribute that to? Is it people not following the mandates, is the weather playing a role?
It’s probably a combination of many factors, but I would say it was quite expected when we started the reopening. When you have more people getting together and no longer isolating, it’s expected you’ll see an upward trend. I don’t think the weather has much to do with it, but I can tell you everyone is watching the flu season very carefully. The reasons are twofold. One, the flu is going to exactly mimic COVID’s symptoms, and unless you have robust testing, then health systems could be overwhelmed with people who are presenting with respiratory symptoms and not knowing whether it’s flu or COVID. And two, if you have the flu, you may be more at risk for COVID. My advice when it comes to this is go get a flu vaccine — right now. Don’t wait. If you get it, it’s going to be very helpful not only for you, but for everyone else.
And aside from the flu, what are you keeping an eye on?
Certainly, I’m watching businesses. We’ve had the luxury of spending time outside, whether it’s weddings and banquet halls, or restaurants and cafes. With the cold weather, those businesses are going to be forced to have patrons inside, so compliance with the safety measures is going to be a must. In addition, we cannot emphasize enough how important it is to continue the hygiene practices, and to do them properly. You cannot have a mask hanging from your chin, or not covering your nose. Proper use of face coverings is not only going to protect you from COVID but the flu. In some cultures, specifically in China, a lot of people wear masks during flu season and that drops the flu transmission tremendously. So we all need to stay diligent through the coming months, because it is quite normal to feel what we call “COVID fatigue.”
Speaking of COVID fatigue, it still feels like we have a ways to go before this is behind us. Imagine you’re in the future and you are able to tell the history of this pandemic. What stage would we be in now?
I don’t know if there really are stages, but personally, I agree with Dr. Fauci that we are at the second surge of the first wave. Many people are talking about a second wave, but the fact is we haven’t seen a period, globally or nationally, where the cases were down tremendously. So what does the future hold? We won’t get to a post-COVID phase until an effective vaccine has been developed, distributed and large numbers of people are taking it. Unfortunately, that is not going to happen until early next year, maybe March or maybe even July, as a best case scenario. And again, public cooperation will be absolutely essential. Even if you have a vaccine, if people don’t take it, then it’s useless. Herd immunity is only going to be established when we get 70 percent or more of the population vaccinated.
As you know, I teach Introduction to Public Health, and I posed a discussion question to the 100 or so students in my class. And I asked them, if there was a vaccine that was developed by November, as some officials have claimed is possible, would you take it or not? And it was fascinating that 95 of the students said they would not take it immediately, they would wait at least a year. So I think restoring the trust of the public in science and scientists will be our major task, and unfortunately, science has been politicized.
Absolutely, but it seems like public health departments are one place where the climate is less political. I’m thinking of the many interviews I’ve seen with public health officers, and whether they’re working in red or blue states or counties, they all seem to be putting out a very similar message.
I agree. There is politics in everything, let’s face it. But as a public health officer, you are very much a part of the community and you are really working with people. You’re not only putting orders in place, you’re executing the orders. So it becomes less political because you are able to see the very tangible value in what you do.
