State Health Officer Dr. Thomas Dobbs has led Mississippi's response to COVID-19 since the first days of the crisis. Now, facing spiking metrics in all of the state's key indicators for the spread of the virus, even in the warm summer months in which it was hoped that the novel coronavirus infections would recede, Dobbs told the Jackson Free Press in a phone interview to prepare for an overwhelmed hospital system in which basic emergency care will be rationed.

JFP: Today marks the single largest number of COVID-19 infections reported since the beginning of the crisis, 611. It is the second day in a row with the highest seven-day rolling average of coronavirus detections: yesterday was 355 and today is 392. Yesterday marked the highest combined total of COVID-19 hospitalizations ever suspected and confirmed at 710. What new steps are MSDH and the State of Mississippi taking to counteract these trends?

Dr. Dobbs: First and foremost, we're not remotely surprised.

I mean, we've been anticipating this and been talking about it for weeks, because we've been seeing outbreaks, we've seen transmission. We have been seeing people taking on risky behaviors that we knew would lead to transmission.

People are not paying attention to the guidelines we have. We feel pretty good that the social distancing guidelines that are actually in the executive orders, that are basically legally binding, are pretty strong.

But we're seeing this sort of widespread abandonment of following those orders. And so it's been extremely frustrating to be quite honest. You can only do so much, but people refuse to do what can be done to prevent transmission. So that's one of the things.

We're anticipating an absolute disaster coming into the fall because we're ramping up.

We had hoped to see a lull in the summer to give us an opportunity, not only to prepare, but also to do planning and minimize transmission in a time when virus transmission typically will increase. So we are preparing and trying to make sure that our hospitals are equipped as much as they can, that our health systems (have) contingency plans available, but at some level there's no amount of planning or preparation that can overcome the amount of disease transmission. That will happen if people do not follow the rules that prevent people from getting it in the first place.

JFP: Help me understand something right now. As far as I'm aware, all businesses are allowed to open and the social distancing guidelines (allow) 20 people indoors and 50 people outside. Remind me, is that with or without social distancing in place?

Dr. Dobbs: Twenty indoors and 50 outdoors is if you can't social distance, and if you can social distance, it's up to 50 indoors and 100 outdoors.

JFP: I don't understand what prevents transmission in a cluster of 20 people inside or a cluster of 50 people outside. That's people following restrictions.

Dr. Dobbs: Well, certainly you can have transmission.

There's no doubt about it. And I'll tell you what, Nick, (the guidelines) would be a lot more strict if (they) were likely to be successful. We're trying to find a medium where it can be beneficial, but also livable, but folks are not even following that. The things that we're seeing, these mass transmission events are hundreds of people.

If you go by restaurants or bars and they're packed, and people aren't separated and aren't wearing masks, it's really a frank abandonment of the rules.

JFP: Well that sounds to me like a failure of enforcement, then. Have you had a conversation with Gov. Reeves about increased enforcement of the executive orders?

Dr. Dobbs: We have talked about it. A lot of it is a local thing. And this is a great conversation because I understand that a lot of the local folks from law enforcement are not enforcing this in every location.

If everybody chooses to break the law, it's almost unenforceable. It's really a population issue. This isn't something that's unique to Mississippi: understand that people across the nation are tired of coronavirus, but just because you're tired of something doesn't mean it's gone. And we are gonna pay for it. We're paying for it now. And it's just going to continue to get worse.

Now from a regulatory perspective, the Health Department, we are going to enforce these in our restaurant inspections. We are going to do what we can do to make sure that people are following these (rules), but out in public, people have choices that they can make.

And one of the things that's going to be really important is for those who are in positions of power, (meaning) leaders of churches, leaders of business, leaders of communities, to step up and make sure that they understand what they need to do to protect their communities, to protect their customers, or their patrons or their congregations.

That's going to be the real challenge going forward. I've had some fantastic meetings with different people across the state: churches, church leaders. I went to Copiah County and had an absolutely fantastic visit. Their cohesiveness is really laudable. I think they're going to do some great things for their county.

If we can get a critical mass of leaders (and) people to embrace the thing that makes sense, it's simple. I mean, six feet, a mask in a small group, and coronavirus would fade away. But we just don't have the patience. We don't have the discipline to do it.

We need leadership and our goal is going to be trying to build that coalition of leaders that can help get us to those community behaviors that are gonna keep us safer, in a way that also lets the economy go. I understand people gotta have a job and money to pay the bills, but they're not mutually exclusive, and I think that's a real fallacy that some people have bought into.

JFP: Just today in the Mississippi Senate, there's the "Back to Business Liability Assurance Act" that just passed through committee. It sets up protections for businesses against future liability claims if they are the source of an outbreak of coronavirus. I want to point out that they do have to be in compliance with the guidelines set forth by the State Department of Health. But do you worry that legislation like that is convincing business leaders and community leaders, churches, places like that, that this has passed, and that they will be protected, even if they do provide an area for this to spread?

Dr. Dobbs: In a way, I think it would be beneficial because it codifies that to have these liability protections you do have to follow the guidelines with the Department of Health. You do have to follow the guidelines for the executive orders. We're not seeing that now.

I think it could be helpful because we're not going to prevent all transmission. We totally get that. And sometimes there's gotta be a balance.

I mean, we can. We can stop transmission. If we close everything down 100%. But there may be an unacceptable cost to that. But if businesses buy in and if leaders buy into following the guidelines, then we will be in such a better place than we are right now.

Even if they do have those liability protections, it gives us a little bit more impetus to follow the guidelines we're trying to promote.

JFP: Let's talk about additional guidelines. Governor Reeves acknowledged last Thursday that he had issued mandatory mask orders to certain counties. Is it time for a statewide mask order? Is it time for a return to Safer at Home orders, Shelter in Place orders, business closings?

Dr. Dobbs: I think we've come a long way in our understanding of (how) to do things safely.

As an example, at the Department of Health we've had people in this building the whole time. Of course, you have people teleworking and we've had to modify our physical locations, our layout, how to do stuff, (but) we haven't had any outbreaks. So, you know, I think we've learned a lot and that's just an example of finding ways to do things safely.

We've learned more about how the virus transmits, what simple things you can do. As far as closing businesses, I just can't imagine that we're going to do that in any way. There's safer ways to do things. Certainly, you know, having mechanisms to ensure that those safe things happen are going to be very important.

JFP: What are some of those mechanisms?

Dr. Dobbs: I think some of them are going to be like what you said: people understanding the potential liability that might exist if you're not following those issues.

We are trying to partner and to communicate with the businesses. We did a business call this morning (about) safe mechanisms to return to work.

I think the businesses have actually been some of the best folks to work with because they want to succeed. They don't want their employees sick. They want to be able to be productive. And if there are safe ways to do things, I found that extremely engaging and that's very encouraging.

JFP: Repeatedly I've asked what we want our numbers to look like, what we want our trajectory to look like. And I understand that that's a difficult thing to anticipate. But as you said, we're approaching the middle of the summer. The metrics are all up. And as you just said earlier, this state of affairs proceeding to the fall would be devastating. What does the roadmap to safety look like? What does the spread need to look like in August? What do the numbers need to look like in September? Is there any roadmap to avoiding catastrophe that we can grade ourselves on? What are the numbers that we need to see at a certain time to feel confident that we can make it through the next year?

Dr. Dobbs: Oh, we'll make it. it's just a matter of how we make it. Everything's speculative, as far as we go into it, but what we really need to see is stabilization. We need to stabilize and then have at least a small decrease. That's what we saw! We were seeing some stabilization about a month ago. We were feeling like things were going right.

I was admittedly maybe a little bit naive, thinking that people would in fact show the restraints that we need. It's not a Mississippi thing, it's a whole nation thing. I understand that.

JFP: But there are parts of the nation that are showing declines, and frequently they have stronger restrictions.

Dr. Dobbs: Yeah. But a lot of those places had really massive jumps. Some places are declining, and I get it. But even, you know, New York is starting to be a little bit more lax in some of their systems. I think it's just a matter of where you are in the cycle.

If we can flatten the decline going into the fall. One thing that we're going to have to do, Nick, is we're just going to have to prepare for it to be really bad. And that's part of the planning that we're looking at. It's just going to be bad. Not to be fatalistic, but it's hard to imagine that some degree of really bad is -- it's non-avoidable.

JFP: Can you be a little more explicit when you say some degree of really bad? What should Mississippi start preparing for?

Dr. Dobbs: Prepare for not being able to get into the hospital if you have a car wreck, (to) have a heart attack and there not be a ventilator to put you on.

JFP: Dr. Dobbs, I'm going to report that you are saying 'prepare this fall for the hospital system to be overwhelmed.'

Dr. Dobbs: Absolutely.

JFP: I know they were thinking about turning Camp Shelby into an emergency (field hospital.) Is that progressing now that we are anticipating the hospital system being overwhelmed?

Dr. Dobbs: No, the key element to all this is staffing. The thing that's going to be the most important approach is going to be to decompress the hospitals for everything that can be decompressed.

And then let the folks there take care of the sickest people they can. Part of that is we are working with hospitals for a more robust system of care that distributes patients where they can go.

What we would do, and we have already started doing, is getting less-ill people out of the critical hospitals, so that they can make room for more people coming in.

It's a little bit of a reverse thing where basically we can offload people. In that setting, maybe the Camp Shelby location plays a role for getting convalescent patients out so that you can get sicker folks in.

JFP: We're looking at this growing catastrophe in the fall. You really do not feel like any shutdown orders would prevent that overwhelming of the hospital system? You don't think if we possibly returned to Shelter at Home that we could flatten that curve through the fall so that people could get to the emergency room for car wrecks?

Dr. Dobbs: If people would do it, it would work.

JFP: Why are we the only place that can't do it?

Dr. Dobbs: Do you mean the only country?

JFP: Sure.

Dr. Dobbs: Boy, that's a bigger question than me, because I really thought we would. It doesn't take that much, honestly, Nick. Where we are, if we would do the smaller things you know, a flyswatter kills flies but so will a bazooka.

But if we would just use the flyswatter we wouldn't have to use the bazooka. And I don't know why when all this happened early on, everybody wanted to shut everything down, and I understand everybody was scared. But now everybody wants to not do anything.

It's a climate of extremes and it actually doesn't take that. It's a frustrating thing to live through and I'm sure it's a frustrating thing to watch for you guys.

JFP: Let's go back to mandatory mask orders. I feel like I know your answer on this: sure, a mandatory mask order would be great, but you don't think that people will do it.

Dr. Dobbs: I don't think people will do it in general. And I will tell you that, just like anything, sometimes you have to develop a base of support. And one of the things that we did in the counties that we did the mandatory mask (order) and other social distancing stuff is we had the buy-in of the local leadership.

We had the buy-in of the mayors and the supervisors in the hospital. The local people drove it and they asked for our help. When you have that sort of local support, not defiance, but absolute support, then you're a lot more likely to be successful.

We don't have statewide support. I don't think it would be successful, but as we look forward, I think it's going to be really important to develop not only local coalitions of support for things that are going to be useful to the community, but also get those critical stakeholders involved, whether it's business or church leaders, and other political leaders to acknowledge the benefits that will happen when things (do) kind of go off the rails.

I think that almost certainly localized restrictions, mandatory masks and more restrictive social distancing orders are in our future. And it may be we go statewide at some point, if it gets really rough. But at least for the foreseeable future, statewide is not doable.

JFP: In this process, what are some of the things that you and Gov. Reeves have disagreed on?

Dr. Dobbs: Disagreed on? Nothing. The relationship with Reeves has been good. He's been very thoughtful and he pays good attention to data and stuff. He's actually been pretty resolute on some of the public health things. There's not really any disagreement between the public health department and the governor's office as much as there is a lack of buy-in from the community in different areas.

So it kind of fits in the same sort of narrative we've been talking about of trying to get local support. The governor was very supportive. He's been a good supporter of public health strategies. So we'll continue to do it and if we give data that indicates something, he's willing to make hard decisions.

JFP: Let's talk about MSDH's data system. We recently have had several delays in getting (COVID-19) information out. First, can we get a breakdown of the lump data from between June 18th and June 21st?

Dr. Dobbs: No, the allocation of that information by date would not be strictly accurate, so we're not comfortable releasing it.

JFP: Okay. What is the name of MSDH's data system? When was it implemented?

Dr. Dobbs: It's called EPI Tracks. Oh boy, a long time ago. 2009.

JFP: You've described the problem as a validation issue. What is delaying the results and what are the concrete steps being taken to prevent that from happening in the future?

Dr. Dobbs: It's a system that wasn't designed to handle a pandemic, right. So within the database, there are obviously 25,000 cases, but then out of those 25,000 cases, there are over 14 million data elements.

So it's a lot of information to process and to do analysis on. But we're also putting in negative results and we already have like 260,000 negative results that we're trying to use and so what we've had and what we've experienced is the system's unable to handle the stresses on it.

And then last week, it basically just kind of ground to a halt. It was operational, but so slow as to be dysfunctional to have good, reliable and trustworthy results be brought on. So we pulled the plug. We'd rather take the heat for not doing anything than to put out something that we didn't have confidence in.

And so what we've done is over the weekend--we worked all weekend. I mean, morning into the night. We developed a workaround system where we can pull data out and analyze it and do validation algorithms to make sure that we feel comfortable that the data is accurate. And so we still have the system and there's some uses to it, but we have a workaround that uses other technology that's more modern where we can do it. It's kind of labor-intensive, but we're committed to the importance of it. And we're also in the process of trying to identify an updated system that we can use that will be better suited to our needs.

JFP: Are the funds and manpower available? The Legislature's leaving in the next week or so. Is there legislative support that's needed?

Dr. Dobbs: No, we had baked it into our COVID grants.

State intern Julian Mills contributed to this report. Read the JFP's coverage of COVID-19 at jacksonfreepress.com/covid19. Get more details on preventive measures here. Email state reporter Nick Judin at [email protected] and follow him on Twitter @nickjudin.