♪ opening music ♪ ♪ ♪ ♪ Welcome to This Week in South Carolina I'm Gavin Jackson.

opioid abuse continues to rise in our state, as does alcohol abuse.

SC DAODAS director Sara Goldsby joins us to talk about what her agency is doing to help with these addictions, but first, SC DHEC's director of public health Dr Brannon Traxler discusses the Covid 19 pandemic, monkey pox and the West Nile virus outbreak.

Dr Traxler, welcome back to the show.

<Sara> Thanks.

Thank you for having me again.

<Gavin> So, let's just start off by talking about what's the latest in the current Covid 19 pandemic in the state, Dr. Traxler, how things are going, the status of that outbreak, the pandemic and, of course, who should be getting these new boosters and when?

<Dr.

Traxler> Sure, and so I am pleased to say that things do look like they're improving right now.

We saw a second Omicron mini surge is what I'll call it, really a bump on the later part of the summer.

It really has been occurring across the world with the subvariant BA.5 taking over and I'm pleased to say that it looks like we're on our way out of that bump.

We have been having had a couple of weeks where it wasn't a complete downward trend, but otherwise the last number of weeks have been going down in terms of cases.

The also have very good news with this was with this mini surge or bump, we did not see a correspondingly you know, year high increase in hospitalizations or deaths.

We saw a little bit of an increase, but not significant certainly not to the extent we've seen before.

So, that shows that this virus as it mutates, thankfully while it may get more contagious is getting less severe and then certainly having these bivalent boosters that target that BA.5 as one of the components of it is great and it really is a game changer if enough people get vaccinated with it.

<Gavin> and these boosters like you're saying is kind of targeted toward... these variants too and it's for pretty much the general population, people that weren't covered by previous boosters.

Kind of just break it down maybe for folks who are interested or want to know more about these.

<Dr.

Traxler> Sure, it can be for people who have or have not had previous boosters as long as they've had that primary series, and so it is.

It's got two components.

That's one thing a lot of folks don't realize.

We mention the word bivalent, which is this is the first of the bivalent boosters that but that just really means that there's two parts to it that combats two different things and so it still has a component that is the same formulation as the original vaccine.

So, the same thing everybody's been getting but then the other one targets BA.4 and BA.5, and so anybody who is finished their primary series who is 12 and up for Pfizer or 18 and up for Moderna, is really encouraged to get it as long as they're two months out from their last shot, and the other piece is if you have had a Covid infection and you've tested positive but we really do recommend you wait three months before you get this booster to get the maximum benefit from them.

<Gavin> I had Covid in early August, so I'm guessing just wait a couple more months, probably wait until things really get colder and we see those kind of, all those rates kind of tick up too, and when we talk about flu we talk about all these different things that happen when the weather gets cold.

<Dr.

Traxler> Absolutely and so I would recommend, correct, I think that would put you right at early November being eligible for it and that's when we start seeing the cold weather usually in South Carolina and so I encourage you to get it then.

<Gavin> So, Dr. Traxler, when we talk about that we look back to last year when we had that horrible surge that was the worst part of the whole Covid 19 pandemic, to date for our state I'm guessing you don't expect anything like that.

Do you expect that this will just kind of become endemic almost, like the flu and that we'll be getting these boosters and we'll be combating any potential massive surges like we saw?

<Dr.

Traxler> So, I certainly hope that we do not see a surge like we saw last winter and even though we saw the highest case counts really of the pandemic I will say it was not the worst in terms of hospitalizations and deaths.

Again, because we were, it was the Omicron that was here, the initial Omicron at that point.

I do expect that there will be some increase in the winter, like we see with flu, but again if this is endemic, we know it's going to be out amongst us our goal is to keep that increase down to a minimum really to just see a barely a blip see like we do with flu and really keep especially down the number of severe cases and so I do think that this is going to become very similar to the flu.

It may have different seasonality We may see more of a summer and winter bumps.

We just don't know yet, depends on what the variants do, but I think the goal is also to continue then to get a yearly booster and I know that is certainly the federal government's plan and the scientists' and everyone's hope.

<Gavin> We'll be looking... Hopefully to combine it even with the flu and so that you don't have to get two shots <Gavin> Yeah definitely, but an internal review of DHEC's handling of the Covid 19 pandemic was reviewed by the Post and Courier recently, and it found that DHEC was unprepared for the unique challenges of a novel pandemic, unable to communicate effectively with partner agencies in the public, and understaffed for sustained emergency response that ultimately lasted more than 780 days.

Dr. Traxler, you've been director of public health since April 2021.

Tell us about what's being done to address these issues and if this is still a problem.

<Dr.

Traxler> Sure, and so we are really looking both agency wide.

Dr Simmer is doing it, and I can tell you that I'm doing it in public health at every aspect of this response.

With that, you are correct that is our after action review that we contracted with a consultant to...do and so based on that, the team is going through and creating basically an improvement plan creating, identifying of these recommendations of which, you know that there's over a hundred in the report identifying what of those need to be implemented, you know, soonest versus can wait a little bit, and adding to them that you're really having important sometimes difficult but very necessary discussions about what we can do to improve things so that we are more agile and flexible and ready to go the next time though hopefully that won't be for many years.

<Gavin> ...and are you getting enough support now from the state, it feels like this was a kind of a big wake up call for state budget writers.

I mean, DHEC's now going to get a new 100, 140 million dollar lab.

Obviously, that was a big a...pin point during the pandemic because all the testing that was going through that state lab and of course contractors as well, but there was a bottle... in the beginning so tell us about what kind of support you get from the state to fix some of these problems, too.

<Dr.

Traxler> Certainly, and so we are getting more support not only from state, not only from the budget writers, but really from everyone, you know we're getting more support from everyone out there in South Carolina.

I think this is been a wake up call for everyone that public health is critical and a lot of people I think in South Carolina didn't even know what all DHEC did.

A lot of our work, we like to do in the background we'd like people to not have it necessarily on their radar, and so we want to keep people healthy and safe with minimizing disruption certainly to their lives, but this wake them up and they do realize now what all we do and so really seeing support from everywhere has been really important, especially I think for morale of the team.

Certainly then, financial support has been critical and so beneficial.

We are ecstatic about the 104 million dollars for this new lab.

I have a meeting this afternoon.

We're looking at you know proceeding right along with the lab building plans and we're looking at drawings and such and so that is very exciting.

Our lab team needs it and it's...really just very forward thinking and so I'm very pleased that we were able to do this, that we got that support.

<Gavin> ...and of course, not just Covid 19, but a variety of different viruses and diseases, which we'll talk a little bit more about in a moment, but of course, you know there's also talk about splitting up DHEC.

That's something that that you're not, dealing with directly of course.

You're not the director of DHEC, but that's something that has been floating around the Statehouse, too and of course that bill didn't make it to the governor's desk this year, but we'll see what happens in the future, legislative sessions but Dr. Traxler, I want to pivot now to monkey pox or MPOX as DHEC is calling it to help de-stigmatize this.

It started spreading around the world earlier this year, ramped up in the summertime especially here in South Carolina.

There's more than 22 thousand confirmed cases nationwide more than a 130 here in South Carolina.

How concerned should folks be about monkey pox?

<Dr.

Traxler> So, right now the risk to the general public is low.

However, I do encourage people to keep it on their radar - Our aim is to keep the rest of the general public and to every member of South Carolina of our residents, low.

Right now we are seeing it especially in the sub-populations of men who have sex with men and we're seeing some disparities even within it, seeing higher case counts among Blacks than we are Whites and so we're really trying to do a lot of education as well as targeting our vaccine campaign to those who are at highest risk, but the risk to the general population as a whole is still low at this point.

<Gavin> So, what's DHEC doing out to reach out more.

I know we got you know, the emergency dosing recommendations from the federal government talking about stretching this very limited supply.

I think, you guys have given about more than 14 hundred doses, so far over the past two months.

We're coming up on two months, I think.

Has that been going slower than expected and what are you guys doing to expand that outreach to maybe boost those numbers.

<Dr.

Traxler> We are we're doing everything we can in terms of outreach to folks through all different avenues and really our partners have been critical with that, so we work to get vaccines out into other providers hands particularly some of our Ryan White clinics and other FQHCs are too who have been great and so we do have a vaccine locator map now, similar to the one we had for Covid.

We have one for MPOX now on our website, so people can go there and see it's not just the health departments anymore that have it available.

<Gavin> ...and you guys have expanded the criteria for folks from originally it was like really if you had a close contact or something like that to now basically the entire gay population of the state.

<Dr.

Traxler> Sure so right now it's gonna be, it's all MSM, all men who have sex with men but also all persons regardless of gender who are on a pre-exposure prophylaxis we call prep for HIV.

<Gavin> Gotcha.

and then really quick Dr. Traxler another outbreak that we're seeing in the states, specifically here in Richland County is the West Nile virus.

There's been one death so far, a couple cases.

Tell us what people need to know about this, the status of this outbreak, and what they should be looking for to prevent getting this virus.

<Dr.

Traxler> Certainly, so as of a couple of days ago latest data I have, we have 11 cases in the state in 2022, and correct six of those were in Richland County nine of them were in the Midlands region and that includes that one unfortunate death.

West Nile virus is something that we see some every summer, but we are seeing an increased activity in Richland County in terms of surveillance among mosquitos, as well as among, in birds and humans and so what we're encouraging people to do is get rid of your standing water.

Standing water outside your home is really, it is a breeding ground for mosquitoes.

They love it, so get rid of any even just buckets that you might have laying around that collect rain water, any standing water.

Wear bug spray.

Wear insect repellent.

When you're going outside make sure that you're not letting mosquitoes into the house.

You know, make sure windows and doors are tightly fitting.

<Gavin> It's also pretty rare too, so people shouldn't be too, too concerned, but just take some precautions because of this outbreak.

<Dr.

Traxler> Correct, the majority of people who get infected, will not have any symptoms, and then about a fifth of them will have fever, body aches, feel poorly and less than one percent will have very severe where it does affect their brain or nervous system, but as we have seen with this very unfortunate, one death here in the summer in South Carolina in the Midlands it can happen to people and so we really want them to take, easy precautions to take we really would like them to do it for their health.

<Gavin> Some important information there, Dr Brannon Traxler.

She's DHEC's director of public health.

Thank you so much for joining us.

>> Thank you.

Have a good day.

<Gavin> Joining me now to discuss drug and substance abuse issues in the state is Sara Goldsby.

She's the director of the Department of Alcohol and Other Drug Abuse Services, Sara, welcome back.

<Sara> Thanks Gavin.

Great to be here.

<Gavin> So Sara, we have a lot of new information to talk about since we've last spoken, but I want to get you to just paint us a picture.

Give us a refresh on the current state of overdoses and opioid overdose deaths in our state.

What's that look like?

I know we had a bunch of increases, unfortunately, What's the latest data saying?

<Sara> Yeah, so we're still leaning on the 2020 drug overdose death data, eagerly awaiting, you know, anticipating the 2021 overdose death data as it gets finalized by DHEC and the CDC.

You know.

what we saw in 2020 was just a dramatic increase nationwide really and, and that includes our state what we saw was about a 51, 52 percent increase in drug overdoses for the state between 2019 and 2020.

Unfortunately, we had anticipated some of that, you know, because we knew that, you know, the isolation, the conditions of the pandemic would lead to more drug use, but I think what we recognize now is that simultaneously, the black market for drugs, the illicit drug market in the United States and in our state too, shifted dramatically in that year from 2019 to 2020, in ways that we couldn't have anticipated, with the introduction of fentanyl, very potent fentanyl in the opioid products that were coming into the United States but also in non-opioid products including you know, stimulants, the cocaine and methamphetamine that we see now almost all of it is laced with fentanyl, the drug that's causing most of the overdoses.

<Gavin> And yeah, I think it was some 4,000 South Carolinians have died over the past three years.

Is that about right?

<Sara> Yeah, that sounds about right, you know I think we're looking around 1500 to 1600, 1700 a year.

Just, you know, folks in our neighborhoods, people we know and the demographics even shifting slightly as we monitor this week to week with our partners on the opioid emergency response team, we're noticing shifts in the African American communities in South Carolina now, climbing with overdose incidents where other states had seen this before.

So, we're monitoring that closely and trying to get the word out to particular demographics and populations, because what we think and expect is that certain drug markets like I said are being really, you know, infiltrated by this deadly fentanyl.

<Gavin> Sara, before I move on to the latest in news that you guys have about combating this problem, can you tell us about do you think that those trends are holding steady are they plateauing at all for 2021 when you look at anecdotal data.

I know it's not finalized yet, but you know 2021, 2022, can you speak to any of that?

<Sara> I think you know with the preliminary data available from the CDC we will see an increase again from 2020 to 2021 in overall drug overdose mortality.

What we're monitoring week to week is incidents of suspected overdose and the first responders' response to those incidents and I hate to be too optimistic too early, but I do notice that we are starting to level off in those incidents, and so I remain hopeful and we expect and hope that it's just due to a lot of hard work between our public safety partners, the law enforcement doing incredible interdiction work on the traffickers and the supply, but a lot of hard work by all of our community partners around the state, awareness raising, prevention work, and then, of course, having the overdose antidote naloxone available, getting more people into treatment.

All of these things combined, we think is - we're hopeful that we're seeing the trends level off week to week now.

<Gavin> Sara, your agency has a pretty broad mandate when it comes to dealing with a lot of these issues that folks deal with unfortunately.

Can you tell us you know, we hear about opioids and those unfortunately get a lot of the headlines and because it is just such a massive issue, but what about other substance abuse issues that your agency is dealing with and combating?

<Sara> Well, Gavin I know we've talked since, you know the start of the pandemic, but I think even before isolation measures went in place, we were worried that when they did folks would turn to alcohol and drugs to cope with you know, the things that we were experiencing at the time and some national surveys that occurred in you know, the spring of 2020 showed us that people were experiencing worry and sadness and fear and loneliness.

Those things are all, you know, experiences that cause people, that trigger people to cope with substances like alcohol and drugs.

So, we're very worried about at the time about alcohol in particular and monitored, you know, social media, which I think we talked about before, we saw a lot of social media means supporting more alcohol use and alcohol use at earlier hours during the pandemic as a means to cope with isolation, the stress of working from home and home schooling, you know, so I don't know that we can honestly say we've seen the impact of what may have shifted during the pandemic in terms of folks needing treatment seeking treatment, but we know that there's been an overall rise in drinking in the citizens of our state.

Another indicator of this is with an analysis of the South Carolina alcohol liquor tax revenue, which shows significant increases in tax revenue from alcohol sales in our state over these past couple years and it's just one more indication that the amount of South Carolinians are drinking has risen significantly and so just... this warrants our attention and I think, you know, our messaging has been to take a pause, consider you know your own personal relationship with alcohol, and, you know, putting things on our website like the alcohol use self test, you know, ten questions that anyone can ask themselves to really see if their drinking poses a risk to dependency and addiction.

So another main thing that we're worried about.

<Gavin> For sure, yeah that stuff a good self check right there, in the red flags that you're seeing in terms of consumption rates and abuse, unfortunately as a result the pandemic.

So many things we've seen come out of the pandemic, but one of those that... we're talking about opioids, of course, in one of the big settlements we saw was I guess, what, 26 billion dollars.

It was a big settlement with three of the nation's top pharmaceutical wholesalers, as well as Johnson and Johnson.

That's a nationwide settlement.

South Carolina's getting about 360 million dollars over the next 18 years.

Tell us where this money is going to go this 360 million dollars over the next 18 years Sara, and how we're gonna hopefully fix some of these problems.

<Sara> Well, first Gavin, we really have to thank our community leadership and the leadership of the South Carolina Attorney General, who spearheaded this litigation on behalf of the state and you know it's really, you know going to see the reward of, the communities being represented in that litigation, you know, getting the funds and the resources and the relief that they need to address the epidemic head on.

You know, that litigation has led to like you said, the settlement, and the South Carolina Opioid settlement allocation agreement, which folks can find online at the National Opioid Settlement website, really outlines how that money is going to be spent with, you know the Guaranteed Political Subdivision Fund and the proportions of that money that will go directly to the municipalities and counties around our state who participated in the litigation, and then, you know, in the spring the General Assembly created at the South Carolina Opioid Recovery Fund Board with nine appointed members.

This was possible with the South Carolina Opioid Recovery Act.

Those nine members will really administer and disperse the South Carolina Opioid Recovery Fund in accordance with the terms of that settlement agreement to make other funds widely available for discretionary grant applications.

<Gavin> Do we have any idea about what these grants might be looking like, any idea what might be rolling out soon?

<Sara> As far as I know, the board has met in July.

They'll be meeting again soon and I think we all anticipate directions and the way to apply for those funds and information about how the political subdivisions will be getting that money in the coming weeks.

<Gavin> Really, just to get that money out to these localities, these smaller places to really just try and get some best practices there to help fight this crisis <Sara> Yeah absolutely and you know the settlement really outlines what the agreement refers to as approved uses and core strategies and so the money can really only be used for those evidence based practices or what clinical expertise and systematic research have evidence to, you know, support outcomes and I think it's important and really a highlight of this broad sweeping national litigation, because we've seen what settlements in the past funds coming back to the state that have wide opportunity for multiple uses that don't necessarily go to remediation or abatement of the problem, and so we were excited.

In June we partnered with the South Carolina Institute of Medicine and Public Health and pulled together some subject matter experts from universities in our state Clemson, DHEC, the University of South Carolina: MUSC to really contribute more content to the list of those core strategies and approved uses in hopes that the decision makers at the local level will find this as a resource really outlining strategies, but with richer context and a connection to the national guidance that we have.

The message being, you know, with all of this, we know what works.

There's no need to invent anything new to address the opioid crisis.

It's really just about scaling the best practices and spreading the best practices.

<Gavin> Sara, how does this money this, you know, 360 million dollars, - Correct?

Was that what we were talking about?

360 million over 18 years, like you said that's about two million dollars a year about.

What?

How can you make that?

How does that supplement what's already been put in the state budget?

Are you guys getting more money from state lawmakers even as we see these opioid deaths skyrocket?

<Sara> So, the majority, I think of the relief so far to the state to address the opioid crisis has come from Congress and federal appropriations as Congress has made, you know, really states a priority and a leader in in addressing the crisis.

So, we've had several packages appropriated and authorized by Congress that have come to the state by way of the State Targeted Response Grant and the State Opioid Response Grant, and so we're in the third wave of those and those have, you know, averaged, you know, between 16 and 23 million dollars a year in two year, you know, grants.

The importance of that can't be understated, because it's really builds the infrastructure for the programs and services that we currently have to address prevention, intervention, treatment and recovery.

The Department of Health and Environmental Control has also been awarded funds by the CDC to address certain aspects of the crisis and when we tie all these things together, we've really done a lot of ground work in the state to address the crisis.

The money that will come from the settlement funds can build on that and I think if we align all of these strategies and fill the gaps geographically in our state where we know we need that scalability and the spread of best practices, this money will go a long way to shore up services and do prevention work for a number of years.

<Gavin> Yeah, not 2 many dollars a year, 20 million dollars a year.

So, a substantial amount there going out throughout the state, but really quick, Sara, I know, there's a lot to talk about, but we got to wrap up.

Just tell me how folks can get resources if they are going through crisis, if they're in recovery, how people can get educated to know some of the warning signs or just to deal with opioids, in general the state.

<Sara> Yeah, the best website for opioids information is still the justplainkillers.com website.

We have new information on there now about the risks and dangers of fentanyl and also all of the places in the state where naloxone, the opioid overdose antidote is available, or treatment or recovery services are available.

For anyone looking for you know recovery or treatment support, or information on any other substance use, we've got a couple sites, of course the embracerecoverysc.com website really talks about the nearly half a million South Carolinians are recovering more and more every day and where mutual support and treatment can be found around the state and then the DAODAS.SC.gov website, of course, the alcohol you self test that we talked about there and all the resources that we have.

<Gavin> Well, thank you so much.

That's Sara Goldsby.

She's the director at DAODAS.

Thanks Sara.

>> Thank you Gavin.

<Gavin> For South Carolina ETV I'm Gavin Jackson.

Be well, South Carolina.

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