- (female announcer) Production funding for Behind the Headlines is made possible in part by the WKNO Production Fund, the WKNO Endowment Fund, and by viewers like you, thank you.

- The Director of the Shelby County Health Department, tonight on Behind The Headlines.

[intense orchestral music] I'm Eric Barnes with the Daily Memphian.

Thanks for joining us.

I am joined tonight by Dr. Michelle Taylor, Director of the Shelby County Health Department.

Dr. Taylor, thanks for joining us.

- Thank you for having me.

- Along with Bill Dries, reporter with The Daily Memphian.

We appreciate you doing this by Zoom, and just in the very last minute, so thank you so much for doing this.

I think my opening question to you, and we'll talk a bunch more about COVID, but just a quick... COVID is still very present, although it is not as present as it obviously was.

Where are we with COVID?

Where are you, as the Health Department, with COVID?

What are you looking at?

And just give us a status update.

- Well, thank you for the question.

We are happy with the fact that we really have seen a plateau with COVID cases since the end of May, and we continue to see that.

We know that COVID is still in the community, but we also know that people in the community continue to get vaccinated.

And corresponding with the back-to-school season, we've seen a rise in people getting vaccinated.

So right now in the county, we're right at about 54% fully vaccinated, and about 61% of our population has had at least one dose.

And as you know, because we've gone through a couple of surges over the last year, we have some people who still have some level of natural immunity, too.

So all of that combined looks like it's working in our favor and keeping us at a plateau of cases.

But of course, we're still recommending that people who have not taken advantage of getting vaccinated, do so, if you are eligible for a booster, and most people down to age five are eligible for at least one, and folks over 50, or people who are immunocompromised are eligible for two boosters, make sure you're taking advantage of that, as well, as we continue to weather the storm.

- And the storm seems different than, boy, a year ago, year and a half ago, in the real height of this, in the sense that, and you correct me if I'm wrong, people who are vaccinated are sometimes getting...

There can be spikes and jumps of people getting infected, but the symptoms are mild enough that hospitalizations really aren't jumping, and in that sense, again, correct me if I'm wrong, the vaccines are working.

You may get it.

I got it, I don't know, two, three months ago, fully vaccinated, but it was just a minor cold, certainly no ramifications and so on.

Is that overwhelmingly what you're seeing for vaccinated people?

- That's exactly what we're seeing, and you described it perfectly.

The vaccine is doing what it was designed to do, and that means that it's protecting people from serious outcomes and hospitalizations for the most part, and that's really what we wanna see.

You remember, earlier in the pandemic, and particularly with the Delta and Omicron surges, what we were worried about was an overwhelming of the hospital system, and so many people with serious symptoms of COVID having to be admitted and treated in the hospital, and being able to handle that level and that number of people with serious complications.

We just don't see that spike in hospitalizations now, and like I said, that's because the vaccine is working the way it was designed, and I believe it's also because people have really gotten a lot of practice on how to protect themselves.

I still see a great number of people wearing their masks when they're in indoor public spaces, and I see a lot of people just socially distancing when it's possible to do so.

- Yeah, I'll do one more question, then I'll get to Bill.

It's just, when... At this point, when you hear from people who are resistant to getting a vaccine, what are their reasons?

- Oh, goodness, the reasons run the gamut.

I have not heard some of the more farfetched reasons, recently, but I do have some people tell me that they're just still worried about what they perceive as the quickness that the vaccine was developed.

And when I have these conversations, and they've always been respectful.

I explain to people that now, we have millions of people who have received this safe and effective vaccine.

We are finally able to vaccinate children down to six months of age.

And we know that all vaccines have some level of side effects, but the most common side effect is pain and redness at the injection site.

And so I won't say that I've convinced everybody that has expressed their hesitancy to me, but I will say that it's hard to argue with the facts when you see so many people walking around fully vaccinated, boosted, going on with their lives, and doing well.

- Okay, Bill.

- Dr. Taylor, I believe, in September we are supposed to see the Omicron booster.

Should people wait for that if they're not fully boosted at this point?

- Great question.

I would say, instead of saying that you're waiting for a specific booster, really look at what the time period has been since you had your last booster, continue to look at our website, Tennessee Department of Health, and the CDC's website to get the latest information.

But if you're due for a booster now, my recommendation would be to go on and get that booster and protect yourself going into fall and winter, because we know that we will be outside less.

Thankfully, we live in this area of the country where it doesn't get quite as cold as some other places, but we still wanna do everything we can in the time hacks that we've been given on these vaccines to get boosted.

- Right, and in terms of what is called long COVID or long-haul effects from having the COVID virus earlier in the pandemic, is there a public health response to that?

And what is the magnitude that you see from a countywide level, here in Shelby County, of long COVID?

- Great question.

I would say that the main public health response to that is to really support our providers in the field who are dealing with these patients every day.

We don't have as much of a presence, because, as you know, at the Shelby County Health Department, we don't do primary care, but what we do is make sure that we provide providers in our community the latest information on what's coming down from the CDC, what they're seeing from national studies and international studies on long COVID, and making sure that they have the latest information so that they can give their patients the best care.

- And I would imagine it's a fine line, because you want people who may have those specific symptoms to not feel like they're the only person out there with it, but you also don't want to alarm people and have people think that long COVID is inevitable, either, right?

- That's exactly right.

You all are 100% correct on this one.

One of the things that public health tries to be very good at is reducing stigma and reducing fear, and in the case of long COVID, we know that there are people in our community that are suffering with that.

We want to make sure that they have all the supports necessary to continue to live and have a quality of life.

And as more studies come out, hopefully, we will see more therapeutics on the horizon for people who have been dealing with these symptoms for so long.

- To kind of get into how this works and the relationship between the State Health Department and the Shelby County Health Department, the autonomy that the Shelby County Health Department had was curtailed by the Tennessee Legislature, and I believe that coincided with when you first got here almost exactly a year ago.

What is the relationship between the two health departments at this stage?

- Well, I will tell you that we have always maintained a really good relationship, at least during my one-year tenure here, with the Tennessee Department of Health, and I'll tell you why.

Just because the Tennessee State Legislature curtailed the autonomy of all of the Metro health departments across the state, I will tell you that Tennessee Department of Health has continued to be a faithful partner to us.

When I first came in, they made sure that the commissioner visited, they made sure that we were able to present our plan to be able to start sourcing COVID vaccinations again after what had happened with my predecessor, and they continued to fund multiple programs across the Shelby County Health Department.

So I will say that I am happy with the relationship with Tennessee Department of Health, and I do understand their constraints, because the Tennessee State Legislature is more of a direct supervisor to them than they are to us, and so I've been pleased with their response to any needs that we have here in Shelby County, and they've been quite supportive.

- We'll move on to some other issues, monkeypox included, some other things going on, but I wanna stay with COVID, just because it has been this transformative generational thing, and it's still very present, so thank you.

You've just had your one-year anniversary in the job.

You mentioned your predecessor.

We don't have to go back to that, but it was a very difficult situation for the Health Department, to put it lightly, during deep COVID, and have you and your staff gone back, and not so much to finger point, but to learn from mistakes, and God forbid we have another COVID or another pandemic, to what degree do you go back and say, "Hey, we did this well, we did this badly, we need to prepare in other ways," everything from vaccine distribution, to communication, to individuals and businesses, to who has what role, city, county, state, public, private?

- Well, you know, I will tell you that, and I like to remind people, this is not my first time working at the Shelby County Health Department.

I actually was here as the Deputy Administrator for Maternal and Child Health between 2013 and 2016, and I will tell you that the Health Department has always had a practice of going back, doing hotwashes, making sure that we do after-action reports, and if we feel like something could've been done better, and you know, in any operational setting, there's always things that could've been done better, we're going back and evaluating that.

Now, for this past year, what I will say is that I have one of the best teams across Shelby County, and I like to say I have the best team, and so there were, of course, many people who had been here through what you called deep COVID, and as we were making plans to staff up again, to get through the surges, they were very careful to remind me of some of the missteps, to remind me of some of the history, and also to set the record straight about what actually did happen behind the scenes and what didn't.

And so all of that has informed this last year, and I couldn't be prouder of the progress that we've made to start to rebuild the trust with the community, and I think that we've made a lot of progress in that, but also to continue our mission of promoting, protecting, and improving health of everyone in Shelby County.

- With that in mind, monkeypox, what is the status?

What should people be worried about, what should they not be worried about?

And how prevalent is it or could it get to be within Memphis and Shelby County?

- Yes, so I have been reading a lot on social media across the country about the fact that, technically, we are in a double pandemic, in some cases, depending on where you're sitting.

In Shelby County, right now, we have 9 confirmed cases of monkeypox.

There are 42 confirmed cases across the state of Tennessee, and we are currently able to vaccinate, with a limited supply of vaccinations, those who are considered to be in high-risk groups, and that vaccination is ongoing as we speak today.

And so, I would say that the things that people need to not worry about, but be cautious about is if you know that you, as an individual, have a rash, and you're not sure where that came from, you should stop, you should call your provider, and you should go get tested.

And then you should also know that monkeypox is spread from person to person by skin-to-skin contact, and usually, that skin-to-skin contact is intimate personal contact.

It can also be spread by someone who has monkeypox, and if you come in contact with the linen or clothing of someone who has that rash, it can be spread that way.

But I am happy to report that everyone who is a confirmed case right now, in Shelby County, are isolating at home.

We are able to offer the vaccination to their close contacts, and we are making sure that the message gets out across the community about how it's transmitted.

- And I should note that we are recording this a week earlier, so the numbers may have changed a little bit by the time this...

But any other parts with monkeypox, are people, coming off the pandemic, especially, are people overreacting to it?

- You know, I never like to say that people are overreacting, but what I do like to say, because everybody...

Perception is real, and everybody is worried about what this is, what it looks like, particularly after two-plus years of COVID, But what I will tell you is that this is not COVID-19.

We know a lot more about monkeypox than we did about COVID-19 when that first came on the scene.

And the other good thing about monkeypox is we know that it typically is what we call self-limited, meaning that it does go away, it heals on its own.

What concerns people, I believe, is that it takes so long.

So normally, once you get the rash, it's two to four weeks until resolution of that rash, and we ask that people isolate for the entire period until they have a new layer of skin form, and that way, we know that they are no longer contagious.

And so I would say, instead of allowing people to overreact, we're arming people with information to bring down the anxiety level, to help them to know not only how it's transmitted, but also help people to be cautious and understand that yes, there are high-risk groups, but we're trying to bring down stigma, too, and help people to understand that this is direct skin-to-skin contact, so even if there's a high-risk group, history tells us that any communicable disease that has a high-risk group doesn't always stay in that high-risk group.

So, that means that we need to make sure that people are getting vaccinated.

We need to make sure that people know how to protect themselves, and we need to make sure that we're taking care of each other.

- Last question, and I'll go to Bill.

Are kids at risk?

And you can think of young kids, you can think of kids on the playground, you can think of kids in preschool, who, they're playing, they're rolling around, and all that kind of stuff.

What is the risk for children?

- You know, I believe that the risk for children is somewhat low, but remember, we know very young children like to have a lot of skin-to-skin contact, so I would hope that any adults that are working with children and have to do that kind of work wouldn't be coming to work with a rash, anyway.

And then the other thing to remember is that with contact sports, coaches, teachers, staff at schools, they're already quite vigilant about illnesses at school, period.

This really is about doing what we already know how to do, and that's making sure that if you're sick, stay home.

If you have a rash, stay home, get it investigated before you go to work or school.

And I think if we do that, everyone will be just fine.

- So Dr. Taylor, if someone has no symptoms of this at all, should they go ahead and line up for the vaccine, or with a limited supply, do you need just the people who have tested for this to come and get the vaccine?

- With a limited supply, and this is what we have on our website, too, we're asking that only people who are in high-risk groups line up for this vaccination, and we are being very forthright about the fact that once that supply has gone, we have to wait until the State of Tennessee sends us more.

So those high-risk groups are people who have had known sexual contact with someone with a known confirmed case of monkeypox, someone who... Men who have sex with men, someone who has had recent group sex, someone who has had contact with someone that they know has a confirmed diagnosis of monkeypox, those are our high-risk groups, and so right now, we're asking that those folks, as we have supply, line up, with the understanding that when you get here, we may be out, and we ask that everyone be patient, because I'm sure everyone knows across the nation, there is a shortage of this vaccine.

I think that we just have to be patient, wait and see what the federal government is gonna be able to do in order to increase the amount, and in the meantime, continue, continue to do all of the other things we know that we have to do to protect ourselves.

- I also wanted to shift gears a bit to talk about insulin.

Congress had a big discussion about capping the price of insulin, and they made the decision that they made, prices are escalating for insulin.

Is there a public health role, especially in a city, in a community, that has a significant problem with diabetes, for dealing with those kind of price hikes and the limits on availability that it causes?

- Well, in my opinion, the biggest public health role is at a policy level, advocating for the people that we know that we're serving every day who have diabetes and a need for insulin, but also advocating for the expansion of Medicaid in our state.

We know that we have a large population who would be eligible for Medicaid, but we also know that we are not an expansion state, and we know that a lot of the people who are suffering from these price hikes are people who would benefit from being able to be insured so that they can get this medication.

And so the public health approach, from this standpoint, would be to help our providers really advocate at a policy level to make sure that payers, insurance, will pay for these people to get their insulin.

It is so very important.

- You mentioned earlier, I believe I heard you right, your previous stint at the Shelby County Health Department was maternal care.

Does the overturning of Roe v. Wade and the implementation of various laws that Tennessee Legislature has put into effect prior to and since, does that change anything with care for mothers, for children, for pregnant women, through the Shelby County Health Department?

- It does not change a thing with care for Shelby County Health Department, and I'll tell you why.

First, we are not abortion providers, we never have been, so that's important to say.

But then, the other thing is we have a very robust family planning program, and the services that we provide through that program will continue, and we are looking at ways to make sure that we are able to expand that programming wherever possible, and sustain that expansion to make sure that families in our community can plan their families in the way they see fit.

- Just a few minutes left here, three minutes left.

I guess we're going into flu season.

The last year, last two years, were very, very light flu seasons, given that people...

I think it seemed that because people were distanced, they were masked, it had a positive effect on flu.

Are you expecting a bigger flu season this year?

- You know, we never know what kind of flu season that we are going to have.

We did see a bit of a spike early in the summer that kind of fizzled out, and now we're waiting to see.

I would suspect that as we have less people distancing, less people masking, you may see a rise in flu again, but it just depends.

We're gonna have to wait and see.

We will know better around October or November what the flu season is going to look like.

- There was also, in the pandemic, a huge spike nationally in opioid overdoses, drug use.

It seemed to be the isolation, just people who had a drug problem getting worse.

What is the Shelby County Health Department's role in... You've had an ongoing role in trying to deal with the opioid crisis.

What is that role?

- So we subcontract with some community partners to do a bit of harm reduction work, but right now what we're doing is we are planning to do a gap analysis to see if we can expand our role in that area.

As you can imagine, the services that are available across the county from all kinds of providers, are limited, but we do know that this is a significant problem, and we do know that public health has a role to play, and so as we get that gap analysis done and really figure out what else the community needs in this area, you will see us doing even more.

One thing that we do well right now is we have been following it through data and making sure that providers who need that information are provided that information, as well, and I am hoping that within the next year we will see even more robust programming coming out of Shelby County Health Department.

- And just one last question, anyone who's driven through the Medical District in recent year or so, there's a whole lot of construction going on around Shelby County.

What are those buildings?

What has that enabled for the Health Department?

- Oh, well, of course, you know, our headquarters is new, and the team actually moved into this new building right before I stepped into this role, in July of 2021, and then, of course, right next to us, we are preparing for a surface parking lot where the old building used to be.

And then some of the other construction, Le Bonheur is expanding some of their units, and then UT is building a series of units catty-corner from us for their students.

So yeah, there is a lot of movement going on in the community, in the medical community, here.

- Okay, Dr. Michelle Taylor, thank you so much for joining us.

Really appreciate you doing this by Zoom.

Again, for those who missed me saying it earlier, we recorded this about a week ago, but thank you for joining us, and thank you all for joining.

If you missed any of the show today, you can get it on wkno.org, or you can get the full podcast on iTunes, Spotify, wherever you get your podcasts.

Thanks very much, and we'll see you next week.

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