Posted by Dr. Honora Norton
Dr. Bob England former Director of Public Health, Maricopa County Health Department and former Director of Pima County Health Department was the recent keynote speaker at the Rotary Club of Scottsdale's weekly Zoom meeting. Dr. England has served in numerous roles at the Arizona Department of Health Services, including medical epidemiologist for HIV & STD services, chief medical officer for the Bureau of Epidemiology and Disease Control, TB control officer, and state epidemiologist. He previously spent several years as a local health director in Connecticut.
Dr. England shared many lessons learned during the early stages of the Coronavirus outbreak, including: lack of testing; unknown actual mortality
rates (likely 2-3 times higher mortality rate than typical flu); lack of available post-antibody testing study data; fast decisions made without
reliable data and expert input; unknown economy impacts and impacts to the health providers, businesses (closures) and people (unemployment);
prevention  - masks (noting often not being worn correctly), washing hands, social distancing, curfews, closures, no visitations, etc., mental health
impacts (suicide rates have doubled), and more. 
Per Dr. England, medical and government officials realized early on that no matter what decisions were made, people were going to die and it would beimpossible to balance the enormous economy and health damages. 

Dr. England stated, area hospitals have seen dramatic increase in admissions over the past few weeks, especially in Pima County. He discussed the
coronavirus individual timeline from incubation, getting sicker, then better, then sicker, testing, procurement of lab results (in his own case 9
days) and investigation time can take anywhere from 2-3 weeks.  Therefore, any reported COVID-19 counts lag 2-3 weeks behind reality. 

When asked to describe those most vulnerable to COVID-19, Dr. England stated the virus can seriously affect those with: heart, lung, and major organ diseases; unmanaged diabetes, hypertension and obesity; residents in long term care facilities; mass transit travelers; and those aged 65 years+. Additionally, social economic status and access to healthcare and basic hygiene options can increase vulnerability.  Anyone at risk is open to getting infected more often, especially with those with poor hygiene. 

Dr. England responded to questions from the Rotarians related to COVID-19 resurgence during flu season and respective preparedness for the next flu season. 

In closing, Dr. England's best advise was - anyone over 50 and at risk should limit his/her opportunities to attract and transmit COVID-19. The
fact is more transmissions are going on now than in March.  The time and level/closeness of exposure to COVID-19 can significantly be impacted by a sneeze, a cough and even one on one talking.  These exposures can expel a loading dose of over 1,000 virus particles/droplets especially indoors.