When will we get back to normal? An interview with the head of Kalamazoo County’s pandemic response
Jim Rutherford would like the Kalamazoo County Health and Community Services Department to get back to focus on what it usually does, like finding which restaurant caused an outbreak of food poisoning or making sure hazardous waste doesn’t ruin neighborhoods.
Contagious disease also falls under his purview and when a strange new virus coming out of China showed up in Kalamazoo, it took over.
“I think I’ve just resolved over the last couple of weeks that this is something we’re going to be doing for a long time,” Rutherford said in an interview with NowKalamazoo.
Until there’s a vaccine, he said, the main tools to the highly-contagious COVID-19 pandemic are “distancing, hygiene, sanitation, the availability of PPE, wearing a mask.”
“It’s just not rocket science,” he said.
When it comes to its impact on the community, things get complicated.
The virus has put a strain on society, exacerbating pre-existing hardships. People who are homeless, people who are underserved in healthcare, people of color, the elderly and others in long-term care facilities, are facing some of the largest impacts of the new virus.
“If we were struggling before COVID, with the advent of COVID it’s really going to create a significant amount of burden to a system that’s already burdened.”
And looming is an influx of more than 20,000 college students, adding more potential spreaders of the virus.
Below is the full interview with Rutherford, including how he is approaching the coming public school year, how the county is dealing with the global pandemic, what citizens can do, and what we might expect in the near future.
The interview was edited for length and clarity.
NowKalamazoo: When did you know this would be a problem for Kalamazoo?
Jim Rutherford: [Checking his calendar] I have a meeting that goes back to the early part of February … Feb. 4. I believe it was a call with the state public health department.
You heard early issues related to China, Wuhan, and at the time we certainly didn’t think it’d be as significant as it is now, and as it’s become. Those meetings in February continued to ramp up to the levels that, eventually, it consumed our days, and the days became a lot longer.
I’ve seen these types of diseases come in, but just not in my professional time, not to the level that this one has. I’ve been in public health for about 30 years now, and you get to a point in time when you look at your career and you look at some of the things you’ve encountered.
Prior to being here, I was the health officer in Calhoun County when we had the Enbridge oil spill, and in the middle of that – that went on for years as well – but in the middle of that I just thought to myself, it can’t get any more significant than this. [COVID-19] did, obviously on a global level. That’s what I liken this to, in terms of the amount of time and energy that we’ve devoted.
And you try to get to an idea of how long we’re going to be doing this, and I think I’ve just resolved over the last couple of weeks that this is something we’re going to be doing for a long time. As the seasons begin to change, and we start to look at fall, you just realize that the areas of concentration have evolved to where, now, I’m really focused on what it looks like to reengage our colleges, to reengage our K-12 system, early childcare facilities, whereas, you know, months ago I was really focused on – well, I go back to the beginning.
I go back to the beginning, and really, the focus from the start of this was just accessibility of testing, or the inaccessibility of testing, rather. And the challenges that ensued with the lack of testing capability. After that, we were able to get our federally qualified health center up and running, and the test kits became available, the challenges transitions as we continued to do tests, they evolved into the challenges of our vulnerable populations.
When we started testing, and identified that you’ve got a homeless population for instance, we need places for individuals who need to quarantine or isolate, where are they going to go? That takes a lot of time and energy to develop those contingency plans, because you’re looking at having to acquire hotel space, basically. We’ve talked to the universities, and it just wasn’t feasible for us to put these individuals in dorm-like settings, because they still had students that were in these dorms. So we’re ultimately able to enter into a regional quarantine and isolation facility, a 60-room hotel. The logistics of that are significant in that you just have a lot of considerations for this population that, you know, are challenges that relate to the daily need for three meals, the medical attention, transportation, the mental health needs were significant. That was several months of just exhaustive work. And at the same time that we were dealing with that, you’re dealing with the long-term care facilities, and probably 75 percent of the deaths that we’ve encountered have occurred or are a result of individuals in our long-term care facilities. We’re dealing with outbreaks within these respective facilities.
All the while, when we’re talking about homeless residents, and residents within long-term care facilities, you still have challenges with the staff that provide service within these populations and when they’re sick or when they’re too anxious to work in that environment, you come very close to potentially having to close it down, a homeless shelter or close down a long term care facility. So that’s a huge burden on the community.
I think that overall COVID has really identified some shortcomings, certainly at the national level, and that trickles down to the state and local level as well. We weren’t prepared for this, particularly as it relates to our vulnerable populations. We know that we have housing issues for homeless individuals to begin with, but when you add COVID to that, it creates just significant challenges. And it reflects, I think, the fact that if we were struggling before COVID, with the advent of COVID it’s really going to create a significant amount of burden to a system that’s already burdened.
Over the past few months some theories about the virus have changed. What do you know now about this that you didn’t know then, and what would you do differently?
There’s been a lot of additional information that’s come about. I think the biggest ah-ha moment for me, really – if you would’ve said to me early on, wearing masks was going to be such a critical part, what really became a big part of this was the hand-sewn masks that were almost a necessity, and that PPE was in a significant shortage. We have access through the fifth district medical coalition – so every emergency preparedness region in Michigan has access to personal protective equipment in a regional location. And when we started getting into that equipment, a lot of the masks had been around for a long, long time. The inventory that we did have – and there is a shelf life to an N95 mask, not so much the mask itself but the rubber band that attaches, it breaks much more readily if it’s been around for a long period of time.
I think we identified a real challenge with PPE, I think that people still, unfortunately, question the value of a mask when in my mind it’s pretty common sense that we’re trying to minimize the transmission of, you know, the two places on the human body that are going to be responsible for harboring the virus are found within the nose and the mouth. So if we can effectively cover those when interacting with individuals in closer proximity, then it just stands to reason you’re reducing the likelihood – I’m not saying eliminating – you’re reducing the likelihood of transmission significantly by utilizing a clean mask.
Basic hygiene is another part – really, transmission of a communicable disease, you can get it through airborne, you can get it through fecal, you can get it through waterborne, so we’ve known this in the world of public health for a long, long time. There’s not a lot of new issues with that. I think we go back and forth with the viability of the virus, and I still think there’s research that continues in terms of, I think they’ve pretty much known from the beginning, in terms of the incubation period, and the fact that it can actually take up to 14 days for somebody to really get a full amount of virus in their system. I think they’ve been good with the required amount of isolation and the required amount of quarantine, so I think we have a lot of history with coronaviruses, and obviously the fact that COVID-19 is considered novel, basically new, there’s a lot of research that has existed prior to COVID-19 about coronaviruses.
I think there’s some real applications from that. I’m still surprised at the amount of resistance and some of the silliness that I see that relates to the viability and efficacy of basic things like preventing the transmission from the nose and the mouth through the utilization of a mask, basic hygiene, and basic distancing. Those are not complicated, scientific processes, so much as they’re just common sense in my mind.
It’s no mystery. It’s not the 1800s when surgeons weren’t washing their hands. We know this stuff.
Exactly. The conspiracies and some of the silliness that goes on, are just – I don’t have a lot of time for.
In May, when plans were in the works to reopen businesses, MLive quoted you saying “This reopening is a big train, and it’s leaving the station, whether we like it or not.” Do you think that political and economic pressures to return to something like normalcy have overruled medical science?
If that existed in the beginning, I think it’s less present now. I do believe that this particular governor (Gretchen Whitmer) … I think that she’s listening more to science now than she’s done in the past.
It was new for that administration and it’s new for the state health department – I mean it’s new for everybody basically. You try to weigh the impact on the economics of our community and the economics of people that are unemployed. Certainly the stimulus and the availability of unemployment, the national incentive, I think has helped out. But I do believe it’s important that we try to get to some level of a semblance of [normalcy].
I guess I liken this to the schools right now. I’m a proponent of schools, particularly if we can stay in phase four [of the state’s six-phase MI Safe Start Plan], of getting back up and getting in-class learning. I think, we go back to that population, kids under the age of 18, this really hasn’t impacted them compared to the level of impact for people over the age of 70.
I still think that it’s important that we take all of the measures to heart, and we’re working again with K-12. I know the schools are actively working very hard to be able to accommodate all of the requirements and recommendations of the MI Safe return to school roadmap.
I have noticed that Gov. Whitmer does seem to listen to the epidemiology that we have available, the data, and I think of late some of the decisions being made are data-driven. However, when I look at other regions within the state, for instance Lansing and Grand Rapids, where they’ve moved from a phase four to a different phase, there doesn’t seem to be any repercussions associated with that. And by that I mean, the governor may have gone in and put some restrictions on bars, it doesn’t seem like that’s had a significant impact, and it seems like most bars continue to remain open. I question how effective that particular executive order might have been.
Do politics play a part? Certainly. But I do think that the governor and her staff are looking at data, when making decisions.
Based on what we know now, should we have kept maybe a more of a stay-at-home policy in place?
No, I think the restrictions being lifted were probably timely, and I think the community in Kalamazoo, particularly, we have seen a little bit of an uptick [in cases], but that was anticipated. When you ease restrictions and you have more people out and about their business, you’re going to have more social interaction, so it was expected that we’d have some additional cases. We’re seeing younger people that are testing positive a little bit more.
I think people need a gentle reminder that mask-wearing helps to reduce the transmission. I do believe you’re going to garner some level of herd immunity. I think the ideal situation is that we get a viable vaccine option, particularly for those vulnerable populations, people over the age of 60 or 70, people that have pre-existing health conditions. I have talked to people, some of the younger people, talked to younger parents, and I think you’re going to get some reluctance from them to either vaccinate themselves or have their children vaccinated, and I think the primary reason for that is there’s some fear as it relates to a new vaccine. Obviously there’s controversy around vaccines in general, and you’re always going to have that anti-vaccine population, it’s not significant but it’s out there. I think you’re probably going to get a relatively higher level of people under 30 that are reluctant to vaccinate.
But I’m hopeful that those vulnerable individuals, that are trying to abide by the executive orders, are able to vaccinate and I think that’s going to add to their level of confidence and comfort in terms of going out and about. Many of them have a lot of anxiety going out because of either their age or because of their health condition. So we’re anxiously anticipating the availability of a vaccine, hopefully early this winter.
You mention the uptick, there’s a bump in the new cases rate happening in Kalamazoo and Michigan – not like Arizona, Texas and Florida – but what we’re seeing now, could it become a huge spike, is that something we should be prepared for in the fall? It is possible that it could just jump as schools reopen, so …
It’s difficult to predict. I think the uptick that we’re experiencing, particularly in Michigan, is the result of more people, younger people, out and about and interacting and probably not adhering to the recommendations for wearing a mask and distancing. This isn’t a terrible surprise, and I think that in Kalamazoo, we’re still in a pretty good spot. We’re still in phase four – there’s been talk about Muskegon, Kalamazoo, being kind of on the edge. But I’m hopeful that we can continue to make good progress.
The reality is, in about six to seven weeks, we’ve got the introduction of 20,000 new students at Western Michigan University and Kalamazoo College, at KVCC. And you’ve got 15,000 K-12 students that are going to be reintroduced back into their schools. I don’t have a crystal ball as it relates to what that’s going to look like. I’m hopeful that we’re going to effectively implement the tools that we have that are readily available, absent a vaccine – again it goes back to distancing, hygiene, sanitation, the availability of PPE, wearing a mask.
Again I go back to the advantage that we have with COVID-19, is that it has not had a significant impact on this age group. I’m hopeful that that continues.
It might not have an impact on them, but they might not even worry about it, as you see in video clips of parties and bars, young people close together – they might feel invincible. But they’re going to spread it to the rest of us, they’re going to go back to Mom and Dad and —
Yeah, and I just expect a challenging population, in that they really haven’t encountered it, so a lot of them may feel that way, but we continue to try to work with them. In talking with representatives of our colleges, they’re going to be very diligent about [students] wearing a mask. The last thing that any of these schools want is an outbreak, or worse, to have a fatality of one of their students or even one of their students getting very ill as a result of this. I think they’re taking every precaution that they can, and it’s taking that step forward, similar to that step we took in May when some of the restrictions were lifted, going into restaurants – theses are just steps we have to take as a community, and we just don’t have all the answers.
So you kinda have to take a leap of faith, and abide by the best practices we have available. And when we practice the right way I think the results are going to be better than if we don’t, as evidenced by what we’ve experienced with some of these larger group gatherings ending up with outbreaks.
If there’s a worst-case scenario, if there’s a big spike of new cases in the fall, are Kalamazoo hospitals ready? What do they need if they’re not ready?
I think that our health systems are in good shape. Their capacity remains good. We meet with them twice a week, their PPE is in good shape … From a regional standpoint, the Kalamazoo region is in good shape.
From our perspective, our testing capacity is much better shape than what it’s been in the past. We are fortunate in Kalamazoo that we have our own laboratory here. There’s five counties that have a regional lab, and Kalamazoo is fortunate enough to be one of those counties. So we have acquired some quick-testing equipment, so we have an Abbot ID quick test unit and a Panther quick test unit. And then we’ve been able to acquire over 3,000 test kits that we’re sitting on, basically, with the intent if we need to go out and do some disease investigation, we’re ready to do that, and we’ve got the resources to be able to do that quickly.
The quick test units allows for us to make good informed decisions rapidly, so that if I have to do quick closure or quarantine or isolation, it helps with us to be able to provide rapid contact tracing. I think from a public health perspective we’re in good shape. We’re in as good a shape, if not better, than many other communities because of that laboratory capacity.
How is Kalamazoo’s contact tracing?
We’ve always had very vibrant communicable disease investigation team, so public health has always done disease tracing. Oftentimes we’ll do food-born outbreaks and a lot of that is based upon contact tracing, and following suit with who could’ve been exposed, what is the source of the exposure, what is the source of the infection, and just following that web out to be able to make sure that those that need to quarantine and isolate are effectively doing that, thereby mitigating or reducing the likelihood of further exposure. And that’s what public health has done for decades.
You’ve answered this over and over without us asking, but let’s just to make sure it’s clear: What would you really like the citizens of Kalamazoo to do, and to not do, to keep COVID-19 from spreading?
I guess basically I want people to understand that this is a communicable disease that’s transmitted from person-to-person, so be aware of that. Take the necessary precautions. I don’t want them to be afraid to interact and go about their day. The things that are being asked are not that significant. To wear a mask when you’re going to be out or when you’re in close proximity. To distance, I think is important.
Try to avoid misinformation and be aware of where you’re getting your information. Try to stay away from conspiracy [theories] or silliness that sometimes gets in the way of good factual data and common sense things like wearing a mask and hygiene. Hygiene has always been the cornerstone of public health, practice good hygiene. Again, it’s just not rocket science.
What is a day in the life of Jim Rutherford like now?
It’s a big part of my life, and has been and will continue to be. I’m at the latter part of my career. I love the work that I do, and we’ve got some phenomenal people here at the health department, we’ve got phenomenal people as partners. I’ve grown to have so much respect and admiration for the people that are at our shelters, the people that are in our health systems, the people that are at places like the United Way, our housing specialists, people within our long-term care facilities.
So for me, this brings out the best in our community, and that’s why I get a little frustrated with the silliness that goes on sometimes with the politics, or the misinformation. Because 90 percent of this is just good and people want to do the right thing. I think these are extremely trying times, and it’s difficult sometimes for me to go home and watch the news at night. My wife used to say, ‘why are you even watching that?’ Because I’m mired all day long with what’s at the state and local level, I really need to get a national perspective and this helps me to accomplish that. But sometimes you just gotta turn it off. Just like everyone else, I’m tired.
And in public health – we need to get back to doing some of the basic public health that we do. We’ve always continued to do restaurant inspections, immunizations and our WICC program and our home visitation program, our maternal/infant health program. So it’s just wanting to spend more time and get back into that work, and knowing that there are people who are doing that, but it’s a challenge because this is all-encompassing, and it will be for quite some time.”
I’m optimistic, I think we’re better today than we were two months ago, and I’m a little anxious about those next steps, particularly as it relates to schools, but you just take it one day at a time. Continue to do good work with good people, and we’re gonna win in the end.
It seems like we should look at this as a natural disaster, no different than if a hurricane has hit, and your house might not be flooded, but your neighbor’s house is going to be flooded. Everybody’s got to pitch in.
Yeah, but the only difference between that analogy is that when science plays a role, it can be more complicated for people to grasp something that they can’t really see. You can’t see a virus with the naked eye. You certainly can feel it, but you can’t see it.
And the other thing I didn’t really focus on is that we’re right on the corner of coming into our cold and flu season. So that adds a whole other layer of complications as it relates to the importance of people getting their flu shot, the importance of knowing what is an influenza case and what is a COVID case, versus the common cold. And believe it or not, the common cold is in the coronavirus family. So, that’s going to add another layer of complexity to this. And the potential for how that interplays with the COVID world will be interesting moving forward. To say the least.
Anything else you’d like to add?
No, I don’t think so. Just the focus on how this is impacting minority populations, how it’s impacting people who, it’s not a huge surprise that we’re seeing more African Americans testing positive than white people. It’s just not a surprise to see people that have inaccessibility to health care, they’re [being impacted] the worst. That’s why there’s such a concern with homeless population and underserved individuals, those are the people who oftentimes have their own health issues that lend themselves to the complications.
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