Side effects of pandemic mitigation | A conversation with Dr. Rene Bravo

Dr Rene BravoMany people have expressed frustration with the massive regions dictating new business closures and stay at home orders. But Dr. Rene Bravo’s recent social media post prompted us to reach out to hear a perspective from the medical community. Bravo, one of San Luis Obispo’s most highly respected pediatricians, also served on the California Medical Association committee advising the governor on reopening. Here are some highlights from our conversation. 

On the danger of losing public trust

Pandemics and epidemics have natural life cycles. And we’re trying to slow the spread. But if we’re giving the perception to the public that we can completely stop it, that’s not accurate. We’re just buying time to get people vaccinated. And if we lose credibility in controlling the population, then I think we lose credibility in vaccinating people. We’re losing a lot of our goodwill capital by some of these moves.

On the new restrictions and regions determining them

I was happy to hear that they were going to be including hospitalization and ICU utilization in determining what level of closure to articulate. Because if we just look at San Luis Obispo County, we would be doing great. But when they lump us together with 20 million other people in Southern California, a region that’s profoundly diverse, that just speaks doom for us.

What we need to do is regionalize this and allow for more local control. With local control, you’re gonna have more accountability. And people will feel a little bit better that there’d be accountability to elected officials rather than to one central situation.

Monterey, San Luis Obispo, Santa Barbara, Ventura County — I think this should just be one region, because the hospitals talk to each other here, and the public health departments know each other, and I think that would probably make a lot more logical sense.

More regionalization is going to be important, because I respond better to my neighbors than I do to a faceless bureaucrat in Sacramento. On the flip side, I think Sacramento has a difficult, difficult, difficult job. The governor, I would not want to be him right now because he’s going to be making  someone unhappy everywhere he turns. But they can tighten the regional control a little bit better than they have because if they don’t, they’re going to invite revolt. And I fear that we’re losing track of what we’re trying to do because what we’re trying to do is control a pandemic and not restrict people’s freedoms.There has to be a balance in there.

On the situation in SLO County 

My prediction, once the population of Cal Poly empties out, which it just has after finals week and it’s gonna be gone for a month, we’re gonna see probably a fairly significant change in the demographics because most of the demographic in this county is the 19-30 year-old age group. So we’ll probably see that decline. (In coming months) we’re going to see increasing numbers of people who are at least partially protected by this vaccine. So everything is on the horizon. And then they closed down the businesses. That sends the wrong message.

On protecting the vulnerable and mitigating spread 

Limiting people’s exposures, creating a social habit of masking and social distancing — I think that’s been spot on. There’s no question that there’s science that’s behind that that’s showing that that’s helpful and useful. The other part of it is trying to specifically isolate the most vulnerable within the community. It’s clear that senior citizens, people in nursing homes, people with significant medical conditions are at the highest risk, so they need to be at the top of our consideration in terms of isolating. The third thing I would do is make testing more abundant than it is right now. I don’t know. People realize we’re running out of testing supplies again. Um, yeah. I mean, because it’s such a demand for it. And I would allow for more voluntary compliance because I think people will be much more amenable to complying if they’re allowed to do it voluntarily rather than being forced to.

On business compliance with measures 

Most of the restaurants are doing the right thing. They spent money on tents and everything else, and to suddenly say that you’re being shut down while the big box corporate stores are being allowed to stay open under the guise of essential —I think that’s unfair. And then there’s a lot of little industries in there like the gym, the health fitness people — they’re openly just revolting. And they have a point because they are in the business of keeping people healthier.

Let the businesses stay open, but provide them with all the tools to do it safely. The City of SLO  is a good example of what they did with the restaurants. They allowed them to open the sidewalks. That was giving them a fighting chance of survival. I applauded that. I thought that was a great thing to do. Now they’re gonna kill that. That’s just not right.

On the long-term effects of economic shutdown on public health 

When I’m talking about preserving the economy and business, I’m actually talking about the future because the kids that we saved from this are going to have to inherit something that isn’t destroyed. We could spend the next generation trying to recover from all this, and and we can do some of this, prevent more of the economic destruction

I haven’t even touched on suicide, depression, social isolation. The public health people, even the American Academy of Pediatrics is starting to really ring the bell that we’re seeing a lot of harm coming to children in poor home environments. Depression, social isolation, suicide, crime. This whole thing is just exacerbating the pathology that normally exists in society. We don’t want the cost of controlling the virus to be greater than the mortality and morbidity of the virus.

On whether higher numbers should dictate a shut-down

I do think it would be wise to do that, but I think it would happen naturally. People would voluntarily do that. As numbers go up, I don’t think you have to tell people to close down. I think people will do it naturally. I think we’re underestimating the response of private citizens. This is a unique area for that. There’s a lot of personal responsibility here. People are very socially conscious on the coast, you know? They care about their environment, they care about education, they care about the quality of lives. That’s what we’re here.


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