RICHMOND, Va. -- Danny Avula knew he wanted to be a doctor in middle school, but it was not until his third year in medical school that he realized public health was his calling. The idea that where you live, your job, and your income could have a major impact on your health fascinated him.
"The fact that some communities were healthier than others, and some were impacted by culture, and policy, and access," Dr. Avula said.
Avula now experiences that every day.
He, his wife, and their five children live in Church Hill, not far from some of the most impoverished parts of the City of Richmond.
They are areas that Avula said are most vulnerable to the COVID-19 pandemic.
"Because of the lens we bring in public health about structural inequities, and the fact that that means African-Americans, in particular, are going to feel the brunt of this disease more severely," Avula said.
Avula runs both the Richmond and Henrico Health Departments.
And, similar to Dr. Anthony Fauci on the national level, to many, Avula has become the face of the fight against the coronavirus in Central Virginia.
"I was walking my dog the other day, three people, one driving by and two people who walked past, said, 'Hey, you're that doctor,'" Avula said.
Avula has worked around the clock for weeks, often appearing on television as COVID-19 turned from a potential risk to a real crisis.
"Undoubtedly there has never been a public health threat that has consumed me and our team like this has," Avula said.
Much of that time and energy has been focused on the outbreak at the Canterbury Rehabilitation and Healthcare Center in Henrico's West End.
With 46 deaths, it is likely the worst situation of its kind in the entire country.
"We as a society are constantly looking for the villain or scapegoat in this situation, and I'm just not sure that exists here," Avula said. "Them being on the front end, that occurring at a time where we weren't making these recommendations to preemptively cohort staff, or isolate based on symptoms versus waiting for a diagnosis."
So far, Avula said there are outbreaks at 16 long term care facilities in his districts, and that number is rising.
"All of the standard practices we've used with other diseases, those things have worked with other diseases in this setting, but it's not working here," Avula said. "For example, let's say you test three roommates at a nursing home for the virus and two of them test positive, but one tests negative. You immediately isolate the two positives, but what about the negative? Where do you put them? Because it's possible they could have contracted the virus in the time it took to get a test result back."
Avula said the answers to these questions are all having to be figured out on the fly.
"But you can see, as you think about where health care workers are working, and how they're moving through different floors, and on different units, that creates a complicated puzzle to sort out," Avula said.
Complicated indeed, and it is not something Avula believes is going away anytime soon.
He is predicting a COVID-19 peak in Virginia in early May.
"We've got two months plus on the downside of that curve before we can really stop doing the physical distancing and stay at home guidelines. I really do think it's mid summer or later before we are able to lift those," Avula said.
Doctor Avula said he recognizes the dramatic economic hardships the restrictions are creating, especially for low-income families. But, he said we do things as a society that are for the good of others.
To that end, he is pushing to create walk up testing sites in specific communities starting next week.
Most patients with COVID-19 have mild to moderate symptoms. However, in a small proportion of patients, COVID-19 can lead to more severe illness, including death, particularly among those who are older or those who have chronic medical conditions.
COVID-19 spreads primarily through respiratory droplets produced when an infected person coughs or sneezes.
Symptoms include fever, cough, and difficulty breathing. Symptoms appear within 14 days of being exposed to an infectious person.
Virginia health officials urged the following precautions:
- Wash your hands often with soap and water for at least 20 seconds.
- Use an alcohol-based hand sanitizer only if soap and water are not available.
- Avoid touching your eyes, nose, and mouth.Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
- Clean and disinfect frequently touched objects and surfaces.Stay home when you are sick.
- Avoid contact with sick people.Avoid non-essential travel.