Editor's Note: Dr. Brobson Lutz is an infectious disease specialist who practices in New Orleans, Louisiana. In his own words, Lutz shares his experience treating COVID-19 and dealing with the symptoms himself.
New Orleans physicians have provided care for persons with infectious diseases from our city’s beginning. My predecessors tackled smallpox, cholera and yellow fever in the 19th century. In the 1900s, we had seasonal polio outbreaks and several major influenza epidemics beginning with that infamous 1918 pandemic.
More recently, in the early years of the AIDS epidemic, physicians in New Orleans were the only beacon of hope for hundreds of patients from across Louisiana and half of Mississippi. Treating patients with scary infectious diseases is woven into the fabric of local physicians and nurses. It is in our collective DNA.
I am humbled to be on the current frontline following my predecessors. As a primary care physician sidelined from active hospital care in this era of hospital employed hospitalists, my current mission is to do everything possible to help my patients with COVID-19 infections avoid hospitalizations.
Every winter, visits and telephone calls from patients with respiratory illnesses spike. These spikes correspond with the entry of influenza into the community tempered by such factors as how close the seasonal vaccine matches the primary viral culprit of the season.
Most of my patients opt for yearly influenza immunizations, so in a good year when a vaccine matches, I see fewer flu-like illnesses. When calls increased in January, I assumed that this was one of those years when the vaccine was not a good match with the circulating influenza strain. Gosh, was I wrong. I believe archeological serologic investigations will show COVID-19 crept into New Orleans and other cities months before we began to endure President Trump’s daily press conferences.
In retrospect, I began seeing COVID-19 infections in January. One stands out. Tyler is a student at Tulane University from Massachusetts. He gave me permission to use his name. Tyler sent me an email asking if he could come see me the following Monday. He had a fever and sounded awful on the phone. He added, “It is going around. Everybody at school is sick.” We arranged to meet that same day at my office. It was Saturday, Jan. 25.
Tyler had what seemed like influenza in reverse. Typically, influenza hits like a freight train with the sudden onset of fever, chills, and muscle aches and pains. Patients often pinpoint the exact hour of their initial symptoms. Tyler described just the opposite. He had the insidious onset of a sore throat and cough that got worse over four to five days, culminating with a fever of 101.5 when he saw me. I diagnosed a post-influenzal bronchitis.
About five days later I had what I suspected to be a mild “winter cold” with some nasal congestion and a cough. For a couple of nights, I experienced mild chills, but I didn’t feel feverish enough to chase down a thermometer. My symptoms dissipated over the next few days. I fled New Orleans for a week in New York City just before Mardi Gras in late February. My symptoms were consistent with what we now see with a mild COVID-19 infection.
Nationally, we are fighting this epidemic with a fractured, broken and depleted public health system. Federal budget cuts beginning with the Reagan administration and continuing over the past few decades decimated public health funding nationally. The situation is even more challenging in New Orleans. Bobby Jindal, a former Republican governor, eliminated much of our state health department. And former mayor Mitch Landrieu, a Democrat, slashed the city’s health department budget and closed multiple public clinics.
In New Orleans, the COVID-19 daily death rate remains elevated consistent with complications and downward spirals in persons hospitalized weeks ago. The number of positive cultures represents expanded testing more than an ongoing epidemic curve. But most importantly, our number of new hospitalizations has plummeted.
From a historical standpoint, our current death statistics pale compared to the yellow fever epidemic of 1853. The mayor was accused of not doing enough. Driven by the data of that era, he ordered the firing of cannons and the burning of tar pots to purify the air. Over 7,000 New Orleanians, about 10% of the then population, died that summer with up to 300 daily burials at the epidemic’s peak.
As a New Orleanian, I am concerned that our municipal government is moving too slowly to reopen our city. Our mayor feels compelled to continue more strenuous quarantine measures than our governor.
New Orleans should not drag out COVID reopenings to match the demolition of the collapsed Hardrock Hotel building. Those ruins have been standing since October. It makes no sense to me to allow open grocery stores and forbid restaurants from opening with spread out table service. Our small retailers are suffering.
I can go in Costco and buy living room furniture, but the local mom and pop furniture stores in New Orleans remain shuttered by the mayor’s orders.
Her intentions are no doubt good but closing parks, prohibiting even partial in-restaurant dining, and an emphasis on increased test numbers are akin to firing cannons and burning tar in my opinion. She says she is driven by data not dates. However, I worry that she is using statistics like a drunk uses a light post – more for support than illumination.
Dr. Brobson Lutz was born in New Jersey but learned to talk in Alabama. His undergraduate degree is from Vanderbilt University. He attended medical school at Tulane following by internal medicine and infectious training at Charity Hospital. He also has a Masters in Public health from Tulane. He was appointed as the New Orleans Director of Health in 1983, a position he held for 11 years. Presently, he is in full-time private practice. He is a bee keeper and also raises Birmingham roller pigeons.