Dr. Bert Eichold, chief health officer at the Mobile County Health Department (MCHD), said to think of it like a wildfire. If you create a fire break — an area of land cleared of dry vegetative fuel ahead of the main fire line — there is a chance of suppressing its progression.
“With the novel coronavirus, it’s trying to get to another source of human beings so it can continue like a wildfire and burn out of control,” Eichold said Monday. “So, the social actions we took as an agency were similar to a fire break. If you let the fire get so hot and so out of control, nothing can stop it until there is no fuel left for the fire.”
For COVID-19, humans are the fuel.
That is one reason Eichold determined, in what some consider a controversial decision, to close all restaurants and bars in the county to dine-in patrons March 18 by a mandatory health order, the first he’s issued in his 30-plus year career at the MCHD. But it’s not the only reason. There is also a lesson from history.
“What was going on in China and worldwide with the dissemination of COVID-19 was very alarming to me and I think my training in public health brought me back to experiences that occurred in the last major pandemic, the 1918 Spanish flu,” he said.
One of the teaching points of that pandemic, he said, was the response to the Spanish flu in Philadelphia, Pennsylvania, versus the response in St. Louis, Missouri.
“In Philadelphia they didn’t take it seriously and by the end of the season they allowed parades to go on and public gatherings — 12,000 residents died in Philadelphia,” he said. “In St. Louis the public health commissioner ignored the objections of the influential businesspersons and closed the city schools, bars, cinemas and sporting events, and due to that unpopular action the fatality rate in St. Louis was 1,700 people. So, history has a tendency to repeat itself and those that don’t experience it, we have to rely on training and reading, and I don’t think a lot of people have been reading about pandemic flus or have been taught pandemic flu until now, when it’s a crisis.”
Eichold’s order carried a term of one week and is set to be re-evaluated March 25. But last Thursday, Gov. Kay Ivey issued a similar order for restaurants and bars statewide, adding Gulf beaches, child care facilities and gatherings of 25 people or more to the list of closures through April 5. As of Monday, Eichold appeared to still be displeased with the availability of local testing or positive statistics and couldn’t say whether the orders would be rescinded or extended.
“We had gone from one case on March 13 to 39 cases on March 17, and currently since March 13 [the state of Alabama] now has 167 cases over 12 days,” he said. “Some people said you need to wait until there is a case in Mobile, but public health would say you need to prevent [infections] from occurring if at all possible. And once the adverse event starts happening, you need to pull a domino or two out of this chain of events before we have a catastrophic outcome, similar to what happened in 1918.”
When the Spanish flu pandemic subsided in 1920, estimates were between 50 million and 100 million worldwide had succumbed to the illness, or between 3 and 6 percent of the global population. Roughly 675,000 died in the U.S., according to the Centers for Disease Control and Prevention.
Eichold attended Tulane University, where he obtained a bachelor of science degree, master of public health degree, medical doctor degree and a doctorate of public health degree. He was appointed Mobile County Health Officer in 1990.
“Pandemic flu was not my area of study or concentration, but it was subject matter we all needed to know about,” he said, adding basic courses of study included the history of public health. Those included lessons such as how Hungarian physician Ignaz Philipp Semmelweis established basic hygiene guidelines like hand washing, and how England developed wastewater systems after “The Great Stink” of 1858 and to lower the risk of water-borne diseases like cholera and typhoid.
“There is a lot of history,” he said. “Traditional public health is what has extended life expectancies of people around the world from immunizations, sanitations, nutrition and clean potable water. Public health is important, but right now it’s inconvenient.”
MCHD actually predates the state of Alabama and today, along with the Jefferson County Department of Health, it remains one of only two county health boards in the state. The other 65 counties are served by local extensions of the Alabama Department of Public Health out of Montgomery.
The health officer is elected by the seven-member Mobile County Board of Health, which includes six appointees from The Medical Society of Mobile County plus the president of the Mobile County Commission. The board meets nine times each year, but Eichold said the COVID-19 threat “happened so quickly,” his order was not vetted by the entire board.
“The last board meeting had already occurred and the next board meeting was going to be a month away, so in consultation with Jefferson County, the state health officer and the chairman of the Mobile County Board of Health, the Mobile County Health Department issued the health officer’s order as allowed by Title 22 of the state code under extreme circumstances,” he said.
Since the order, Jefferson County became the first and only county in the state to close all but “essential businesses,” but no county in the state has issued a stay-at-home order. Across the country, more than 17 states have issued stay-at-home orders, currently affecting roughly 40 percent of the population.
“I think it’s a moving target,” Eichold said. “Jefferson County is probably getting ready to increase activities as far as regulations and I think we can see what happens in Jefferson County with new case reports. So, if they get a leveling off of new cases with more aggressive regulations, then yes, the entire state will probably model after Jefferson County. Or if there is leveling off with more aggressive measures in other states, I think [the state health officer] and his team and the governor will recommend more aggressive activities.”
But Eichold said he didn’t think it would change locally in the next week.
“With this particular illness you wake up one day and something different has happened,” he said. “I just hope the United States doesn’t look like Italy, and I hope Alabama doesn’t look like New York in regards to this illness and the number of people infected.”
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