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Dr. Rohr-Allegrini, Epidemiologist & Scientist talks COVID-19

San Antonio’s own Dr. Rohr-Allegrini whom headed up San Antonio’s flu pandemic response for the H1N1 pandemic joins The Alamo Hour to discuss what is going on locally and globally. She gives us her insight into the virus, San Antonio’s response and the unknowns, currently.

Transcript:

Justin Hill: Hello and bienvenido San Antonio. Welcome to the Alamo Hour, discussing the people, places, and passion that make our city. My name is Justin Hill, a local attorney, a proud San Antonian, and keeper of chickens and bees. On the Alamo Hour, you’ll get to hear from the people that make San Antonio great and unique and the best-kept secret in Texas. We’re glad that you’re here. Okay, welcome to the Alamo Hour. Today’s guest is Dr. Cherise Rohr-Allegrini. Did I say that right?

Dr. Cherise Rohr-Allegrini: You got it.

Justin: All right. I’m joined with her and my dog Winston, in case you hear him bark, I apologize. Our guest is an infectious disease epidemiologist and consultant, has a long list, a long resume. I think one of the more important things or what I thought was interesting was you were the pandemic flu coordinator for San Antonio Metro Health District, which I think probably has a lot of overlap to what’s going on right now.

Dr. Rohr-Allegrini: Yes, that’s right.

Justin: We’re going to get to Covid, we’re going to get to how people are responding and reacting, what San Antonians should be doing to make sure they’re looking out for their neighbors. First, I want to go through just a few general questions with you and get to know you. This is the first time we’ve met. Jody Newman told me I should reach out to you and you were gracious enough to give me a little bit of your time. Do you have any pets?

Dr. Rohr-Allegrini: I do. I have a dog, Chico, and three cats.

Justin: All right. One thing I did notice, you and I both have been where I live for Rivard Report.

Dr. Rohr-Allegrini: Right. I actually did a lot of writing for Rivard Report.

Justin: I saw that too. [laughs]

Dr. Rohr-Allegrini: It’s a great series.

Justin: Favorite place to eat right now?

Dr. Rohr-Allegrini: Right now? Thai Lucky. Or there’s a Chinese place on the west side, whose name I always forget. It’s on Ingram Road and we go there for takeout quite often.

Justin: Is it the one behind the mall?

Dr. Rohr-Allegrini: Yes.

Justin: Okay. Kind of a younger lady who runs the show?

Dr. Rohr-Allegrini: Yes, probably.

Justin: I think Jody and her husband took me there.

Dr. Rohr-Allegrini: They go there a lot. Yes.

Justin: It’s fantastic.

Dr. Rohr-Allegrini: Awesome. Yes, it’s our favorite place. My kids keep asking when we can go get takeout again.

Justin: Okay, so I think you’ll probably have a good answer to this. Everybody that comes to San Antonio, I always say, “Okay, you’ve done that but you’ve got to go do this.” What is your sort of hidden gem you tell everybody about?

Dr. Rohr-Allegrini: Usually, it’s a friendly spot.

Justin: Okay, fair.

Dr. Rohr-Allegrini: It’s not really hidden but it’s one of my favorite places to hang out. I often just say, “Just take a stroll along the river, it’s absolutely wonderful.” I love walking downtown super early in the morning, 5:00 AM, 6:00 AM when nobody’s out, it’s really quiet and beautiful.

Justin: Japanese Tea Gardens is one of them.

Dr. Rohr-Allegrini: That’s gorgeous. Yes.

Justin: I’ve had a guest say Esquire Downstairs. There are some hidden gems.

Dr. Rohr-Allegrini: Right.

Justin: Other than your job or your professional involvement, which we’re going to talk about, are you involved in any outside nonprofits charities that you’re all passionate about?

Dr. Rohr-Allegrini: I’m involved in a lot of things, I wear a lot of hats. For a long time, I was the president, I’m not anymore but friends of Bonham Academy which is our public school, we have a foundation that supports Friends of Bonham. I’ve been with them for eight years or so. It’s a Title I SAISD School and we’ve done a lot to raise funds for their programs there.

I am also the president of my neighborhood association, the Lavaca Neighborhood Association. I have been doing that for a few years, so heavily involved in urban planning issues and community issues at that level.

Justin: Your neighborhood, it sounds like everything’s kind of right there.

Dr. Rohr-Allegrini: Yes. Yes, absolutely.

Justin: Any odd hobbies?

Dr. Rohr-Allegrini: Odd hobbies.

Justin: You make birdhouses, you quilt, anything strange?

Dr. Rohr-Allegrini: No. I feel so boring. God. I do a lot of things. I’m usually so busy doing different things. I’ve got kids so that takes up a lot of my time. I love theater, mostly to watch and memorize all the songs, I don’t actually perform. My kids are in theater, so I support that. I used to play soccer, I don’t anymore. I used to be a diver and I’m not anymore, but I try to do a lot of little things here and there. I’d love to tell you I have one hobby and now I don’t know. I’m usually supporting my family’s hobbies. [laughs]

Justin: Yes, jack of all trades- [crosstalk]

Dr. Rohr-Allegrini: That’s what happens when your mom too. [laughs]

Justin: This is one of my favorites. I had a mullet when I was a kid, what terrible trend did you follow?

Dr. Rohr-Allegrini: I’m so not a trendy person. I feel like I’ve had the same hairstyle since 1995.

Justin: Not when you were 14.

Dr. Rohr-Allegrini: No. I’m trying to think. When I look back at those photos, my God, they’re not any different. I was, “Something’s wrong with me.” I was never that cool.

Justin: The first guest is [unintelligible 00:04:43] and his horrible trend was he had a picked out Afro which is just funny– [crosstalk]

Dr. Rohr-Allegrini: All right. That’s awesome.

Justin: How long have you lived in San Antonio?

Dr. Rohr-Allegrini: I moved here in 2001.

Justin: Favorite Fiesta event?

Dr. Rohr-Allegrini: King William Parade.

Justin: Okay. All right. That’s I think the standard now among every guest has been the King William Parade.

Dr. Rohr-Allegrini: Really? That’s great.

Justin: Yes.

Dr. Rohr-Allegrini: It’s my neighborhood event. I would say the fair except usually we just do house parties during the fair. I don’t really go into it anymore but it’s like a big community party.

Justin: My law firm is the first aid station sponsor for King William Fair.

Dr. Rohr-Allegrini: Wonderful.

Justin: Yes, yearly.

Dr. Rohr-Allegrini: Awesome, that’s great.

Justin: You’re the only second epidemiologist I’ve ever met and the first had some sort of strange interest and I want to say crop funguses, would that be right? Would that be an area of epidemiology?

Dr. Rohr-Allegrini: Absolutely, that’s an area. It’s a disease of plants.

Justin: Do you have any weird specific interests among epidemiology? I saw your post today about armchair epidemiologists, apparently, that’s an interest but any others?

Dr. Rohr-Allegrini: [laughs] I’ve worked on a lot of different things and most people know me now in relation to TB, STDs or flu or respiratory diseases, but I actually started in vector biology, so diseases transmitted by bugs of some sort: mosquitoes, ticks, fleas– not fleas, not really, sand flies. I used to work on all of those, and that’s really my first love is the mosquito-borne diseases.

Justin: Is that what vector means, is it travel species?

Dr. Rohr-Allegrini: The vector is what’s transmitting the virus or the parasite or the bacteria from an animal to human usually, or between humans.

Justin: We have a real problem if a really bad one starts getting transmitted by mosquitoes here in San Antonio.

Dr. Rohr-Allegrini: Yes. Dengue exists in Central and South America. We’ve seen a few cases pop up, coming north but not anything transmitted locally. We were very worried about Zika virus for a while, that’s definitely around but it hasn’t been as bad as we were worried about but it’s there. We used to have malaria in the US until 80 years ago or so. Then we drained swamps and a lot of places. Washington DC actually used to be full of malaria. It has existed here before, we’ve just been able to get rid of it.

Justin: DDT, was that a big part of it?

Dr. Rohr-Allegrini: DDT? No, I think for the malaria mosquitoes, it was really draining the swamps in a lot of places.

Justin: Different species.

Dr. Rohr-Allegrini: Different species of mosquito, yes. DDT has helped to get rid of mosquitoes in a lot of areas but now we see resistance so we see the mosquitoes coming back.

Justin: Got you. What is an epidemiologist?

Dr. Rohr-Allegrini: An epidemiologist is a jack of all trades, really. I say jack of all trades, master of some because you have to know a lot about a few different fields but you have your hands in a lot of different things. It was perfect for somebody like me who’s interested in many things. I started college as a political science major in international relations. Then I went to biology and then I went back to political science then I went into epidemiology in graduate school.

I love it because you have to understand not just the science of the disease, not just the modeling. A lot of people think of epidemiologists are just modelers, they’re working on data behind a computer. An epidemiologist is actually someone that has to understand the social dynamics and disease transmission. You have to understand the culture of the place, you have to sometimes understand the history and the politics of a place.

A lot of the work I did initially was in tropical diseases, so in a lot of countries in Africa or Southeast Asia, where you really have to understand the local community and what’s their historical context. Have they had a disease like this before? Have western doctors come in and told them something and that’s made them not trust us and so you have to be very conscientious and work with the folks there.

You really have to know anthropology and sociology as well as infectious disease and a bit of data modeling. Although, and frankly, I like to turn to the statisticians to do the data part and then I can explain it. I let them play with the number. I like playing with numbers too, a lot. [laughs] I would say that’s a little bit of a hobby. Give me an Excel spreadsheet, I’m really excited. Really, the high-level statistics I ask the statistician to do it then I can explain it in terms of the context of the community that’s impacted by it.

Justin: I guess from the same perspective of like a pharmacist, you can be a retail pharmacist or you can be a research pharmacist. From an epidemiological standpoint, it sounds like you have more involvement than probably some in the government role and or response to disease, would that be fair to say?

Dr. Rohr-Allegrini: Yes. I started in academics but the people I was trained by were usually physicians who were also epidemiologists and had worked in the field. They were the ones that were doing the outbreak investigation. Some of them had done the original Ebola investigation in 1976 or Lassa fever around that same time. Those were my early professors, which was just amazing to have that experience, the real-world experience. I think that’s a lot different from when your experience is based on computer modeling. One of the advantages that I had was coming to work for San Antonio Metro Health District, I came in as a quasi-academic.

I had also done a lot of fieldwork because I’d worked in tropical diseases but I hadn’t done on the ground EPI locally and working for San Antonio Metro Health, I was working with an epidemiologist who was not academically trained but was really a bootstrap EPI. We butted heads a lot at first because I was this young highly educated epidemiologist. I was going to show him what to do and he would get annoyed with me. In the end, I’m so grateful for the experience I had, the mentorship I had from somebody like that, who had so much real-world knowledge of what the diseases look like and how we had to investigate it. I had learned it but I hadn’t actually seen it in practice.

Justin: And they knew how it looked in a community.

Dr. Rohr-Allegrini: Exactly. It was little things like this is how you talk to that community and I knew that academically because we did study it. You often come in with this idea and you expect people to follow it and then you realize, “Why aren’t they listening to me?” Because you didn’t talk to the right people. I knew that in the African situation but I didn’t think of it locally. I remember going with him and he’s chatting with somebody and like, “Ask them the question. Come on, we need to get the information.” He’s like, “Just wait,” and then he eventually got all the information we needed because he knew how to work, ask about the family, ask about the kids, then they’re more likely to talk to you.

That happens here as well as in Central Africa.

Justin: It’s so strange to think that you’ve got to have those skills even when it’s your own neighbors, as opposed to going into a different culture and country.

Dr. Rohr-Allegrini: You do because our work is so dependent upon trust. The folks have to trust us and if they see us as this outside force, even if it’s just somebody in a tie, we have to get them to trust us and so that matters to have that link. I think I had that experience because I’ve worked at the local level and so a lot of government EPIs have but that’s different from academic EPIs who– Some of them might have worked in that area and some of them have not.

Justin: I think my biggest exposure to it was listening to a PBS show about how epidemiologists and anthropologists went into Africa during the most recent Ebola and got them to change burial practices. How much effort that took to convince people about hundreds of years of cultural changes, cultural significance needed to be changed. It’s pretty interesting.

Dr. Rohr-Allegrini: It’s fascinating stuff and I’m glad you bring up Ebola because, in the ’76, original Ebola outbreak, that was one of the big issues. These Western scientists said, “Okay, you need to stop burying people like this.” and they were like, “Get out of here. We’re not going to listen to you.”

It took a long time and they finally worked with the village elders to discuss why that needed to be done. Then the village elders went and told the people and got them to change the practices and so they had to do it again in the last Ebola outbreak.

Justin: Which is crazy that we’re talking about that in terms of this and I still have people that want to meet up tomorrow for drinks. We’re dealing with this right now culturally, whether we want to admit it or not and we look at our neighbors and our neighbors are almost foreign people in terms of following the rules and what we know is the safe practice. Talk to me a little bit about why Covid is such a unique danger to our community and why it needs to be taken differently than what you see on Facebook of, “Hey, it’s a flu. It’s close to the flu.” Why is this different?

Dr. Rohr-Allegrini: Flu is pretty bad, to begin with. Seasonal flu kills a lot of people every year but it has a lower case fatality rate, so 0.1% versus what we’re looking at 2% to 3% of people that get it die. So already a lot more people die from it. It also has a higher contagious rate, so you’re going to give it to a few more people than you are with flu. It’s a little bit higher and so it’s going to spread faster and it’s going to kill more people overall. We’re still in the early stages of that. It’s a completely different virus from flu. It causes a similar type of illness but it’s much more severe.

In a lot of people, it’s not severe. 80% of cases, it’s fairly mild but that doesn’t mean that if you’re in that 80%, you’re not impacted in any way. If you’re even a low-risk person, you could still die from it. It’s a different story than flu because it’s spreading so fast and it’s killing more people, and we don’t have a vaccine.

Justin: My own personal feeling, which you can tell me I’m wrong if I’m wrong, is that it seems like our numbers in America at least are bullshit, because we’re not really testing and it’s sort of here’s what we know but there’s a whole lot we don’t know. Do we have enough data internationally to say, “Okay, the mortality rate is point 0.1%”? Have we gotten there yet you think?

Dr. Rohr-Allegrini: We have a lot of data but it’s still lacking because it’s different for each country. It is bullshit really what we have in the US. We’re testing likely positives. In fact, if you look at our local rate, it looks like we have a lot of people getting infected because the rate of positives in the test we’re doing is about 10% to 11%. That’s huge. South Korea, it’s 2.5%.

Justin: Where they’re testing tens of thousands of people a day.

Dr. Rohr-Allegrini: Because they’re testing everybody. We’re only testing people that are likely to be positive. When you think about that 10, 11 is actually pretty good because these are people we think have it and it turns out that 90% of them don’t, but still, we’re only testing those that are likely to have it. We’re not looking in the general population because there’s probably a lot of lower-level infectious people out there and we’re not finding them. We have a lot of data worldwide, it’s telling a story, but we have to look at the data in context. That’s a lot of what I do. I’ve been writing a lot about that, trying to explain the story.

The story in South Korea is very different from the story in Italy, which is different from the UK, which is different from the US.

Justin: Let me ask you this, is there a genetic component to how our bodies culturally react to or can fend off viruses as they sweep through? Say, I’m sure it’s not true but would Italians who have probably a more homogeneous population than Americans, is there some effect of genetics for certain societies as to whether they’ll be more susceptible or not?

Dr. Rohr-Allegrini: There’s certainly some diseases where that’s a factor. For example, with malaria, a lot of Africans have something called the Duffy factor on the red blood cells, which makes it more difficult for one of the strains of malaria to infect them.

You don’t see that particular malaria parasite. You see other malaria parasites but not that one, causing disease in Africa. That is a genetic variation. There’s no reason to believe we have a genetic variation with Covid. It doesn’t appear to have a genetic variation. Certainly, every person is different. It’s interesting that you mention the homogeneity of our immune system. It’s actually better to interbreed with other ethnicities because you mix up the immune profile that you have.

Justin: Hybrid vigor.

Dr. Rohr-Allegrini: Exactly.

Justin: My dogs going to live till better be 50, at least.

Dr. Rohr-Allegrini: Right. There’s some validity to that theory, whether or not that’s relevant to Covid, probably not to be honest, but it’s certainly an interesting thing to look at. That doesn’t mean that the Chinese or the Italians are more susceptible or not. I think what we’ve seen in both those populations has a lot to do with the social dynamics that have led to increased infection.

Justin: I want to get there in a second but one thing that I found really interesting was The Economist ran an article that said the next five populations that are most at risk for a big outbreak. One was Iceland and they said Iceland is having a very– It’s for each person infected, they are infecting more people than in other cultures. Have you looked at that?

Dr. Rohr-Allegrini: I haven’t seen that. I’ll take a look at that afterward. There’s been a couple of cases where it looks like the rate of spread is much higher. This is new, it could be that 10 people that are infected and they’re each infecting three, which is what we think it is.

That’s 30 people that they’re infecting but we may only know of one of them that’s positive. We may assume that all those 30 came from one case when in reality they came from 10 cases. We don’t know that yet.

Justin: Before you came on, I asked people to send me some questions that they have. One of the questions that I’ve gotten, which seems absurd, but honestly, it is one of these things is, what is the six-foot radius? Why is that so important? People are not emanating this virus, are they?

Dr. Rohr-Allegrini: When you speak, stuff comes out of your mouth. When you cough, for sure, and sneeze, for sure, but even when you speak, there’s little particles that come out. Sometimes it’s obvious, we know the spitters, but sometimes it’s not obvious at all. Most of the time, it’s not obvious. The virus it’s in droplets that’s in that spit. That’s also why you need to clean the microphone after I’m done.

The virus is in those droplets and those droplets can’t travel very far. They don’t float through the air. It’s not aerosolized, but if you’re within three feet, there’s a good chance that droplet is going to land on your mouth, land on your face, land on your nose, land on your hands and then you touch yourself and that’s how you transmit it. So by keeping three to six feet is what we say, and six feet is we try to be careful.

Justin: For our listeners, that’s about what we are right now.

Dr. Rohr-Allegrini: Exactly. I was thinking about it today. Tony Parker is six feet two, so think about it as like, just if you’re Tony Parker distance apart, you’re good. It’s not very far. It’s easy to have a conversation that you’re six feet apart, but that’s the important thing because if we’re that far apart, I’m not going to get the virus from you talking. If you’re coughing really hard and spitting up that might be [unintelligible 00:19:49]

Justin: Which you should stay home anyway.

Dr. Rohr-Allegrini: Which you should stay home. A normal conversation you’re not likely to be. That’s why that six-foot rule matters.

Justin: Okay. We’ve got an order starting tomorrow. It sounds like it’s going to go until April 9th and then they’ll reevaluate. The goal is social distancing it sounds like and it’s government-mandated because probably people weren’t following that. Is there a metric by which the city as far as–? Let me ask you this. Are you involved in the city’s response to this?

Dr. Rohr-Allegrini: Not officially, no.

Justin: Okay. Maybe a consulting capacity or got some friends in city government who are discussing with you? What are we looking for? Let’s just talk in the abstract. If you were in charge of this response, what will we be looking for in terms of this April 9th deadline? Are we going to be able to measure anything and say, “We’re doing good”? Or do we still not have enough test to even get good data?

Dr. Rohr-Allegrini: We don’t have enough tests to get good data. Ideally, we’ll have less infection. I will tell you I’m not optimistic because even if we have more tests, we’re going to see an upswing in cases. We’ve really just started testing. Expect the next two to three weeks to see those numbers skyrocket, but don’t be scared by that. We already assume those people are out there infected, we just haven’t been looking for them because we haven’t had testing capacity. As we get more tests, we’re going to find more positives and those numbers are going to go up.

That’s good information because then we can say, “Okay, everybody that you’re in contact with, we also need to test them and isolate them while we’re evaluating those tests, quarantine if necessary.” Eventually, we can start doing more targeted isolation. We don’t have to shut everything down. We can just focus on those communities that are highest risk or those folks that are likely positives.

Justin: What was the reasoning? I know you can’t speak for what people do, but it seems as though we kind of had a blahzay approach to this, too little too late, not just San Antonio, but America did. Is it just a cultural attitude? Is it that people didn’t think it was going to be as bad? This has to be the same story for epidemics and pandemics, time and time again, what is the idea that, “Oh, it won’t happen to us”? What is the cultural thing that keeps people from going, “Holy shit, we need to stop what we’re doing right now”?

Dr. Rohr-Allegrini: I think part of this because it started in Asia and we just assume, “Oh, that’s going to happen over there. We’re insulated from that.” I will tell you when I was doing pandemic planning, this was 2005, 2006, we were really worried about avian flu becoming a pandemic. The way it infected people, it wasn’t transmitted between people. It was only bird to human. It was very, very bad for those humans that got it, but they didn’t give it to anybody else, so it didn’t turn into a pandemic. It was pretty isolated. That prompted us to do a lot of planning.

I probably gave 100 lectures around the city with different types of organizations. I worked extensively with the hospitals. We’ve developed a response plan. I worked with city agencies to develop response plans, and a lot of times it was well received. I would say things like, “What are you going to do if 20% of your workforce are sick or those 20% are sick and the other 20% are home taking care of their kids because school’s closed? How are you going to function? How are you going to maintain your business in that sort of situation?” A lot of the bigger businesses already do that.

H-E-B does that already. They already had their strategic planners on staff. USAA already had that, but a lot of smaller businesses didn’t. Often I would hear it was either scared, people were scared, or I was shaking a little, running around, the sky is falling, the sky is falling. Then we had a pandemic in 2009, which a lot of people actually forget about. That actually– the first cases were identified here in San Antonio. Most people don’t know that. [chuckles] They were found here in San Antonio and I was the communicable disease manager at Region 8, which is Department of State Health Services. I was actually running that response.

Justin: Was this H1N1.

Dr. Rohr-Allegrini: H1N1, but it turned out to not be as bad as we expected a pandemic to be. It was still pretty significant, but it wasn’t the skies falling that we expected.

Justin: Can you talk to that? Look, you know this, we’re in a world where people put the dumbest crap on Facebook and it just circulates as though it somehow gospel. One thing I’ve seen over and over is this, “Oh, well, in H1N1, we weren’t tanking our economy and screwing things up.” Compare, if you can, our response to H1N1 and the actual facts of the virus compared to what we’re dealing with today.

Dr. Rohr-Allegrini: I think our response then was pretty intense. Certainly, as the public health person overseeing our local response, it was extremely intense and we closed some schools, but it wasn’t the broad-scale closures because we didn’t need to do that, and just the disease was not as severe as we would have expected. It wasn’t killing people as fast. It was deadly in pregnant women. That was the population most affected and I was pregnant at the time so I [chuckles] was pretty scared, but I think the general public didn’t perceive the threat as much because the threat wasn’t as big.

This is just a different situation we have, it’s deadlier and it spreads faster. We’re faced with a different situation and it’s a new virus we don’t have testing. At least with H1N1, we can test for flu and we were able to test right away and start typing it and identify it. We didn’t have a vaccine for that strain. We have a vaccine for other strains, it’s a little easier to build on that foundation to get a new vaccine.

Justin: Would a regular flu test pick up H1N1 back then?

Dr. Rohr-Allegrini: Right.

Justin: Okay. We had some in the- [crosstalk].

Dr. Rohr-Allegrini: We could identify if you were infected with flu, and then the reason we found it, and this is important because we don’t do surveillance like we used to, but we have surveillance so we have sentinel sites, different clinics in the city and this is across the country, that actually take a sample and sends it to CDC. If you think you have flu and you go to the doctor, they don’t always test for it. They may say, “Okay, it’s flu season, you have all these symptoms. I think you have flu, here’s Tamiflu go home and get better.”

There’s certain clinics that will always test for it and then they’ll take a sample of those and send them to the CDC and they’ll type them. They’ll see like, okay, is it flu A? Then if it’s flu A, is it H3N2 or any of the ones that we have, flu B. They do that with a small subsample. These individuals, two individuals, they happen to go to this clinic that was a sentinel site. They did their normal thing of taking samples and sending them to the CDC after they had verified it was flu. CDC said, “Whoa, whoa, we’ve got a new virus. This is not like anything we’ve seen before.” It looked like swine flu, which is why we were calling it swine flu at the time.

That virus is what we see every year. We still have H1N1 that’s in our vaccine every year because we see it every year, but we have a vaccine for it.

Justin: Is Covid in our yearly repertoire of viruses now? Is this going to be here to stay?

Dr. Rohr-Allegrini: I really don’t know. I hope not, [chuckles] but it could be.

Justin: It’s a coronavirus, Latin for crown. Coronaviruses are pretty common, right?

Dr. Rohr-Allegrini: Right. The common cold is caused by a lot of different viruses, but corona is one of them.

Justin: Okay. Do coronaviruses generally stick around? Are there some that are just seen for a year or two and gone?

Dr. Rohr-Allegrini: SARS, we haven’t really seen since the first outbreak. I think there was a little spike after that, we haven’t seen much. MERS is another coronavirus that–

Justin: The Middle East Respiratory?

Dr. Rohr-Allegrini: Right. That caused a lot of deaths and we haven’t seen that pop up again. Generally, with severe viruses, what they do is they kill too many people so the virus doesn’t survive a virus. If you’re a virus that wants to live, you don’t want to kill your host. You want to make them– you don’t even want to make them sick, you just want to be passed on enough to live, to go to another host. If you kill too many of your hosts, then you can’t go anywhere and you die too.

This virus is different because it’s not as deadly as SARS. The death rate is a lot lower in our sort of young healthy population that people are going to keep transmitting the virus. We may end up seeing it as a yearly thing. We’ll hopefully see cases go down and really what will stop it as a vaccine.

Justin: Okay. You were going to say, “We’ll hopefully see them go down, maybe come back.” We don’t know yet whether the seasons are going to affect this yet, do we?

Dr. Rohr-Allegrini: We don’t. A lot of people think it will because flu is seasonal, but it doesn’t have anything really to do with the heat so much. There’s still a lot of debate about that. Certainly, heat and humidity have an impact on virus survival on surfaces so that could be a factor, but mostly it’s because of how we live. We tend to be indoors more in the wintertime than the summertime. San Antonio is different, it’s hot, people aren’t indoors in the summer.

H1N1 started in April. It was beginning of April and worldwide cases dropped in the summertime, but in South Texas, they stayed pretty high. They dropped a little bit, but we’ve had consistent high numbers of cases through the summer and then a big peak again in September and October.

Justin: I had a flu in June.

Dr. Rohr-Allegrini: Yes. It can happen. It can happen any time of the year, so it’s not that the virus doesn’t live in the heat. We’re hoping that it’ll follow a similar pattern and the summer will give us somewhat of a break, but it’s not clear.

Justin: What is your plan as it relates to the sit tight and wait? Are y’all stay at home no guests, no visitors, only leave if you need to get supplies? Is that the best plan for people to take?

Dr. Rohr-Allegrini: That is the best plan for people to take, but I’m a strong believer in being outdoors. We’re not like Italy. We don’t live as densely as Italy. I live in Southtown, which is a pretty urban-ish area, but there’s a lot of houses. My whole family can stand outside of our house as well as everybody in my block and we’re still 20 feet apart. The need to stay indoors is not necessary. In fact, it’s better to be outside. I strongly encourage people to go to a park but don’t go and play escapes, don’t touch stuff, kick around the soccer ball but don’t play soccer and tackle. Those sorts of things are healthy, good things to do. The virus, it can persist outside on surfaces. It probably doesn’t last as long, but also as long as you’re six feet apart, it disperses more in the air so you’re kind of better off outside. If you’re inside, you’re more likely to touch stuff. Our thing is we’re not inviting people over. My kids, I’ve encouraged them to go outside and play but again, in very specific environments. I go shopping but only for groceries. We just don’t need to go out. Fortunately, my husband and I are both in professions that we can work from home fairly easily.

Justin: That’s nice.

Dr. Rohr-Allegrini: I work from home normally so now it’s just I have four people in my house instead of myself. For us, it is a fairly easy transition. I know it’s a lot more complicated for a lot of other people. Limit what you do. We don’t eat out that much even despite living in Southtown. We are doing a little more takeout than we normally do just to try to help the local businesses, but limiting what we do and we do go out. We walk the dog every night and I would go running in the morning and I don’t see very many people and that’s fine. It’s easy enough, especially with my dog, to keep people six feet away.

Justin: Are the parks all open? I mean, is that still a thing?

Dr. Rohr-Allegrini: Parks are open, yes. In some cities, they’ve closed them. For example, the LA area has closed most of its parks and beaches. The general LA area, LA County has done that, but that’s because they were so crowded. My sister lives there and she was– she said, I’ve been going running and the trails I usually run on where there’s nobody are just– she said it was like Disneyland. It was so packed and so–

Justin: Somewhere to go.

Dr. Rohr-Allegrini: People are off they want to be outside, which is we normally encouraged but she said it was like Disneyland there so it’s hard to stay six feet away so that’s why they closed them. We’re not in that situation here. We don’t have that density to start with and even in our densest parts of town, that’s generally not an issue so go out to the park to be outside, just remember to stay six feet away.

Justin: We talked about this before, but this was one of the questions that was asked. Are pregnant women at any additional risk of this or passing it on to the fetus or anything like that?

Dr. Rohr-Allegrini: It does not appear so. This is new, we’re still learning. We were worried about, obviously, we always worried about pregnant women because they are more medically fragile. Our bodies are just not functioning like normal and certainly, with H1N1, pregnant women were at the highest risk. So far, we’re not seeing any increased risk in pregnant women.

Justin: Another thing that was asked and you see this on Facebook is this sort of idea that it’s a future political agenda but what countries have you seen that are doing the best and what makes them the best at containing this and keeping a lid on it?

Dr. Rohr-Allegrini: South Korea, for sure. Singapore is doing a pretty good job. Their situation’s a little different. South Korea, one, they were prepared after MERS when they got slammed, they said we’re not going to let this happen again. When they started to see cases, they acted immediately. Most of it’s testing and contact tracing, so identifying the people that you’ve been in contact with and then isolating them. They’ve done a lot of things that probably wouldn’t work here. First, in a way, they got lucky because their first cases were in this church population, which tended to be younger.

The individual that probably infected a lot was older but most of the people that they tested from that population were younger so they had a lot of positives, they had over 5,000, I believe. They were relatively young healthy adults who didn’t get very sick, but because of that, they were able to isolate them all immediately. Anybody that was positive that didn’t need hospital care was taken to another facility where they could be monitored until all their symptoms were gone. They didn’t really need hospitalization, but they were kept out of the general population.

Some of the things they did that wouldn’t work in this country is they got cell phone data of every positive person and they could find out where they’ve been. It was their way of tracking contacts and they also would say okay, there’s a case not– I don’t think they set a specific address, but they would give a general location and that would alert everybody that okay, there’s a case within a mile of you, you need to go get tested. That worked. That’s not something I’m recommending at all. In fact, some political leaders wanted to do that in H1N1, that’s a huge violation of privacy.

People, not just a privacy issue but human reaction can be extremely problematic. We’ve seen it before with not just stigma but the physical attacks on people. We don’t want that to happen. Korean society is a lot different. People are more willing to sacrifice those personal liberties for that–

Justin: Community.

Dr. Rohr-Allegrini: Yes, for the community and they did it. I’m not recommending that level here, but I am recommending the testing. That’s the huge difference. They didn’t hesitate to test. They started testing as broadly as they could not just the sickest people, but the potential contacts. They’re still prioritizing. They weren’t testing everybody that walked up initially. It was sort of if you’re a contact to a case so there’s reason to think, well, we build up capacity to test more. That’s really what we need to be doing here.

Justin: I think I read they’re doing phone booth testing, they call it now where you can literally just walk in.

Dr. Rohr-Allegrini: Right. It’s like a concealed area so the person dealing with you is totally protected.

Justin: They stick gloves through holes.

Dr. Rohr-Allegrini: Exactly, and that’s important, too, because right now you go into a clinic waiting room, you’re waiting there, you’re infecting everybody in the room. It’s really important that they’re isolating any potential infected people and really doing an amazing job. We’re starting to see cases jump up a little bit in South Korea, that’s normal, we see waves. What will be the clincher is is that wave small. We expect it to happen but as long as it doesn’t skyrocket and I don’t think it will because they’re doing such aggressive testing.

Justin: As they reopen up society do those waves stay about the same heights as the crests?

Dr. Rohr-Allegrini: Hopefully, they’ll go down into a smooth after a while and totally flat after a while, but it’s normal to see little spikes here and there.

Justin: Why have we been so ill-equipped to test? Why don’t we have enough tests? Are they hard to create? Are we failing somehow on that?

Dr. Rohr-Allegrini: It’s that we wanted to create our own instead of using what China already had, what South Korea already had.

Justin: Why? What is the upside? Is it a profit deal?

Dr. Rohr-Allegrini: I’m not sure it’s profit. Frankly, I think it’s more arrogance. We don’t trust them from somewhere else. Arrogance but it’s also just care, caution, and that’s totally understandable.

Justin: It’s a very nice way to put it.

Dr. Rohr-Allegrini: This thing came from another country, we don’t– they don’t necessarily have the same standards of control so we want to do it our way because–

Justin: Then a good starting point, though.

Dr. Rohr-Allegrini: It would have, but I understand that, too. It’s not and I shouldn’t say, arrogance, because that’s probably part of it, but that’s not all of it. It’s we have certain standards of control so we want to make sure every test that we use has met our control standards.

Justin: It’s pretty bizarre we buy most of our pharmaceuticals from these same countries and we wouldn’t accept their tests. That is a strange dichotomy to this argument. It’s just sort of an odd deal.

Dr. Rohr-Allegrini: Absolutely.

Justin: I read in The New York Times there’s some opinion writer there who’s really into this and he doesn’t like the way we’re approaching it. He talked a lot about we could do this through horizontal or vertical interdiction. His sort of take is let’s do this shut down vertically across age groups as opposed to horizontally being everybody. Is their data outside of this New York Times article to discuss whether or not that’s working? Is there any evidence this is being used in other countries? Or is this just armchair quarterback?

Dr. Rohr-Allegrini: He’s not an epidemiologist, but he is very familiar with epidemiology. He actually was in graduate school at Yale the same time I was, but we were not friends. I knew him vaguely, but more from by name than– we didn’t hang out together.

[laughter]

Justin: [unintelligible 00:38:17] of college [unintelligible 00:38:20] right now.

Dr. Rohr-Allegrini: I don’t remember. I just remember his name very well from that time period. He’s not the only one that thinks that. There’s a number of other older, very reputable scientists and epidemiologists that agree with him. There’s not necessarily data on exactly that from around the world, but South Korea, for example, didn’t do this massive shutdown. They did more targeted where people that were contacts to cases were isolated rather than the whole city. In Wuhan China, they shut down the whole city but it was already so out of control that they had to, but they didn’t have to shut down the whole country.

They just shut down the city and they were able to get it under control. In South Korea, they haven’t had to go that far because they’ve had such aggressive testing that they can isolate, targeted isolation, which really is kind of what he’s getting at, that we can do more targeted isolation.

Justin: You have to have the data to do that.

Dr. Rohr-Allegrini: You have to have the data, you have to have the testing. You have to have the testing do it. I shared that article because it made a lot of good points. There’s a lot of epidemiologists that were furious with that article who are also experts and have a very, very different opinion. The thing is when you say that, then people say, “Okay well, everything we’re doing is wrong and we don’t need to do this.” The reality is we need to do it. We need to shut down things because we need to get some time to control this. New York is getting into a very difficult situation because they have so many cases that are overwhelming capacity. The only way to slow that down is to shut everything down.

If we just shut it down and do nothing, we’re just shifting the peak. We’re going to see the same number of cases in a month from now. Ideally, while we shut things down, we’re also ramping up testing capacity and ramping up hospital capacity. Getting those temporary hospitals set up if we think we need them, making sure we have enough respirators, making sure we have all the masks and the gloves that we need so that if we get to that point where we have a lot of cases, we’re able to take care of them.

Justin: What is the mentality or thinking if you know about why we aren’t designating this hospital is going to be our hospital for Covid and this one’s not going to be dealing with that? It seems like it’s so contagious. It’s such a thing everybody’s worried about. Why aren’t we limiting facilities?

Dr. Rohr-Allegrini: We might get to that point. I think the facilities need still need to function as they normally function. They’re still seeing car accidents, heart attacks, all the things that they normally do. They all have isolation units, they all have isolation wings, and some of them are turning a whole wing into an isolation area. We might have to go to where we just put every in one hospital, but just one hospital won’t work. We’re going to need to have multiple hospitals.

It’s going to be important to manage across the city. We have STRAC, the South Texas Regional Advisory Council, who are the ones who coordinate with all the hospitals, and they’ve been doing it for years and years and years since I came to San Antonio. They know what hospitals have availability, how many beds there are, how many vents there are, what’s their capacity. They know that and can make sure that we’re sending people to the right places.

Justin: How is our capacity now? We haven’t been overwhelmed by this yet, have we?

Dr. Rohr-Allegrini: We’ve not been overwhelmed at all. In fact, from my understanding, this was a few days ago, we’ve had a lot more cases since then, but when we had about 30 cases, only a few of those had even hospitalized and none of them had been in ICU, so they were not very, very sick people. The one death we had, it’s still a little bit unclear. I believe that person had been in hospice care already. That person was already in a place where–

Justin: Vulnerable.

Dr. Rohr-Allegrini: Vulnerable, but also had said I don’t want any life-saving measures at this point. She had already had respiratory pneumonia already. That doesn’t diminish the importance and significance of it. It just helps to put it in perspective, that we have not seen the overwhelming burden on our local hospital system yet. It’s still flu season. There’s still a lot of people in the hospital with flu. They’re working pretty darn hard, but a lot of it too is they need to get prepared. They need to make sure they have their supplies ready.

Justin: I think I was trying to figure out what is our next run of San Antonio? Are we looking at probably these shutdowns coming in waves? Are we looking at this 14 days will give the city time to prepare and that we should be in a good position with social distancing measures? Or do we really have no idea what’s going to happen after this 14 day shut down?

Dr. Rohr-Allegrini: Our hope is that the 14 days buys us enough time to get ready. I will argue though, that unless we do testing, a lot of testing very quickly and do contact tracing, which is essential, then that shut down is not going to change anything. We’re not going to see a decrease in cases in the next two weeks because we’re going to start testing more, so you’re going an increase. It’s going to look like we don’t have it under control. Ideally, if we’re doing enough testing, we don’t have to continue the shutdown because we can focus on those individuals or communities or households where we know the cases are and protect them.

I suspect schools are going to be closed for the duration. I know schools want to reopen. School kids are not really at high risk, they’re less likely to be infected, they’re less likely to be infectious as far as we know. Data is still new. It’s very different from flu. Flu, shut down the schools because the kids are transmitting it. In this case, it’s your kid is more likely to get it from you than from another child. That’s not 100%. There’s always the outlier. There’s always a few cases that still get it and we have seen it in kids, it’s just they’re not as significant drivers of transmission that we know of now. The data may change that, but right now, they’re not.

That said, just because of the structure in place of how schools work I think it’s going to be hard for a lot of them to restart given that we’re so close to the end of the year. School pretty much ends the end of May here.

Justin: You’ve been involved in San Antonio pandemic response before, just tell us generally about how those discussions go when you’re talking about pandemic response in terms of what all interests have to be juggled. We know there’s going to be an economic hit here that we’re going to feel for a long time and that’s definitely something being juggled, but talk about how those conversations go down in the rooms when these tough decisions are being made.

Dr. Rohr-Allegrini: I can’t tell you what’s happening right now, but in the past, certainly how is going to impact our businesses? How’s it going to– Not just the businesses but the workers. We have a lot of people unemployed. We haven’t had to shut down to this level before. Before it was just hypothetically, what are we going to do? We never really had good answers for what we’re going to do. Shutting down means unemployment. Are we ready to step up our unemployment response? Do we have the funds to help people through that process?

Holding rent is great for the worker that can’t afford to pay their rent, but the landlord who lives off of the rent from that one apartment building, they’re now not able not just to pay their mortgage, but to pay all their other bills and their food and whatever they need for living. There’s a ripple effect that goes up as well as down. Then businesses, small businesses struggle to survive. Some of the stronger ones will be able to manage but a lot of the small ones they can’t survive past a month, and it’s not just the restaurants.

I have a friend who’s a dentist, started their practice about a year and a half ago and really if they can’t get a freeze on their mortgage, they’ll probably not be able to reopen. They’re skilled people, and they’ll be able to find another job, hopefully, but a lot of dental practices are small. They’re like small businesses. It’s not just the restaurant workers that are suffering, it’s all levels of society.

Justin: Starting a small business takes a while to get up and going.

Dr. Rohr-Allegrini: Exactly, no matter what you’re doing. A lot of people are going to suffer. Some of the other things we talked about are the food bank, is a food bank stocked up? Are they going to be impacted? Certainly, donations are going to slow. When my income goes down, I’m not going to be able to donate as much. All the nonprofits that are impacted. Canceling Fiesta was the right move to do but that’s a huge impact on nonprofit, so hopefully, we’ll be able to have it in November, which will help them re-boost.

The schools that rely on support from community members are not going to get that support. School districts, most of our school districts provide meals to kids. I’m in SAISD and they give meals to 100% of the kids. There’s a lot of families that don’t need it, but there’s over 90% that do so they just give it to them all. Those 90%, some of them can’t survive and so we’re trying to figure out how we can get food to them. We’re doing the meal pickups right now, which is helping, but for a lot of them, they’ve got three kids at home, including the baby getting out to just go pick up that breakfast and lunch is hard, not to mention what they’re doing on the weekends.

There’s other programs in place that help people through the summer months that are not quite in place now. Even going to H-E-B is a challenge because they have to get there on the bus. They can’t leave their three kids home alone so they have to take the whole family, the bus is risky and they might have to spend two hours in line at H-E-B and still not get what they need. Those are all things that we take into consideration.

Also the buses. I know, I’ve been asked, “Should we drop bus service?” We might have to and certainly, if we’re not using the bus as much because we’re shutting down so much, but so many of our workers that are still going to work are the ones who use the bus including our health care workers. We’re better if we can increase service, especially on the busy line so that the buses aren’t packed.

Justin: They just made them free I think.

Dr. Rohr-Allegrini: They just made him free, which is a wonderful thing. I would love it if– I don’t know how crowded they are right now. That’s what I told him. I said, “You need to study it right now.” The very first stages, this was a few weeks ago, to see are there certain lines that are really crowded because what you might have to do is cancel one line and move that over to the other one just so people don’t have to crowd a bus; for the driver’s sake as well as for the passenger.

Justin: It sounds like if I’m hearing you right, we can’t really come up with any other approach to the way we’re dealing with this until we get more data and the only way to get more data is through testing.

Dr. Rohr-Allegrini: Right.

Justin: Okay. I think that’s important because you hear a lot of people talk about what does it matter the testing if they’ve got it, if they don’t, and you’re hearing some countries now they’re even saying, “Look, don’t waste a test if it’s not going to change the way we’re handling treatment.”

Dr. Rohr-Allegrini: That’s true and I’ve said that before. When we first got our 500 tests in the city, I wrote a post saying, “Don’t worry. If you think you’re positive and you’re not high risk, then stay home. Just assume you’re positive, stay at home.” You’re not going to get any treatment anyway because there’s not much treatment we can do. As long as you’re not needing medical care, it doesn’t matter if you’re positive or negative. You have an infectious disease most likely of some sort so you should isolate yourself.”

That said, people don’t do that. That would work really if everybody with a cough stayed home, or a fever stayed home, but we all assume like, “Oh, I’m okay, I can still do things.” We need those tests. We need the test to document. There are some places where they’ve said, “Unless it’s going to change the course of treatment, don’t waste the test.” which I’ve also argued like, “If somebody is really sick in the hospital, you’re going to do the same thing with them. You’re going to treat them like they have a severe pneumonia.”

The difference is that the level of PPE, the personal protective equipment, the level of isolation in the hospital is going to be different because if you think they have Covid versus flu, you’re going to keep them in a separate wing, a separate room, you’re going to use a lot of other control measures, which wastes valuable PPE if you don’t actually need it for that thing. If we had unlimited personal protective equipment, then it wouldn’t matter, but because we’re limited on tests and personal protective equipment, we really have to identify which are the priority cases to test.

Justin: Really the only countries that seem to have done a good job of flattening the curve, as I say, are the countries that have done a ton of tests.

Dr. Rohr-Allegrini: Right. Exactly. Singapore is another one. I hesitate to say too much about Singapore because they have a very restricted culture even much more so than South Korean, and they’re very small. What they did there is not really– It’s gonna be hard to do here.

Justin: They had one of the big outbreaks, 20 years ago or 15 years ago, I can’t remember which one it was, and I was reading an article how they built this infrastructure for a pandemic because of what happened last time. If we did do that, we have lost it, which is the-

Dr. Rohr-Allegrini: We have lost it.

Justin: -unfortunate thing.

Dr. Rohr-Allegrini: I will say– I don’t want to be political but– I’m normally very political in my personal life, but what I see is we want to blame the current administration, and we can blame them for a lot of things, but when I started working at the city, we had a lot of funds from Homeland Security, it was all in response to 9/11. That administration was dumping a lot of money into Homeland Security funds, which is how I got hired to do– it was actually bioweapons response planning, and then that kind of led into pandemics, but over time, those funds went away.

They went away with each administration, but it wasn’t just the presidents because we had Bush then we had Obama and now we have Trump. It wasn’t necessarily that decision of the leader but the Congress made that decision and Congress made decisions based on what they thought the people wanted.

Justin: Sure.

Dr. Rohr-Allegrini: We were far enough away from 9/11 that the immediate fear of responding in this capacity just didn’t seem as important. I blame us as a society for letting that happen. We stopped caring so much about it and so we elected people at every step of the way from local leaders to a president who didn’t push for it.

Justin: Sure, let it go away.

Dr. Rohr-Allegrini: [crosstalk] Right. Whereas there’s a lot of anger at the current administration and there’s a lot of wrong things that are being done, but to be fair, I’ll just say this is a 20-year process-

Justin: wasted away,

Dr. Rohr-Allegrini: -that is gone. That’s normal. That happens all the time. We did it with tuberculosis. We were so good at blocking tuberculosis that we stopped funding it and then we saw an outbreak when we had HIV and now we’re doing a lot more with tuberculosis. Again, we’re victims of our own success.

Justin: Is sort of the realities of today whether and obviously, global warming is happening, why is a different question, but are the realities of sort of temperatures changing, climate changing as well as just human density, is this our new normal of having these sort of pandemics or outbreaks in a way that we didn’t use to have?

Dr. Rohr-Allegrini: Probably, increasing population means you– A lot of our new outbreaks come from animal pathogens and so the virus or bacteria or parasite lives normally in the animal population and then makes a jump into humans, either because it doesn’t necessarily need a mutation to do that.

Sometimes it does, sometimes it doesn’t, but our increasing close contact with that animal population because of how we live, doing things like cutting down forests, and moving into this space where they were, not only has an impact on the climate and the environment, but it also means that those animals have a different habitat and so they’re now more in close contact with humans and so you’re more likely to be exposed.

Justin: That’s what I was reading about this bird or pangolins, whatever these are, people are actually moving into their habitats.

Dr. Rohr-Allegrini: To their territory.

Justin: So it’s not necessarily people are eating these things as opposed to human interaction with animals that used to be on their own island.

Dr. Rohr-Allegrini: Exactly. Exactly. We didn’t really interact with them to that level that we are now and that’s having an impact and we’re going to see that more as long as we keep doing this.

Justin: We’re about out of time, what is the best source of information that you can tell our listeners to check out?

Dr. Rohr-Allegrini: Apart from my page. [laughs]

Justin: That’s very true.

Dr. Rohr-Allegrini: It’s not that thorough, but I do thoroughly research everything I do. It’s a Facebook page. I’m not going to spell it out because it’s my name, which is really long but you can share it.

Justin: Your personal page or your professional page?

Dr. Rohr-Allegrini: I have a professional page, it’s Cherise Rohr-Allegrini PhD, MPH Consulting. I try to post something new every day. Everything I put there is very thoroughly researched, but I don’t post everything. There’s a lot of other stuff out there. I’m working on a lot of topics right now. One good source, it’s hard to say. I usually refer people to the CDC website. That’s very useful information. I’m not sure that’s being updated as much as people would like, but it is valid information. The World Health Organization website. Again, it’s not updated as frequently as some people would like, but what’s there is accurate. So definitely useful.

The Johns Hopkins website, they have that coronavirus tracker with a map. Everyone loves that. It’s great for just raw numbers. If you just want to know where the cases are. It’s valid. It’s absolutely valid.

Justin: They’ve been leaders in this research [unintelligible 00:55:32]

Dr. Rohr-Allegrini: They have been. Any of the universities that are doing infectious disease work, I trust their stuff. I can’t pick one over the other. They’re all useful. They’re all valid.

Justin: No, I think definitely yes.

Dr. Rohr-Allegrini: What’s important to know is anything you see, you need to understand the context. Normally, when you doing scientific research, it’s years of research, and then you write the paper and it’s a year or a six months process of somebody reviewing it, multiple people reviewing it, telling you it’s crap or saying, no, this is great, or you missed something here, fixing it and then–

Justin: Peer review.

Dr. Rohr-Allegrini: Right. Then it gets published. Now, we’re skipping peer review because– It’s important, we need to get that information out there, we’re trying to get out fast, so a lot of stuff is coming out and it’s not been peer-reviewed. It’s the kind of thing that gets a hypothesis going. It’s what you need to start, everyone does. It’s a pilot. Like we found four cases of this. Does this mean anything? We don’t know. Usually, the author say that. Like we don’t have enough data to make a definitive conclusion, but this is interesting–

Justin: Here’s an anecdote.

Dr. Rohr-Allegrini: Right. Right. It’s interesting to consider, let’s look into it more. What happens because that’s publicly available, then that gets taken off as gospel truth and often it’s not and a lot of what I end up doing is like, “Okay, let me go to that paper. Let me see what they said. Let me see what else I can find.”

Justin: No, that’s great.

Dr. Rohr-Allegrini: Put it all together and some of it is right and some of it is not and most of it has some validity, but it’s important that you just look for other sources that verify what that one is paper saying. I’ll stick with CDC and WHO as the key websites for factual information.

Justin: And yours.

Dr. Rohr-Allegrini: And mine, of course. I tell everyone, “Don’t share a post unless you have thoroughly researched through the sources. If you don’t know the name of the person that’s posting-

Justin: I’ve told people that too, they don’t care.

Dr. Rohr-Allegrini: Yes, they don’t care. They want to share it anyway. I did that, even mine. If you don’t know who I am, you better find out who I am. At least look at my LinkedIn profile. I’ve explained on my page who I am and what my background is and why I feel comfortable speaking with a certain amount of authority, but question me. My conclusions may seem bogus to somebody else, and that’s totally fine. I want you to tell me you’re questioning me so I can revise my thinking as well.

Justin: Really? You want people questioning you on Facebook? Because it’s going to get really- [laughs]

Dr. Rohr-Allegrini: No, not really, that’s going to get crazy, but people have. My page is set up so– most people do it privately and like, “Okay, let me rethink what I said.” Usually, it’s the general public. I haven’t had any scientists really question me. The general public, I just have to work like, “Okay, I didn’t explain that very well, so let me explain that.”

Justin: Or, what do you think about this other article?

Dr. Rohr-Allegrini: Right. Yes, I get that all the time and I’m grateful that people ask me, “Tell me what you think of this?” Economists like to use the data and play with it a lot and make really pretty graphs and it sounds really great. The math is good. The math is sound. Go talk to an epidemiologist to make sure that the conclusions they’re drawing are accurate.

Justin: Yes. Thank you so much for being on here. Maybe if this is still a topic of discussion in 30 days, we can have you back on and maybe have a whole bunch more data that we can discuss.

Dr. Rohr-Allegrini: Thank you. I hope so. Thanks for the invitation. I would love to discuss if we have more data.

Justin: Yes, and I’m going to tell everybody to go check out your professional page. I’ll put a link-up.

Dr. Rohr-Allegrini: Okay. Awesome. Thanks.

Justin: All right. That about does it for this episode. A huge thank you to Dr. Rohr-Allegrini to talk about Covid. We don’t know who our next guest will be, but it’s going to be somebody to talk about how to stay busy and how to keep your mind sane during your lockdown. My guest wish list continues, coach Pope Robert Brevard and Jackie Earle Haley, so if you know them, tell them to call me. Thank you for joining us and we’ll talk to you next time.

[music]

Justin: Thanks for joining us on this episode of the Alamo Hour, you are what makes this city so great. We hope you join us next week. In the meantime, subscribe to our podcast. Check us out on Facebook at facebook.com/alamohour or website alamohour.com. Until next time, viva San Antonio.

[00:59:46] [END OF AUDIO]

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