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Doctor’s Orders

When the news mentions the “novel coronavirus”, sometimes the “novel” part isn’t emphasized enough. It means COVID-19 is completely new, something the world has never seen before. In the fight against it, doctors and government officials alike have scrambled to simultaneously learn as much about this new virus as possible while giving the public the most accurate information at hand in a manner average people can understand. In Louisiana, Dr. Alex Billioux, the former assistant secretary for the Louisiana Department of Health’s Office of Public Health, was at the forefront of these efforts until he resigned from the LDH at the end of September.

Dr. Billioux said the key to successful communication with the public is honesty and transparency. Messages shouldn’t be overplayed. They should be delivered in a scientific but accessible manner. When situations change, officials must be forthright and open with people about why things changed and what we know now.

“We don’t ever want to lose our credibility,” Dr. Billioux said.

The most obvious example involves the messaging regarding masks. At first, many public health officials questioned the efficacy of masks. Some, including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, feared a public run on masks would make them less available for medical professionals. However, the medical community eventually learned masks can at reduce the likelihood of an infected person spreading that virus to others. An uninfected person may not receive 100% reliable protection from a mask, but an infected person can greatly reduce the likelihood of spreading it to others by wearing one.

Dr. Billioux said the last point is important because COVID-19’s properties make it well suited to spread like wildfire around the globe. Many people with COVID-19 experience either no symptoms or mild symptoms. Dr. Billioux said even people who eventually have symptoms shed the most virus approximately 48 hours before symptoms and 48 hours after the start of symptoms. The old advice of “if you feel sick, stay home” is insufficient in preventing the spread of COVID-19 (although you should absolutely still stay home if you have COVID-19 symptoms). Many people spread the virus without ever knowing they’re sick. This is why mask use is important.

Dr. Billioux said another key component in containing COVID-19 is contact tracing and isolating infected citizens. Contact tracing cannot be done without adequate testing. At press time, there are still problems with test results taking days, and in some cases weeks, to get back to patients. Dr. Billioux said anyone who gets tested should isolate until they get their results. If you get tested, then see others for three days, and find out you tested positive, then that means you’ve exposed other people to COVID-19 for three days.

To help with testing, Louisiana Governor John Bel Edwards recently entered a pact with the governors of Maryland, Massachusetts, Michigan, Ohio and Virginia to order three million rapid antigen tests. Dr. Billioux said this agreement lets companies know there is a market for these tests and there are financial incentives to make them.

Dr. Billioux said these antigen tests can reduce the aforementioned wait times from test to result. Doing so helps reduce future spread and allows those who test positive to receive appropriate treatment quicker. Even if these tests aren’t quite as accurate as the PCR tests (polymerase chain reaction), they will still catch most COVID cases and they will catch the patients who are shedding the most virus. They will still be very helpful in limiting COVID-19 spread. These tests will also make testing more accessible for Louisiana residents.

2020 has been a trying year around the world, full of fear and uncertainty. It is easy to feel hopeless and overwhelmed. However, Dr. Billioux advocates for “cautious optimism.”

“The entire world is focused on trying to address this virus,” Dr. Billioux said. “I have every reason to believe we will have breakthroughs.”

While Dr. Billioux believes the scientific and medical communities will make important strides in the battle against the coronavirus, he said Americans should expect mask wearing to be a part of life even after vaccines are available. It may never become a permanent part of our culture the way it is in parts of Asia, but it will remain a part of it for the foreseeable future.

“Masks are going to be around for a while,” Dr. Billioux said.

Dr. Billioux also emphasized that even if the state and the country experience additional surges or outbreaks, it is not reason to despair. He said New Orleans is proof of that. Cases skyrocketed in the Crescent City in late March and early April, but steadily dropped in the ensuing weeks. If New Orleans was able to turn things around once, there’s no reason it couldn’t turn things around again. The same is true anywhere else.

“We can really control this thing with something as simple as wearing masks and being more careful about who we see and when we go out,” Dr. Billioux said.

The 39-year-old Billioux is a native of Greenville, South Carolina. He first came to Louisiana as an undergraduate at Northwestern State University in Natchitoches. He has an M.D. from Johns Hopkins University and a Ph.D in clinical medicine from the University of Oxford. The combination of intellectual challenge and rewarding interpersonal relationships is what attracted him to medicine and what keeps it exciting.

“It’s problem solving to make someone feel better,” Dr. Billioux said.

When Dr. Billioux is not practicing medicine, he enjoys being with his family (he is the proud father of two daughters). It is his love of spending time with his family that led him to announce his resignation in September. According to a farewell letter to the Office of Public Health (OPH), Dr. Billioux left his position to spend more time with them.

“Our families know how important our work and mission is to us and we owe it to them in return to recognize that taking care of our own health and being there for them is our deepest felt priority,” Dr. Billioux wrote. “… My own family has made sacrifices and faced challenges while the demands on OPH and me grew steadily. I believe that I need to honor those sacrifices and prioritize those who matter most to me in this world.”

“We completely understand and respect his decision, but we are really sad,” said Aly Neel, communications director for the LDH.

In his letter, Dr. Billioux wrote of his OPH tenure with pride and affection for his colleagues. “My time at OPH has been nothing short of transformative for me.”

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