LETTER: Bulloch County Doctors Urge Statesboro Council to Order ‘Shelter in Place’

This is the letter as read out by Mayor Jonathan McCollar during Sunday’s emergency Statesboro City Council meeting.

You can read the rundown of what the executive order from the City of Statesboro calls for here.

Dear local and state officials:
We are physicians who serve Statesboro and the surrounding communities. Collectively
we are acting to respond to the COVID-19 pandemic as it enters our community. This
letter and our signatures represent our individual professional opinions regarding swift
and bold action that must occur to curb the potentially-devastating impact on our
hospitals, our patients, the city of Statesboro, and the state of Georgia.

It is inevitable that the virus enters our community, as neighboring cities and counties
are beginning to report positive results of the COVID-19 test. It is not a question of IF,
but WHEN. As are many communities and hospitals across the country, we are woefully
underprepared for the number of people who will need treatment when it comes to
availability of ICU beds, ventilators, personal protective equipment. Our only action then
is to make choices which may slow the spread of the virus, so that we have a chance to
not completely overwhelm our healthcare infrastructure to the point where rationing
lifesaving measures becomes a reality.

As such we implore you to put a shelter in place order effective immediately, or
as soon as is feasibly possible.

We understand that there will be unintended consequences of these drastic measures,
but the alternative is worse. If we cannot slow down the rate of infection immediately,
our health care system will be overwhelmed. This is what we mean when we say to
“flatten the curve.”

We applaud your sophisticated understanding of this disease and its spread. As you
and your public health advisors likely already know, COVID-19 is contracted through
respiratory droplets (sneezes, cough, just breathing, on hands/surfaces) and should be
considered highly contagious. While the majority of patients (>80%) will recover without
the need to be in the hospital, up to 10% will be so ill they need to be admitted to the
intensive care unit (ICU). The death rate is much higher than with seasonal influenza,
particularly for people with certain medical problems. The death rate is also significantly
higher for patients over age 60 and possibly over 20% for those over the age of 80.
The recommended measures of personal hand hygiene, avoiding touching your face,
and aggressive social distancing are burdensome but are the best measures to reduce
the number of people getting sick. Just as important, these measures will reduce the
speed with which the virus spreads. If we can reduce the number of cases but also
double or triple the time over which those cases happen, the healthcare system will be less likely to be overwhelmed by the demand; this is “flattening the curve.”
East Georgia Regional Medical Center (EGRMC) has a total of 24 critical care beds.
You can imagine how quickly these will fill if our community becomes sick all at once.
Slowing the spread or “flattening the curve” will undoubtedly save lives.

The timing and scope of these additional measures are difficult considerations. It is
possible that any measures at this time could be deemed either overly aggressive or too
late. With that in mind, we advocate for steps that may be deemed overly aggressive,
as this is preferred in matters of community safety. We commend you and city leaders
for the aggressive actions you have taken to date, such as closing our public schools
and also canceling any large official gatherings to lower the likelihood of community
spread.

The hours and days ahead will be critical to mitigating community spread. While
recommendations for hand hygiene and social distancing are spot on, their voluntary
implementation in our community are clearly challenging and not optimally effective
given the exponential growth in COVID-19 cases in numerous communities across the
country despite widely-publicized recommendations for social distancing.
We know these are difficult steps, and we are hesitant to have to recommend them. We
as a state may face short-term economic set-backs as a result, but the long-term
economic consequences of not acting now are greater. The big-picture perspective is
necessary.

We also want to acknowledge that this virus tends to be surprisingly mild and
well-tolerated in most kids, healthy young adults, and middle-aged adults. This makes it
really tempting to say it isn’t a big deal, most people get this virus. Although they may
not be severely affected by the virus, young, healthy people must practice social
distancing. In South Korea, where significantly-more testing has been done, 20-29
year-olds represented 30% of those infected. Individuals in this age group can have
relatively mild symptoms but still spread the COVID-19 virus. If infected, older family
members, friends, or other vulnerable community members may be hospitalized or die
with this virus, particularly if there are shortages of medical care.

Hindsight will not look kindly on actions that are taken too late here. Moreover, as
health professionals, we know that the weeks to come are already at risk of
overwhelming our fragile healthcare system. Please help us so we can help our
community face this crisis.

Thank you for your consideration of our perspective. We would be happy to discuss
further if you have questions or concerns. Likewise, we would be happy to provide
resources and guidance to you.
Best regards,

Chelsea Mikell, MD 
Obstetrics and Gynecology
Ogeechee OB/GYN 

Scott Mikell, MD 
Family Medicine and Geriatric Medicine
Statesboro Family Practice 

Ian Munger, MD
Emergency Medicine
East Georgia Regional Medical Center 

Sreelu Dega, MD 
Urgent care Physician
Mednow / Northside Hospitals – Augusta / Atlanta   

Ruthie Crider, MD 
Emergency Medicine
East Georgia Regional Medical Center 

Hugh James, MD 
Anesthesiology
Anesthesia Management Associates  

Albert Lee, MD
Anesthesiology 

James Hiller, MD
Obstetrics and Gynecology
Southern OB/GYN 

Ajay Jain, MD
Cardiology
Cardiovascular Associates of Eastern Georgia

Rani Reddy, MD 
Internal Medicine
Candler Internal Medicine

Brian Moogerfeld, MD
Internal Medicine
Moogerfeld Internal Medicine

Maria Moogerfeld, MD
Internal Medicine
Moogerfeld Internal Medicine

Angela Davis, MD
Family Medicine
Family Health Center

Anna Benson, MD
Pediatrics
Mama Doc Pediatrics

Al Palmer, MD
Obstetrics and Gynecology
East Georgia Women’s Center

Benajmin Oldham, MD
Obstetrics and Gynecology
Ogeechee OB/GYN