Dr. Nate Smith on reopening businesses, a fall school schedule, and the quest for a vaccine

Dr. Nate Smith, Secretary of the Arkansas Department of Health, says it’s possible that a vaccine for COVID-19 might not emerge and that handling the pandemic like other viruses may be the eventual norm.

Appearing on this week’s edition of Talk Business & Politics, Smith said Arkansas escaped the doomsday scenario that states like New York experienced for a variety of reasons.

“We have a lower population density, a smaller population. We don’t have as much international travel as some other states, and so those helped us,” Smith said. “I think we’ve also had some very good decision-making by the governor. He has really used the data to drive our decision-making and has had a cautious but clear approach.”

Smith has led the state’s health agency since 2013. He’s board-certified in internal medicine and infectious diseases and has studied HIV, tropical diseases and emerging infectious diseases.

He said Arkansas’ deaths per population – 98 deaths out of a population of more than 3 million – has been extremely low compared to other states, a sign he says is a hopeful one. When asked if Arkansas just got lucky by not being wiped out, Smith said, “I guess you could call it whatever you want. Divine providence is probably what I would prefer to say.”

The state has moved into a phase 1 reopening plan that has allowed everything from parks, casinos, restaurants, barbershops and hair salons to open on a limited basis. Smith said that Arkansas met the gating criteria laid out by the federal government with 14 days of downward cases, although they weren’t 14 days in a row.

He said the state has seen a downward trend in the ILINet system [Influenza-Like Illness Network] as well as downward trends in positive test results and managing hospital capacity, which remains manageable.

Smith said that the reopening process is an ongoing dialogue between Gov. Asa Hutchinson and him.

“This has been an ongoing conversation between me and the governor from the beginning. And I understand that public health isn’t just about healthcare. It’s about people’s entire environment they live in. We sometimes call that the social determinants of health. And I will guarantee you that there’ll be more people who die this year in Arkansas from conditions that are more closely tied to their socioeconomic status than to COVID-19,” he said.

There is much speculation about whether or not schools will reopen this fall. Smith thinks they will, but not necessarily unless conditions improve.

“I think the governor has made it clear, and I think many other governors as well, that the intention is that we would have an in-class school year starting in the fall and I really hope that that is possible. I think we will all work very hard to make that possible,” Smith said.

He notes that kids are not immune to COVID-19, but so far they do seem less likely to become severely ill. However, they can be carriers of the virus and, in a school setting, could impact teachers, administrators and other workers in an education environment.

“In a school setting, it’s not just children. It’s their teachers, and many of our schoolteachers have risk factors. And then it’s their families when they come home and it’s grandparents, etc. So, we are a highly-integrated society and I don’t think it’s possible to just say, ‘Let COVID-19 run loose in this sector,’ and then hope that we can protect others,” Smith said.

“I think things would have to be different before I would be comfortable opening the schools, but I could see a variety of scenarios,” he added.

Those scenarios include downward trends in new cases and hospitalizations, he suggested.

“If over the course of the summer, we’re able to sort of wrangle this epidemic in Arkansas down to the ground to where we have very, very low case numbers, then I think going to school and being highly vigilant, if we had an outbreak, jumping on it quickly with our case investigations and contact tracing, I think that would be one option.

“Another option is to scale up our testing to such a point that we can basically be screening people often enough to know who’s positive and who’s negative. If there’s no one who’s infected, then it doesn’t really matter what you do in terms of social distancing, you’re going to be okay. But to have that testing capability to where you could know that for sure, that’s not where we are now, but it could be where we are in the fall,” Smith said.

Many leaders from the President down to city mayors as well as public health experts have suggested that we won’t be truly safe until a vaccine is developed. However, public health officials, including Smith, warn we may not find a cure for the latest coronavirus.

“I think vaccines have been transformational in terms of healthcare in our lifetimes, and we have so many highly effective vaccines that have really changed human existence. And it’s frustrating sometimes when there are sort of anti-vaccination messages out there, but things like measles, smallpox, which has been eradicated, many other vaccine-preventable diseases, our lives have been changed fundamentally by the presence of those vaccines, the existence of those vaccines. So, that would be our first choice for this,” Smith said.

“Of course, it was our first choice for HIV and we still don’t have a vaccine there. It would sure be nice to have a highly-effective vaccine for malaria or tuberculosis, but we don’t have those either. So, if we can get a vaccine for COVID-19, that would definitely be the first choice, but there’s always the possibility that that will elude us,” Smith added.

You can watch Smith’s full interview in the video below.