A MAN, A PLAN, A PANDEMIC

DR. JOSE ROMERO TASKED WITH KEEPING ARKANSANS SAFE.

Dr. Jose Romero, 65, succeeded Dr. Nate Smith as state Secretary of Health in July, first on an interim basis and then by appointment by the governor in August. Romero, a native of Mexico City, is an infectious disease doctor, professor of pediatrics for the University of Arkansas for Medical Sciences and has worked with the health department on pediatric health initiatives for patients with HIV, hepatitis C and tuberculosis. He also serves on the Centers for Disease Control and Prevention’s Committee on Immunization Practices, which is providing guidance to the Food and Drug Administration on the COVID-19 vaccine. Because he is bilingual, he has worked with media targeting the state’s Latinx community to provide guidance on the pandemic. The Times asked him about his background and his work heading up the state’s public health effort to contain the coronavirus.

You came to Arkansas Children’s Hospital from the University of Nebraska Medical Center in 2008. What brought you here?

The chairman of pediatrics, Dr. Richard Jacobs, and I knew each other. He reached out to me to be section chief. I came down here initially as a courtesy. I was expecting a small children’s hospital. … I used to say, though it is probably not true anymore, that Children’s Hospital was the best-kept secret in the South. The opportunities here were significant, and I was offered an endowed chair.

Earlier this year you accepted Smith’s offer to be chief medical officer of the health department, which was similar to a job you held in Nebraska.

I thought that when I stepped back from academics, it would be interesting to be a medical officer. To get a flavor of what was being done here, I asked if I could volunteer. I came by on March 11 [coincidentally the day the first COVID-19 case was announced in Arkansas]. And then because of everything going on, I spent a lot of time working and helping a little bit more. Nate and [senior deputy director] Stephanie Williams felt they had need of a person with my previous skill, so they moved my start date to April 1. Another ironic day.

The Journal of the American Medical Association published an article in August about attacks on health officers during the pandemic, including death threats, doxxing, vandalism and other forms of harassment; 27 in 13 states have resigned or been fired. Have you been threatened in any way?

I have not had anybody show up here. I have been told that there were threats [made to me] indirectly at a rally recently. … Just something that was shouted in the heat of the rally.

I was told that at the Sept. 3 rally at the state Capitol led by conservative legislators after they sued to end the state’s public health emergency that there were cries of “String him up!” at the mention of your name.

It was brought to my attention by my staff here, who had appropriate concerns and wanted me to know about it.

Are you surprised by the resistance to science you see in Arkansas, such as the reluctance of parents to vaccinate their children against lifethreatening diseases?

I’m no longer surprised, because of my feelings and interactions with the vaccine-hesitant. … That surprised me when I was younger. I couldn’t understand why, if we had the measures that prevented disease and death and maiming of children, why [parents] wouldn’t take it. I don’t understand the logic behind it, but I understand these parents, although misinformed and misguided, may be making decisions I don’t consider appropriate but they are making decisions for their children because they care for them. … The important thing is we convey fact. Convey the issue that vaccines are safe. I’ve been successful in some cases.

Do you think you have made an impact on the attitude toward COVID-19?

I think there is always going to be a subpopulation within the state, within the country, that don’t believe this is a major issue for whatever reason. I think that people are listening to us and taking into account our recommendations. We — and especially myself — need to champion and bring this forward. We can’t fall back and minimize it in any way.

Have you ever had to convince Governor Hutchinson of what the right thing to do is about coronavirus?

I don’t know that I convince him. My job is to advise him, present the information to him, the science and the data he needs to take as part of the total decision. His [job] isn’t just the health of the state, it’s the economic health of the state. ... My job is to present him the facts as they stand.

What is your greatest fear about the pandemic?

There are several areas that concern me. One is that, as you know, there’s a challenge to the authority of the governor and the Arkansas Department of Health to issue directives for a state of emergency. … I think if you remove that ability, then we can’t act quickly. We have to be able to act quickly to make decisions on what we think is the best outcome. The other is that people understand the mandate that we have the mask, social distancing — that needs to continue. I understand people are tired of it. … It’s becoming obvious there will not be sufficient vaccine [for public needs] until the middle of next year. The next hurdle is getting people to take the vaccine, to trust the vaccine, so we have enough people immune to the virus. [If not,] we’re still going to be doing this. We’re still going to be wearing this mask, we’re still going to be having to social distance.

What is the greatest fear you have about the infectivity of the virus?

We need more clarity on what the disease is like in children. We’re learning that, right? In the beginning they thought they would be OK. There is data that suggests that even normal adults have inflammation within their hearts. Getting a handle on what this does in the long-term — and we won’t know that for years — that’s very important.

What about the virus has surprised you?

Everything. We thought this was going to be a respiratory virus, because it resides in the respiratory tract, so it completely surprised us. This virus causes [blood] clotting and strokes and emboli in the lungs. We know it causes inflammation of the vessels around the heart and in the heart and causes myocarditis. It affects the central nervous system, it knocks out the sense of smell … these are very unusual findings. It’s going to teach us a lot. I don’t know if it’s genetically determined, but what we know is that it triggers a very intense immune response and that [in children can lead] to MIS-C [multisystem inflammatory syndrome in children].