Dr. Ulyee Choe: this is a ‘once-in-a-lifetime’ pandemic

When Dr. Ulyee Choe’s phone rang at 3 a.m. one March morning, he knew instantly what the call would be about. 

As the director of the Florida Department of Health in Pinellas County, Choe had been keeping tabs on Covid-19 long before it became a household name. He knew it was only a matter of time before Pinellas County would report its first case of the virus, so when the phone rang, he was prepared – as much as anyone could be during an unprecedented global pandemic – for what was to come.

“Obviously, we were watching it very closely,” said Choe, who has served in his role since 2015. “What we saw early in 2020 was how rapidly it spread and how contagious it was and how transmissible it was, and as we saw it march through Europe and on the west coast, we were very concerned.”

Fast forward six months and Choe, like the rest of us, is still learning about the virus as he works tirelessly to keep the community safe. He recently spoke to the Catalyst to share his experiences during the pandemic, his expectations for a vaccine and how he unwinds at the end of a long week. But despite all the hours he logs and all the meetings he attends, he’s not looking for praise. He saves that for his team.

“People don’t see all the work and hours my great and dedicated staff has put in, so I have to give them kudos,” he said. “I’m really humbled to lead this amazing group of professionals.”

The Catalyst: When did you learn about Covid? When did you realize it was going to be different than Zika and Ebola and other outbreaks you’d encountered?

UC: At the end of 2019, we were successfully wrapping up operations with a pretty large Hepatitis A outbreak. Even for that, our team was working countless hours and ultimately through vaccination efforts we were able to control the outbreak. I started hearing reports about Covid out of China and the Wuhan region around the holiday season.We had an incident management team who was leading the Hepatitis A response so out of an abundance of caution, we transitioned that team to monitor and prepare for any potential outbreak. We tracked it very closely as it spread through Europe and especially Italy, then the first case in the U.S. in Washington and then ultimately in early March when we had the first case here in Florida. You can prepare as much as you want but until you have that case, it’s difficult to know all the detailed action needed for the response. 

What were the concerns in the early days?

It’s hard to think back. The concerns I recall were making sure there were adequate supplies like PPE and determining the best testing strategies, keeping in mind that testing was very limited early on, and the need for public education. Probably the biggest challenge then, and to some degree now, is that this is a novel virus and we’re learning about it each and every day. We’ve learned some but there are still a lot of unknowns.

Related content: Dr. Ulyee Choe walks through the latest numbers and talks COVID past, present and future

Would you call this the greatest medical crisis of your career? 

What I can say is it’s a once-in-a-lifetime pandemic, the likes of which we have not seen since the Spanish Flu. During my career, we dealt with Ebola, which we didn’t have in Florida, Zika, where we had one case in Florida and outbreaks of other things such as measles and Hepatitis A. Just given the unknown and changing dynamics of Covid, I would say this has been one of the biggest challenges of my career. 

The positivity rate has dropped dramatically and schools have not seen outbreaks that might have been anticipated. The two-week positivity rate has dropped to around 2 percent. How has Pinellas County handled things so far and why have they been so successful? 

We’ve built a great network through our community partnerships. I’ve worked very closely with Pinellas County and the Sheriff’s office through our policy groups, but beyond that we’ve developed so many other work groups focused on various things from hospitals to long-term care to homeless and mental health as it pertains to Covid. It really has been all hands on deck, so kudos to the partnerships, to emergency management, EMS, the fire department, law enforcement – we’ve all worked well together to address this pandemic collectively. 

On the flip side, the state has allowed bars to reopen at 50 percent capacity and now Pinellas County is planning to review its mask ordinance in October. Do these things concern you? 

Overall, our trends are encouraging and our numbers are great in terms of hospital capacity. I would contend we’ve seen those positive trends because of our efforts with social distancing and masks. However, most experts – not just me –  believe this is far from over. What’s concerning is that experts think we’ll continue to see spikes of cases throughout the fall and into the winter. That’s what worries me the most. 

Do you fear that the gains we’ve made could be in jeopardy if these types of safeguards are removed?

From my standpoint as a public health professional, we need to follow data and science. What I’m going to say through this whole pandemic is we need to follow the advice of experts. Until there is an effective treatment and vaccine, we need to continue those measures including social distancing and masks. Ultimately, on the mask issue, no one will say wearing a mask is comfortable. Most of us would rather not stay six feet away from friends. I can’t recall the last time I shook someone’s hand, but most experts recommend doing these things to ensure the health and safety of the community, especially in our vulnerable populations. In Pinellas County, we have an older population with multiple co-morbid conditions, and that’s a challenge. If we do see spikes, we will see a disproportionate amount of severe outcomes including hospitalizations and deaths. To date, there have been 712 deaths, and about 70 percent of them came from long-term care facilities. 

People talk about going back to normal. Do you see things going back to how they were pre-pandemic? 

My hope is we can get back to that sense of normal eventually, but I don’t believe it will occur until we reach herd immunity or develop an effective vaccine. In the meantime, the biggest struggle we face is Covid fatigue. For the last six months we’ve been messaging out the same things including social distancing and wearing masks. You can only say it in so many different ways.

Do you ever take a day off?

I haven’t taken a vacation day since March and I do work every day. I try to get some downtime on the weekends. I play guitar and ukulele as stress relief and spend time with my family. I have three small kids so this time is very important to me. We like to play tennis and basketball, and they also play violin and piano. 

Any new pandemic hobbies?

Growing up, I never cooked or baked so in the last year, I’ve picked up baking and cooking as a new hobby, but mainly I’m a big charcoal griller.

Speaking of food, how did you get your groceries in the early days? Have you gone out to eat yet?

I never took advantage of grocery delivery but we did take precautions and wore masks early on, we’d stay socially distant and we’d go to the store during less crowded times of the day. As for dining out, I’ve gone to a couple of outdoor places, but I’m trying to limit that. I haven’t eaten anywhere indoors. 

What are your thoughts on a vaccine?

We’re monitoring vaccines very closely. I believe there are nine in phase three right now, which is the final phase of testing and the point where we get the safety and effectiveness data on them. It’s hard to predict when they’ll complete phase three. A lot of federal experts have mentioned that they’re hopeful one will be approved in the near future, possibly by the end of this year, in a limited supply with a larger availability early next year, but again, it’s important to monitor the science and the studies.

Do you worry about people who are already saying they won’t get this vaccine?

I can understand people’s concerns. This is a vaccine that was fast tracked and it’s one of the fastest I’ve ever seen developed. I’m aware of a national survey where about 40 percent of people who responded said they would be hesitant to get the vaccine. But on a positive note, no other vaccine has had billions of dollars and so much collaborative effort going into it. If you look at some of the vaccines that are promising right now, they’ve been a collaboration of multiple countries with multiple pharmaceutical companies so you have a lot both dollars and expertise going into their development. From my standpoint, I’m going to study this vaccine more than any other vaccine in my career, and I’m going to look at the recommendations by experts on both federal and state levels and make that determination. If it cuts the mustard from both my standpoint and the experts, I’d be willing to get the vaccine. 

Do you think people view getting vaccinated as a license to go back to the way things were?

I don’t think they have this number yet, but in order to develop herd immunity through vaccination efforts, a certain percentage of people do need to get the vaccine. Until we are able to reach those numbers with herd immunity, we need to continue the course. 

What silver linings do you take away from the pandemic?

It’s good to see the that the response not just from the health department but from the community is working. Our numbers are low as a result of all our collective efforts as they pertain to social distancing and masks. We have great community partnerships, we’ve all been putting in the hours and we’re all working hard in our response. But mainly, it goes back to my staff. Public health professionals do a lot behind the scenes and my staff has put in a tremendous number of hours to support our mission to protect the community, to promote good health and good choices and improve the health of all residents. We have over 800 staff at the health department in Pinellas with 171 dedicated to Covid both full and part time. The nurses at the testing sites, epidemiologists, our contact tracers, our preparedness units, our health educators – I have staff working 24-7. They work through the weekends and put in countless hours to protect the community. I see the work and dedication of my staff and everything they’re doing and I just want to keep it going.