WHEN THE COVID-19 epidemic began to surge in southeastern Indiana, David Welsh, MD, grew nervous.
As the Ripley County health officer, Welsh, a 1984 Indiana University School of Medicine graduate, knew local health systems could be overwhelmed. Ripley and the two neighboring counties, with 78,000 residents combined, have just two critical access hospitals with 50 beds. The problem was simple math.
So, Welsh acted. After the governor put limits on large gatherings, Welsh consulted local law enforcement and began investigating reports the rules were being violated.
Soon, though, Ripley County saw a spike in cases. Five residents died within the first month, and Welsh and his county’s health workers struggled to stay afloat. Ripley County was one of Indiana’s rural hot spots.
In response to COVID-19, IU School of Medicine-trained physicians have performed a variety of roles. Few have faced a more diverse set of tasks than those who also serve as county health officers.
In Hendricks County, just west of Indianapolis, Avon Community Schools announced March 9 that a student had tested positive for the virus, and the district temporarily closed. Other county schools followed.
David Stopperich, MD, the county’s public health officer and a 2002 IU School of Medicine graduate, would see Hendricks County face more than 880 cases by early May. But the most challenging days came in March. With the schools affected, Stopperich found himself shuttling between meetings of anxious parents.
“That first week was very chaotic,” he said.
In Allen County, Deborah McMahan, MD, a 1990 IU School of Medicine graduate, serves as health commissioner. So far, there have been 824 COVID-19 cases and63 deaths. While the virus didn’t swamp local hospitals, McMahan has been worried about local nursing homes and assisted-living facilities—and their health care workers. They not only face shortages of personal protective equipment but they care for the most vulnerable patients.
"These people are going through hell," McMahan said. "I can't imagine how hard that is on the staff."
McMahan contacted the state Family and Social Services Administration about a pilot program to help health care workers cope. Her pitch: send in "strike teams" of mental health professionals to debrief workers. "They need an outlet to work through grief," McMahan said. "This might be a solution."
BACK IN RIPLEY County where the hospitals were under intense pressure, Welsh got on the phone and reached out for help also—to the Centers for Disease Control, to hospitals in Indianapolis and Cincinnati and even to fellow IU graduate and U.S. Surgeon General Jerome Adams.
His calls for help were quickly answered. The city hospitals offered to take patients and ease the burden in other ways. But Welsh went a step further.
He launched a series of short, occasionally humorous, informational videos to get the message out to residents about social distancing, masking and "doing the things your mother taught you," such as washing your hands and covering your mouth when you cough.
To encourage distancing, Welsh promoted membership in a "6-foot club,” illustrating what that distance looked like in several ways. He wielded a bo staff—the wooden shafts employed during martial arts training (Welsh is a fifth-degree black belt). He even told the tale of a farmer's wife who used a pitchfork to keep her husband at the proper distance.
To promote masking, Welsh encouraged viewers to make their own masks from materials featuring their favorite sports teams. He even showed viewers what not to wear—including a softball helmet and a creepy Halloween facemask.
"We wanted it short and to the point. It had to be concise or people wouldn't watch it," Welsh said. "We just wanted folks to do what mom taught us. And it resonated."
The videos were shared on various social media. A television station in Cincinnati did a piece on them. Throughout the videos, Welsh was upbeat and optimistic. But he's also fearful that, like some series on Netflix, a second season of the show might be necessary if there’s a COVID-19 surge in the fall.
All told, Ripley County had seen 103 COVID-19 cases, and six residents had died as of Monday. But the worst of the initial surge, Welsh says, appears to be behind it. "We're no longer gulping for air," he said. "We're treading water."
In Hendricks County, Stopperich found that state-imposed social distance guidelines, including shuttering all schools, gave him and his 30 public health employees time to get their arms around the situation. Things have settled to the point he is now spending more time at his family medicine practice in Lizton. And the calls to the health department are now from business owners seeking clarification on reopening policies.
"The governor's plan is a good one," Stopperich said. "But there's no way they can think of every possible situation."
In Allen County, McMahan and her colleagues have begun to pivot from mitigation to starting a slow return to normalcy under the state's staged reopening plan. But she, too, is concerned about the unknowns. "The real telling part is going to be coexisting with the virus," McMahan said. "We've been hiding from it. Once we come out, it's going to be interesting to see what that does to our numbers."
Communications Specialist Matthew Harris contributed reporting to this piece.
