190: Learning to Live with COVID-19

Justa Encarnacion, Commissioner of the U.S. Virgin Islands Department of Health, discusses the differences and similarities in responding to COVID-19 as a territory as opposed to a state. Encarnacion also expands on the challenges the U.S. Virgin...

Justa Encarnacion, Commissioner of the U.S. Virgin Islands Department of Health, discusses the differences and similarities in responding to COVID-19 as a territory as opposed to a state. Encarnacion also expands on the challenges the U.S. Virgin Islands have faced when it comes to vaccination.

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This is Public Health Review Morning Edition for Wednesday, June 1, 2022. I'm Robert Johnson.

Now, a special conversation with Justa Encarnacion, commissioner of the U.S. Virgin Islands' Department of Health. We caught up with her at last week's COVID-19 summit hosted by ASTHO to talk about changes in her department's response to COVID-19.


You're one of many state and territorial health officials who came to Washington to talk about the next phase of the COVID-19 response. Is it different when you're in a territory? Do you do things differently as it relates to how you manage the virus, how you talk to communities—any changes at all, or is it the same as in the states?


Practically the same as in the mainland. The difference is basically the geographic separation between states and territories—that's basically it.

We're blessed to have a governor that travels quite frequently to the mainland, meets with Congress, meets with delegates to ensure that we are treated equitably, which is important. It's always been a conversation, especially in terms of Medicaid and Medicare services and what we need to do in terms of decreasing the gap for Medicaid reimbursement. And so, we're actually very versed with what's going on within the mainland.

I think one of the biggest differences is, one we spoke about quite frequently throughout this summit, is how do you communicate electronically? And the other states spoke about what we can do differently and how we can actually have an IT system that communicates from state A, to state B, and to territories alike that gives us the daily visual about what's going on from a testing perspective, from a vaccination perspective.

So, we met the same challenges that the other states did. One of the things that I think that I could say is a benefit for us is that we're smaller. And the work was no different. It was just as hard, sometimes I think harder.


When you go home to your island paradise, what will you take from the meeting as a lesson learned or a new idea that will help you lead the response to the virus through the rest of this year?


I have to tell you that the community I think is very dependent on government to tell them what to do: wear your mask, don't go outside, you know? And so, what we're now doing is we're changing our conversation. In other words, yes, we no longer tell you that you have to wear your mask, but you still have that right, that authority to protect your body and the loved ones around you. So, that chain of conversation is more of a behavioral change issue. How are you going to protect yourself? How are you going to protect the ones in your home that are immunocompromised? How are you going to protect the other ones that are living next door to you? And what are your responsibilities?

And so, yes, we still have all our mitigation factors available: we have masks available for you, we have hand sanitizers available for you when we have—we're opening up a little bit more in the territory. We had our Carnival a few weeks ago, which was very successful, but we had a large increase of COVID positive cases.

Thank God hospitalizations remained low, but we're teaching them, "Yes, this occurred. We asked you to wear your mask, some of you did. This is a ramification, so let's work together." But it's a good conversation. It's not, "I told you so." No, it's—this is a change that we have to live with. We have recommendations for the federal government, but we have our own recommendations locally as well. How can we put those together and work best for you?


And this is a recognition, basically, that COVID is here to stay, right? So, we have to learn how to live with it. The worst hopefully has behind us with vaccines and treatments and other things. But that messaging sounds like, to me, is your biggest challenge now.


I think so, but one of the things we've been struggling with vaccinations are presented territory-wide is 54%, which is the thing—that's still pretty low when you look at the population 65 and over is over 80%. And so, we're focusing on the school age group, the younger population, how do we get them vaccinated? So, we haven't given that up. So, that's still very, that is our top priority to get everyone vaccinated, to get everyone boosted.

But I always say, if you take a strong hold on that and say, you know, you blame them for something, that's not the right approach to do it. So, you work with everyone that's there. So, if you choose not to get vaccinated, that is your choice. We're not mandating vaccinations, but we're now giving you other options. We're saying, if you are not vaccinated, we let you know this is what may happen, but to let you know if you do become positive, don't just take a home test and stay home. Have a validation test so that we can give you your medication, your antivirals, that we need—we just need to validate that that's definitely what's there.


Thinking about all that you've been through and what might still happen, how do you feel about where you are right now with your planning, your preparation, with your communities?


I feel comfortable, but I also fear—there's some fear in the future because everyone thinks that if you have a variant from a virus that that variant is going to be less contagious, is going to be—the acuity level that you see reflected is going to be lower. That's not the case at all times. Delta showed us that that's not the case.

And so, you don't know what the future brings. I'm comfortable with our process, but the fear is the unknown. And I think that's okay to say as well. And so, we express that to everyone else also.

We know what we've done. We know we'll continue to basically the same approach because I think consistency is what really breeds success. But at the same time, we have to make sure that everyone knows that COVID is still here, and the variants that may come in the future may be different, and we don't know exactly what to expect.



That'll do it for today's newscast. We're back tomorrow morning with more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.

Justa Encarnacion RN MBA HCM

Commissioner, U.S. Virgin Islands Department of Health