Orthopedic Surgeon, Mayor Team Up on COVID-19 Response

Laird Harrison

April 30, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

In the heart of California's Central Valley, the city of Atwater is shielding itself from the coronavirus pandemic.

Atwater is located on State Route 99 in Merced County, about a 2-hour drive to the Bay Area and the state capitol of Sacramento. On March 9, even though no one in the town of 30,000 had yet been diagnosed with COVID-19, Mayor Paul Creighton declared a state of emergency.

The mayor said he felt moved to act after watching YouTube videos about the pandemic, including scenes of incinerators set up to cremate human remains in Wuhan, China, where the virus originated.

"I thought that for China to be doing that, this is way bigger than the city of Atwater is ready for," Creighton told Medscape Medical News.

The state of emergency allowed Creighton to create the position of medical advisor, to which he appointed Edward Vanek, DO, an orthopedic surgeon.

This is way bigger than the city of Atwater is ready for.

"I'm really looking to establish plans with the city," Vanek told local reporters when the emergency was declared. It will be more of a thought process, as opposed to moving any money around, he explained.

The doctor emphasized the need to protect the city's first responders, who often find themselves in situations where they are at increased risk for exposure. A single infection involving a police officer could quickly spread through an entire department and place the community at risk, he noted.

In his private practice in Atwater, Vanek treats and restores function to injured knees, shoulders, and hips, and this isn't the first time he has advocated for first responders.

Protecting First Responders

He gained notoriety in the growing town — the motto of which is Community Pride, City Wide — and was befriended by the mayor when he treated police officers injured on duty.

"Dr Vanek does charitable medical work for people who can't afford help," Creighton explained.

Vanek is also known in the area for donating to the town's fall festival and helping fund Fourth of July fireworks. His children are young and his penchant for exotic sports cars has made him a favorite of other kids in the community, who often ask for rides in his flashy McLaren 720S.

"All the kids go crazy," Creighton remarked. "He's a super cool guy. Surgeons are at the top of the food chain in my book. They have to know a lot to be able to cut open a human body."

When he assumed the position of medical advisor, Vanek advised Mayor Creighton to close City Hall for a couple of days until workers could pitch a tent outside. There, a clerk directed people to specific offices before they entered the building, which relieved congestion inside, Creighton explained. The city also set up stations with hand sanitizers and sterilizing wipes. And Vanek worked with local restaurants and bars to reduce the risk for contagion on their premises.

This is serious and real.

Vanek is originally from New York State, where his sister still lives and works as a physician on the frontline of the COVID-19 pandemic, and where, by April 30, there were more than 304,000 cases reported, and more than 18,300 deaths.

"We have not faced a crisis like this since World War II," reported Joseph Bosco, MD, president of the American Academy of Orthopaedic Surgeons. "Many of our colleagues are being repurposed."

California reported its first COVID-19 diagnosis on January 25. Then, on March 19, as the number of cases began to rise, Gov. Gavin Newsom ordered all California residents to shelter in place. But this has not put a stop to the toll — or the anxiety — the virus has unleashed.

"We're very cognizant that this is serious and real," Creighton said, "so we're lucky to have Vanek."

To date, the Merced County Department of Public Health has reported 125 confirmed cases of COVID-19, and three of those patients have died.

On Vanek's suggestion, Atwater officials ordered and distributed infrared thermometers to police, the fire department, and city hall.

"The monitors are a godsend because they ease our fears about interacting with people who appear to have symptoms," Creighton pointed out. "And you can't get those now."

Vanek also advised police and firefighters to wear goggles, masks, and gloves while on duty so they don't have to put them on in an emergency. "They don't have time when they respond on the scene," Creighton said.

The city also purchased gallons of disinfectant for use in police and fire department vehicles.

In addition, "Vanek's expertise is helping city staff psychologically," Creighton explained.

His team anticipated that the county’s lack of testing would translate into a sudden spike in COVID-19-positive patients as more tests became available. "But the hospital is staying steady, and I think our data are starting to catch up," he said. Still, the numbers are at least a couple of weeks behind.

"I think we've reached our peak, but we'll have to wait and see," he added.

Officials have implemented more public education about shelter-in-place measures and the county has ordered all parks and public buildings closed.

Merced is a rectangular county that runs east to west across the middle of the state, with Atwater on its east side. The west side is closer to the San Francisco area, and Creighton and others in Atwater worried that people from West Merced County who commute back and forth could bring infections with them. According to Creighton, 60% of the people in the county have personal connections to the Bay Area.

Initially, Creighton was concerned about public-transit buses bringing the virus into Atwater, so he collaborated with the mayor of Los Banos, in the San Joaquin Valley, to provide drivers with shields, encourage riders to wear masks, and ensure that buses were meticulously wiped down with disinfectant.

But now, with most nonessential employees home, Creighton's apprehension has eased.

"If the numbers continue to hold, we're going to start talking about transitioning back to normality," he said, speculating that could happen as early as May. However, state and county orders supersede what Atwater's mayor can do. "We may be on a different trajectory, but we'll still make plans for how to do that, so that when we're released from the state and county, we can hit the ground running. We will figure out how to get to the new normal," he said.

The city and its medical advisor will proceed cautiously to avoid a resurgence, Creighton said. "I'm smart enough to put smart people around me."

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