Q&A with Spokane Regional Health District’s Dr. Bob Lutz
~September 10th, 2020
Dr. Bob Lutz was thrust into the spotlight shortly after COVID-19 reared its ugly head. The Spokane Regional Health District’s health officer quickly became the face of the district’s response to the pandemic and has led the organization’s efforts in stemming the spread of the virus.
Now that Spokanites are settling into an uneasy and still-changing “new normal,” the Journal sat down — masked and distanced — with Lutz in his office to talk about COVID-19’s impacts to Spokane’s community and economy, how Spokane could be involved in production of a vaccine, and how leading the county through a pandemic has affected him.
You’ve been put in a position where you have to consider public health first and foremost, but you also have to consider economic impacts. How do you balance those?
This is a German word that I came across: Zugzwang. A position in chess where every move is disadvantageous, where we must examine every plan, however unpalatable. There’s no good choice.
People have to realize that as a public health official, I have to think first and foremost about the fact that we’re in a pandemic. My responsibility is the 532,000 citizens of Spokane. As a physician, I take care of patients one at a time. Now, all of a sudden, I’m taking care of 532,000-plus individuals. That’s what I’m responsible for. So I have to address the pandemic, and how do I do that? Unfortunately, by putting on restrictions to prevent the spread.
We’ve lost more than 100 people here. It’s very disappointing when I hear the argument that the people who die are primarily those in long-term care facilities, the older people, people with medical problems. They have lives. They have histories. They have families. I don’t write those people off. We write them off as a society. But I can’t write them off, as a human being. I have to try to balance all of that, knowing that there’s no winners, at the end. What I’m trying to do is keep us healthy and safe, knowing that there will be losers, unfortunately.
Early on, we were highly visible. I was highly visible. There was overwhelming support for public health. Now, I think some of that support has waned.
It doesn’t help, with some of the national rhetoric and all the misinformation out there. When I hear from the CDC, which has been this esteemed public health resource seemingly forever, that you do not have to test people who are asymptomatic if they were exposed … where did this come from? It makes no sense. We know that asymptomatic people and presymptomatic people have been major drivers of this pandemic. In this case, you’re contagious a couple of days before you have symptoms, and you may never even have symptoms, but you’re contagious. The misinformation has been a real challenge for us. Look at all the rhetoric around masks. Why have masks been politicized?
My concern right now is that public health is not going to be looked upon in the same way. I think we will be criticized for some of the things we’ve done. And you can’t disprove a negative. In other words, we will prepare for the worst and hope for the best. I truly hope that some of the things that we’re putting in place and that we put in place have prevented poor outcomes. You don’t know. All you can think of is that there seems to be an association.
Case in point: we know that face coverings have decreased cases. But do I have a randomized, controlled trial to say it works? Not necessarily. There are a lot of things that people are going to criticize us for doing, and we’re doing it based upon the science that we know, and what we believe to be the best means to achieve positive outcomes. But what we know today is not what we’re going to know tomorrow. People think that science is linear. It’s not.
What’s your perspective on how local schools have prepared?
They had a whole summer to prepare, albeit I don’t know if all of them approached it with the belief that we would find ourselves having to be in remote learning come the start of school. Many did, or many had that idea that there’ll have to be some component of that. They weren’t given much information to work with from the state Office of Superintendent of Public Instruction back in June. They were given a guidance document that had no detail, it was very conceptual. School districts wanted some answers. We’ve been doing a lot of interpretation, a lot of assistance. We talk with the superintendents weekly.
I get very concerned about those who are more marginalized, those who don’t have access, who don’t have resources. They don’t have a stable home environment that they’re going to call a school environment. Those are going to be the challenges. Those are the kids who are, unfortunately, going to fall behind, and those are the things we need to be looking for. How do schools reach out to those young people? How do they provide the resources and the extra assistance that they need?
Marginalized kids are already behind — how do we prevent them from falling further behind? Educational attainment is so important, and if you don’t graduate from high school, the likelihood of you having a well-paying job and getting yourself in a place where you’re going to have a good health outcome is not very likely. Didn’t Hillary Clinton say it takes a village to raise a child? It takes a whole city to raise our kids now, during COVID-19.
Parents need to be able to know that they have resources to reach out for and how to find them. Schools need to be able to link parents with resources. Parents need to understand when their children are needing help — and not just from a school standpoint, from an emotional, social standpoint. How do you recognize that? What do you look for?
Spokane has grown to be a health care hub — what’s the likelihood that Spokane could play a role in a COVID-19 vaccine?
I think there’s a high likelihood it will be involved with trials, with recruiting individuals to be part of phase-three trials, maybe phase two. I have no doubt that with our health care resources here, both with the hospitals as well as Washington State University’s health care complex, that we will be involved in some capacity.
I don’t know if there will be companies that will have some role in production of vaccines. I look at Jubilant HollisterStier, a little-known company, but they have a huge manufacturing plant that puts the vaccines in the bottles. Might they be part of the vaccine process? I think that’s probably highly likely.
As a health care hub, both with our hospitals, as well as with the medical school and the school of pharmacy and the school of nursing, I have no doubt that we will have some role in vaccine production and/or development.
You’re doing a stressful job in a very stressful time. How do you unwind?
I have my routines. I’m a runner. I run every day, so for me, that’s a stress reliever. I like to get outdoors.
I went 107 days straight without a break, and that was not a smart thing to do. I wasn’t listening to what I know best about myself. I allowed a lot of things to get to me. My predecessors and my generation are used to doing things on our own. We’re not always good at asking for help, or the time and technology that we need. I got burned out, just pure and simple. I was going 24/7 for too many days without thinking of anything else, and it got to me. It was amazing, taking one day off made a huge difference. We have a cabin up in the Methow Valley. I got out, and thought, wow, why haven’t I done this sooner?
As a physician, you can’t take care of anybody else if you can’t take care of yourself, first and foremost. I was at a breaking point. I needed to be hit upside the head a couple of times to realize that, but I did. I have my wife, who is my best friend. She’ll keep me honest. I have too much responsibility. I can’t let people down.
How is this experience of guiding a county through a pandemic going to inform the rest of your career?
It truly is a seminal moment. I’ve learned a lot. I’ve learned about leadership. I’ve learned about the importance of being able to communicate well, the importance of being transparent, and having people understand why I make the decisions I do, acknowledging that what may benefit 1,000 may not benefit every individual the same. There’s an inherent tension there.
As Americans, we’re used to the individual. It’s all about the strength of the individual. Public health is all about the us. It’s about the community. That sense of community is very strong and it’s inherent, an underlying principle. We are truly better for the group. That sense of community is essential in public health.
This is definitely a career-defining time. I think I’m doing a decent job. I think of the times I could have done a lot better. I’ll always be self-critical. I’ve done a decent job at steering us, from a public health standpoint, in the right direction.
It hasn’t just been me. I’ve got 250-plus people who I work with here, and I’ve got brilliant people. What I want people to know is that Dr. Lutz may be who we know, but there’s Cindy, and there’s Lydia and Amelia and Mark and John and Ray. All these people who are doing all this great work.
I still need to learn a lot more. At the end of the day—and I’m not sure when the end of the day is going to be—I think I’ll look back and say, I did a pretty good job. I could have done better, but here’s where I found myself.
This interview has been edited for length and clarity.