A Q&A with Clay Marsh, M.D.
By Samantha Cart
On March 16, 2020, Governor Jim Justice declared a state of emergency in West Virginia, just one day prior to the state’s first confirmed case of COVID-19. As case numbers continued to increase from there, Justice began to assemble a team to see the Mountain State through the unprecedented events unfolding each day. On March 26, 2020, Justice named Clay Marsh, M.D., vice president and executive dean for health sciences at West Virginia University (WVU), West Virginia’s coronavirus czar as part of his Joint Interagency Task Force.
A native West Virginian with vast leadership experience and a specialty in pulmonary and critical care medicine, Marsh’s background uniquely situated him to lead and advise on a course of action to slow the spread of the novel virus while also demonstrating great compassion and care for residents of the Mountain State. At the time of his appointment, there was no way of knowing what the next year would hold, but today Marsh continues to lead as West Virginia outpaces the rest of the country on the delivery of COVID-19 vaccinations.
In this Q&A, Marsh discusses his responsibilities as coronavirus czar, common misconceptions about the virus and how West Virginia’ health care industry has responded and adapted during the pandemic as well as its potential long-term effects on the state’s health care industry.
WVE: What are your responsibilities as West Virginia’s coronavirus czar?
CM: The governor asked me to help coordinate the state’s response with all the other agencies—the West Virginia Department of Health and Human Resources, the West Virginia National Guard and other leadership groups in the state—that would be important when making recommendations to the governor related to the health and scientific components of the COVID-19 response. We are also part of the discussion around economics and education, but for me, it is about making those recommendations about the health care sector to the governor.
WVE: What has it meant to you to serve the state in this capacity?
CM: It is wonderful. My dad was the editor of The Charleston Gazette for many years and had a radio show with Hoppy Kercheval for several more years. He grew up in Logan, WV, in Mud Fork, and his father was a coal miner. My dad’s mother was self-educated and loved to read, a love shared by my father. Because of the GI bill, he was able to go to college. He started working for The Charleston Gazette out of college and ended up writing series of articles about the Buffalo Creek disaster that were submitted for a contest he didn’t know about. He was chosen to be one of five Nieman fellows in the country and got to go to Harvard for a year, which kind of freaked him out, but I think it really helped him see that he was smart enough to be successful in his own life. I’m not sure that he really realized that before. At The Charleston Gazette, Ned Chilton had an internal motto—sustained outrage for social injustice—and that is the house I grew up in. I grew up in Charleston. I went to school at West Virginia University. I went to Ohio State University, and I was there for a long time—twice while Gordon Gee was the president. I was leaving WVU as a medical student when Gordon Gee was president at WVU the first time. When Gordon came back to West Virginia, he pulled me back to the state, and it has been an amazing experience being back. It is really a privilege to be able to serve, and I do feel like in some ways I have taken the torch from my dad. I also really feel like a lot of experiences I had at Ohio State and at WVU really helped prepare me for the opportunity to contribute to the state.
WVE: What are the most common misconceptions about COVID-19?
CM: Number one is that COVID-19 is a hoax. This is a pandemic, and we know this virus spreads very easily. There are a lot of different belief systems out there, and I think that has complicated things, but this kind of disbelief was also seen during the 1918 pandemic, which was the last pandemic our country had to suffer through.
Number two is that mask wearing makes no difference. There is a lot of data to the contrary, and, in fact, mask wearing is like a physical barrier vaccine. Mask wearing is a powerful tool to reduce the spread because spread happens through droplets and aerosols.
Number three is that asking people to wear masks and physically distance is an infringement on their constitutional rights. I don’t want to come off as being argumentative or disagreeable, but the truth is we don’t go out and drive when we drink, not only because we could get arrested but also because we don’t want to hurt somebody else. For me, not taking appropriate precautions during COVID-19 is the same thing. I am going to use a bad analogy, but if you want to jump off a bridge, that is terrible. We would want to do everything to help you not want to do that, and you would really hurt your family and the people that loved you. However, as long as there wasn’t someone right below you, you’re really making a decision that would injure you and no one else. With COVID-19, if you don’t take the appropriate precautions, you can infect a lot of other people.
Number four is that COVID-19 doesn’t really hurt anybody, particularly anybody who is younger. We have seen more young people hospitalized for COVID-19 than the number of people who died in 9/11. We have seen 2 million people around the world die of COVID-19—400,000 in America and more than 1,850 in West Virginia. We also know that COVID-19—even if it doesn’t cause you to die—has long-term effects. So, COVID-19 is not benign. The idea that COVID-19 is nothing to be worried about is a bad narrative.
The last fallacy about COVID-19 is that vaccines are dangerous to take. With the Emergency Use Authorization now granted by the Food and Drug Administration for both the Pfizer and Moderna vaccines, we encourage all people to choose to take the vaccine when it is their turn. With 95% effectiveness rates, these vaccines save lives, reduce hospitalizations and provide us light at the end of the tunnel to ultimately overcome COVID-19.
The other fascinating finding of COVID-19 is the number of lenses people look through that create interpretations of the same data. With the advent of social media and so many news channels, different citizens interpret the real threat from COVID-19 differently. We see different narratives, descriptions and truths. This can create polarization.
WVE: In your opinion, how well did West Virginia’s health care industry respond and adapt to the coronavirus pandemic?
CM: There is always some inherent competition between different entities in any industry sector, whether it is Walmart and Amazon or Kroger and Giant Eagle. I think there has been historic competition in the health care industry as well, as that is fair and good and part of business. Health care is the biggest business industry in our state. It employs more people and generates more revenue. It has been encouraging to see the great deal of collaboration and connection around supporting each other during the past year. Our health care assets have come together as a single West Virginia network.
When the pandemic first started and we were watching Italy getting into a lot of trouble and New York City being like a war zone, we were very worried about West Virginia and what would happen. However, everybody really acted as a single team, from the West Virginia Hospital Association to every hospital system in the state. It required them to cut back on some services they provide that generate revenue. There were temporary furloughs. It was really hard, financially. The CARES Act thankfully helped assist the hospital systems to be financially able to bring people back again.
We aren’t running a drill anymore. This is no longer a fire drill; there is a real fire we are running toward, and it is really inspiring to see the collaboration and service of our people. There are a lot of heroes out there. There is no more competition, no more us versus them. It is really everyone working together. There has been a lot of selfless service done by the health care industry to continue to provide the care West Virginians need. I am really proud.
WVE: How will the pandemic impact health care in the long term?
CM: It is always important for us to debrief on some of the lessons we learned. There are a few in this case that are pretty easy and a few that are a bit more speculative. An easy one is that we have learned we can work remotely and stay highly productive. The use of telemedicine and telepresence has really been done at much higher levels during this pandemic, and it has been really effective. Even having the ability to do a telephone call—not just video visits—because some people don’t have the high-speed internet or the capability to do that, has been really successful.
We also learned that by working together as a community, we do better. By starting to look at the flow of people in and out of our hospitals, we learned how to control the capacity issues much better than we knew before. I think that is really important because eventually you have to maintain that vital capacity to be able to operate.
In the health care sector, we have come much closer together as a community over the past several months. There is a book by Rutger Bregman called “Humankind.” It is about the response to people in crisis. There is a lot of belief—particularly around World War II with Winston Churchill and Adolf Hitler—that if you have enough chaos and crisis in one place, the people will turn on each other. They will just look out for their best interest. What they discovered, and the focus of Bregman’s book, is that crisis actually brings out the best in us. It brings out community, it brings out caring for each other, it brings out connections that maybe we didn’t feel before, and that is a powerful opportunity for us in the future to really look at trying to help people heal.
Hospital systems and the state government have laid down a lot of infrastructure during this time. As an integrated health care ecosystem, we have created our own supply chain; made our own masks, gowns and gloves; made our own testing; designed and tested the efficiency of different kinds of materials to mirror high barrier protection masks; and worked together as a team to be able to solve some of the problems West Virginia has been faced with. We have been able to lay down a foundation that could really allow us to be much better in the public and population health of West Virginia long term. It could help us think about public health in West Virginia—not just hospital and clinic-based health—but community-based health so we can help people be well in their own communities. That opens up a really exciting next chapter for us because ultimately wouldn’t it be great if West Virginia could become the healthiest state in the country, as we have done in our response to COVID-19?
WVE: What are the most important lessons you think we as a state have learned from this situation?
CM: First of all, we have great leadership and very smart people in our state. From our elected officials and educational and business leaders to our community leaders and each citizen, we have understood the power that exists in this state and in its people. Our people and our state have done so much better than we would have ever anticipated. If you had told me today that this would be where we are in the pandemic, that this is the number of deaths we would have and these are all the metrics, I would have taken it in the bat of an eye because the Kaiser Family Foundation had us ranked as the most vulnerable of all states given our rural status, health care metrics and average age. We were thought to be the most likely state to do poorly during this, but we have done pretty well. We know people within our state still care about and for each other, and that has made a huge difference.
We have learned that we are a smart and innovative state. We were the first state to test all the nursing homes and the first to vaccinate these highly vulnerable people. We declared a state of emergency before we had a single documented case. We are among the best in the country in testing our population and have become the model for America on vaccine distribution and vaccination. West Virginia is acting as a beacon for our country and beyond.
We are changing the narrative, and not just to those outside West Virginia. We are changing the narrative our citizens tell themselves. In the past, we may have felt like the world passed us by, but we are a place that maintains a foundation of love for each other, of strong community, of service. We went underground to mine the coal, to build the Industrial Revolution, to fight the world wars. We have a huge per capita veteran population and understand the sacrifices of great service. That spirit is a huge benefit for us. We have smart, innovative people who care about each other. We have great communities, we serve, we elevate our behavior to help each other. We look out for each other, and that is such a powerful strength. I think we are changing that narrative in our own minds, seeing ourselves as a place that is really changing, as the phoenix rising, the place of ascension.
WVE: In your opinion, what will 2021 look like? Is there light at the end of the tunnel, or should we expect more of the same in terms of limited gatherings, social distancing, masks, etc.?
CM: There is absolutely light at the end of the tunnel, and we are already seeing it with the Pfizer and Moderna vaccines. These vaccines are very safe. We know based on our projections that in 2021, we will be able to vaccinate all West Virginians who will agree to be vaccinated. I hope that is all West Virginians, because ultimately a vaccine is not very powerful—a vaccinated person is very powerful.
We have to understand that if one person is vaccinated and nobody else is, then even though that is generally good at protecting the one person, this is not enough for their community. We are really recommending as people are in the process of getting vaccinated that they would be willing to continue wearing a mask and staying physically distanced. Do all those things until we get more people vaccinated, and then we will be able to ease up.
As we get more people vaccinated, there will be less pressure on the health care systems as well, so these should work together and hopefully start to ease that burden. I think that will be an early sign of that light at the end of the tunnel. If we get 70% of the population immunized, you will start to see the virus die down. I would hope by summer, things will look a lot better. I don’t know if it will be all back to normal, but life will be much brighter.
The data suggests that the single most important element in doing well in COVID-19 is unity, or as the governor says, “All pulling the rope in the same direction.” It is really important for us to show our service, altruism, love for each other and love for community, which West Virginians do all the time really well. This is the time that really, really matters, and that is something we have called on people to do in almost every press briefing. We are much stronger together than we are separated. That is a key reason, in my opinion, we have fared so well in this pandemic.
WVE: Some West Virginians have concerns about the coronavirus vaccines due to the speed at which they were able to be created, tested and approved and as well as any potentially unknown side effects. What would you say to help dispel their unease?
CM: There are several types of coronaviruses. A few can cause the common cold and others more serious infections such as the severe acute respiratory syndrome, or SARS, epidemic in 2002 and Middle East respiratory syndrome, or MERS, in 2012. Scientists have been studying coronaviruses for more than 50 years and have existing data and information on the genome and life cycle of the virus. Early efforts to develop vaccines for MERS laid the groundwork for developing the COVID-19 vaccine. In addition, advances in genome sequencing, global scientific collaboration and funding support from multiple agencies and partners helped remove barriers and speed up the authorization process for the COVID-19 vaccines. Data from the clinical trials showed excellent responses to the vaccinations with side effects that are similar to those from flu vaccines. The COVID-19 vaccine is safe and effective, and the benefits of receiving the vaccine far outweigh risking possible infection.
WVE: If you could leave our readers with one thought on the pandemic and how we move forward as a state, what would it be?
CM: We should feel that West Virginia is shining brightly during this really challenging time. The roughest waters give way to the calm water, the most turbulent skies and darkest clouds give way to the sun that is right behind them. We are the calm water, the bright sun and the hope many turn to when they see how our state has responded to this once-in-a-lifetime event. West Virginia should be really proud of how we have come together and supported each other. While we are not perfect—and nobody is—I think the greatness of our people and the commitment to service and altruism has been something we have seen clearly. The more we stay together, the stronger we are; the more we break apart, the weaker we are. This is the time for each West Virginian to answer the call of responsibility. We are using our power to reduce the spread of this virus. We have supported each other with the grit and service that makes our state great. We have shown the world what Almost Heaven looks like.
WVE: Is there anything else you think we need to know?
CM: Leadership is so important right now, and I want to give kudos to Governor Jim Justice. I try to be apolitical as much as I can in my work, but, like everyone else, I am human. One thing I have seen about our governor, and all the great people on our leadership team, is their great heart for helping the people of this state. I know the governor talks about the economy and he’s a business guy, but he has been remarkably able to take a lot of complicated health care information and understand it. He is really good with numbers and has kept the state together. That is not easy to do, and he hasn’t made a single decision, in my opinion, that didn’t prioritize the health of the people in the state when push came to shove. I really give him a ton of credit. I think he has grown remarkably through this ordeal. He has found his purpose, and I think he is all in with his heart. A lot of people don’t get to see the backstage view, but I really commend him on his leadership. He is the CEO of our state, so he has had to make the decisions. Nobody else has made them. I have made recommendations. Sometimes we will have discussions and debates, but it is his decision to make and he has been unfailing, in my opinion, in doing the right stuff for the state to the best of his ability.
