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Five Questions For Interim Surgeon General Celeste Philip

Celeste Philip has been Florida's interim surgeon general and secretary of the Department of Health since March, after the Legislature adjourned without confirming her predecessor, John Armstrong.

The hard-fought battle over Armstrong's confirmation touched on a wide range of issues in which lawmakers questioned the department's performance, including a sharp drop in patient visits to county health departments and the state's highest-in-the-nation rate of new HIV infections. Another controversy centered on changes in the Children's Medical Services program, which provides care to kids with chronic and serious conditions.

Philip --- who had been deputy secretary for health and deputy state health officer for Children's Medical Services --- has focused in her new role on responding to lawmakers' concerns and to an outbreak of the Zika virus, which the federal Centers for Disease Control and Prevention has linked to severe birth defects. Gov. Rick Scott plans to hold meetings Wednesday and Thursday in Washington, D.C. to seek federal funds to help combat Zika in Florida.

Philip has been at the Department of Health for eight years. Her experience includes stints as interim director for three county health departments and as interim bureau chief of the department's Bureau of Communicable Diseases.

The News Service of Florida has five questions for Celeste Philip:

Q: Seven pregnant Floridians have tested positive for the Zika virus. How urgent is the situation?

PHILIP: What we've been most concerned about with Zika is the fact that it's a new virus that we don't know as much about as other arboviruses, which are viruses that are transmitted by mosquitoes. What the CDC has come out with recently that is, I think, the priority for all of us that are trying to prevent the spread is that Zika is now linked definitively with congenital malformations. Microcephaly (a rare condition in which an infant's head is significantly smaller than expected) is the most prominent neurological deficit that they've seen, but apparently there are others as well that they're trying to understand better. So for pregnant women, for families that are planning to grow their family, it is extremely concerning.

Right now, all of our cases are travel-related, meaning someone went to another country, they were infected there, came back home. We have not seen local transmission yet. However, we want people to be aware of how they play a role with mosquito control, period, because there are lots of concerns with mosquitoes. We're talking about Zika now, but we had chikungunya (virus) recently, and we had an outbreak of dengue in 2013 in Martin County and in 2008-2009 in the Keys.

There have been lots of discussions about federal funding, what it could be used for. In our state, we would be considered high priority, because when you look at the prevalence of these mosquitoes, where they're most likely to be found --- which then makes you at higher risk for having local transmission --- Florida is one of the top states. We would look at any additional funding to enhance ongoing mosquito-control efforts. Depending on how much rain we get --- because it is associated with precipitation --- that might change the level of staffing that we need to go out and keep an eye on certain communities … . For those areas that are prone to flooding, for example, we might need additional people to be on the ground, assessing, treating if necessary.

Q: The Department of Health is under fire from members of Florida's congressional delegation for taking roughly 25 percent of the state's HIV cases off the books. Can you explain the department's position?

PHILIP: Whenever there is a newer process introduced into a program or a system that's been around for some time, it can be confusing. The Routine Interstate Duplicate Review, or RIDR process, is something that the department's been working with the CDC (on) for about four or five years. There has been emphasis on making sure states have good information, good data, and why it is important to understand where a person was first diagnosed versus where they're currently living, so we can look at resources, look at risk factors and better allocate our attention and our activities around where it's needed the most.

Understanding that there was some confusion, the department has created a new page on its web site to walk through that process. The information that CDC sends us --- or the people that may have labs or different visits in different states --- we then go through a process so that we understand where the appropriate assignment is, if you will, for diagnosis. So this process, which is ongoing, is part of the reason why the numbers will change, because some people will be reassigned to a different state. Others may be in a different category, so that incidence --- which is when a person is first diagnosed --- that's why some of those numbers may change. So we have the web site to walk people through that process.

We also want to talk about everyone who is living with HIV, and that includes people who don't know yet that they have this virus, that they should be tested. So the department has focused efforts on making sure we understand where we may have communities where there are higher risks for people to not know, and focus our testing there.

So in one sense, saying that we have the highest number of new cases shows that we are targeting the right people, because once people are diagnosed, they know that they're positive, we can get them into care, get them the appropriate treatments, get their viral loads down to an undetectable level, and they can live long, productive lives. And that's why we say "treatment is prevention," because if we can get people diagnosed and treated, they can live long lives. And then they are not likely to transmit the virus to partners.

(A 25-percent drop in those numbers does seem like a pretty big one, does it not?) I think if we could sit with an individual and walk them through the entire process to understand Person A ended up going here, there may be some people who get counted twice because their names might be spelled slightly differently, so they might be reported to us twice but it's really the same person --- if we could walk through all those scenarios and go through all of those 25 percent of people that were moved into other states, I think you would see that, but I can understand that it might seem like it's a large drop.

Q: You're touring the county health departments, which were also a focal point of Armstrong's confirmation fight. Senators were concerned that visits to the county health departments had fallen by 200,000 since 2012. What did you hear from the county health departments about those reductions and potentially their connection to the HIV rate?

PHILIP: In most situations, if there were a transition with (a Federally Qualified Health Center) or a primary-care clinic, there's been a partner who's been interested, who has taken over those services, there's been a transition plan in place. I have gone to these meetings saying that everything is on the table for discussion. There are some communities that want to revisit plans, and that's exactly appropriate, that's what we're here to talk about, that's why we're having these meetings.

Going back to the HIV point, I really believe that we're testing appropriately to get people into care, and that process is important for us to identify everyone who should be receiving medication, be aware of what they need to take care of themselves. We don't want more people to have HIV, but if they've contracted the virus, we want them to know and get into treatment. And once we see our numbers of people with undetectable viral loads go up, then we will see a true decrease in transmission. So we're on that pathway.

Q: Did you get any feedback from local health officials who thought more people should be visiting the county health departments?

PHILIP: What I said to all of the health officers in the meetings was, "If you identify a need, let's use our data to tell our story. Let's then put together a proposal for --- if it's people, if it's a certain type of expertise, some things we get through contracts --- let's look at what that full picture is and then we can move forward." So I haven't gotten any specific requests yet, but everyone is aware of what they can do to address any of those kinds of issues.

Q: Will the department directly notify the families of the 13,000 kids who lost their eligibility for Children's Medical Services last year that they can be rescreened?

PHILIP: We want to make sure we look at all of our options. There are some challenges with a direct reach-out, so we're looking at other ways that we can get there. I think the bigger picture --- when I talk to a lot of our experts who are known not just in the state but nationally, and when you talk to leading groups like the Association of Maternal and Child Health Programs --- we're seeing a lot of change in health care in general, in how we finance health care. Nothing gets done without being paid for, so how can we be strategic as a state to understand what is coming, what is being discussed, and create a system of care for children with special health-care needs that positions us to maximize resources that are coming in, because it will be a different framework for payments --- to make sure that those kids are getting quality care, that we have the provider networks in place to provide all the services that they need. So there are very large questions that we need to look at together to figure out the right model for the state and for these kids.