Merced pediatrician on pandemic: ‘We do have an advantage over other counties’
Editor’s Note: For a community perspective on the impact of the COVID-19 pandemic over the past year, the County Times has been interviewing local movers and shakers from diverse backgrounds. We intend to publish a special report in a multimedia format on our website MercedCountyTimes.com. While all communities in America have faced the spread of the same deadly virus, we have found circumstances that are unique to Merced County, along with special individuals who are making a difference in their own hometowns. People like Dr. Sima Asadi.
Times readers may recognize the mention of Dr. Sima Asadi.
Over the past year, the local pediatrician has made headlines due to her advocacy for children and education during the COVID-19 pandemic, as well as her pro-bono work to vaccinate thousands of local residents.
She has captured attention with her powerful words during regular meetings of the Merced County Board of Supervisors and the Merced City Council. And her grassroots vaccination efforts have taken her from a small medical office in Merced to outdoor rural clinics across the region. Most recently, Asadi has teamed up with the Merced city officials to vaccinate crowds of residents who have shown up at City Hall for a first-time dose.
The pediatrician credits the success in the local vaccination rollout to dedicated medical professionals and a wealth of community volunteers.
“I’m going to quote to you what basically our Public Health Department told me,” Asadi says. “We may not be a very big medical community in this town. In fact, one of the reasons that we did get shortchanged on the vaccine [at first] is because we don’t have as many medical providers. We are designated 100 percent medically underserved. So when you don’t have that many people enrolling into the program to provide vaccine — which by the way, there is no money in this — you are already taking a rag-tag fleet of medical providers and asking them to do something above and beyond the already Herculean task we have of taking care of a community that is short on doctors. You are asking them to provide this service uncompensated, essentially. That’s a big ask. So the Health Department summarizes that we may not have a very big medical community, but the medical community that we have is extraordinarily dedicated. So that puts us actually in my opinion at an advantage over even the largest, richest counties which are two hours west of us.”
Dr. Asadi has come along way since her time growing up in the Bay Area.
Her parents had immigrated from Iran in the early 1960s. They had come to the United States to seek an education and work hard for a better life. In time, education became everything for Sima Asadi. It offered her a future that was bright with promise.
Years later, while earning her undergraduate degree at UC Davis, she met her future husband, another immigrant from Iran. During the Iran-Iraq War, he had come to the United States to further his education.
They both set off together for the University of Cincinnati College of Medicine. She got her MD. He got his PhD. But when Asadi was later placed in residency in Fresno, her husband decided to go into farming. He became the “happiest man on a tractor.”
When Asadi left her residency in 1999, she faced three personal choices over where to go next: Madera, Los Banos or Merced.
“At the time, UC Merced was in its vision stages,” she recalls. “For us, the decision was pretty easy. We met at UC Davis. It was a bit nostalgic for us. And I am who I am because of an education. So we came here and have been supporting UC Merced from its beginning.”
Dr. Asadi started out at Mercy Medical Center. In 2002, she became the chair of Pediatrics and the medical director of the Neonatal Intensive Care Unit that’s owned and operated by Valley Children’s Hospital. Meanwhile, her husband helped support the opening of her own private practice with the idea of building something of her own with the hard work she was already doing.
Together, the couple raised three children in town who are finding academic success. One is in law school at UC Hastings, another is a freshman at UC San Diego, and another is a sophomore at Merced High School.
Before COVID-19, Dr. Asadi’s typical day started at the hospital where she would check in on newborns. She would spend some time at the Neonatal ICU. Perhaps participate in a shared call with colleagues. Then back at her business. There was always a steady flow of sick children to examine and concerned parents. She was easily seeing up to 60 patients a day.
Then in February of 2020, the alarm bells started to go off.
Dr. Asadi found herself at a medical conference with a lot of concerned faces all around.
“We knew there was a coronavirus that had already taken hold in China,” she remembers. “So we were brainstorming how we were going to deal with this as a community.”
That led to more targeted calls with the county’s Public Health Department, health care providers and local leaders, and of course, the first stay-at-home orders and closures that came in mid-March.
“In Merced County, we were a little bit lucky because we were one of the last counties to close school,” Asadi says. “Even when we were closing schools, already there was information coming out of China and other places that this was not a pediatric pandemic. So we were already getting indications that school closures, while reactionary, may not have been absolutely necessary. … Hindsight is 20/20 … So we started to see the school closures happening, and I also started to see pretty quickly that no one entity can really manage this pandemic. My career in medicine goes back 26 or 27 years. What the Health Department is now is not what the Health Department once was. … So early on, most of us realized this had to be a community effort.”
Dr. Asadi, as a pediatrician, chose to tackle the school aspect of the pandemic. Right away she started to see the harm that campus closures was starting to have on children, especially in this region that is home to many low-income families and cultural diversity. She was also one of the first professionals to begin onsite testing. Quest Diagnostics provided her with supplies, and she found herself venturing out to high schools, private schools, and basically, whoever would let her. Some of the school districts were very small, and she was happy to help them prepare for what she knew was coming. Sometime in the summer, California’s Public Health Department came out with a 14-page guideline book, and then the Department of Education added another 63-page booklet.
“For people to be able to take this and synthesize it into a plan is no easy task,” she points out. “We recognized early on that the most successful schools were the ones that recognized you need MDs, Public Health, and all these advisers essentially to be able to help you come up with a plan to help those waivers get through.”
Dr. Asadi is quick to praise the local effort to get schools back online in the fall of 2020. Some 16 out of the 21 school districts in Merced County came back in some way, shape or form. “By any measure in the state of California, that’s impressive,” she says. “So we came together as a community — a medical community and an education community. I’m not in those other counties, but I have plenty of friends across the state, and I think we did pretty well.”
Nevertheless, as Dr. Asadi was supporting back-to-school planning, she was also becoming increasingly vocal at public meetings about the problems and even dangers that local kids were experiencing due to the pandemic lockdowns.
“A lot of the focus when it comes to school closures is on academics,” she explains. “We say, ‘Oh gee, the kids are going to miss this much of their learning.’ But when you are in a poor county, if all these children lose is a year of their academics, then I’m not going to sweat that. The problem I started seeing were kids not being schooled at all. Parents who don’t have internet access, computers, or even if they are given those things, don’t have the savvy to get their kids set up. Or they don’t have the motivation to do it. On top of that, one of the challenges for the high schoolers is that a lot of them were already repurposed. When you have a family of four kids, and you have a 14, 13 or 12-year-old, and you need to get to work, a lot of these kids were being left home alone. That’s the reality some parents have had to face. And that realization — back in early July — was a horrifying moment for me. Some parents were essential workers. Some quit their jobs to avoid leaving their kids. This was among some of the first tragedies. Then I saw parents who were literally shipping their kids out of here. Some people who had access said, ‘I’m going to send my kids to Utah.’ Others were sending kids south to cross the border. Maybe not to go to school, but to be somewhere so someone could supervise them.
“And that’s just the social fabric that you see dissolving in your hands, but then you add on top of that the mental health. I personally pulled numbers from our E.R. I saw, between April and September, a quadrupling of mental health visits for self harm. You had a doubling of visits for suicidal ideation. And the age … whereas before this pandemic the average age in that E.R. for mental health visits among young people was somewhere around 13 to 15, now it was 10. You had little children — 4-year-olds — coming in with anxiety issues. In the fall, I started getting calls routinely from the emergency room. They said they didn’t have anyone else to call. ‘Doc, you got to help us out,’ they would say. ‘We’ve got 3, 4, 5 kids sitting here and waiting for somebody to place them. They just can’t go back to their homes.’
“And then it dawns on you. Wow, you go into an emergency room and here is this young person. A child who is on a gurney in a busy hallway with all kinds of traumatic things happening all around, and yet somehow, for this young person, that’s better off than home? “So yeah those are some of the most powerful moments for me when I have been face-to-face with some of those young people — and I’m not making this up — they look me in face and say: ‘All I want to be is in school.’”
Dr. Asadi told the Times that her multiple public testimonies were designed to make local residents aware of what she was seeing day in and day out.
“Unless you live it, it’s very difficult for people to understand,” she says. “You go back a year ago. Most of our headlines in the newspaper with regard to education were actually about the parents who were being socked because their kids weren’t going to school. And now, a year later, we are not even thinking about that. We are not even thinking about the fact that there are some parents out there that really have no interest in making sure their child is in school. So we don’t know the numbers yet. But I’m willing to bet that there is a pretty substantial number of computers out there that are logged on and there’s nobody sitting behind them.”
Winter and the holiday season came, and according to Dr. Asadi, most of Merced’s medical community knew that those schools which hadn’t opened up to some degree by then were not not going to open up until at least March, or even April. The flu season and a new wave of the virus rolled in. Still, Asadi never doubted that schools could be safe places during this pandemic.
“I absolutely agree with those in the CDC and those in the AAP. All the organizations and scientific bodies. There have been recent studies at Duke University and Wisconsin. All these large studies coming out. They basically say that if you do it right, and you have safety measures in place — just the basic ones, not even the fancy ones — like masking, distancing and hand sanitization, then yes, there is no reason that any school district should remain closed. But again, that’s from a medical standpoint. Beyond that, there are other elements involved in this too.”
Meanwhile, her business was also experiencing a downturn, just like others in the community. There were days when only 10 patients showed up at the office.
“There was a big concern by the American Academy of Pediatrics that people were not going to get their routine care because people are staying home. … I’ve been keeping up with immunizations as best as I can. Luckily we haven’t fallen behind in my practice, but I know that’s not the case everywhere else. We are going to have a lot of children who are very behind in their routine care and immunizations after a year of staying home.”
Dr. Asadi turned her attention to the COVID-19 vaccination rollout when doses became available. She enrolled in the provider program and was approved in 48 hours. After all, her office is set up to immunize people, and she had experience with mass vaccination clinics from the 2009 H1N1 flu campaign.
“The ball just rolled from there,” she reflects. “I think we started with about 50 doses. The vaccine effort isn’t just me giving back to the community. I absolutely recognize that vaccinations, as a tool, are critical for us to get our lives back.”
By early February, Dr. Asadi had helped vaccinate about 1,000 local seniors. And she was efficient at reaching those in need who were unable to compete with a surge of appointment registrations for pop-up clinics that were only advertised online.
“This is a really critical part that I want people to understand going forward,” Asadi said during a times interview in February. “The majority of the vaccine providers right now, today — with the exception of me, and actually this other pediatrician, and maybe one other primary care physician — are all doing this electronically. The county, the college program that’s coming, the large clinics, the hospitals … primarily all these registrations are all done online. So when I’m looking at these birthdates in the 1930s and the 1940s, I think we have made a huge misstep in just assuming that they all have computers, they all have an email address, they are all English speaking, and they are all computer literate. This is a huge problem. So what I have found is that when you are in a crisis, there is no school like the old school. You go paper, and then when it’s all done within 24 hours, you have these high schoolers that are more than happy to come help me with their MacBooks and iPads, and just get all the information electronically at that point. … There is a huge prohibiting factor with electronic registration that needs to be addressed, especially if you are targeting elderly minorities and the impoverished. With any of these things you want to tackle, once you throw a computer in the way, it really stalls things up.”
The Times has been asking one particular question during all the interviews for its special report on the impact the COVID-19 pandemic has had on the local community. The question is: If you were able to talk directly to California’s governor, or the powers that be in Sacramento, what would you say?
Says Dr. Asadi, “What I would tell them is that in a very small way, I have learned that leadership is No. 1 humility, No. 2 collaboration, and No. 3, when it comes time for execution, if you’ve put a good plan in place, and good people in place, then get out of the way.
“Let these people do their thing. One of the reasons that my vaccination clinics — or some people have kindly refer to it as #TeamAsadi — have been so successful is because I know the people who are volunteering for me are overqualified to do this and I trust them. They have all decided amongst themselves whose making the appointments, who is drawing up the vaccine, who is giving the vaccine, and who is documenting. And then my job, as a leader, is simply to supervise this.
“It’s not simple, actually. I sweat bullets. I walk around and keep my eye on everything going on. But that’s what a leader does. A leader doesn’t sit there and ‘Ummm, you know, I think you need to do this.’ Micromanaging is what tripped us up this whole time. I think Sacramento has tried too hard to micromanage every step of this rather than trusting our health departments to know their counties, and to know what their counties need.
“So that is really what I would say. Please can you just trust us to do our jobs. If you trust us to do our jobs, we will get it done. But what I see in a lot of people who work for government, the ones I interact with locally, is a lot of fear. You can feel it. There is a lot of fear. They know how to get the job done. They want to get the job done. But they fear Sacramento.
“Business leaders probably feel the same way. We shouldn’t fear our leadership. Our leadership should be there to guide us, to organize us, to help us, and then to let us do our jobs. That’s what I would say. That’s how I have handled it here in my little, teeny-tiny part of the world.”
Portrait of Dr. Sima Asadi by Jonathan Whitaker