Rambod Rouhbakhsh has traveled a long way – literally and metaphorically – in his medical career, from receiving his medical degree in Portland, Oregon, to becoming the spokesperson of sorts in the fight against COVID-19 in the Hattiesburg area.
Dr. Rouhbakhsh, who serves as a faculty physician at Hattiesburg Clinic and associate program director at the Forrest General Hospital Family Medicine Residency Program, grew up in Portland, where he earned his medical degree from the Oregon Health & Science University. After his residency there, he found his way to South Central Regional Medical Center in Laurel, and earned his MBA in health care management from George Washington University in Washington, D.C.
“It was actually one of these kind of situations where an idealistic primary family care doc, a hippie from the northwest, wants to find a way to help save the world,” Rouhbakhsh said. “A lot of my classmates did things like this, and I’ve got to tell you, I got a lot of street cred for going to Mississippi because that seemed like the most exotic of the places.
“It actually was fantastic – way more than I ever expected. My wife was also from Oregon, and we came here together having never been here before except for the interview. We really actually liked it a great deal, so we signed a four-year contract, which was one of these situations where they pay for your medical school.”
After those four years, Rouhbakhsh and his wife decided they wanted to stay in Mississippi for good. But after talking with his parents – who reminded their son and daughter-in-law that they had just had their first grandchild – Rouhbakhsh and his wife returned to Portland in 2008.
While there, they had a second child and decided they wanted to raise their kids back in Mississippi.
“This was not taken lightly – family was all there, and I had a fantastic career starting,” Rouhbakhsh said. “I played soccer in college in Portland – we got our first Major League Soccer team in 2010, and I was asked to be their team doc.
“So a lot of neat things were going on, and professionally it was fun, but very early on – especially when our eldest started going to school – realized we wanted to raise our boys to be southern gentlemen. It was very hard to do in a culture that was markedly different from that. Don’t get me wrong – this is where we grew up, and we had a lot of pride in the West Coast ethos – but it’s not what we had in mind in regards to raising children.”
So in 2013, Rouhbakhsh came back to Laurel and went back to work at South Central Regional Medical Center. He completed another residency at the University of Pennsylvania, working in preventative medicine and occupational medicine.
As he was finishing that up, a new residency program was forming at Forrest General Hospital, which Rouhbakhsh joined in 2016.
“I had no idea that there were academic medicine opportunities anywhere in the area aside from Jackson,” Rouhbakhsh said. “When the new family medicine residency started and contacted me, they really found me at the right time in my life, when I was transitioning from a traditional practical physician to having more academic interests.
“So it was kind of a confluence of events in regard to my professional development, but from a personal standpoint, just in our gut, we knew this is where we wanted to live and where we wanted to raise our kids. We kind of figured everything else professionally would work out around that, and it certainly has, and I’ve been happier than I could have imagined. I couldn’t imagine enjoying my work the way I do now – it was never an experience I’d had in my life, except for maybe playing sports.”
In March, in the midst of the COVID-19 pandemic, Rouhbakhsh became a public face of sorts in regard to information on the virus, holding news conferences and helping to start the Cough & Fever Clinic. For Rouhbakhsh, who is certified by the American Board of Preventive Medicine, his moving into that role was a matter of chance.
“In family medicine, we encounter the upper respiratory illnesses first-line, and we see a lot of that,” he said. “And of course, I happen to be with the academic arm of these two institutions – Forrest General Hospital and Hattiesburg Clinic – and it just so happened that I was neck deep in our first cases.
“I had a little bit of a leadership role, in terms of the academic component of these two entities, and it’s just chance, for lack of a better word.”
Rouhbakhsh said the pandemic took him by surprise, as it did everyone else. When he first heard about the virus in December or January, he either didn’t anticipate it coming here or the situation turning out as it has.
“Quite honestly, it was just a day by day process, and when those first cases occurred here, you just did what you had to on Day One to get past that acute crisis,” he said. “Those first few weeks were really incredible, because we just didn’t know what we were dealing with, and the (Centers for Disease Control) was augmenting, literally on a day-by-day basis, their recommendations.
“The State Department of Health was also augmenting on a day-to-day basis their recommendations, because this was all new to all of us – we had no real experience. So those first few days in trying to figure out what we do with employees that were exposed to patients, how we were going to staff the hospital and the clinics and keep everybody safe – those were unlike anything I’d ever experienced, or even thought I’d ever experience.”
Rouhbakhsh said there are positive things to look forward to in the fight against COVID-19, but the negative aspect of the virus is that it is significantly present. Because of that, the United States is probably going to remain as the largest test case in regards to what is figured out about the illness, because of the large number of people in the country that are affected by the virus.
“Now, that has also afforded us some really good critical insights, because this information is coming from within our own borders and we’re not relying on foreign entities to provide us with information,” Rouhbakhsh said. “We’re learning about this illness, and we’re learning about it at a staggering rate because different minds in all of medicine have focused on this.
“That is really inspiring and exciting, and stuff is coming out every day, and it can be frustrating from a layperson’s standpoint this wishy-washiness about this finding today and then finding the other x, but this is the way science works. We’re kind of witnessing how we’re aggregating studies, and these studies are of varying rigor, of varying quality, and how do we decide what’s true.”
In addition, officials are learning that COVID-19 is a far more worrisome in some aspects, particularly issues with blood clots and associations with multi-system inflammatory syndrome in children post-infection. Also, it is unknown what the long-term consequences of the virus are in regard to individuals who have recovered from it, and there is very little information on how it affects pregnancy and infants, as well as how long immunity lasts when someone recovers from the illness.
On the positive side, health officials do have approximately three months of data regarding antibodies from individuals who have recovered. That information came from the naval ship Theodore Roosevelt, in which almost everyone was affected, but after three months, all those individuals still have functioning antibodies.
Also, science and industry are moving rapidly to provide tools that could help mitigate the virus, including a vaccine.
“The rate at which we’ve gotten to the point where we are testing vaccines is unprecedented,” Rouhbakhsh said. “Now, I’ll curb the enthusiasm on that a little bit, because vaccine trials, to get adequate data, could take a very long time. What you have to understand is there’s going to be two groups of people: a group that gets a placebo and a group that gets the experimental vaccine.
“Then these people are tested to see the antibody levels … and then they are sent out into the wild to get exposure to this illness. They’re not artificially exposed to this illness; that would be unethical. So it takes a long time to find out if there’s a difference between the placebo arm and the vaccine arm, in regards to protection against this illness.”
Another possible measure could be a therapeutic medicine that changes the course of the virus, or effectively cures it. Health officials are less optimistic about this endeavor because there has historically been little success when it comes to curing viruses.
“HIV is one of our first and best successes in regards to medication that effectively cures this illness, but unfortunately you’ve got to keep taking the medication,” Rouhbakhsh said. “But nevertheless, we’ve relatively found a cure for this virus, and there’s some others that we’ve done fairly well with.
“So that would be a game changer, and there’s all sorts of research going on with that, and that’s where we originally started with the hydroxychloroquine and the azithromycin studies. It’s worth noting this is an example of how science requires patience; that initial French trial that highlighted the benefits of that was very small, it was not placebo-controlled, it was not published. It was just a correspondence between physicians and researchers saying, ‘Hey, this may work.’”
A third measure would be point-of-care testing, similar to pregnancy testing or rapid strep tests. Those tests are being rapidly developed, such as with an initial study from Yale that looked at saliva testing that could provide results in five minutes.
“If we get an accurate test like that, that is available and economically available and widespread, that’s a game changer,” Rouhbakhsh said. “You could test everybody everyday, virtually, and those that test negative could go to work, they could go play sports, they could do whatever. Then we could live our lives and just rely on that rapid testing.”
The most likely measure is mass usage of masks, as officials have good, recent evidence that shows as little as 50 percent compliance with wearing masks can knock the rate of spread down to a twelfth.
“If we get the rate of spread down that low, we’ll get the reproductive rate of this illness … we will exhaust this virus and get over the hump,” Rouhbakhsh said. “So that is probably the most simple, the most likely, and the quickest thing we would do.
“And it’s probably why Hong Kong and other places in Asia were spared relative to us. You think about Hong Kong and how dense that is, and they had a fraction of our cases and a fraction of our deaths, and primarily we think that’s because that’s a mask-wearing culture and has been for years (during flu season).”
Currently, Rouhbakhsh is preparing to transition to program director at the Forrest General Hospital Family Medicine Residency.
“It’s really unique to be able to do academic medicine in a community setting like we are, to live essentially where you want to live, and we’re super fortunate to have what we have available here,” he said. “The clinic is just this remarkable unique entity – this multi-specialty clinic of this size, of 300-plus docs that is physician-owned and physician-run – it’s probably in the top 20 largest (in the country) in regards to physician-owned specialty groups.
“This is a consorts of luck, and good planning, and hard work, where we were far enough away from the big cities that we were allowed to grow on our own without getting gobbled up. Now we are this very sophisticated medical entity that is, for a community of this size, second to none.”