Public Health On Call

What is Disease X? Dr. Amesh Adalja and Dr. Anita Cicero of the Center for Health Security return to the podcast to talk with Dr. Josh Sharfstein about the unknown cause of the next pandemic, which is likely to come from a viral family already known but poorly studied. They talk about how investing now to develop medical countermeasures like diagnostic tests and treatments could buy valuable time and save many lives when the next threat emerges.

Dr. Caitlin Rivers returns to the podcast to talk about her work with the CDC's new Center for Forecasting and Outbreak Analytics. Funded through the American Rescue Plan, the Center works with academic and government partners to model potential health threats and monitor outbreaks. Rivers talks with Dr. Josh Sharfstein about standing up the new center, how omicron gave them an initial test run of analyzing data to brief government leaders on what was to come, and their hopes for eventually creating localized COVID forecasts to help prevent transmission during outbreaks.

Based on past conflicts, if Russia takes over in Ukraine, it's likely that some of Ukraine's public health policies will be essentially rewritten or revoked overnight. Dr. Chris Beyrer returns to the podcast to talk with Stephanie Desmon about Russia's history of revoking life-saving public health policies and imposing its own "traditional" laws like targeting homosexuals for harrassment and assault, cruel detox practices for people who use drugs, decriminalizing domestic abuse, and more violations of human rights. A content warning that the podcast contains discussions of these and other examples of violence.

Chicago's public health response to the pandemic has been focused on racial equity from the beginning—and the approach is paying dividends. Dr. Allison Arwady, Chicago's health commissioner, talks with Dr. Josh Sharfstein about the city's innovative efforts, why they chose to invest in building a public health workforce over bringing in outsourced solutions, and how she and her team have kept up the momentum over two long years.

Epidemiologist Keri Althoff and mental health expert Elizabeth Stuart return to the podcast to talk us through yet another phase of the pandemic. They speak with Stephanie Desmon about where we are now and why there are reasons to be cautiously optimistic, how families can navigate mask-wearing, the CDC's new approach to monitoring risks, and why the COVID response is a dial, not an "on/off switch."

Does Russia's bombing of the Mariupol Maternity Hospital constitute a war crime? Johns Hopkins faculty member and author Len Rubenstein returns to the podcast to talk with Dr. Josh Sharfstein about the recent attack, Russia's history of destroying hospitals, and the importance of accountability to stop such attacks in the future.

The Russian invasion of Ukraine is displacing millions of people across Europe. Humanitarian expert Paul Spiegel returns to the podcast to talk with Stephanie Desmon about the crisis and its tremendous geopolitical significance, major public health concerns at play including mental health trauma, health care for refugees, and the added complication of COVID-19. They also talk about why this refugee crisis is different than others and how discrimination plays a key role in deciding who has access to humanitarian resources.

Two years into the pandemic, we now have more data about how COVID affects people in the long term. Dr. Ziyad Al-Aly, Chief of Research and Education Service at Veterans Affairs in the St. Louis Health Care System talks with Stephanie Desmon about an expansive new study of 11 million people who had COVID-19. The study found that people with COVID are at higher risk for all kinds of heart issues including clots, inflammation, and arrhythmias even a year after having mild or asymptomatic COVID—risks that persisted even in relatively healthy people.

Even before COVID-19, the US was facing a shortage of nurses which has now become a full blown crisis. Nurse Alice, Chief Nursing Officer at nurse.org and host of the Ask Nurse Alice podcast talks with Dr. Josh Sharfstein about the many factors behind the crisis, how the pandemic exacerbated an already untenable situation, and what needs to be done now to address it. Nurse Alice also shares her advice for those aspiring to be nurses or who might be considering leaving the profession.

In the very early days of the pandemic in the US, there was so much we didn't know about COVID and a lot of concern among experts about how the country could weather the health crisis. In this special episode, Lindsay Smith Rogers pulls quotes from "the file," a previously unaired podcast interview recorded with Dr. Josh Sharfstein in early March 2020, about his predictions and concerns. They discuss what he predicted correctly, for better or worse, what he got wrong, and what we still don't really know even two years later.

Dr. Mysheika Roberts has been the health commissioner of Columbus, Ohio since 2017. In March 2020, however, the trajectory of her career changed. Dr. Roberts talks to Dr. Josh Sharfstein about the first moment when she realized what it meant to lead in a crisis. They talk about efforts in Columbus to expand testing, roll out a creative vaccine strategy, and bring together a diverse group of stakeholders to address COVID collectively, honoring "the Columbus Way."

At the beginning of the pandemic, primary care clinicians had few treatments to offer patients who had COVID-19 but were not sick enough to be hospitalized. But they could provide emotional support and steer patients away from harmful treatments. Dr. Pieter Cohen, a primary care doctor at the Cambridge Health Alliance, talks with Dr. Josh Sharfstein about all that primary care clinicians can do for COVID-19 patients today.

Virologist Dr. Sabra Klein returns to the podcast to talk with Stephanie Desmon about what research has seen regarding COVID-19 outcomes for men and women. They discuss what's known now about sex (biological) and gender (social and contextual) differences in COVID-19 infection and vaccination, and why these variables are so important to consider in research and policy.

In early 2021, Virginia's governor tapped Richmond's public health director Dr. Danny Avula to be the State Vaccine Coordinator. Avula talks with Josh Sharfstein about this massive undertaking, including the biggest challenges and biggest successes along the way.

In 1899 W.E.B. Du Bois published a landmark study on tuberculosis in the Black communities of Philadelphia, titled "The Philadelphia Negro." This was the first scholarly work to demonstrate that social forces, including racism, are fundamental to health outcomes. In recognition of Black History Month, sociologist Dr. Alexandre White and health equity scholar Dr. Rachel Thornton join Dr. Josh Sharfstein to tell the story of this remarkable study. They also explain why understanding this history is empowering to medical and public health practitioners today. Read Dr. White and Dr. Thornton's recent publication, with Dr. Jeremy Greene, in the New England Journal of Medicine here. www.nejm.org/doi/pdf/10.1056/NEJMms2035550

When will COVID become just another respiratory illness? Another way to ask that question may be: When will the response to other respiratory illnesses more closely resemble the battle against COVID? Infectious disease physician Dr. Celine Gounder talks with Dr. Josh Sharfstein about the logic of grouping SARS-CoV-2 with flu, RSV, and other respiratory pathogens. They discuss the value of common strategies to address transmission, testing, and treatment and to help prepare for future pandemics.

What do we know at this point about the potential for long term effects on mental health from the pandemic? How can we approach socializing and other activities we may have gotten used to NOT doing? How do we navigate going back to an office? Kids have had so much taken away during the pandemic, will this change them forever? Clinical psychologist Dr. Laura Murray returns to the podcast to talk with Stephanie Desmon about these and more COVID-19 mental health questions.

Although Pfizer's COVID-19 vaccine was authorized for kids ages 5-11 back in November, uptake has been markedly slower than other age groups. Social and behavioral scientist Dr. Rupali Limaye talks with Stephanie Desmon about why vaccination rates are lagging among kids, and a new free course that trains people to be "vaccine ambassadors" and have productive conversations to help promote vaccine acceptance in their communities. Learn more about the course: https://www.coursera.org/learn/covid-vaccine-ambassador

Since 1996, more than 1 million Americans have died of drug overdoses. Beth Macy, journalist and author of Dopesick: Dealers, Doctors, and the Drug Company That Addicted America—which was recently made into a miniseries of Hulu—talks with Lindsay Smith Rogers on the podcast. They discuss the overdose crisis, who's accountable, what research says about what works, and why so many see the situation as a "crisis of compassion." Read more from Macy's recent Washington Post op-ed.

The state of Indiana was focused on bolstering its public health system before COVID-19. The pandemic has only made this work more urgent. Dr. Judy Monroe, former state health officer of Indiana, CEO and President of the CDC Foundation, was tapped by Indiana's governor to co-chair a commission looking at the public health system and making recommendations for future policies. Dr. Monroe talks with Dr. Josh Sharfstein about these reforms and their implications for the rest of the country. This podcast was produced in collaboration with the CDC Foundation podcast, Contagious Conversations. Learn more at cdcfoundation.org/conversations.

Candida auris is a species of yeast that is increasingly becoming a hospital-acquired drug-resistant infection. Dr. Tara Palmore, the hospital epidemiologist at the George Washington University Hospital talks with Dr. Josh Sharfstein about this emerging pathogen and the risks it poses to vulnerable patients, why COVID-19 has made matters worse, and what's needed to stop it.

Dr. Lisa Cooper, a forward-thinking national leader in health equity, returns to the podcast to talk with Dr. Josh Sharfstein about her new book, Why Are Health Disparities Everyone's Problem? Dr. Cooper speaks about her upbringing in Liberia, her family's move to the US, and her initial introduction to health disparities in the US. They talk about Dr. Cooper's groundbreaking work examining why and how health disparities exist and what to do about them.

The Beijing Winter Olympics kicks off this week in a much different pandemic context than the Tokyo Summer Olympics six months ago. Former Olympian and public health expert Dr. Tara Kirk Sell returns to the podcast to talk with Stephanie Desmon about what we know about how omicron and China's Zero COVID policy will likely make this Olympics much more complicated, the limitations of trying to maintain an Olympic bubble, and the dangerous potential for outbreaks given China's relatively low population immunity.

The Supreme Court recently dealt a blow to vaccine mandates for larger employers, saying OSHA had overstepped in requiring employees to be vaccinated or tested weekly in order to work. So how can the Occupational Safety and Health Administration, or OSHA, uphold its core responsibility to keep workers safe? David Michaels, former OSHA Assistant Secretary under Obama, talks with Stephanie Desmon about where OSHA can continue to step up safety in light of COVID-19 and how a lack of vaccine mandates underscores the importance of implementing other measures to help keep workers safe from all airborne infectious diseases.

Public health leaders are tasked with enormous jobs which have been made even more difficult during the pandemic. Dr. Jay Varma, physician and advisor for former New York Mayor Bill DeBlasio on the pandemic response, returns to the podcast to talk with Dr. Josh Sharfstein about why public health officials have to be subject matter experts, politicians, lawyers, visionaries, and humble public servants, and how aspiring leaders can get the cadre of skills required for success.

To understand what is driving beliefs and behaviors around the world, the Johns Hopkins Center for Communications Programs created a global dashboard with data from an ongoing survey of more than 22 million people from 100 countries. Marla Shaivitz and Dominick Shattuck talk with Dr. Josh Sharfstein about what they've learned about global opinions on COVID-19, vaccines, trusted sources of information, and more. Check out the COVIDbehaviors.org dashboard online.

Some COVID patients continue to suffer from symptoms long after the initial infection clears. The formal name for "long COVID" is Post-Acute Sequela of COVID, or PASC. It's a condition that benefits from a comprehensive approach. Dr. Jonathan Whiteson of NYU's Post-COVID Care Program talks with Dr. Josh Sharfstein about how the field of physiatry is well positioned to work with PASC patients, what they've learned about treating symptoms like fatigue and brain fog, and the future agenda for research.

Although the majority of children who catch COVID recover without incident, some progress to multi-system inflammatory syndrome (MIS-C), thousands wind up in the ICU, and nearly 1,000 American children have died. Mark Kline, Physician-in-Chief, Senior Vice President and Chief Medical Officer of Children's Hospital New Orleans talks with Stephanie Desmon about why omicron is such "a different animal," what's next for vaccine trials for kids under five, and how Louisiana is taking big steps to protect children with vaccination mandates.

The Global Health Security Index, released by the Nuclear Threat Initiative and the Johns Hopkins Center for Health Security, looks at every country's capacity to respond to emergencies like a pandemic. Dr. Jennifer Nuzzo returns to the podcast to talk with Dr. Josh Sharfstein about some takeaways from the 2021 report and what we've learned—and didn't learn—from the pre-COVID-19 2019 report. They also talk about the report's use as a tool for countries to shore up gaps in their ability to respond to future crises and why even the most prepared countries, like the US, still struggled with COVID-19 response.

Lincoln, Nebraska has fared quite well compared to counties with similar demographics: the county is in the top 10% in terms of lowest mortality rates and hit the President's 70% vaccine uptake target in July 2021. These successes are in no small part due to the leadership of Mayor Leirion Gaylor Baird who talks with Josh Sharfstein about difficult decisions and her hope that stories of the community's courage, bravery, and generosity will be legacies of COVID-19.

Infectious disease specialist Dr. Monica Gandhi returns to the podcast to talk with Dr. Josh Sharfstein about what the COVID pandemic might look like on the other side of omicron peaks. They discuss how to rethink our safety approaches to move towards accepting COVID as endemic, managing other respiratory viruses like flu, and searching for consensus in the path forward. They also discuss an interesting theory about omicron's origins.

What do we know now about the number of doses needed for people on immunosuppressant medications to be protected from severe COVID? What about the use of "passive" protection like monoclonal antibodies? Why are negative antibody tests more helpful than positive ones? Why are large agencies like the CDC and FDA not discussing individualized medicine when it comes to vaccine protocols? What's the next step in researching COVID-19 vaccine protocols for this unique population of patients? Johns Hopkins transplant surgeon Dr. Dorry Segev returns to the podcast to talk with Stephanie Desmon about what we now know and what still needs to be figured out.

Early in the pandemic, clinicians began to treat people sick with COVID-19 with the plasma of people who have recovered from COVID-19. The idea was that protective antibodies in the plasma would help prevent severe illness and death. Nearly two years later, the evidence is in—and it's being hotly debated. Dr. Arturo Casadevall returns to the podcast to talk with Dr. Josh Sharfstein about the results of the COVID-19 Plasma Project and his take on divergent recommendations about using plasma as a therapy.

For decades, infrastructure policies harmed communities of color. New highways displaced residents through eminent domain, public transit systems were left in disrepair, and urban construction projects often catered to wealthier families. Andrea McDaniels, Director of Communications for the Bloomberg American Health Initiative, talks with Professor Keshia Pollack Porter of the Bloomberg School about how President Biden's $1 trillion infrastructure plan has the potential to rectify many of these inequities, some of the challenges of the federal law, and how infrastructure is intrinsically tied to health and well-being.

Dr. Shaun Truelove, an infectious disease epidemiologist, returns to the podcast to talk with Dr. Josh Sharfstein about the latest model for the COVID-19 Scenario Modeling Hub. How quickly will the wave pass? How much harm will it cause? What happens in February and March? And can we trust these kinds of predictions? Learn more: https://covid19scenariomodelinghub.org/

Dr. Josh Sharfstein checks in again with virologist Dr. Andy Pekosz about omicron and what we now know in terms of increased transmission, immune evasion, and lethality. Spoiler: If you're unvaccinated, you shouldn't assume that omicron will most likely lead to a mild infection. They also talk about what the omicron variant could mean for the future of the pandemic.

In September 2020, President Biden pledged to vaccinate 70% of the world's population by September 2021. More than a year later, however, the US has delivered about 270 million of the 11 billion doses needed to vaccinate the planet. Lawrence Gostin, a Georgetown University professor and public health expert, returns to the podcast to talk with Stephanie Desmon about how things have gone so wrong, why he isn't optimistic about vaccination equity improvements in 2022, and how vaccine manufacturers could be doing so much more to help.

Going into 2022, what should the next phase of our COVID strategy look like? Epidemiologist Dr. Emily Gurley talks with Stephanie Desmon about how our current approach to prevent as many infections as possible is complicated, costly, and carries a lot of collateral damage. Instead, Gurley says, a focus on preventing hospitalizations and deaths could rewrite the script on our approach but it would require some difficult conversations and a strategic rethinking of the public health system.

In the last episode of Season 4, Lindsay Smith Rogers talks with co-hosts Dr. Josh Sharfstein and Stephanie Desmon about 2021: how it started, what happened, and how it's going now. They reflect on where we were one year ago, talk about their favorite episodes and public health moments, give some reading suggestions, and discuss what they're most looking forward to in 2022. If you're in need of a chuckle, stick around for a surprise at the end.

A discussion of vaccines and trust. In an interview with Dr. Joshua Sharfstein, Rev. Dr. Terris King, pastor of Liberty Grace Church of God in Baltimore and former official at the Centers for Medicare & Medicaid Services talks about his work building bridges between faith communities and health care during the pandemic and beyond. Dr. King also talks about his own journey to getting vaccinated.

Nearly a month into the emergence of omicron, much more is known about how omicron behaves in the real world—thanks to the work of scientists like South Africa's Dr. Glenda Gray, president and CEO of the South African Medical Research Council, the equivalent of the US's National Institutes of Health. Dr. Josh Sharfstein talks with Dr. Gray and with Hopkins epidemiologist Dr. Chris Beyrer about how omicron was discovered, what we know about it now, and what it means for South Africa and the world. They also discuss the importance of protecting people who are immunocompromised—including those with HIV— to help get the pandemic under control.

There's still lots to learn about omicron, but two things are certain: vaccinations will provide some level of protection, and until the majority of the world's population is vaccinated, we may continue to see new variants. Vaccine experts Dr. Anna Durbin and Dr. Bill Moss talk with Stephanie Desmon about viral mutations and what we might expect to see when it comes to SARS-CoV-2, what needs to be done to address ongoing challenges with global vaccine distribution, and the importance of sharing vaccine technology to help curb future pandemics.

Public health is having a moment, both in terms of challenges and opportunities. Dr. Anand Parekh, the chief medical adviser to the Bipartisan Policy Center in Washington DC, talks with Dr. Josh Sharfstein about a new report, Public Health Forward, that aims to keep public health top of mind for policymakers and the American public. They talk about why this is a critical moment to think about the future of the public health system, the process behind the bipartisan project, and some major takeaways from the report.

Coming into this holiday season, things seemed a lot brighter than they did a year ago in terms of COVID safety: We have a broader toolbox including masks, ventilation, rapid tests, vaccines, and more. But a new variant of concern and rising levels of transmission remind us that we are still in a pandemic. Epidemiologist Keri Althoff and mental health expert Elizabeth Stuart return to the podcast to talk with Stephanie Desmon about navigating holiday gatherings and travel this year, and how we're slowly moving towards the ultimate goal of living with COVID as an endemic virus.

Addiction prevention often comes in the form of "Just Say No" campaigns. But Dr. Terri Powell knows that to be successful, prevention strategies must be thoughtful and holistic—and focus on connections and support systems that help young people make the best decisions for themselves. Dr. Josh Sharfstein talks with Dr. Powell about Better Together, a prevention program that's based in a public library. Joining them is Diana Fortee-Mason, one of the young leaders of the program.

Dr. Josh Sharfstein checks in again with Hopkins virologist Dr. Andy Pekosz about omicron and what the data are saying about how easily it can spread. So far, there's good news and bad news about this variant—and still a lot we don't know. Still, Dr. Pekosz explains, we can start to make some guesses based on current data and what we know about other viruses like flu.

Prior to COVID-19, the world had the capacity to produce about 5 billion vaccines a year. In the age of COVID, much greater capacity is needed. The U.S. International Development Finance Corporation, or DFC, is a little-known federal agency making big investments to build the global vaccine pipeline. DFC's chief operating officer, David Marchick, talks with Dr. Josh Sharfstein about these efforts and their impact.

Throughout the pandemic, Colombia has fared better than other South American countries in terms of hospital overload and deaths, due in no small part to its emphasis on testing, contact tracing, and isolating of positive and suspected cases. Hopkins health economist Dr. Antonio Trujillo talks with Dr. Josh Sharfstein about Colombia's pandemic strategies, and his research calculating the ROI of testing, tracing, and isolating both in terms of dollars and lives saved.

In the more than 40 years since HIV was first detected there have been incredible advances in testing, prevention, and treatment. But COVID-19 disrupted global gains and will continue to cause backslides until vaccinations are much more widespread. In recognition of World AIDS Day, infectious disease epidemiologist Dr. Chris Beyrer talks with Stephanie Desmon about where the HIV pandemic currently stands in the US, Africa, and around the world.

How did omicron come to the world's attention? Why is this variant generating so much concern? Is it expected that vaccines will provide substantial protection? What can governments do to protect their populations? What can people do to protect themselves? Dr. Josh Sharfstein talks with Hopkins virologist Dr. Andy Pekosz about all things omicron.