Public Health On Call

Where are we in terms of technology in testing for COVID-19? What kinds of tests are available now, how accurate are they, and which tests should be used in different circumstances? Will workplaces require testing? What about schools in the fall? How accurate are over-the-counter COVID tests? Dr. Gigi Gronvall from the Center for Health Security returns to the podcast to talk with Stephanie Desmon about these questions and more on COVID-19 testing. Access the Testing Toolkit mentioned in the podcast here.

Are school closures helpful in preventing outbreaks of COVID-19? Epidemiologist Justin Lessler and statistician researcher Elizabeth Stuart co-authored a recent research paper looking at the risk of COVID-19 in households where a child attended in-person schooling. They talk with Stephanie Desmon about what they learned.

Families in the US are ready for rest and fun this summer after a very long year. But with unvaccinated children and changing guidance for vaccinated adults, how can families plan ahead for summer camps and travel? Guest host Dr. Colleen Barry talks with epidemiologist Dr. Keri Althoff, and Lisa David, director of an overnight camp in Pennsylvania, about COVID safety this summer and making sure that kids, who have been through so much over the last year, have a summer of fun and joy. Note: Dr. Althoff references this framework which has been updated to reflect changing guidance on vaccinations and masks.

Mass shootings are very rare, but they receive a lot of media attention and have enormous social costs. Guest host Dr. Daniel Webster, director of the Johns Hopkins Center for Gun Violence Prevention and Policy, talks with Dr. Jillian Peterson from Hamline University and Dr. James Densley from Metropolitan State University about The Violence Project, research that collects data about the life history of mass shooters and their psychological profiles. They discuss what they've learned, how this research can inform interventions, and why evidence suggests that many of the ways we're currently trying to prevent violence are all wrong.

The Affordable Care Act was meant to bring the US into alignment with every other developed country in offering universal health coverage. Author Jonathan Cohn joins Dr. Josh Sharfstein to talk about how a health care law that has been debated since the 1930s finally gained traction under Obama and insured millions of people with serious health conditions, and yet leaves so much undone. The Affordable Care Act is a story of just how hard policy change in the US can be. Note: You do not have to have read Cohn's book to enjoy this conversation.

Nepal is suffering from a growing humanitarian crisis. Less than 4% of the country is vaccinated, test positivity rates are up to 60-90% in some areas, and outside of capital Kathmandu, ICU care is extremely hard to find. Binita Adhikari, executive director of Health Foundation Nepal, and Anup Subedee, an infectious disease physician in Kathmandu, talk with Josh Sharfstein about what contributed to Nepal's COVID-19 crisis and what the world needs to do to help. Please consider donating to one of these nonprofits: Health Foundation Nepal, America Nepal Medical Foundation, and the Nepal Development Society.

Mental health impacts from climate change are largely thought of as acute exposures to extreme events like hurricanes and wildfires. But there are other concerns like chronic "ecological grief" and anticipated "eco-anxiety." Dr. Jura Augustinavicius from the Center for Humanitarian Health talks with Stephanie Desmon about research at the intersection of mental and environmental health, and why something that is felt at an individual level needs to be addressed at the macro level of companies and governments.

For some, the pandemic has been a "perfect storm" in terms of unhealthy eating resulting in the "quaran-ten" or the COVID "19 pounds." Dr. Elena Jansen and Dr. Susan Carnell, two Johns Hopkins obesity researchers, talk with Stephanie Desmon about how COVID-related stress—combined with being at home more—has impacted our bodies and health behaviors during the pandemic. They also talk about how the pandemic has a silver lining for some families' eating habits and give their take on where pandemic eating is heading in the long term, for better or worse.

Stopping gun violence requires more than thinking about policies and programs that focus on guns alone. Dr. Shani Buggs, a professor with the Violence Prevention Research Program at UC Davis, talks with Dr. Josh Sharfstein about how community-based violence prevention programs identify those most at risk of being involved in violence and connect them to services that can help them solve problems and stay safe. They also talk about the evidence for these programs and their growing popularity across the country.

Vaccinations are seen as the primary tool to prevent COVID-19 infections, but are there other things we should be doing to bring down transmission rates? Dr. Caitlin Rivers and Dr. Crystal Watson from the Center for Health Security return to the podcast to talk with Dr. Josh Sharfstein about where we are, what still needs to be done, and when they'll know that the pandemic is truly in the rearview mirror.

We last heard from Matt Hornbeck—longtime principal of Hampstead Hill Academy, a K-8 school in Baltimore city—in the fall for an update on how the school community was faring with online learning. Hornbeck returns to the podcast to talk with Dr. Josh Sharfstein about the school's recent reopening to more than 500 students for in-person instruction. Does it feel the same?

India is in the throes of the world's worst COVID-19 infection with overwhelmed health systems and a shortage of oxygen, hospital beds, testing, and medications. Dr. Amita Gupta, chair of the Johns Hopkins India Institute, Dr. Randeep Guleria, Director of All India Institute of Medical Service in New Delhi, and Dr. Gagandeep Kang, professor of microbiology at Christian Medical College in India, talk with Dr. Josh Sharfstein about this "unprecedented public health disaster" and what needs to be done to address the crisis.

At the onset of the pandemic, the world's family planning community worried about the impact COVID-19 would have on access to contraception and unintended pregnancies in lower- and middle-income countries. Dr. Phil Anglewicz and Dr. Caroline Moreau of Performance Monitoring for Action talk with Stephanie Desmon about what some initial research says about impacts on contraceptive use and access, what is still unknown, and what the concerns are—especially for young girls facing economic hardship and food instability during the pandemic.

India produces much of the world's vaccines in normal times, and even produced enough COVID-19 vaccines that it was donating doses to poorer countries earlier this year. So how did a vaccine powerhouse with an existing distribution infrastructure end up with one of the world's worst COVID crises? Dr. Anita Shet of the Johns Hopkins International Vaccine Access Center talks with Stephanie Desmon about India's vaccine situation, what the crisis could mean for the supply of other critical vaccines, and what needs to be done to stem the outbreak.

Ghost guns are firearms that can be made at home from kits or 3D printed parts. They're unregulated and untraceable, meaning no background check is required to purchase them. Dr. Alex McCourt, a public health lawyer with the Hopkins Center for Gun Violence Prevention and Policy, talks with Stephanie Desmon about why these guns are so dangerous, what we know and don't know about their use in violent crimes, and Biden's proposal for ATF regulation.

Canada is experiencing a serious wave of COVID infections with the majority from variants of concern like B.1.1.7. British Columbia currently has one of the highest rates of P.1 outside of Brazil itself where the variant was first discovered. Dr. Brian Goldman, the host of two CBC podcasts and a clinician at Sinai Health System in Toronto, returns to the podcast to talk with Dr. Josh Sharfstein about the factors that contributed to Canada's COVID crisis, including logistical issues with distributing vaccines.

India is in the throes of the world's worst COVID-19 infection with overwhelmed health systems, and a shortage of oxygen, hospital beds, testing, and medications. Dr. Amita Gupta, chair of the Johns Hopkins India Institute, talks with Dr. Josh Sharfstein about how this "unprecedented public health disaster" snuck up on the country after they successfully controlled the first wave back in the fall. They also discuss what needs to be done to address the crisis, and how you as an individual can help. Note: Please consider donating to the following organizations: https://giving.jhu.edu/ways-to-give/international-giving/johns-hopkins-india-institute/ https://www.jhpiego.org/countries-we-support/india/

The recent mass shooting in Indianapolis sparked a national conversation about "red flag" laws, or Extreme Risk Protection Orders. Dr. Josh Sharfstein talks with Dr. Shannon Frattaroli of the Johns Hopkins Center for Gun Violence Prevention and Policy, and Josh Horwitz of the Coalition to Stop Gun Violence about ERPOs and what went wrong in Indiana, and what needs to be done to implement laws effectively that keep firearms from people at high risk of harming themselves or others.

Lancaster County is home to one of the largest Amish and Mennonite, or "Plain", communities in the US. In the last year, it's estimated that 90% of families had a case of COVID-19 in their household, but experts don't know for sure how widespread infections were because of a lack of testing data. Reporter Nicole Brambila talks with Stephanie Desmon about the challenges of getting Plain families to adopt public health measures, and how past experiences from polio and measles outbreaks can offer insights for rallying the communities to get vaccinated.

Early in the vaccine rollouts, 14 clinics in the San Francisco Health Network texted their most vulnerable patients a webform to sign up for COVID-19 vaccine appointments. Dr. Anna Robert, director of primary care, talks with Dr. Josh Sharfstein about how the webform went viral with people from all over the Bay area taking appointments meant for specific individuals, how the clinics addressed the situation, and what they learned about outreach to patients who most need the vaccine but may be hesitant to sign up.

In this episode, Dr. Josh Sharfstein talks with Hopkins researchers who break down three papers looking at reinfection. Dr. Sheree Schwartz, an epidemiologist, talks about a CDC paper on reinfections in a single Kentucky nursing home. Henri Garrison-Desany, a doctoral student in epidemiology, talks about two papers: a Lancet paper from Denmark and one in the Journal of Infection from Brazil. These researchers are part of the Hopkins novel coronavirus research consortium, with many summaries of new studies available at http://ncrc.jhsph.edu.

COVID is creating massive environmental issues such as the 1.56 billion face masks that entered the oceans in 2020 alone. Teale Phelps Bondaroff, the Director of Research for Oceans Asia, talks with Stephanie Desmon about how improperly discarded PPE to a massive rise in the production of single-use plastics are setting the world significantly back in controlling its problem with microplastics and pollution. KEYWORDS: environmental health; policy

61 million Americans have a disability yet most haven't been prioritized for COVID-19 vaccines. And while eligibility has opened up across the nation, there remain significant barriers for people with disabilities to get appointments. Maria Town, President and CEO of the American Association of People with Disabilities talks with Stephanie Desmon about how COVID has exacerbated longstanding gaps in health equity for people with disabilities, and also some silver linings of the pandemic that she hopes will remain. KEYWORDS: vaccine distribution; telemedicine; healthcare infrastructure

Across the country, COVID case rates are going up and public health officials are racing to get vaccines in arms. Dr. Letitia Dzirasa, Baltimore City's Health Commissioner, talks with Stephanie Desmon about the unique ways the city is trying to reach those at highest risk including mobile vaccination teams. They also talk about this critical point in the pandemic, how vaccine questions are not limited to one specific racial or minority group, and the importance not only of reliable public health messaging but of creating equitable access points to reduce barriers to getting vaccinated. KEYWORDS: vaccine distribution; health communication

The race between vaccines and variants has to be won globally, but at the current rate, much of the world won't reach herd immunity until 2023. Congressman Jake Auchincloss from Massachusetts talks with Stephanie Desmon about the immediate need to address manufacturing bandwidth and the opportunity for the US to lead production. They also discuss the US's obligation to maintain a healthy and thriving economy by investing in global public health infrastructure, and how this could help restore the US's image as a moral leader in times of crisis. You can read Auchincloss's CNN op-ed here: https://www.cnn.com/2021/03/29/opinions/marshall-plan-for-global-vaccinations-auchincloss/index.html. Please note: This conversation was recorded on April 5. KEYWORDS: vaccine distribution; viral mutation; supply chain

This week, the FDA paused the use of Johnson & Johnson's COVID-19 vaccine because of reports of six women under 50 who developed a rare form of blood clots called cerebral venous sinus thrombosis. Today, Stephanie Desmon talks with Dr. Josh Sharfstein about what this means for vaccine rollouts, vaccine hesitancy, and what might happen next. This bonus episode has been lifted from yesterday's Facebook live which can be seen at www.facebook.com/JohnsHopkinsSPH/.

There are psychological and cognitive obstacles to compassion, especially against an invisible virus. Dr. Paul Slovic, a psychology professor at the University of Oregon, and his son Dr. Scott Slovic, a literature professor at the University of Idaho talk with guest host Dr. Colleen Barry about the psychic numbing that occurs when considering large-scale crisis like genocide, climate change, and COVID-19. They also discuss pandemic literature and what it's like to work together as father and son from two seemingly different disciplines. KEYWORDS: risk perception; policy; community mental health

We're in a strange "limbo" where vaccinations are on the rise, but so are hospitalizations. Epidemiologist Keri Althoff and mental health expert Elizabeth Stuart return to the podcast to talk with Stephanie Desmon about making safe decisions, why vaccinated people shouldn't take off their masks just yet, and the need for flexibility as mixed messaging and lots of transitions may be the "new normal" for now. KEYWORDS: herd immunity; viral mutation; policy

There's a lack of data around COVID-19 in humanitarian settings and refugee camps so it's difficult to know how people there have fared in the pandemic. Paul Spiegel, director of the Center for Humanitarian Health, talks with Stephanie Desmon about the data vacuum and the importance of vaccinating all who are at high risk of severe COVID. They also discuss how humanitarian assistance has fared since the pandemic cut off many aid zones from international funds and resources, leaving local and national NGOs to fill the gap. KEYWORDS: vaccine distribution; international health; healthcare infrastructure

While one-third of Americans have received their first COVID vaccine dose, COVID cases in parts of the U.S. are at their highest levels since December because of new variants that are more contagious. Dr. Michael Osterholm, an infectious disease expert, and adviser to President Biden talks with Stephanie Desmon about the critical place we're in now, his fears for children who are both more likely to spread and be sickened by the B.117 variant, and his worries about newer variants that might not be thwarted by current vaccines. KEYWORDS: viral mutation; child health

Dr. Susan Sherman talks with Lindsay Smith Rogers about her 2016-2017 research on the relationship between female sex workers and police, including how abusive policing practices directly and indirectly put the health and safety of the women at risk. They then discuss Dr. Sherman's recommendations for a different approach. Note: After this podcast was recorded, Baltimore State's Attorney Marilyn Mosby announced that the city will permanently stop prosecuting prostitution, drug possession, and other low-level offenses—a move that began during COVID-19 as a way to dedensify prisons and jails. KEYWORDS: decarceration; substance use; gender equity

The theme of this year's National Public Health Week is "Building Bridges to Better Health." Dr. Georges Benjamin, president of the American Public Health Association, talks with Dr. Josh Sharfstein about the poor condition of these bridges, from archaic lab technology and a sparse workforce to gross inequities in health care. They discuss what needs to be done to fix the system so these inequities, and current and potential health threats, can be addressed to save lives. KEYWORDS: health equity; healthcare infrastructure; policy

In a special 4-part series excerpted from a webcast, we look at the extraordinary challenges facing the field of public health in the COVID era. In the final episode, we hear more about how serious the problems are and what can be done about it. Lori Freeman, NACCHO CEO; Chrissy Juliano, Executive Director of the Big Cities Health Coalition; and Dr. Marcus Plescia, Chief Medical Officer of ASTO, talk about direct calls to action to address the "boom-and-bust" cycle of public health infrastructure to address the COVID-19 and future pandemics and all sorts of other issues that threaten the public's health. KEYWORDS: misinformation; pandemic response; policy

In a special 4-part series excerpted from a webcast, we look at the extraordinary challenges facing the field of public health in the COVID era. Today, Dr. Sara Cody, Health Officer and Director of the Santa Clara Public Health Department in California; Jennifer Kertanis, Director of Health at Farmington Valley Health District in Connecticut; and Lisa Macon Harrison, Health Director of the Granville-Vance Health Department in North Carolina talk about their experiences with harassment and what needs to be done to protect public health workers. Then, Dr. Josh Sharfstein talks with Dr. Joneigh Khaldun of the Michigan Department of Health and Human Services about fallout from this crisis and signs of hope from a new administration. KEYWORDS: misinformation; pandemic response; policy

In a special 4-part series excerpted from a webcast, we look at the extraordinary challenges facing the field of public health in the COVID era. Today, Dr. Beth Resnick and Paulani Mui of Johns Hopkins talk about their research on the issue of challenges facing public health officers during the pandemic. They put current challenges in the context of long-standing underfunding of critical public health infrastructure. The presentation referenced in this episode can be seen in the recorded webcast here: https://www.jhsph.edu/covid-19/news-and-events/events/2021/february-24.html KEYWORDS: misinformation; pandemic response; policy

In a special 4-part series excerpted from a webcast, we look at the extraordinary challenges facing the field of public health in the COVID era. Today, a message from Dr. Rochelle Walensky, director of the CDC. Then, we hear from three public health officers: Dr. Mysheika Roberts, the Health Commissioner of Columbus Public Health in Ohio; Dr. Greg Holzman, the State Medical Officer of the Department of Public Health and Human Services of Montana; and Dr. Jennifer Bacani McKenney, the Health Officer of the Wilson County Health Department in Kansas. They talk about the significant challenges they and their staff have faced during the pandemic. KEYWORDS: misinformation; pandemic response; community mental health

Una conversación entre Dra. Sara Polk, una de las directoras del Centro Sol de la universidad de Johns Hopkins y Gabriela Calderon Velazquez, especialista en salud escolar de Johns Hopkins. Hablan sobre el regreso a clases en persona en el tiempo de covid. Escuchemos.

The American Rescue Plan Act, meant to help the country dig its way out of the pandemic's disastrous economic effects, has some benefits that could be long-term game-changers for children and families. Bruce Lesley, president of the bipartisan advocacy group First Focus on the Children, talks with Stephanie Desmon about the Child Tax Credit's potential to cut child poverty by 45%. KEYWORDS: child health; social determinants of health; policy

When the historic Apollo Theater in Harlem paused live performances last March, there were questions about what would happen next. Like many venues, the theater made the transition to virtual performances, drawing audiences from all over the world, but it also considered ways to serve its local community including microgrants for nearby businesses and displaying messages of hope on its marquee. Fatima Jones, the senior director of marketing and communications, talks with Dr. Josh Sharfstein about how the health of the community and the theater are intertwined, and how the pandemic may have a lasting impact on how The Apollo thinks about its programming. You can check out the Apollo Theater at www.apollotheaters.org. KEYWORDS: community mental health; performing arts; pandemic response

The pandemic halted all in-person performing arts in the last year: a "big hole to crawl back out of," says Marin Alsop, music director of the Baltimore Symphony Orchestra. Alsop talks with Josh Sharfstein about what's been lost during a period of "emotional stasis," but also how the pandemic, alongside the Black Lives Matter and Me Too movements, offer the chance for much-needed change for and modernization of the orchestral performing arts. KEYWORDS: pandemic response; unemployment; community mental health

Research suggests that the arts—a sprawling industry of museums, theaters, studios, production companies, artists, administrators and more—have lost over $15 billion in the COVID-19 pandemic. But the losses go beyond financial to the existential: who are we without the arts? Kate Levin, who oversees the Bloomberg Philanthropies Arts program, talks with Dr. Josh Sharfstein about how the losses of these experiences impact everything from people's mental health, to neighborhood and community cohesion, to social services. They also talk about signs of hope for the future including support of the arts in the most recent disaster relief bill. KEYWORDS: community mental health; performing arts; pandemic response

Is the recovery on track or about to be derailed? What can we do alongside vaccines to step down case numbers? What does the CDC's relaxed guidance for 3-feet of distance for kids mean for schools reopening? What are the key metrics of vaccine success? Dr. Jennifer Nuzzo from the Center for Health Security returns to the podcast to talk with Dr. Josh Sharfstein and answer some questions about yet another pivotal moment in the pandemic. KEYWORDS: health equity; racial disparity; social determinants of health

Life expectancy in the US has been declining over the last 30 years, especially among working-age adults—a stark contrast from wealthy peer countries in Europe and Asia where adults are living longer, healthier lives. Hopkins health economist Dr. Darrell Gaskin talks with Dr. Josh Sharfstein about new data on this American crisis including a confluence of factors including a lack of jobs, systemic racism, and the greater availability of opioids. They also talk about how the crisis has been exacerbated by the pandemic, and about where to look for solutions to address a problem that "is not going away."

Staying on top of the COVID-19 pandemic means understanding the infectiousness, lethality, and spread of variants of SARS-CoV-2. Dr. Jonathan Quick, managing director for pandemic preparedness and prevention at the Rockefeller Foundation, talks with Dr. Josh Sharfstein about a new report with a vision for tracking variants across the United States and the world. KEYWORDS: viral mutation; testing methods

Many of the largest clusters of COVID-19 cases in the U.S. are in prisons, jails, and detention centers—places that have not been prioritized for vaccine rollouts. New data also shows that there are thousands of people who are pregnant being admitted to these facilities each year. Dr. Chris Beyrer returns to the podcast to give an update on COVID and prisons, and Dr. Carolyn Sufrin talks about the needs of pregnant people behind bars and how this is further complicated because pregnancy is a risk factor for more severe disease from COVID-19. KEYWORDS: vaccine distribution; decarceration; maternal health

Last week, parts of Europe suspended the use of AstraZeneca's COVID-19 vaccine after a few vaccinated individuals reported dangerous blood clots. Johns Hopkins vaccine safety expert Dan Salmon talks with Stephanie Desmon about the situation and why it's reassuring in terms of vaccine safety monitoring, and how these are questions that "can and will be answered by science." Note: This conversation was recorded on March 17. Since then, the European Medicines Agency has concluded that the vaccine's benefits outweigh the risks. KEYWORDS: vaccine authorization; vaccine trial; vaccine hesitancy

In this episode, Dr. Josh Sharfstein talks with Hopkins researchers who break down three research papers looking at the relationship between obesity and COVID-19. Lauren Peetluk, a graduate student from Vanderbilt University, talks about a study published early in the pandemic looking at obesity and mortality from COVID-19. Dr. Sabina Haberlen talks about a CDC paper on the relationship between BMI and COVID-19 severity and death. Dr. Nikolas Wada talks about a paper that teases out the relationship between obesity and COVID from other possible factors like diabetes and coronary artery disease. All three researchers are part of the Hopkins novel coronavirus research consortium, with many summaries of new studies available at http://ncrc.jhsph.edu. KEYWORDS: vaccine distribution; comorbidities

POTS is a chronic syndrome marked by high blood pressure and dizziness that can be debilitating. It's often diagnosed after patients recover from viruses like strep or mono, and now doctors are seeing patients develop POTS-like symptoms after infection with COVID-19. Dr. Christina Kokorelis and patient Vanessa McMains talk with Stephanie Desmon about POTS and the long-term prognosis for patients suffering from symptoms long after recovering from COVID. KEYWORDS: chronic disease; long-term symptoms; post-viral syndrome

Last fall, the state of North Dakota had the highest COVID-19 rate per capita in the world and Sanford Medical Center in Fargo was nearly overwhelmed with COVID patients from as far away as Montana. Dr. Doug Griffin, Sanford Health vice president and medical officer, talks with Stephanie Desmon about how the hospital got through that crisis and what things are like today, his fears of another surge, and the hope that a robust vaccination plan will keep COVID-19 cases in check. KEYWORDS: pandemic response; policy; health infrastructure

Baltimore County's mass vaccination sites—called "PODs," which stands for Point of Dispensing—can serve up to 500 patients an hour. The logistics of moving so many people safely through a space are complicated, but Terry Sapp, the public health emergency coordinator for Baltimore County, is drawing on his years of experience setting up venues for the heavy metal rock band Twisted Sister. Sapp talks to Dr. Josh Sharfstein about crowd control and the human psychology behind successful PODs and, yes, the jokes he hears—"As far as COVID vaccines, we're going to take it...and we want you to take it too." KEYWORDS: vaccine distribution; pandemic response