Public Health On Call

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

While COVID-19 showed all the ways the health care and public health systems in the US are broken, the pandemic has also led to innovative problem solving and fixes for the future. Health economist Dr. Melinda Buntin talks with Stephanie Desmon about what went wrong, what went right, what changes she hopes will stay, and what comes next for health care and public health. KEYWORDS: telemedicine; health infrastructure

Physicians play a crucial role in educating patients, who have lots of questions about COVID-19 vaccines. Drs. Jay Bhatt and Hussein Lalani are part of a digital campaign called This Is Our Shot that aims to drive out misinformation and elevate personal stories from physicians about getting COVID-19 vaccines. They talk with Stephanie Desmon about their work and how it's "drawing on the very best of humanity" to end the pandemic. You can learn more at www.thisisourshot.info. KEYWORDS: health communication; vaccine hesitancy; health equity

This week, the CDC released new guidance for vaccinated people who can resume some lower-risk activities. Dr. Tara Kirk Sell from the Center for Health Security talks with Stephanie Desmon about the impacts of "relaxing the rules," how this might help vaccine uptake, what we might expect next in terms of "Phase 2" guidance, and how we can all help those who are still awaiting their shot(s). KEYWORDS: vaccine hesitancy; policy; pandemic response

Does taking immunosuppressant drugs put you at higher risk of more serious disease from COVID-19? Dr. Caleb Alexander and PhD candidate Kayte Andersen talk with Dr. Josh Sharfstein about their new research looking into this question. They also discuss future research to tackle the next set of critical questions for the millions of people who need these medications to stay healthy. KEYWORDS: immune response

How do you have meaningful conversations around really big, complex problems like climate change or COVID-19? How can we address "climate anxiety?" Dr. Adam Levy—aka ClimateAdam on YouTube—a science journalist and communicator with a degree in atmospheric physics, talks with Lindsay Smith Rogers about his work trying to creatively "close the gap between research and action." KEYWORDS: environmental health; policy; misinformation

We know that having diabetes is a risk factor for more serious COVID-19 disease, but is being seriously ill from COVID-19 a risk factor for diabetes? Hopkins endocrinologist Dr. Mihail Zilbermint talks with Stephanie Desmon about what we know—and don't know—about the relationship between COVID-19 and diabetes. KEYWORDS: chronic disease; health equity

Dr. David Relman, a professor of medicine and microbiology at Stanford, talks with Dr. Josh Sharfstein about his view that more investigation is needed into the origins of the SARS-CoV-2 pandemic. Dr. Relman also explains why stronger controls on research that involves pathogens with pandemic potential are urgently needed. KEYWORDS: zoonotic virus; policy

With a limited supply of COVID-19 vaccines, the focus has been on getting the most vulnerable vaccinated first. But to reach the kind of population-level immunity needed to truly curb the pandemic, children will also need to be vaccinated. Dr. Kawsar Talaat, who led one of Pfizer's COVID-19 vaccine trials in adults, talks with Stephanie Desmon about when and how vaccines will be authorized for children. KEYWORDS: child health; vaccine authorization; vaccine trial

Morale is up and case numbers are down at Johns Hopkins Hospital, but infection prevention expert Dr. Lisa Maragakis says vaccines are in a race against variants and we shouldn't let our guard down. Dr. Maragakis talks with Dr. Josh Sharfstein about "watching evolution in real time" with mutations of SARS-CoV-2, staying the course with infection prevention, and when things could really take a turn for the better if we resist the urge to relax too much, too quickly. KEYWORDS: viral mutation; herd immunity; pandemic response

Infectious disease specialist Dr. Monica Gandhi returns to the podcast to talk about why she's so optimistic about COVID-19 vaccines and their ability to free us from the pandemic. Dr. Gandhi talks with Dr. Josh Sharfstein about the great results from clinical trials, why she is hopeful the vaccines will work against variants, some guidance for the newly-vaccinated about returning to "normal" life, and her latest insights on masks. KEYWORDS: vaccine trial; vaccine authorization; immune response

Although America is struggling to vaccinate our most vulnerable populations in a race against variants, just vaccinating people here won't help bring the pandemic to an end around the world. Lawrence Gostin, a Georgetown University professor and public health expert, talks with Stephanie Desmon about how our ethical duty to ensure equitable distribution of the vaccine worldwide is not only the morally right thing to do, it's in our own national interests. KEYWORDS: international health; supply chain; vaccine trial

This week, the US passed the tragic milestone of 500,000 lives lost to COVID-19. Each death generates a circle of trauma for family and friends. Annette March Grier is a nurse and the founder and president of Roberta's House, a support center to help grieving families in Baltimore. Grier talks with Dr. Josh Sharfstein about how to cope with grief, how to help others, and what the nation needs to do to heal. KEYWORDS: community mental health; intergenerational trauma

From seasonal flu to SARS, outbreaks and epidemics occur regularly and require sophisticated data analysis to help decision makers know how to respond. Dr. Caitlin Rivers from the Center for Health Security talks with Dr. Josh Sharfstein about President Biden's new federal directive to create a National Weather Service model for epidemics to track infectious disease threats. Someday soon, perhaps: Don't forget an umbrella...and a mask. KEYWORDS: policy; forecast

While some predicted that lockdowns in the US might lead to a baby boom, the reality is that COVID-19 seems to be impacting demographics more like a disaster or a recession than a snowstorm. Sociologist Dr. Philip Cohen talks with Stephanie Desmon about the pandemic's effects on babies, marriages, and divorces, some unique methods of predicting trends, and the likely demographic effects of a situation that's "exacerbating every kind of inequality we see." KEYWORDS: health equity; community mental health; birthrate

The COVID-19 pandemic has been a stress test for democracy, exposing fault lines that already existed. So, where do we go from here? Dr. Hahrie Han, inaugural director of the SNF Agora Institute and Hopkins political science professor, talks with Dr. Josh Sharfstein about what it means for democracy to be in crisis, the parallels of this moment to a century ago, why the pandemic became politically polarizing in some countries but not others, and what we can learn from history and evangelical megachurches to help us address these challenges going forward. KEYWORDS: policy; pandemic response

A person's worldview is a fundamental, gut-level set of instincts that has played a larger role in influencing political attitudes and affiliations in the last two decades. It can also influence thinking on the COVID-19 pandemic and on protective actions like mask wearing and social distancing. Marc Hetherington and Jonathan Weiler, UNC professors and authors of the book "Prius or Pickup? How the Answers to Four Simple Questions Explain America's Great Divide," talk with guest host Colleen Barry about the concept of worldview and why it matters for understanding the politics of COVID-19. KEYWORDS: policy; political science

In this episode, Dr. Josh Sharfstein talks with Hopkins researchers who break down three research papers with implications for the national discussion over COVID and schools. Dr. Nikolas Wada talks about a paper related to how the coronavirus is transmitted in schools in the United Kingdom; Dr. Sheree Schwartz talks about a paper examining children's role in the household transmission of COVID-19; and PhD student Greg Rosen talks about a study of what happened with national COVID cases in Israel when schools reopened with few precautions last spring. All three researchers are part of the novel coronavirus research consortium, with many summaries of new studies available at http://ncrc.jhsph.edu. KEYWORDS: child health; student life; pandemic response

Jim Golen, a nurse in Minnesota, became sick with COVID in March of 2020. Nearly one year later, he still suffers from severe shortness of breath and brain fog and may have permanent lung damage. Golen talks with Stephanie Desmon about how he got COVID, the doctors who misdiagnosed him with anxiety and depression, and how long-haul COVID has completely changed life for him and his wife. Golen also speaks about support groups for long-haulers that have been helpful for him and one message he hopes everyone hears: Wearing a mask is an act of empathy and kindness. Read more about Jim Golen's story in Hopkins Bloomberg Public Health Magazine: https://magazine.jhsph.edu/2020/covid-long-haul Have you tested positive for COVID-19 or experienced COVID-19 symptoms? Our Johns Hopkins led study wants to learn more about COVID-19 symptoms in the short and long term. Tell us about your experience with COVID-19 by filling out a short, online questionnaire. Learn more by clicking here https://covid-long.com/. KEYWORDS: long-term symptoms; post-viral syndrome

150 years ago, it was common—even expected—that children would die, and tragedy struck families from the poor to the rich and powerful. Dr. Perri Klass, a pediatrician and author of A Good Time to Be Born, talks with Dr. Josh Sharfstein about the incredible scientific, public health, and social movements that made child mortality so rare in the United States. They also discuss why disparities persist and how today's parents, despite being "the luckiest in history," are not any less anxious about the safety and well-being of their children. KEYWORDS: child health; social determinants of health

On a special episode, Tradeoffs host Dan Gorenstein talks with Tracey, a staff member at a long term care facility, about her experience with having COVID-19, her hesitancy to get vaccinated, and how her workplace has used "learning circles" to address questions and concerns. Gorenstein also talks with Dr. Jasmine Travers, an NYU nursing professor about the pros and cons of mandates and incentives, and how long-standing mistreatment of frontline workers in these facilities have contributed to distrust and feeling unvalued and invisible. Listen to the original episode here: https://tradeoffs.org/2021/01/14/we-need-you/ KEYWORDS: vaccine hesitancy; policy; geriatric health

COVID-19 is tied to sleep issues like insomnia but is this a result of stress and anxiety or is there a biological issue caused by the virus? Dr. Rachel Salas, a neurologist and sleep specialist at the Johns Hopkins Center for Sleep and Wellness talks with Dr. Josh Sharfstein about sleep anxiety and the neurological drivers behind insomnia in patients regardless of whether or not they've had COVID. They also talk about the sleep issues plaguing health care workers, changes in circadian rhythms for people working from home, treatment plans for sleep issues, and why seeking help for insomnia may be easier than ever. KEYWORDS: sleep hygiene; orthosomnia

While schools may not be inherently safe during the COVID-19 pandemic, they can be made safer. Dr. Caitlin Rivers of the Center for Health Security talks with Dr. Josh Sharfstein about what schools can do to consider reopening safely including the data to consider, and risk-reduction methods like masks, distancing, testing, and more. They also discuss how variants of SARS-CoV-2 could factor into these developments. KEYWORDS: child health; student life; pandemic response

Matthew Hornbeck, principal of Hampstead Hill Academy—a K-8 public school in Baltimore City—talks with Dr. Josh Sharfstein about the challenges of virtual learning, the excitement and fears of teachers and staff, and plans to reopen for in-person learning in the coming weeks. They also talk about how the vaccine might make a difference in giving confidence to reopen, and how some teachers are centering the wellbeing of students and their families in their decision to get vaccinated. KEYWORDS: child health; student life; pandemic response

COVID-19 has increased awareness of public health, health inequities, and shortcomings of the US health system, but it may also negatively impact college students in terms of opportunities for personal and professional growth. Dr. José Ramón Fernández-Peña, APHA President and Northwestern's director of Health Professions Advising, talks with Stephanie Desmon about how the pandemic is affecting undergraduate students, an increasing interest in and appreciation of public health work, and how this "disaster time" may be forcing students to grow up faster while robbing them of vital experiences to develop some skills and pursue professional opportunities. KEYWORDS: student life; college; health equity

Although the CDC has found little evidence of COVID spreading in schools with proper precautions in place, 17% of districts in the US are fully open for in-person learning. Dr. Annette Anderson of the Johns Hopkins School of Education returns to the podcast to give an update about the impacts of the pandemic, academically and socially, on K-12 students. Dr. Anderson also talks with Stephanie Desmon about why schools may not fully reopen until the fall, and the opportunities now for schools to address a longstanding lack of innovation. KEYWORDS: child health; student life; pandemic response

Although private schools and daycares have been open across Chicago since June, public schools are only now preparing to reopen for in-person learning. Dr. Ken Fox, chief health officer and "the district's pediatrician", talks with Dr. Josh Sharfstein about centering the well-being of kids in reopening, what the science says about how to do things as safely as possible, and his hopes for getting caregivers, teachers, and everyone else on board through transparent communication and a dedication to the kids they all serve. KEYWORDS: child health; student life; pandemic response

Dating is already so much about trust and safety—COVID-19 adds new complications. Dr. Keri Althoff and Dr. Laura Murray return to the podcast to talk with Stephanie Desmon about why human connection is so important, how to navigate difficult conversations, the new ways people are meeting—not just online!—and how COVID-19 may change dating forever, possibly for the best. KEYWORDS: community mental health; social distancing; young adults

After public health measures helped stem a massive first wave of infections, fatigue set in, and Brazil is now facing the worst moment of the pandemic so far. Dr. Luana Araujo, a public health consultant in Brazil, talks with Dr. Josh Sharfstein about why Brazil is struggling despite a robust universal health care system. She also makes the case for greater inclusion of Brazil in discussions of global health. KEYWORDS: pandemic response; health communication; vaccine approval

Even after the 1918 pandemic supposedly "ended" a significant number of people continued to die from "flu-like illnesses" for years. So do pandemics really "end" or do they fade from the public's consciousness? Medical historians Jeremy Greene and Graham Mooney return to the podcast to talk with Stephanie Desmon about how we really mark the "end of a pandemic", why today's vaccine hesitancy is strikingly similar to resistance to smallpox inoculations a century ago, and the hope that a focus on health disparities due to structural racism—not individual behaviors or innate characteristics—will endure through whatever the "end" of COVID-19 looks like. KEYWORDS: health equity; racial disparity; health communication

In this episode, Dr. Josh Sharfstein talks with Hopkins researchers who break down three COVID-19 research papers: Dr. Sheree Schwartz talks about a preprint study of a healthcare worker who experienced COVID-19 twice; Dr. Nikolas Wada talks about a study of why some people, especially men, may have more serious disease from COVID-19; and Dr. Ashwin Balagopal talked about a clinical trial for an inhaled Interferon treatment. All three Hopkins faculty are part of the novel coronavirus research consortium, with many summaries of new studies available at http://ncrc.jhsph.edu KEYWORDS: COVID-19 therapy; immune response

Until 2020, PIVOT, an NGO in Africa, had an operations model that looked much like many organizations of its type: a 200-person team on the ground in Madagascar and a 10-person administrative team in the US. But early in 2020, the organization decided to let the majority of US employees go and shift operations to Madagascar and the communities that PIVOT serves. Executive director and Hopkins alum Tara Loyd talks with Lindsay Smith Rogers about how this transition was managed and what the change means not only for the organization, but for global health care. You can read Loyd's commentary in Stanford Social Innovation Review: https://ssir.org/articles/entry/moving_closer_to_the_problem_and_closer_to_the_solution KEYWORDS: international health; community health workers

How do I find out where to get vaccinated? How much flexibility in timing is there for the second dose? If I've gotten vaccinated, can I be infected by one of the new variants? Should I get the vaccine if I currently have COVID? Can the vaccine alleviate long-hauler symptoms or long-term loss of taste or smell? Dr. Josh Sharfstein talks with Stephanie Desmon to answer listener questions about COVID-19 vaccines. KEYWORDS: long-term symptoms; viral mutation; household transmission

Once vaccines are more widely available, employers may start requiring their workers to be vaccinated. Employment law expert Karla Grossenbacher talks with Dr. Josh Sharfstein to break down vaccine mandates, how these work with the Americans With Disabilities Act, Title VII, and other federal laws, and what questions employers are asking before they make a decision to move forward. KEYWORDS: policy; vaccine hesitancy; vaccine authorization

In a special two-part episode, we look at the landscape of vaccine hesitancy and what can be done to address it. In part one, Hopkins vaccine safety expert Dr. Dan Salmon talks with Stephanie Desmon about his new and ongoing research on acceptability of COVID-19 vaccines in minority communities and the importance of listening to understand hesitancy to help people feel more confident. In part two, Dr. Rupali Limaye, a Hopkins expert in vaccine behavior and decision-making talks with Dr. Josh Sharfstein about misinformation, why hesitancy around COVID-19 vaccines is different from anti-vax groups like measles, and creative strategies like "prebunking" to address misinformation. KEYWORDS: health communication; herd immunity; risk perception

In a special two-part episode, we look at considerations of ethics and equity in vaccinating a nation. In part one, Stephanie Desmon talks to Johns Hopkins ethicist Dr. Ruth Faden about the ethics of COVID-19 vaccine distribution and choosing who is and who isn't eligible to be vaccinated in the near term. They also talk about what happens when someone jumps the line to get what is, for now, a scarce commodity. In part two, Dr. Josh Sharfstein speaks with Dr. Chidinma Ibe, an assistant professor of medicine and the associate director for stakeholder engagement of the Center for Health Equity at Johns Hopkins. They discuss equity in vaccine distribution, or why we have to do more than just count the number of vaccinations. KEYWORDS: supply chain; vaccine hesitancy; social determinants of health

Why is it so hard to get vaccines to people who need them? Maine's CDC Director Dr. Nirav Shah talks to Stephanie Desmon about the massive logistical challenges with COVID-19 vaccines: identification of groups, notification to let groups know when it's their turn, and then actually registering, scheduling, and vaccinating people with two doses—all while not being able to anticipate supply more than one week out. They also talk about the troubling realities of vaccine hesitation which may not be as visible right now with demand far outpacing supply. KEYWORDS: supply chain; policy

2021, so far, looks a lot like 2020 in terms of pandemic fatigue. What are signs of burnout and mental exhaustion? What can we do about anger? How can we "just hang on" until the pandemic is under better control? How can we deal with the stigma and shame around getting sick with COVID? Clinical psychologist Dr. Laura Murray returns to the podcast to talk through these and more questions with Stephanie Desmon. KEYWORDS: community mental health; stress management

After the murder of George Floyd, a number of jurisdictions formally declared racism a public health crisis. Dawn Hunter, deputy director of the Southeastern Region for the Network for public health law, is studying these declarations to see how cities, counties, and states actually take action to follow through. Hunter talks with Dr. Josh Sharfstein about what the declarations actually do and why they are important, and how they put in place real world solutions to combat systemic racism and create healthier communities where everyone can thrive. KEYWORDS: health equity; racial disparity; social determinants of health

Today's episode is audio from a webcast recorded last week with two members of President Joe Biden's COVID-19 advisory board. In a conversation moderated by Global Health NOW's Brian Simpson, infectious disease and epidemiology expert Dr. Celine Gounder and public health policy expert Loyce Pace talk about the challenges the new administration faces coming into the COVID-19 crisis with millions of cases and hundreds of thousands of deaths, a significant number of Americans who deny the severity of the virus, a faltering vaccine distribution effort, and a new and more contagious variant of the virus—all in the context of a bitterly divided nation. KEYWORDS: policy; vaccine hesitancy; health communication

There are more than two million federally-subsidized apartments, units, and homes designated for senior housing. These communities, which tend to serve lower-income racial and ethnic minorities, have unique opportunities and challenges compared to assisted living and nursing care facilities and have been largely overlooked in the COVID-19 response. Juliana Bilowich, director of Housing Operations and Policy at Leading Age, and Shanna Dell, the lead infection control adviser on the outbreak team of the Baltimore City Health Department talk with Dr. Josh Sharfstein about these challenges and about a new, free course available on Coursera developed to help assisted living facilities to keep their residents safe. https://www.coursera.org/learn/strategies-senior-housing-covid19 KEYWORDS: geriatric health; health equity

What accounts for the sluggish rollout of COVID-19 vaccines? Dr. Michael Fraser, executive director of the Association of State and Territorial Health Officials, talks with Dr. Josh Sharfstein about the challenges states are facing with vaccine distribution, what's working and not working well so far, and why there are reasons for hope in the coming months.

Urban areas in Spain have been hard hit by COVID, but the rural northern state of Cantabria has fared much better thanks to a strong public health approach. Dr. Paloma Navas, former director general for public health in the region, talks with Dr. Josh Sharfstein about the area's hard-won successes in lower case counts and deaths. KEYWORDS: policy; pandemic response; contact tracing

What caused the variants seen in the SARS-CoV-2 virus in the UK and elsewhere? Why is the UK variant more contagious? Is it more lethal? Will the current vaccines still work against these variants? Is there anything we should be doing differently to protect ourselves? Expert virologist Dr. Andy Pekosz talks with Dr. Josh Sharfstein about how the virus that causes COVID-19 is changing, and what it means for 2021. KEYWORDS: viral mutation; spike protein; policy

The Latino immigrant community has been hard hit by COVID—in Baltimore, there are sustained positivity rates of up to 30%. Dr. Kathleen Page, medical director of the Johns Hopkins The Access Partnership, talks with Stephanie Desmon about how undocumented and low-income immigrants are caught in a "perfect storm" with conditions for lots of transmission and few ways to seek help. They also talk about how unchecked transmission anywhere means the pandemic will continue to rage, and the culture of fear that will make it harder to provide vaccines to immigrants. KEYWORDS: health equity; racial disparity; vaccine hesitancy

Helping members of the Black community get the information they need in order to trust COVID-19 vaccines is a daunting task. But it's also an opportunity to invest in the health and wellbeing of Black people. Rev. Dr. Terris King, pastor of Liberty Grace Church of God in Baltimore and former Center for Medicare and Medicaid Services minority health director, and Hopkins immunization policy expert Lois Privor-Dumm, talk with Stephanie Desmon about the opportunities the pandemic has brought forth to build bridges between health institutions and the Black community. KEYWORDS: health equity; racial disparity; health communication

With a shortage of COVID-19 vaccines, is it a good idea to give people just one dose now and a second dose later when there is more available? How can the process of rolling out vaccines be sped up? What do we know about potential side effects? Which vaccine should I get? Immunologist Dr. Gigi Gronvall from the Center for Health Security talks with Stephanie Desmon to answer these questions and more about COVID-19 vaccines. KEYWORDS: vaccine hesitancy; herd immunity

States are rolling out COVID-19 vaccines to "high risk groups" but there's a lot of nuance in how "high risk" is defined. Dr. Monica Bharel, health commissioner of Massachusetts, talks with Dr. Josh Sharfstein about the state's unique approach, which includes prioritizing communities impacted by institutional racism and those with disproportionately high numbers of COVID infections. Dr. Bharel also talks about what the state is doing to go beyond just making the vaccine available to support high uptake of vaccination among people who can benefit the most. KEYWORDS: health equity; racial disparity; health communication

COVID-19 is having dangerous impacts on mental health in the US with more than 14% of all adults meeting the criteria for serious psychological distress. These numbers are even higher among Latinos with more than 19% of adults experiencing distress. Dr. Margarita Alegria, chief of the Disparities Research Unit at Massachusetts General Hospital, and Hopkins mental health and policy researcher Dr. Beth McGinty talk with guest host Dr. Colleen Barry about mental health and wellbeing nine months into the pandemic, the factors behind high rates of distress among Latinos, and policies that could make a difference in the months ahead. KEYWORDS: community mental health; health equity; racial disparity

Assisted living facilities are small, congregate settings that make infection control measures harder to implement. These facilities also care for a large proportion of residents with Alzheimer's disease—a challenge for enforcing guidance like mask wearing, hand washing, and social distancing. Dr. Morgan Katz, a Hopkins geriatrician and infectious disease specialist, and Shanna Dell, lead infection control adviser on the outbreak team of the Baltimore City Health Department talk with Dr. Josh Sharfstein about these challenges and about a new, free course available on Coursera developed to help assisted living facilities to keep their residents safe. KEYWORDS: mental health; pandemic response; geriatric health