Public Health On Call

Early on, Israel surfaced as a pandemic success story when strict lockdowns kept case counts low. The country returned to something close to normal, reopening businesses and schools and resuming gatherings and activities. But the optimism was short-lived, and Israel had to go into a second lockdown when COVID-19 started spreading uncontrolled across the country. Dana Schleifer, director of the impact team in Tel Aviv working on complex city challenges, talks with Dr. Josh Sharfstein about the second lockdown and what may happen next. KEYWORDS: pandemic response; policy; contact tracing

This fall, Cornell University invited all students back to campus. Out of roughly 28,000 people on campus including students, faculty and staff, the school has seen only 100 positive tests. Provost Dr. Michael Kotlikoff talks with Stephanie Desmon about Cornell's success which includes robust testing in an on-site lab, contact tracing, and a strategy called "adaptive testing" where tracers work to identify how people who test positive may have been exposed and then test those people and their contacts to break potential transmission chains before they start. KEYWORDS: student life; college; testing methods

This week, senior White House officials embraced the Great Barrington Declaration, a statement funded by a libertarian think tank that calls for an end to most COVID-19 response measures. In this two-part bonus episode, Dr. Josh Sharfstein talks with epidemiologists Dr. David Dowdy and Dr. Amber D'Souza about the harm this strategy would cause. Part two is an excerpt from Sharfstein's conversation with immunologist Dr. Gigi Gronvall, who crunches the numbers and looks at key players behind the declaration.

Why is it so important for African-Americans, Hispanic Americans, and other members of racial and ethnic minority groups to participate in COVID-19 vaccine trials? Why is recruitment difficult? How can long standing mistrust of the medical community be mended? What needs to happen to battle myths and inconsistencies that undermine participation? Dr. Lisa Cooper, director of the Johns Hopkins Center for Health Equity, returns to the podcast with Dr. Josh Sharfstein to answer these and more questions about diversity in COVID-19 vaccines clinical trials. KEYWORDS: vaccine authorization; racial disparity; misinformation

Halloween is approaching, followed by Thanksgiving and the winter holidays. What should parents and families be thinking about? Elizabeth Stuart and Keri Althoff return to the podcast to talk with Stephanie Desmon about how COVID-19 will impact the holidays and may move life indoors as the weather cools off. They discuss how to make celebrations special, how to think about travel and hosting, and how to plan for the unexpected. KEYWORDS: social distancing; child health

In the unprecedented COVID-19 pandemic, safety and speed are critical for developing an effective vaccine which means finding lots of volunteers for clinical trials. Georgia Lewis signed up for the Pfizer clinical trial and has received two doses of an experimental COVID-19 vaccine. Lewis, a pediatric nurse practitioner, talks with Stephanie Desmon about why she volunteered, her experience with this and another clinical trial she participated in, and why her involvement is helping her communicate about the efficacy and safety of vaccines to her patients and their parents. KEYWORDS: vaccine authorization; vaccine trial; herd immunity

Back in April, Dr. Brendan Nyhan, an expert in the politics of misinformation about health, talked with guest host Dr. Colleen Barry, chair of the Department of Health Policy and Management, about social media, scientific uncertainty, and COVID-19's misinformation storm. Today, he returns to the podcast to discuss what we've learned about misinformation since then, why—like the virus itself—it's so hard to eradicate, and a new threat: how COVID-19 misinformation may impact the upcoming election. Nyhan also talks about how misinformation may be threatening the very fabric of democracy, and what social media platforms and leaders should be vigilant about in the days and weeks to come to promote the integrity of the election. KEYWORDS: health communication; political science

Today, we're releasing a special bonus episode with what might be an opportunity for you or for someone you know—a chance for a full scholarship to the Johns Hopkins Bloomberg School of Public Health. The program is called the Bloomberg Fellows Program and it's part of the Bloomberg American Health Initiative. You may be eligible to apply if you work in the United States now on one of these issues: addiction and overdose, adolescent health, environmental challenges, obesity and the food system, or violence. The deadline to apply for the program is December 1. Learn more at americanhealth.jhu.edu. In this episode, Fellowship staff, current students, and alumni speak about opportunities and experiences with the Fellowship program.

October 12 is Indigenous People's Day, a movement that originated in the late 1980s to address the erasure of history of America's indigenous people. Dr. Melissa Walls, director of the Great Lakes Hub for the Center for American Indian Health at Johns Hopkins and a member of the Bois Forte and Couchiching First Nation Anishinaabe, talks with Dr. Josh Sharfstein about the holiday that shares a date with a more well-known holiday. They discuss the need to overcome false narratives of the past, learn from the resilience of native communities and cultures, and appreciate the contributions that research in Native communities have made to scientific knowledge. KEYWORDS: racial disparity; substance use; health equity

Election season has begun and voting options vary by state. In this special bonus episode, the Center for Health Security's Dr. Caitlin Rivers and Dr. Josh Sharfstein break down what you need to know about the risks and safety precautions for on-site voting.

This week we put the former principal deputy commissioner of the US Food and Drug Administration, Dr. Josh Sharfstein, on the other side of the mic to answer questions about some of this week's remarkable list of COVID news. How damaging are conflicting messages from the White House about COVID-19? What happened between the FDA and the White House over COVID-19 vaccine safety? Is Regeneron, a cocktail of monoclonal antibodies, really a "cure"? And why is the New England Journal of Medicine heating up on social media? Dr. Sharfstein talks with Stephanie Desmon about all this and more. KEYWORDS: vaccine authorization; health communication; COVID-19 therapy

Johns Hopkins Bloomberg School of Public Health professor Keshia Pollack Porter and colleagues recently penned a Health Affairs blog calling for nonpartisan, objective analysis of legislation by a Congressional Health Office. The Office would evaluate and score legislation for intended and unintended impacts on health and equity, help educate policymakers, and advocate for "health in all policies." Dr. Porter talks to Dr. Josh Sharfstein about how such a new office might work, and obstacles to its success. KEYWORDS: policy; social determinants of health

Molecular tests, antigen tests, antibody tests, nasopharyngeal, saliva, blood... When we talk about COVID-19 testing, what are we actually talking about? Dr. Yuka Manabe, a Johns Hopkins expert in infectious diseases and testing, talks with Stephanie Desmon about the various types and methods of COVID-19 testing, their pros and cons when it comes to convenience and accuracy, the type of testing used at the White House, how current testing can be improved, and what innovations we might see in the near future. KEYWORDS: testing methods; antibodies

COVID-19 drew the curtain on live theater across the country, putting 90% of the industry out of work. Producer and publicist Matt Ross is part of a COVID Theatre Think Tank, a research group of actors, directors, musicians, and many other industry professionals. Ross talks with Stephanie Desmon about how the group works closely with public health experts and advisors to "interpret the science for the field" and provides guidance on thinking about ways to safely resume some performances, considering factors like testing protocols, mask requirements, and ventilation. "The field thrives on creativity and innovation," Ross says. "[Our] responsibility is to provide the logistical and the science side." KEYWORDS: performing arts; pandemic response; unemployment

In a bonus episode recorded Sunday, October 4, Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security, talks with Dr. Josh Sharfstein about the origins and consequences of the White House COVID-19 outbreak. They discuss what's needed to get the situation under control, the implications for upcoming debates, and the threat of this major outbreak cutting across the corridors of power in Washington, DC.

Six months ago, Dr. Lisa Maragakis was one of the podcast's very first guests and she talked about how Johns Hopkins was preparing for an influx of COVID-19 patients. Things have calmed down a bit since then, but cases have plateaued at a concerning level at the same time we're entering respiratory virus season. Dr. Maragakis talks with Dr. Josh Sharfstein about ongoing challenges in the hospital with having to conserve PPE and testing, pandemic fatigue, and the importance of getting a flu shot. They also discuss the possibility that vigilant social distancing, masks, and widespread vaccination and masks could help curb flu infections this year, reducing the risks of coinfection and diagnostic complications. KEYWORDS: co-infection; testing methods; pandemic response

The vacancy on the Supreme Court left by Justice Ginsburg could have an unprecedented impact on critical public health issues. In a special Friday episode, Dr. Josh Sharfstein talks with three experts in public health law—Lainie Rutkow, Jon Vernick, and Joanne Rosen—about the ACA, the Second Amendment, and Roe v. Wade. They discuss the Court's precedents around these issues, how nominee Amy Coney Barrett's originalist and textualist philosophies might be used to interpret them, whether one judge can make a significant difference in overall decisions, and the potential impacts reversals and changes to existing laws could make on the public's health. KEYWORDS: policy; firearms; abortion

The University of Arizona recently tracked a potential COVID-19 outbreak in a dorm by testing sewage. Johns Hopkins chemist Dr. Carsten Prasse, who studies wastewater-based epidemiology, talks with Stephanie Desmon about what poop can tell us about the health of individuals and communities, privacy concerns, and how sewage surveillance could be part of the COVID-19 response in certain circumstances. KEYWORDS: pandemic response; viral shedding; human waste

We last heard from Matt Hornbeck—longtime principal of Hampstead Hill Academy, a K-8 school in Baltimore city—in the spring after schools abruptly closed. Hornbeck now returns to the podcast to talk with Dr. Josh Sharfstein about the first few weeks of online learning and what a typical day looks like. They also discuss successes and setbacks, how to think about prioritizing ESOL students and those with special needs, and what might happen regarding reopening for in-person learning in the months ahead. KEYWORDS: schools; student life; pandemic response

When the world first heard about a new respiratory virus, it was a surprise to learn that patients were suffering from blood clots, strokes, and heart attacks. Johns Hopkins hematologist Dr. Robert Brodsky talks with Dr. Josh Sharfstein about recent research exploring the role of complement, a part of the immune system, in COVID-related clotting. Brodksy talks about how COVID-19 may be similar to other diseases that involve complement, and the implications of the theory for treatment and diagnosis. KEYWORDS: spike protein; COVID-19 therapy; endothelium

Research has shown that COVID-19 transmission is largely through airborne droplets and particles expelled during sneezing, coughing, talking, and singing. There's little evidence, though, that surfaces are making us sick. Microbiologist Dr. Emanuel Goldman talks with Stephanie Desmon about the science behind COVID transmission research, the strong evidence that infection comes from aerosols and not surfaces, and how excess sanitation in public spaces may be giving us a false sense of security when all we really need is to wash our hands. KEYWORDS: fomite; hand washing; pandemic response

How can we deal with all of the unique stressors happening right now? How can families adjust to "back to school," in whatever form that may take? Is it helpful to have a broader perspective of what's going on in the world? What should we be doing to prepare for the winter months ahead in terms of our mental health and outlook? Dr. Laura Murray returns to the podcast this week with Stephanie Desmon to talk us through dealing with some of the punches 2020 has thrown. KEYWORDS: community mental health; stress management; child health

Bestselling author Wes Moore remembers the feelings of heartache, anger, and complicity following Freddie Gray's funeral. Five years later, the Black Lives Matter movement has shown that the issue is much bigger than Baltimore and its policing. Moore talks with Dr. Josh Sharfstein about how the police were the last in a long line of systems to fail Gray throughout his life, how Black Lives Matter means addressing all stages of the lifecycle of Black people, why COVID-19 is life or death for many, and how to get people to pay attention and create change. KEYWORDS: racial disparity; social determinants of health; health equity

At the beginning of the pandemic, many in the US seemed to view public health measures like lockdowns and social distancing and economic recovery as a tradeoff. But economist Dr. James Galbraith says this is an incorrect assumption, and that early failures to contain the virus mean the US now has uncontrolled spread and a less resilient economy. Galbraith talks with Dr. Josh Sharfstein about the current state of the US economy, the failure of the government to launch an effective public health response, why another shutdown may be necessary, and what we need to think about to address urgent economic impacts to low-income and minority populations hit hard by the pandemic. KEYWORDS: unemployment; health equity; schools

As some schools and leagues resume play among youths, how can parents assess which activities are safer than others? Dr. Tara Kirk Sell—an expert from the Center for Health Security and an Olympic silver medalist in swimming—talks with Stephanie Desmon about how to think about levels of risk in different sports both on and off the field or court, how pro sports teams are thinking through safety, and how they can be messengers for public health. Sell also discusses why, with so many activities deemed nonessential, watching and participating in sports are important for our well-being. KEYWORDS: athletes; college; student life

The University of Alabama saw some 2,000 cases of COVID-19 within the first few weeks of students returning to campus. Walt Maddox, mayor of Tuscaloosa and dad to an Alabama freshman, talks with Stephanie Desmon about how intertwined his city is with the university and how town and gown have had to work together to implement public policies to stem the spread. Maddox also talks about the economic impact COVID-19 has had both on the school and the city, and how all decision making has been rooted in public safety, logic, data, and science. KEYWORDS: young adults; student life; college

Fire season in the western US is starting earlier and ending later each year and has seen larger, more intense fires in the last 10 years. How do these fires impact the health of people living nearby and, as smoke plumes spread across the US, can they impact the health of people further away? In this bonus episode, Dr. Kirsten Koehler, an expert in air pollution, talks with Dr. Josh Sharfstein about the massive fires currently burning on the west coast, the impacts on human health, how individuals can protect themselves, and what the rest of the US can expect as the smoke spreads.

What we are learning from universities that are opening their campuses for in-person schooling? Are rapid COVID tests as accurate as PCR tests? Can asymptomatic people experience heart and lung damage and other long-term health issues? If only some people are being tested, what does the positivity rate really tell us about community spread? If a student is symptomatic, should the entire class be quarantined? Can trick-or-treating or holiday caroling be done safely this year? Dr. Tom Inglesby and Dr. Josh Sharfstein answer more of your COVID-19 questions sent to [email protected]. KEYWORDS: testing methods; student life

Iceland, an island nation of about 400,000 people, has seen fewer than 2,500 COVID-19 cases and only 10 deaths. Dr. Thorolfur Gudnason, Iceland's chief epidemiologist, talks with Dr. Josh Sharfstein about how the country's pandemic strategy meant they never had to close schools or restaurants, and how its research with genomic sequencing helped shed light on COVID-19 transmission and immunity. Gudnason also talks about the public's response, how the country's vital tourism industry has been affected, and his outlook on the next year. KEYWORDS: contact tracing; antibodies; pandemic response

Chicago has seen drastic increases in opioid-related overdoses and deaths compared to 2019—an uptick that started prior to the arrival of COVID. Dr. Wilnise Jasmin, Medical Director for Behavioral Health, talks with Dr. Josh Sharfstein about how the pandemic has exacerbated the opioid epidemic while, at the same time, opening up new opportunities, and how Chicago's response to COVID-19 includes addressing the mental health needs of its citizens. KEYWORDS: stress management; substance use; community mental health

A cohort of COVID-19 patients—mostly middle-aged women—who experience "mild" disease not only don't seem to be getting better, they're developing new symptoms like debilitating cognitive fog, dizziness, and palpitations that linger for months after diagnosis. Dr. David Putrino, the Director of Rehabilitation Innovation at Mt. Sinai Health System in New York, talks with Stephanie Desmon about the emerging phenomenon of "long-haulers," expectations around recovery, why the term "mild COVID disease" is problematic, and why this group is vulnerable to medical gaslighting. KEYWORDS: long-term symptoms; post-viral syndrome

Flint's water crisis, which exposed thousands of children to excess levels of lead, is far from over, but the city is making progress. Dr. Mona Hanna-Attisha, the Michigan State pediatrician who exposed the crisis, talks with Dr. Josh Sharfstein about how an "unfair and preventable health crisis" became an opportunity to address disparities and do better. This focus on secondary prevention actually helped build up public health infrastructure that's now being used in the COVID-19 response. Hanna-Attisha also talks about how COVID-19—another preventable health crisis—could be a wake-up call for the rest of the nation to hold leaders accountable, address disparities, and invest in public health. KEYWORDS: health equity; racial disparity

Why would a virus that primarily affect the lungs also cause a heart attack? How do you treat injury to the heart and is recovery expected? Is there evidence that people with asymptomatic COVID cases could still experience injury to the heart and lungs? Should athletes who have had severe COVID seek a cardiac assessment before returning to sports? Hopkins cardiologist and myocarditis expert Dr. Nisha Gilotra talks with Dr. Josh Sharfstein and answers questions about COVID-19's impact on the heart. KEYWORDS: heart attack; cardiomyopathy; cardiac health

Outdoor interactions are safer when it comes to COVID-19, but what can be done to improve ventilation in buildings? Dr. Ana María Rule, a Hopkins ventilation expert, talks with Stephanie Desmon about how ventilation systems can reduce the risk of exposure, whether heating or air conditioning are different, and whether airplane ventilation systems are better or worse than buildings. Dr. Rule also breaks down a case study of a restaurant in China which led to an outbreak of COVID-19 due to poor ventilation. KEYWORDS: filters; aerosols

Why are Black people so much more likely to die from COVID than whites in Louisiana and elsewhere? Dr. Tom LaVeist, dean of the Tulane University School of Public Health and Tropical Medicine, talks with Dr. Josh Sharfstein about misconceptions and misunderstandings about race and health. Dr. LaVeist also talks about his work on a COVID-19 task force to make permanent policy changes that will help towards building a healthier and more equitable society after the pandemic. KEYWORDS: racial disparity; social determinants of health; health equity

Thousands of COVID-19-related papers are released every week. But the information is of varying quality and health care workers don't have time to sift through the deluge. Johns Hopkins epidemiologist Dr. Kate Grabowski talks with Stephanie Desmon about the Novel Coronavirus Research Compendium, a literature curation effort by more than 50 people across collaborating institutions. Every week, the group reviews and summarizes the newest and most exciting COVID-19 research to help those on the front lines working with testing, contact tracing, and other public health responses. Grabowski also talks about how COVID-19 has meant more public scrutiny of research, how mistakes are inevitable and expected, and that retractions and corrections are part of the usual publication process. KEYWORDS: peer review; misinformation

The FDA last week issued an "emergency use authorization" for convalescent plasma for COVID-19 patients – after a press conference attended by the FDA Commissioner at the White House. "Public Health on Call" co-host Dr. Josh Sharfstein was second-in-command at the FDA early in the Obama Administration. He talks to Stephanie Desmon about the controversy over the announcement on convalescent plasma and the brewing concern over whether politics could interfere with decisions on a COVID-19 vaccine. Correction: The first EUA was for an anthrax vaccine in 2005. Dr. Sharfstein signed the next set starting in 2009 for H1N1 influenza. KEYWORDS: COVID-19 therapy, vaccine authorization

Michigan State University decided not to have in-person learning this fall after a notable outbreak in the nearby community, positive tests among athletes who returned to campus, and a review of outbreaks at similar schools. University president Dr. Sam Stanley talks with Stephanie Desmon about that decision and how his experience as an infectious disease doctor has informed his work around COVID-19. Stanley also talks about what went into the polarizing decision to cancel Big Ten football this fall. KEYWORDS: young adults, student life, college

The University of Michigan plans to conduct an in-person semester this fall. Dr. Preeti Malani is back to talk with Dr. Josh Sharfstein about the public health strategies in place to mitigate risk, changes to physical spaces, efforts being made to promote safety in the off hours, and her concerns about COVID-19 preparation not eclipsing other health issues like depression, anxiety, and loneliness.

The pandemic has seen health officers being attacked online, threatened at their private homes, fired or forced into resigning. But although the hyper-polarization of COVID-19 has further contributed to an erosion of trust in institutions, these tactics aren't new. California Senator Dr. Richard Pan talks with Dr. Josh Sharfstein about a small but vocal group that opposes public health measures like vaccines and the bullying and intimidation tactics they've used against health officials in recent years. Pan also talks about how social media has given them a platform for bad behavior and the real life consequences of online harassment.

In low-resource settings worldwide, poor infrastructure like transportation may impede pandemic response efforts. In these settings, digital technologies—used to deliver test results, manage cases, and support contact tracing—can help amplify public health services. Guest host Sara Bennett talks with Smisha Argawal, research director for the Hopkins Global mHealth Initiative, about the potential and pitfalls of these platforms and what decision makers should assess to implement people-centered solutions.

How can we think about the long-term impacts of disruption caused by COVID-19 on kids and adults? How can we get kids to talk about their feelings? Are we becoming "numb" to COVID and taking more risks? How can we reconcile feelings of blame towards people who might be making decisions we wouldn't make? Clinical psychologist Dr. Laura Murray returns to the podcast with Stephanie Desmon to answer your COVID-19 mental health questions.

Since Baltimore shut down in mid-March, health commissioner Dr. Letitia Dzirasa and her team have been working to implement response strategies that meet the city's unique needs. Public-private partnerships have bolstered mobile testing in COVID-19 hotspots. A historic hotel was converted to care for unstably housed people in isolation and quarantine. Workforce development efforts shifted to hiring contact tracers and community health workers. Dr. Dzirasa talks with Dr. Josh Sharfstein about these and other innovative approaches, and her hopes and concerns for the future.

How should schools react to positive cases? What should trigger shutdowns and how can leaders know when it's safe to reopen? How can teachers and parents help children manage distress caused by uncertainty, distance learning, and what may be a year of continuous closings and reopenings? In a webcast last week, Johns Hopkins University experts Josh Sharfstein, Jennifer Nuzzo, Annette Anderson, and Tamar Mendelson weighed in on what's next—and specifically the different scenarios that leaders, teachers, parents, and students may face in the coming months depending on the pandemic's trajectory in their communities.

COVID-19 has presented a variety of challenges for employers including leave needed by employees who are sick or taking care of someone who is, employees with children who are out of school or daycare, and employee concerns of risk as they return to the workplace. Maryland employment lawyer Jennifer Curry talks with Stephanie Desmon about how employers are thinking about these challenges, existing legislation, and what the next year might look like for schools in terms of employment and safety.

UNC Chapel Hill brought students back to campus for fall and had to close a week later after COVID-19 cases began surging among students. Dr. Mimi Chapman, chair of faculty, talks with Stephanie Desmon about the decision to bring back students, what the university has since learned, and why UNC's outbreak is not unique in the context of the US's larger problems with controlling the epidemic.

COVID-19 has revealed many weaknesses about the US food system: 14 million children are now regularly missing meals while farmers are dumping millions of pounds of food, and COVID-19 death rates are higher among people with food-related illnesses such as diabetes. Dr. Roy Steiner and Paula Daniels, co-contributors to Reset the Table, a new report from the Rockefeller Foundation, talk with Dr. Josh Sharfstein about these failures and propose solutions to fix the supply chain, close gaps in healthy food access, and keep food workers safe.

Dr. Monica Gandhi, an infectious disease researcher at the University of California at San Francisco, argues that a key to beating COVID-19 is increasing the proportion of infections that cause no symptoms. But how? Dr. Gandhi explains to Dr. Josh Sharfstein the answer may be as simple as having more people wear masks.

Nursing homes and other long term care facilities have been heavily impacted by COVID-19 in part because of inherent weaknesses in their structure and management that leave residents vulnerable to infectious diseases. Most private companies also have a financial model that is critically challenged by the pandemic. Dr. David Grabowski, a health policy researcher and professor at Harvard, talks with Dr. Josh Sharfstein about how COVID-19 has exposed an existential crisis facing U.S. nursing homes.

Regardless of whether schools kick off online, in person, or with a hybrid approach this fall, there will be learning disruptions to consider. Dr. Ruth Faden of the Berman Institute of Bioethics and Dr. Annette Anderson of the Johns Hopkins School of Education talk with Stephanie Desmon about now COVID-19 is exacerbating growing inequities around achievement, development, and graduation rates, how under-resourced schools could rethink instruction, and the data still needed to show policymakers definitive gaps in learning loss.