Public Health On Call

On April 1, 2020, the first case of COVID-19 was recorded among Arizona's White Mountain Apache tribe. New cases quickly mounted to 70 a day among the close-knit community. Even though the state remained fairly relaxed, Tribal Chairwoman Gwendena Lee Gatewood quickly shut down the reservation and implemented strict stay at home orders. Her fast and effective response to the crisis means that, today, the number of daily new infections is less than 10. Guest host Allison Barlow, director of the Center for American Indian Health, speaks with Gatewood about the response and how the community is faring.

Countries are investing huge sums of money in vaccine technology and some, like the US and the UK, are spinning deals with private companies to secure doses. But defeating the pandemic will require vaccinating the entire planet and nationalism is at odds with the global cooperation needed to do so. Tom Bollyky, director of the Global Health Program at the Council of Foreign Relations, talks with Dr. Josh Sharfstein about the global nature of supply chains, why it's not in the economic interest of nations to be concerned only with their citizens, and the developing solutions and opportunities for collaboration to bring a working vaccine to the world.

Russia made headlines this week with a purported COVID-19 vaccine that the country is already planning to administer to frontline healthcare workers, teachers, and the military. But the candidate skipped Phase III clinical trials and no scientific data around its development or efficacy has been published to date. In a bonus episode, Stephen Morrison, director of the Center for Strategic and International Studies's Global Health Policy Center, talks with Stephanie Desmon about Russia's vaccine, the political motivations behind it, why declaring an early victory is so problematic, and what the world might have to consider if the vaccine turns out to be successful.

Why isn't the potential of contact tracing being realized right now in the US? Can an MMR booster protect me from COVID-19? Is it better to go to the grocery store several times a week or make one longer trip? Will social distancing and masks make for a lighter flu season? Can a COVID test become negative if it sits too long before processing? Should I shave my beard? Dr. Crystal Watson from the Center for Health Security and Dr. Josh Sharfstein address your questions submitted to [email protected]

Economic upheaval, school closures, social distancing, and job losses have all contributed to worsening mental health for parents and behavioral health for children. Pediatrician Dr. Stephen Patrick is the lead author of a new study that shows how COVID-19 has caused major disruptions to the lives of children and parents. Patrick talks with guest host Colleen Barry about how these issues are having particularly devastating impacts on parents facing job loss and food insecurity. One possible upside: the pandemic has elevated policy issues around child care and food security to consideration by Congress.

Nearly six months into the US outbreak, getting a test for COVID-19 is still messy, and getting results can take so long that they're useless for contact tracing and isolating. Scott Becker, chief executive of the Association of Public Health Laboratories, talks with Stephanie Desmon about the complexities of testing and why we should not expect anything to change in the next six months. Becker also talks about the innovation happening to try and reduce excessive wait times for results, the role of public health labs, and the burden of responsibility on individuals to "flatten the curve" of demand on testing.

COVID-19 shutdowns forced businesses into a remote work culture—many of them almost overnight. As employers contemplate how to safely bring staff back to work, they'll need to consider the ways in which "work" itself and the role of the physical office have changed. Steve Lang, President and CEO of Dancker, a US company that designs office space, talks with Stephanie Desmon about solving for basic needs like safety and wellness while considering how to reconfigure physical office spaces to be places for collaboration and community.

How do social injustices contribute to health problems among Black Americans? Today, we look at racial disparities through the lens of kidney disease. Dr. Tanjala Purnell and Dr. Deidra Crews talk with Dr. Josh Sharfstein about a confluence of factors—including harmful experiences and societal barriers to equal housing, employment, and other opportunities—that contributes to Black Americans experiencing kidney failure at three times the rate of whites. They also talk about the concept of "weathering," the added complexities brought by the COVID-19 pandemic, and what actions individuals can take to start addressing systemic health inequities caused by racism.

A special episode today as Dr. Josh Sharfstein discusses Henrik Ibsen's play, The Enemy of the People, with Dr. Leonardo Lisi, Hopkins professor and an expert in 19th century Scandinavian literature and philosophy. The play, which was written in 1882, draws parallels to the COVID-19 pandemic like the vilification of health officials whose guidance may run counter to political and economic interests. Lisi and Sharfstein discuss the play's relevance to current events including attacks on health officials and social inequality. (Don't worry: You do not have to have read this play to enjoy the discussion!)

Dr. Mikhail "Doctor Mike" Varshavski, D.O., a board certified family medicine physician, has amassed six million subscribers on YouTube where he posts fun and engaging videos that demystify healthcare and combat misinformation. Doctor Mike talks to Dr. Josh about his "edutainment" approach to inform and engage people on health literacy, and how physicians and institutions can help make medicine more approachable.

India's Pradhan Mantri Jan Arogya Yojana, or PM-JAY, was founded in 2018 as a government-funded health insurance initiative that provides free services to the poorest 40% of the population. Dr. Indu Bhushan, the Chief Executive Officer of the National Health Authority and CEO of the PM-JAY, talks with Sara Bennett about the COVID-19 pandemic in India and how the health system is addressing the crisis.

Forty million people are at risk of eviction in the US as a result of COVID-19-related unemployment. Emily Benfer, Wake Forest law professor and co-creator of the Princeton Eviction Lab's COVID-19 Housing Policy Scorecard, talks with Stephanie Desmon about what could be the biggest housing crisis in US history and the lasting impact this could have on individuals, communities, and the housing market.

With resources strained and attention focused on the COVID-19 pandemic, active hurricane and wildfire seasons could add more deadly threats to the mix. Craig Fugate, the director of the Federal Emergency Management Agency in the Obama administration, talks with Stephanie Desmon about how disaster management experts are prepping shelters and crews, and what people can do to keep themselves and their families safe from both COVID-19 and imminent environmental threats.

How close are we to a vaccine? What do efficacy trials actually entail? What are the challenges to achieving diversity in clinical trials? How long would a COVID-19 vaccine provide some level of protection? How is vaccine safety assessed? Should pregnant women be included in vaccine trials for COVID-19? Dr. Ruth Karron, one of the top vaccine experts in the world and a professor in International Health at the Johns Hopkins Bloomberg School of Public Health speaks to Dr. Josh Sharfstein to answer these and more questions about the COVID-19 vaccine.

Sweden's approach to controlling the spread of COVID-19 has relied largely on providing guidance and expecting compliance. What's gone right? What's gone wrong? Anders Tegnell, Sweden's chief epidemiologist, talks candidly with Dr. Josh Sharfstein. He rejects the idea that the nation has been complacent, saying the goal has always been to reduce transmission, using mandates as necessary to achieve the goal. He also explains why Sweden has not hospitalized more older adults who contracted COVID-19 in nursing homes, a population that has accounted for a large share of deaths.

Over 300 homeless youths ages 14-25 come to the Youth Empowered Society (YES) Drop-in Center every year. They come for food, clothing, mental health counseling, job training, housing and rental assistance, and many more basic services. But COVID-19 is presenting even greater challenges for clients and has forced the staff to rethink service delivery models. YES executive director Blair Franklin talks with Dr. Josh Sharfstein about these challenges, innovations in care provision, dealing with staff exhaustion and burnout, and the added impacts of racial violence and protests on clients and staff. More about YES available at: http://yesdropincenter.org

Experts are concerned about outbreaks of seasonal influenza alongside further spikes of COVID-19 infections this fall and winter as some people return to work and school. Jen Gerber, a recent PhD graduate from the Johns Hopkins Bloomberg School of Public Health, talks with Stephanie Desmon about the importance of the flu vaccine to keep people from getting sick and filling hospital beds needed for COVID-19 patients. She also busts some common myths about why people don't get vaccinated.

In May, the mayor of Dallas appointed Dr. Kelvin Baggett as the "COVID Czar." Now, amidst rising cases across the state, Johns Hopkins Bloomberg School of Public Health alum Baggett is tasked with reducing harm and suffering from COVID-19. He talks with Dr. Josh Sharfstein about his work as COVID Czar, how the city is addressing disproportionate impact on minority communities, and how the pandemic may be helping to elevate critical conversations around health disparities.

This week, we're checking in with guests we interviewed earlier in the pandemic. Today, Dr. Josh Sharfstein gets an update from Dr. Monica Schoch-Spana, an expert on the mental health effects of the novel coronavirus. Schoch-Spana talks about the challenges for psychological well-being caused by the resurgence of cases in the US. She also talks about a new report she co-authored about what will be needed for a safe and effective vaccine to be widely accepted and equitably distributed.

This week, we're checking in with guests we interviewed earlier in the pandemic. Today, Dr. Josh Sharfstein gets an update from infectious disease epidemiologist Dr. Justin Lessler who was one of our very first podcast guests. Back in March, there were a lot of unanswered questions. Lessler talks about what we now know about transmission and fatality rates and what questions remain, what needs to happen in the short term to get cases under control, and what might be a truly transformative innovation in the fight against COVID-19.

This week, we're checking in with guests we interviewed earlier in the pandemic. Today, Stephanie Desmon gets an update from epidemiologist Dr. Chris Beyrer about the status of the pandemic in jails, prisons, and immigration detention centers. Beyrer also talks about the victories they've had with decarceration and releases of individuals who are high-risk for serious COVID-19 illness, the role of community transmission, and what still needs to be done to get hotspots under control.

This week, we're checking in with guests we interviewed earlier in the pandemic. Today, Stephanie Desmon gets an update from Dr. Emily Gurley about contact tracing as a strategy for slowing the spread of COVID-19 and what is still needed for contact tracing to be successful in the US. Gurley also talks about a new course that will help tracers and organizers build programs and evaluate their impact.

Dr. Josh Sharfstein gets an update from Dr. Arturo Casadevall about the innovative idea of using convalescent serum from patients who have recovered from COVID-19 to help others. Since we last heard from him, Dr. Casadevall has launched a plasma project that, along with others across the US, has helped over 35,000 COVID-19 patients. Casadevall also talks about how data from the project can help with vaccine and other therapy developments

Are people who test positive for weeks, or even months still infectious? Are face shields more effective than masks? If COVID-19 is airborne, does this mean we don't have to be as concerned about surfaces? If a person tests positive multiple times, is each new test considered a new "case?" If you're sick with COVID and you wear a mask, will you get sicker because you're breathing in more virus? Would the virus disappear if everyone quarantined? Dr. Caitlin Rivers from the Center for Health Security and Dr. Josh Sharfstein address your questions submitted to [email protected]

Recently, the White House and HHS have undermined credibility of the top US experts on pandemic response. Dr. Josh Sharfstein reminds us that the battle we're fighting is not about Democrats vs. Republicans, nor about public health vs. the economy. The battle is humanity vs. the virus, and we need evidence and experience to prevail.

Early in the US's COVID-19 outbreak, Michigan experienced a surge in cases that led to the governor issuing an aggressive stay-at-home order. Despite pushback, the state successfully flattened the curve and is now trying to address gaping health disparities and prevent another surge. Dr. Joneigh Khaldun, Michigan's Chief Medical Executive and Chief Deputy Director for Health, talks with Dr. Josh Sharfstein about the pandemic's uneven impacts, visibility as a public health official during a pandemic, Michigan's current prognosis, and the importance of data in identifying solutions.

New evidence points towards likelihood that the virus may be spread through aerosols that linger, not just droplets that fall. Dr. Elizabeth Matsui, a pediatric allergist and immunologist, talks with Dr. Josh Sharfstein about the growing evidence of aerosol spread, why it's been controversial, and what it means for safety measures to limit viral transmission.

In some areas of the globe, people are seeing blue skies for the first time during COVID-19 lockdowns. But is this really indicative of a major shift in the reduction of air pollution? Dr. Urvashi Narain, lead economist at the World Bank of South Asia, recently authored a report: "Air Pollution: Locked Down by COVID-19 But Not Arrested." Dr Narain talks with Dr. Josh Sharfstein about how activity restrictions have and have not reduced air pollution, how pollution can contribute to the transmission and severity of COVID-19, and why bluer skies should not lead to complacency in regulating emissions.

Patients who have spent time in the ICU because of COVID-19 face a long recovery. Comprehensive rehabilitation that starts early and continues after release can make all the difference in getting patients back to day-to-day activities. Johns Hopkins physiatrist Dr. April Pruski talks with Stephanie Desmon about the team of physical, occupational, and speech therapists, psychologists and more performing early interventions with COVID-19 patients and what recovery looks like after the ICU.

What are the mental health challenges for people living in areas where cases are spiking? How can parents help younger children who are missing school and camps or college-aged children who aren't sure when they can return to campus life? How can people deal with work-from-home stress while feeling grateful about having a job? Dr. Laura Murray talks with Stephanie Desmon to answer your COVID-19 mental health questions.

Communities of faith can be integral in supporting the health of individuals, especially when partnered with health care organizations. Guest host Dr. Panagis Galiatsatos talks with Dr. Daniel Hale, director of Johns Hopkins's Health Community Partnerships, and Imam Hassan Amin, the founder and director of the Muslim Social Service Agency in Baltimore, about how health organizations can partner with religious leaders to provide basic but critical health information. The collaboration can also help leaders de-stigmatize and demystify care for congregants to prevent and manage chronic and infectious diseases, including COVID-19.

Most higher-ed institutions closed and shifted to online instruction last spring but many are now considering how to safely bring students back to campuses this fall. Reopening schools will never be 100% risk-free, but there are steps that colleges and universities can take to ensure the safest possible experience. Lucia Mullen and Dr. Crystal Watson of the Johns Hopkins Center for Health Security talk with Stephanie Desmon about the Center's reopening toolkit for colleges and universities and what administrators, students, and parents should consider about returning to campus.

Brown University economist and bestselling author Dr. Emily Oster is probably best known for her writing about parenting and childbirth. Now, she's taken her data-centric approach to demystify the COVID-19 pandemic on a new website, explaincovid.org. Oster talks with Stephanie Desmon about the most frequently asked questions, what the data says about childcare facilities that have remained open, how schools should approach reopening in the fall, and why this virus has been so confusing for so many.

From January to May, Cambodia had only 125 coronavirus cases—70% of which were from people traveling from outside of the country, and the rest of which could be linked to those cases. Even as sporadic cases continue to be detected in travelers returning at the border, Cambodia's implementation of WHO guidelines—test, isolate, trace, quarantine, and care —has kept numbers low. Dr. Kumanan Rasanathan, Health Systems Coordinator for WHO in Cambodia (and Incident Manager for COVID-19 from March to June), talks with guest host Dr. Sara Bennett about Cambodia's response and what has contributed to its relative success.

Early in the pandemic, the National Institutes of Health launched a response against the new virus that has expanded to include basic and clinical research, and research into vaccines and treatments. Dr. Emily Erbelding, director of the Division of Microbiology and Infectious Diseases, talks with Dr. Josh Sharfstein about NIH's role in supporting the scientific community, what treatments are currently gaining attention and scrutiny, and how the race to produce a vaccine needs multiple contenders.

Louisiana was hit early and hard by COVID-19 but, over the past three months, the statewide response has strengthened. Now, Louisiana health officials are using the lessons they learned from the outbreak's early days to ensure that they are prepared to weather the surge in cases throughout the American South. Dr. Alexander Billioux, assistant secretary of health for the Louisiana Department of Health's Office of Public Health, joins Dr. Josh Sharfstein to discuss the strategies that have worked, the underlying realities the pandemic has exposed, and the vast amount of work that's still left to be done.

Vaccine challenge trials, in which healthy volunteers are infected with a pathogen to determine whether a vaccine works, can be done faster and with fewer participants than traditional efficacy studies. But there are downsides: challenge trials require young, healthy participants which may not help produce a vaccine that would protect older populations at risk for severe COVID-19 disease. There are also serious ethical considerations. Volunteers would be infected with a virus for which there is no cure, and so much is still unknown about why this coronavirus can cause severe disease in people without any known risk factors. Johns Hopkins vaccine researcher Dr. Anna Durbin talks with Stephanie Desmon about this method of getting to a COVID-19 vaccine, her experience with a dengue challenge trial, and what we know so far about whether COVID-19 antibodies confer immunity.

COVID-19 is causing disruptions in health services around the world and new data shows that 18 million children across 68 countries are at risk of not getting vaccinated. Dr. Chizoba Wonodi, the Nigeria Country Director for the International Vaccine Access Center, and Dr. Anita Shet, a pediatric disease specialist, talk with guest host Dr. Sara Bennett about the impact of disrupted vaccines and how maintaining these systems are critical for avoiding preventable deaths and maintaining trust for when a viable COVID-19 vaccine is available.

Why has the US had a harder time with the virus than Europe? Why does contact tracing seem to be working in some places but not others? Does it make sense to wear face coverings outside? Can COVID-19 be killed in the freezer? Can I get COVID-19 from a pool? What about in an elevator? Dr. Tom Inglesby of the Center for Health Security and Dr. Josh Sharfstein address your questions submitted to [email protected]

COVID-19 has seen unprecedented harassment of state and local health officials. In a bonus episode, Dr. Georges Benjamin, executive director of the American Public Health Association, talks with Dr. Josh Sharfstein about the threats facing public health officials in the pandemic.

Public health's focus on the root causes of disease and injury mean the intersecting crises of COVID-19 and racism provide a critical opportunity for the field. Dr. Georges Benjamin, the executive director of the American Public Health Association, talks with Dr. Josh Sharfstein about the sector's reckoning with reality around naming, defining, and addressing racism as a critical public health problem.

With vacations and camps upended, families with young children are struggling with making summer plans—especially when there's often confusing or conflicting guidance. Biostatistician Dr. Elizabeth Stuart and epidemiologist Dr. Keri Althoff return to the podcast to talk with guest host Dr. Colleen Barry about their decision-making framework for assessing risk to address questions like childcare, visiting with older relatives, and "quaranteams" with other families. Stuart and Althoff also break down how to make sense of COVID-19 data at the community level and what families can do to still have a joyful, memorable summer.

Several Latin American countries are seeing a wave of COVID-19 cases and deaths. Dr. Carlos Castillo-Salgado, who has trained hundreds of epidemiologists in Latin America, talks with Dr. Josh Sharfstein about what's going wrong, what's going right, and what needs to change fast on the continent to save lives.

The rapid pace of reopening the US without the public health capacity to contain the virus has Dr. Leana Wen worried. Wen talks with Stephanie Desmon about the current state of the pandemic, what we did and didn't learn from the surge in New York, what individuals can do to reduce their risks, and what policy makers should be doing to prevent another 100,000 deaths and countless suffering.

A year ago, the American Academy of Pediatrics released a landmark statement about the impact of racism on child and adolescent health. Dr. Maria Trent, the lead author of this statement, talks with Dr. Josh Sharfstein about the many ways that racism undermines health over a lifetime. Trent also discusses how to give pediatricians, teachers, parents, and caregivers the language and tools they need to address racism's impacts on children's safety and wellbeing.

En nuestra segunda entrevista con miembros de Centro SOL, Mónica Guerrero Vázquez, directora ejecutiva y una graduada de la escuela de salud pública de Johns Hopkins y Dra. Kathleen Page directora y médico infectóloga del hospital de Johns Hopkins, hablan sobre el virus que sigue afectando al mundo, incluyendo las noticias más recientes y lo que podemos hacer ahora para protegernos.

Retractions of scientific papers happen for a number of reasons. The desperation driving COVID-19 research has brought this "nuclear option" of scientific correction to a much more public sphere. Dr. Ivan Oransky, who co-runs Retraction Watch, talks with Stephanie Desmon about what retractions typically mean—and don't mean—and how COVID-19 may incite an "existential crisis" in the scientific research community in the push to publish.

Can smartphones assist contact tracing, a public health tool critical to getting the pandemic under control? What's known as "digital contact tracing" has been utilized in other countries, but there are privacy, policy, and equity issues to be worked out before a US launch. Bioethicist Dr. Jeffrey Kahn talks with Stephanie Desmon about the potential and pitfalls of this technology.

Early in the US outbreak of COVID-19, New Orleans was struck hard. At one point, the city of about 400,000 people was seeing up to 450 cases diagnosed per day. Today, it has reduced cases 95% from that peak. Dr. Jennifer Avegno, director of the Health Department in New Orleans, said this is due in no small part to New Orleans's history of disaster and the infrastructure and partnerships that were put in place following Hurricane Katrina. Avegno talks with Dr. Josh Sharfstein about how New Orleans pulled out of the tailspin, what the city continues to do to keep cases down, and why protesting is an "essential" activity.

The protests following the homicide of George Floyd reflect serious questions about the legitimacy of the police. Law professor and philosopher Ekow Yankah talks with Dr. Josh Sharfstein about the nature of legitimacy and the longstanding double standard that has led the nation to a moment of reckoning on race. He explains, "We can no longer have an America where white problems are social problems and black problems are policing problems."