Public Health On Call

A special episode today as Dr. Josh Sharfstein discusses Albert Camus's The Plague with Dr. Mark Christian Thompson, chair of the English department at Johns Hopkins. The Plague, which was written in 1947, is immediately relevant to our experiences with COVID-19 and so much more. Thompson and Sharfstein discuss the book's relevance to current events including racial and social inequality. (Don't worry: You do not have to have read The Plague before listening to the podcast!)

The science behind loneliness shows that it's common and has significant impacts on physical, mental, and emotional health. The unusual and socially isolating circumstances of COVID-19 are exacerbating this issue and could lead to a "social recession." Former Surgeon General Dr. Vivek Murthy talks with guest host Colleen Barry about how COVID-19 is affecting our social health, how to protect ourselves from the deleterious effects of technology, and what we can do to promote a "social revival" and connect in a time of distancing.

Leaders of the Johns Hopkins Center for Gun Policy and Research Dr. Daniel Webster and Dr. Cass Crifasi have studied the relationships between communities and police forces for years. The researchers, with colleagues, recently released a new report looking at enforcement of gun laws in Baltimore. In the wake of the homicide of George Floyd and drawing on this report, Webster and Crifasi talk with Dr. Josh Sharfstein about the profound loss of trust between minority communities and the police and the role of greater transparency and accountability to move forward.

At first, it seemed that COVID-19 was sparing children from critical—and even mild—illness. Then, doctors began connecting a constellation of symptoms in sick children to what is now known as Multi-System Inflammatory Syndrome in Children, a rare and dangerous disease thought to be caused by an immune reaction to SARS-CoV-2. Dr. Lasya Gaur, a pediatric cardiologist at Johns Hopkins Hospital, talks with Stephanie Desmon about what we know and what we still need to learn about this disease, what parents should know, and what treatments have been helpful for children who become ill.

The Latinx immigrant community has been hit particularly hard by the COVID-19 pandemic for reasons that include housing, employment, transportation, and obstacles to receiving care. George Escobar, chief of programs and services at CASA, an immigrant advocacy organization in Maryland, talks with Dr. Josh Sharfstein about the policies that led to this population being particularly vulnerable to COVID-19, changes needed to ensure future health, and what CASA is doing to help during the pandemic.

As restrictions lift and businesses think about reopening, many aren't sure what they should consider in order to protect their employees and customers. Lucia Mullen and Dr. Crystal Watson co-authored a toolkit for businesses that includes checklists to follow and suggested modifications to put in place before reopening. They talk with Stephanie Desmon about how businesses can assess risk and create solutions that fit their budgets and resources.

Until now, the focus of this podcast has been on COVID-19. Today, we are broadening the podcast to cover other urgent public health issues starting with racism, police violence, and the national protests over the homicide of George Floyd. Dr. Josh Sharfstein talks with Baltimore author, artist, and activist Chris Wilson about his experiences both in and out of the prison system, his reflections on "unstacking the deck" against people of color, and the role of art in healing, documenting, and storytelling during galvanizing moments.

What can people do to reduce their risk of contracting COVID-19 during a protest? Do higher-risk patients ever have mild novel coronavirus or do they always get very sick? When is it ok to resume routine medical and dental care? Will people who have had COVID-19 be eligible for a vaccine when it's available? Are gloves necessary like masks?

To what extent has COVID-19 affected Americans' mental health? In this episode, guest host Colleen Barry speaks to Beth McGinty, lead author of a new study which finds a significant increase in psychological distress among adults in the U.S. in April at the height of social distancing. Dr. Dani Fallin, Chair of the Department of Mental Health, also discusses mental health as a public health issue more broadly and ways to protect our own mental health and those of others during these stressful times and beyond.

Long term care facilities that house vulnerable populations in a communal living setting have been hotbeds for COVID-19 outbreaks. Infectious disease physician Dr. Morgan Katz has been working with some facilities to provide guidance on COVID-19 response. She talks with Stephanie Desmon about infection control procedures, how testing is a double edged sword, the biggest lessons we've learned so far, and what the future of long term care facilities may look like.

Underlying medical conditions such as cardiovascular disease, hypertension, and Type II diabetes are risk factors for critical illness or death from COVID-19. Just as these chronic health issues disproportionately impact different racial and ethnic groups in the US, so too is COVID-19. Dr. Eduardo Sanchez of the American Heart Association talks with Dr. Josh Sharfstein about how the US's failure to address the underlying health of its populations is contributing to COVID-19 fatalities and what needs to be done to preserve the health, wellbeing, and the economic viability of our nation.

Dr. Julie Gerberding was director of the CDC during the 2003 SARS outbreak and lessons learned from that response are now informing her work overseeing some 65,000 employees around the world as executive vice president of Merck. Gerberding talks with Dr. Josh Sharfstein about the US's response, how Merck is keeping things moving, why emerging infectious diseases may be a new normal, and how the pandemic is contributing to the threat of antimicrobial resistance.

How do you deal with things you can't control? How do we decide what actions are right for ourselves and our families without judging others in the process? What is contributing to COVID-19 stigma? How do we consider the future without feeling overwhelmed? Clinical psychologist Dr. Laura Murray returns for another round of mental health Q&A with Stephanie Desmon.

As of recording, there were no confirmed cases of COVID-19 in Lesotho, a country in southern Africa. But the country borders South Africa which has close to 5,000 cases, and shares a migrant workforce that has been coming home to Lesotho amidst shutdowns. Dr. Tafadzwa Chakare, technical director for Jhpiego in Lesotho, talks with guest host Dr. Sara Bennett about the challenges of managing the pandemic in highly mobile, migrant populations.

Johns Hopkins Hospital paused elective surgeries (surgeries that are scheduled ahead of time) in March. Like some of his other colleagues, Dr. Rick Redett volunteered to be redeployed to the COVID ICU. Redett talks to Stephanie Desmon about exhausting shifts, the challenges of shifting from surgery to supportive care, and how things may be different as surgeries resume.

Like many countries, Canada recognized the pandemic in stages, but unlike some, Canada used advanced warning to their benefit with swift mandates. Dr. Brian Goldman, host of CBC's "The Dose" podcast, talks with Dr. Josh Sharfstein about how although Canada's response has differed from the US's, the country faces many of the same challenges with testing, outbreaks in vulnerable populations, and a patchwork approach of mandates across provinces.

Is Vitamin D deficiency correlated with severe outcomes? Is it safe to use dry bat guano fertilizer? People in my area seem to be social distancing, so why are there still so many cases? If I received a flu shot, will it help protect me from severe illness with coronavirus? Dr. Caitlin Rivers of the Johns Hopkins Center for Health Security addresses your questions submitted to [email protected]

The use of investigational drugs during a public health crisis is not new. In 2014, Dr. Linda Mobula had experience administering an untested drug during the Ebola response in West Africa. Mobula talks to Dr. Josh Sharfstein about how the technical framework that came out of that process could have been used to provide guidance for investigational drugs in COVID-19, and how political figures created a global push for hydroxychloroquine.

For people who live on or earn their income from the streets, COVID-19 has made their lives exponentially harder—they may be more vulnerable to the novel coronavirus and to other outcomes like violence, injury, or illness. Caring for these populations is necessary for public health, says Dr. Susan Sherman, founder of a harm reduction center in Baltimore. Dr. Sherman talks to guest host Dr. Colleen Barry about her outreach work during COVID and how principles of dignity and respect are even more important at a moment like this one.

Reopening schools is a crucial goal for the well-being of students and for parents to return to work. But there are gaps in what we know about kids and COVID-19 transmission. A new report from The Center for Health Security lays out the evidence schools would need to assess safety for kids, teachers, staff, and families. Co-authors Anita Cicero and Tara Kirk Sell talk with Stephanie Desmon about what questions need answering to safely set up schools for students to return.

The Joint Hopkins Maryland Federal Medical Station, a 250-bed unit inside Baltimore's convention center, opened on April 27 for non-critical patients recovering from COVID-19. Dr. James Ficke, the Station's director, talks with Stephanie Desmon about how his experience standing up combat hospitals in northern Iraq prepared him, the influx of patients they're seeing, and what it takes to set up a fully operational contingency hospital with food, bathrooms, showers, and even its own pharmacy.

Maryland Governor Larry Hogan ordered restaurants and bars to end in-house dining back in March. Two people from Baltimore's restaurant community—Barri Yanowitz, a bartender at Brewer's Art, and Carlos Raba, a co-owner of Clavel—talk with Stephanie Desmon about how each outlet has addressed the mandate, what this has meant for business and their community, and what they anticipate in the coming weeks and months.

When can I see my family again if I have been quarantining? Does a person's blood type affect how severely ill they might become? Are women taking oral contraceptive pills more at risk from blood clots from COVID-19? Can you get COVID-19 from second-hand smoke? What is social distancing fatigue and what can we do to address it? Dr. Amesh Adalja of the Johns Hopkins Center for Health Security addresses your questions submitted to [email protected]

Responses to COVID-19 such as school closures and shelter-at-home orders may inadvertently raise the risks of child sexual abuse. Dr. Elizabeth Letourneau, director of the Moore Center for the Prevention of Child Sexual Abuse, talks with Dr. Josh Sharfstein about risks, prevention strategies, and a new online resource for parents, caregivers, and people at risk of offending. Warning: This episode covers difficult topics directly.

It's been a few months since COVID-19 first arrived in the US, so what have we learned? Dr. Albert Wu returns to the podcast with Stephanie Desmon to discuss social distancing fatigue, new symptoms and disease observations, hopes for treatment, and what we should expect in the coming months in terms of a "return to normal."

Although COVID-19 does not appear to infect children at the same rate as adults, there are significant indirect impacts on kids from the pandemic. Baltimore pediatrician Dr. Megan Tschudy talks with Stephanie Desmon about the "profound disruption" of the pandemic and its impacts on vaccinations, regular check-ups, and other aspects of children's physical, mental, and emotional well-being.

Dr. Panagis Galiatsatos spends 12-16 hour days attending to COVID-19 patients in the ICU at Johns Hopkins Hospital. When he's not at the hospital, he's on duty in the community working with faith based organizations, schools, and housing units to help leaders protect their community members from getting sick. Galiatsatos talks with Dr. Josh Sharfstein about these dual roles of being on both the last and first lines of defense—caring for patients in the ICU and helping to prevent them from getting there in the first place.

How can I convince my family and friends to follow social distancing guidelines? How can I stay informed without becoming overwhelmed? How can I help family members if I can't be near them? What does resilience look like in this new normal? On this week's Q&A, Laura Murray, a clinical psychologist and senior scientist at the Bloomberg School of Public Health addresses listener's mental health questions with Stephanie Desmon. Note: This podcast is also available as a video at youtube.com/johnshopkinssph

The global health community has worked for years to lower rates of maternal and child mortality in low- and middle-income countries. But while the world focuses on the number of deaths from COVID-19, estimates of indirect mortality due to disruptions in health systems cannot be ignored. Tim Roberton, an assistant scientist in International Health, talks with guest host Sara Bennett, a professor in International Health, about a paper he co-authored that estimates there could be a 45% increase in child mortality and a 38% increase in maternal mortality in severe scenarios where care is disrupted due to COVID-19. One way to head off these numbers is to categorize care by prioritizing only emergency care that cannot be delivered in any other way.

Dr. Arturo Casadevall—head of the convalescent plasma research project at Johns Hopkins—talks through the WHO's recent statement that there's no evidence of COVID-19 infection leading to short- or long-term immunity. Casadevall and Dr. Josh Sharfstein also discuss how COVID-19 is not like HIV or pneumonia, and what we currently know about new strains of the novel coronavirus.

The intensive care unit can be stressful for all patients but those with COVID-19 face unique challenges when it comes to mental and cognitive health. Clinical psychologist Dr. Megan Hosey of the Johns Hopkins Hospital ICU talks with Stephanie Desmon about ICU delirium, COVID-19 stigma, and what longer term prognosis could look like for patients inside and after the ICU.

Schools are scrambling to figure out education during the COVID-19 pandemic. Matt Hornbeck, principal of the top-rated Hampstead Hill Academy—a Pre-k-8 public school in southeast Baltimore city—says instruction is only part of the challenge: technology gaps, trying to reach vulnerable students, and the trauma of a sudden separation from friends and teachers are unprecedented issues to address. Hornbeck talks to Dr. Josh Sharfstein about how Hampstead Hill is trying to take care of its school community, and how they're preparing for the next period of uncertainty.

Homelessness is already a public health emergency in the US. COVID-19 now adds to the unique challenges facing individuals without homes. So how are the homeless and their caregivers responding? Kevin Lindamood and Dr. Adrienne Trustman of Baltimore's Health Care for the Homeless, and Barbara DiPietro of the National Health Care for the Homeless Council talk with Dr. Josh Sharfstein about homelessness amid a pandemic.

What makes this virus different from hundreds of other similar viruses? What happens if parents don't take their children for routine immunizations? Does prone body positioning help ICU patients? Does coronavirus spread best in wet or dry environments? What are randomized control trials and why is everyone talking about them? Is it possible to give someone a tattoo from six feet away? Lauren Sauer, director of Operations with the Johns Hopkins Office of Critical Event Preparedness and Response (CEPAR) and Assistant Professor of Emergency Medicine at Johns Hopkins Medicine, addresses questions submitted to [email protected]

In March, Johns Hopkins Hospital began making its own COVID-19 tests. The lab now has the capacity to run 600 tests per day, but is limited by shortages in the supply of reagents: the chemicals needed to process the tests. Dr. Karen Carroll, director of the Division of Medical Microbiology at Johns Hopkins Hospital talks with Dr. Josh Sharfstein about what it takes to develop a working COVID-19 test, why labs across the US are struggling with shortages, and what needs to happen to fix access to testing.

Since the COVID-19 pandemic began, the opioid epidemic disappeared from headlines but not from reality. Dr. Josh Sharfstein talks to Dr. Yngvild Olsen, the medical director of an addiction treatment program in Baltimore and the Vice President of the American Society of Addiction Medicine, about how her clinic had to pivot to stay open while protecting both patients and staff, how federal regulations have shifted, and what the status of the epidemic is and might be post-COVID-19. Disclosure: Medical school classmates, Dr. Sharfstein and Dr. Olsen are married.

Misinformation about COVID-19 can have real human costs in the forms of physical harm and "straining the fabric of democracy." But where does misinformation come from and how can it be prevented when so much is still unknown about the virus? Guest host Dr. Colleen Barry, chair of the Department of Health Policy and Management, talks with Dr. Brendan Nyhan, an expert in the politics of misinformation about health, about why people might believe false claims, the role of politics, and how to keep science at the center of the discussion. Learn more: jhsph.edu/covid-19

It might be too late to halt transmission of COVID-19 but contract tracing could help bring the outbreak under control. Dr. Emily Gurley and PhD candidate Brooke Jarrett break down contact tracing and what it would take to get "an army" off the ground in US cities. Gurley and Jarrett also helped develop a free course on contact tracing which will soon be available from Johns Hopkins on the Coursera platform: www.coursera.org/jhu

As officials consider how and when to scale back social distancing restrictions, a big question is: When the economy reopens, will there be anywhere to go? Financial crises expert and author Kathleen Day returns to talk with Stephanie Desmon about the millions of Americans filing for unemployment, whether our current crisis will rival the Great Depression, and how we could start to dig our way out. (Recorded April 13)

With organ transplants on pause in the US to free up needed hospital resources, Americans with kidney failure are forced to assume the risks of going to crowded dialysis centers three times a week. Kidney transplant surgeon Dr. Dorry Segev talks with Stephanie Desmon about how the organ transplant community can rethink ways to resume transplants, assess which patients might fare better with risky transplants, and if COVID-19 patients can be organ donors. Learn more: jhsph.edu/covid-19

For the subset of people who become critically ill from the novel coronavirus, cytokine storms could be to blame. This severe inflammatory disease happens when the immune system goes haywire in response to a novel threat. Rheumatology fellow Dr. Max Konig and neurosurgeon Dr. Chetan Bettegowda talk with Stephanie Desmon about the vital role of cytokine in immune responses, how to identify who might be at risk, and how research is looking into stopping the storms before they start. Learn more: jhsph.edu/covid-19

Until there is a vaccine, the best hope for the novel coronavirus is finding the right "cocktail" of treatments for managing severe illness. A unique clinical trial model developed several years ago may now help identify treatments that work. Dr. Derek Angus talks to Dr. Josh Sharfstein about the Bayesian inference model, a "March Madness" of testing multiple therapies at once. Learn more: jhsph.edu/covid-19

Virologist Dr. Andrew Pekosz returns to the podcast with an update on what his team has learned about COVID-19. Pekosz and Stephanie Desmon discuss further indications that COVID-19 may not be seasonal, why COVID-19 is "the flu on steroids," and how learning about how the virus replicates in our upper respiratory tracts could hold clues for treatment and prevention. PLUS: An update on the convalescent plasma therapy trial. Learn more: jhsph.edu/covid-19

The market is suddenly flooded with antibody tests claiming to prove whether or not people have already been exposed to COVID-19. But two critical questions are yet unanswered: Are any of these tests accurate and does past exposure mean immunity? Immunologist Dr. Gigi Gronvall of the Johns Hopkins Center for Health Security talks to Dr. Josh Sharfstein about a new report outlining the potential and pitfalls of antibody testing. They discuss how long it might be before we understand more about antibodies and immunity to COVID-19 and how widespread testing could help capture the true footprint of the coronavirus's spread. Learn more: jhsph.edu/covid-19

If bats are immune to the novel coronavirus, can we learn something to help fight the virus in humans? How can I tell if my cough is spring allergies or COVID-19? Is it too soon for businesses like barber shops and salons to reopen? Can the virus crawl or be blown by the wind into your nose? Why are some people asymptomatic? Dr. Jennifer Nuzzo of the Johns Hopkins Center for Health Security addresses questions submitted to [email protected]

Most schools closed suddenly and have had to scramble to stand up online learning or other solutions to continue instruction in the midst of the pandemic. Further complicating the response is the fact that no one knows how long this will last. Dr. Annette Anderson of the Johns Hopkins School of Education talks to Stephanie Desmon about the Digital Divide, how schools are trying to prevent a "COVID slide,"—the fear that learning can be lost over long breaks. They also discuss the burden on parents, and how some districts are stepping up to address disruptions to vital services like food and mental health support for students and their families. Learn more: jhsph.edu/covid-19

Much of our world was suddenly postponed, canceled, or shuttered in the last month or so. There's now an opportunity to be more thoughtful about reopening. There are risks either way: wait too long and there are consequences for health, safety, and the economy. Open too soon, and viral transmission may ramp up and out of control. Dr. Caitlin Rivers of the Center for Health Security is coauthor of a recent report geared towards governors considering how to reopen non-essential businesses. She talks to Dr. Josh Sharfstein about the basic principles behind deciding when to reopen bars, gyms, salons, and other nonessential businesses. Learn more: jhsph.edu/covid-19

The challenges presented by the pandemic are giving rise to a pipeline of research proposals focused on COVID-19. Julie Messersmith and Denis Wirtz are leading Johns Hopkins University's multidisciplinary research projects to develop better detection and protection tools and treatments for COVID-19 patients. They talk to Stephanie Desmon about how engineers, public health specialists, and medical doctors are teaming up to develop better testing and treatment solutions on incredibly fast-tracked timelines. Learn more: jhsph.edu/covid-19

Colleges and universities are already starting to think about what it would take to reopen for the fall semester. But bringing back students, faculty, and staff—and welcoming the class of 2024—will require a complete rethinking of campus life. Dr. Preeti Malani, chief health officer of the University of Michigan, talks to Dr. Josh Sharfstein about how she's considering the health and safety of 50,000 students plus faculty and staff during the COVID-19 pandemic. Learn more: jhsph.edu/covid-19

Drawn from a webcast series "The Politics and Policy of COVID-19," a product of the Stavros Niarchos Foundation SNF Agora Institute. This episode focuses on the comparitive responses of different countries and political systems to the pandemic. Featuring Anne Applebaum, SNF Agora Senior fellow; Ho-fung Hung, professor and chair of the department of Sociology at Johns Hopkins; and Dr. Josh Sharfstein; and moderated by Hahrie Han, director of SNF Agora Institute.