Latest / The SHEA Podcast / COVID-19: Racial Disparities, 7/09

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COVID-19: Racial Disparities, 7/09 · The SHEA Podcast

• 0:07
  SPEAKER_01: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, or SHAY, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:22
  SPEAKER_01: My name is Christy Weinshell, and I'm the executive director of SHAY and will serve as today's moderator.
• 0:26
  SPEAKER_01: Discussion on the podcast does not reflect Jay's perspective, but facilitates communication and multiple perspectives and experiences as we go through this challenging time together.
• 0:35
  SPEAKER_01: Jay is excited to launch the 21st episode of this podcast, COVID-19 updates, What We Know Now.
• 0:42
  SPEAKER_01: Today's episode will focus on racial disparities during the COVID-19 pandemic.
• 0:46
  SPEAKER_01: Our speakers today are Dr.
• 0:47
  SPEAKER_01: Ivikune Accamboyo, assistant professor of pediatrics at Duke University School of Medicine.
• 0:54
  SPEAKER_01: Dr.
• 0:55
  SPEAKER_01: Marla Mattel, anesthesiologist and critical intensivist at Promedica Toledo Hospital, Dr.
• 1:01
  SPEAKER_01: Jasmine Marcellin, Assistant Professor, Department of Internal Medicine at the University of Nebraska Medical Center.
• 1:08
  SPEAKER_01: Thank you all for joining us today.
• 1:11
  SPEAKER_01: I now want to move on to the discussion with our first question.
• 1:14
  SPEAKER_01: Dr.
• 1:14
  SPEAKER_01: Akamboyo, there are concerns for transmitting SARS-CoV-2 virus because of the large number of people coming together.
• 1:20
  SPEAKER_01: How do you think protesters can best protect themselves from COVID-19?
• 1:24
  SPEAKER_02: Thank you, Christy.
• 1:25
  SPEAKER_02: I think this is a nuanced question.
• 1:28
  SPEAKER_02: Certainly the risk of COVID-19 has been discussed at length at other venues.
• 1:33
  SPEAKER_02: But the idea is that we've encouraged people to shift away from large gatherings, but there are a lot of issues at play that have pushed people to go out and protest against a lot of the social issues that are going on currently.
• 1:47
  SPEAKER_02: Recently, the concerns have been around a lot of large gatherings around protesting, but large gatherings are happening in other settings.
• 1:55
  SPEAKER_02: I will say that the most recent evidence that has looked at this suggested that cities that had a lot of protests did not directly lead to a large spike in cases, but time will tell what impact it would have on COVID-19.
• 2:11
  SPEAKER_02: I think the key point here is there have been a lot more questions about how to protest safely.
• 2:19
  SPEAKER_02: And those recommendations were written out in a document that was published recently, and it includes ensuring you wear a mask, ensuring that in outdoor settings, if you can, social distance where you can, if you are part of a mass protest and within five to seven days of that protest you develop any symptom, ensure you get tested.
• 2:41
  SPEAKER_02: Try and isolate after a mass protest.
• 2:43
  SPEAKER_02: And sometimes, even if you're asymptomatic, there are quite a few cities that have offered free testing if you're part of a protest.
• 2:49
  SPEAKER_02: So I think it's hard to answer this question because we're now playing out two very major issues: COVID-19, but also all of the disparities and a lot of the structural inequities in the United States as playing out on a more public screen.
• 3:03
  SPEAKER_02: So protests have happened.
• 3:05
  SPEAKER_02: I haven't seen a direct spike.
• 3:07
  SPEAKER_02: There are ways to do it safely, and we're monitoring closely to ensure that protesters are protected both during the protests and even afterwards.
• 3:15
  SPEAKER_01: Thanks.
• 3:16
  SPEAKER_01: I really appreciate the nuanced response to that.
• 3:19
  SPEAKER_01: One concern that we've seen voiced among infectious disease physicians is that tear gas has the potential to increase the spread of SARS-CoV-2 virus.
• 3:27
  SPEAKER_01: Do you know how high this risk is?
• 3:29
  SPEAKER_02: It's hard to measure how high the risk is.
• 3:31
  SPEAKER_02: And I like to work with numbers and data.
• 3:33
  SPEAKER_02: And so this is one of those questions where it's hard to say objectively this is the exact amount of increase, this is how much we're going to increase the risk of coronavirus, SARS-CoV-2 transmission.
• 3:42
  SPEAKER_02: However, I think tear gas, pepper spray, those are chemical irritants.
• 3:47
  SPEAKER_02: And any irritant that leads to either tearing to making tears or any injury to mucosal surfaces, the mouth, the nose, leads people to take off their mask just because they have to wipe it off.
• 3:59
  SPEAKER_02: I think those would increase the risk of transmitting COVID-19, especially when you're in a large group of people.
• 4:07
  SPEAKER_02: We've said, and I say we as a general, we, I think the medical community has come up pretty strongly to say that as much as possible, try and limit chemical irritants.
• 4:15
  SPEAKER_02: So we're not sort of just adding more foil to an ongoing fire.
• 4:18
  SPEAKER_02: If we're worried about people gathering in large groups, we certainly don't want to increase the risk of transmission by increasing the chances of people touching their faces or of them coughing and sneezing due to a chemical irritant.
• 4:34
  SPEAKER_02: So while it's not a direct objective measurable risk, it certainly increases the chances that SARS-CoV-2 could be spread by people that may be asymptomatic but are not forced to sort of go into a coffin or sneeze an episode.
• 4:47
  SPEAKER_02: So just a personal opinion here, I think this is certainly not going to help the situation if that continues.
• 4:53
  SPEAKER_01: Thanks.
• 4:53
  SPEAKER_01: I know those were some very specific questions.
• 4:55
  SPEAKER_01: So now we're going to go to some broader questions about racial inequities.
• 4:59
  SPEAKER_01: There are systems and policies related to both access and treatment that cause harm to patients and disproportionately affect those in the black and brown communities across medicine.
• 5:08
  SPEAKER_01: How does this specifically relate to infection prevention or antibiotic stewardship as you see it?
• 5:14
  SPEAKER_02: For this question, I will certainly also look to my colleagues on the podcast today to weigh in because a number of people have shared their perspectives and also have done a lot of research on this topic in particular.
• 5:28
  SPEAKER_02: So thinking through how it relates to infection prevention and stewardship, I think the fact that we're dealing with the pandemic and this has catapulted infection prevention to a national or global stage means that we almost now have a platform to ensure that statements that are made, policies that are made, how we parse out data, how we present data accounts for a lot of the historical structural inequities, particularly in the United States, and also the systems that are set up that may prevent a lot of the black and brown communities from fully complying or participating in some preventive measures.
• 6:05
  SPEAKER_02: So, for example, just to kind of break this down a little bit, in the beginning of dealing with the pandemic, we were all just scrambling to ensure we're staying ahead of the data that was coming out, and also we're able to keep up with both the CDC policies, internal policies, community settings that we're just trying to figure out what to do.
• 6:21
  SPEAKER_02: On some level, I think the messaging was that it's very easy to social distance and it's very easy to just find a, when we got to wearing masks, but to find a mask.
• 6:30
  SPEAKER_02: But as we clearly saw, most of the occupations that were classified as essential outside of sort of healthcare and some of the other specific things in the hospital, I think a lot of them put people in the black and brown community in situations where they were working outside of their home.
• 6:46
  SPEAKER_02: A recent study from within the United States kind of estimated back in 2018 that less than 20% of black and brown people are able to truly work from home.
• 6:56
  SPEAKER_02: So even just a simple thing as reducing COVID-19 transmission by staying at home is not accessible to a good portion of the black and brown community.
• 7:05
  SPEAKER_02: So that's just talking about policies.
• 7:07
  SPEAKER_02: Now talking specifically about infection rate and death and hospitalizations, we've seen that it's just a disproportionate impact.
• 7:14
  SPEAKER_02: We're seeing more black and brown people that are in the hospitals being infected and certainly leading to worse outcomes, particularly death.
• 7:23
  SPEAKER_02: The reasons for that vary.
• 7:24
  SPEAKER_02: Some of it is prior comorbidities, but we cannot ignore all of the inequities with access to care, just access to food and resources if you cannot work and you're infected.
• 7:35
  SPEAKER_02: So, how do you kind of put that all together and specifically talk about infection prevention and somewhat stewardship, but this may be more related to infection prevention?
• 7:43
  SPEAKER_02: I think now more than ever, we've had data, say for example, from the H1N1 pandemic, about how pandemics can impact Black and brown communities disproportionately.
• 7:54
  SPEAKER_02: We're seeing it again.
• 7:55
  SPEAKER_02: We knew it was going to happen.
• 7:57
  SPEAKER_02: And we need as a group to kind of come together and ensure that the next steps we take forward in how we perform research, in how we speak on whichever platform we have, to community leaders, to politicians, to the NIH, to some of our larger groups, account for the disproportionate impact and shift resources to these communities to ensure that we can one, mitigate the pandemic, the ongoing pandemic, but also particularly prevent any future ones from having the same impact.
• 8:27
  SPEAKER_02: And I know others will have more to say on this, and I can kind of come back to it, but it's a large topic.
• 8:31
  SPEAKER_02: There are many numbers that already have proven this, and we should continue to push for data that will show the disparity because I think that also helps we get in additional resources as we continue to manage this.
• 8:46
  SPEAKER_03: So that's a great question.
• 8:48
  SPEAKER_03: And I think the root of what you're getting at is what is the impact of structural racism on infection prevention and antimicrobial stewardship, and really relating to the access that individuals may actually have to healthcare facilities or healthcare professionals to be able to first off test for COVID-19 goes back to the historical redlining of multiple communities across the country where more resources were allocated to parts of different towns or counties that were predominantly white versus those parts of those towns or counties that were predominantly black or the minority populations.
• 9:35
  SPEAKER_03: And so the downstream effects of those historical redlining policies means that the number of healthcare facilities in minority communities often are fewer, and the resources that are available within those healthcare institutions, organizations are also fewer.
• 9:56
  SPEAKER_03: When I think about that in relation to a testing strategy, for example, the big questions that come to mind are are individuals able to access the testing at those facilities?
• 10:10
  SPEAKER_03: Do the facilities themselves have access to the testing because they may not have the cash money resources to purchase the tests that are needed?
• 10:21
  SPEAKER_03: But when you think about innovative ways to consider the testing strategies like drive-thru testing, for example, that requires people to have access to vehicles.
• 10:32
  SPEAKER_03: And if people generally don't have access to vehicles because of their financial instability, then that is another way that they're being excluded.
• 10:43
  SPEAKER_03: One last thing that I would probably bring into the fray here when we're thinking about infection control and mitigating spread is thinking about mask wearing.
• 10:52
  SPEAKER_03: One of the things that we have been trying to spread the messages about the community wearing masks.
• 10:59
  SPEAKER_03: And in the beginning, when we started to share that community members should be wearing masks, but at the same time saving the surgical masks for healthcare professionals, the advice that was being given was to wear bandanas or t-shirts or any sort of cloth material affixed to your face and mouth to just simulate the mask.
• 11:23
  SPEAKER_03: And that's a problematic recommendation for the black and brown community because oftentimes these simple appearing makeshift masks will automatically transform a black man or a Latino male, for example, who might be walking into the bank to cash their check in the minds of the people who are in the bank, that person may be automatically transformed into a bank robber or somebody who's there to harm them rather than somebody who's trying to protect themselves and their community.
• 11:57
  SPEAKER_03: And so the messages that we are sending out to our community about what they should and shouldn't do really need to be taken from as much of an individualized lens as possible or contextualized lens, recognizing that a blanket recommendation may not work for all communities.
• 12:17
  SPEAKER_01: Thanks.
• 12:18
  SPEAKER_01: Dr.
• 12:18
  SPEAKER_01: Mattel, from the public health perspective, COVID-19 herd immunity will be essential and require high vaccination rates once a vaccine is developed.
• 12:26
  SPEAKER_01: Historically, there has been disparity in access to vaccines for minority communities.
• 12:32
  SPEAKER_01: How have these challenges been addressed in the past and how would you see them being addressed for COVID-19?
• 12:37
  SPEAKER_00: The idea of herd immunity is interesting in public health because it requires a large portion of the community to not only one become infected, but two, become immunized.
• 12:51
  SPEAKER_00: And thus, if you reach a certain threshold, a certain percentage of the population becoming immunized, you basically prevent the spread of the disease from people who aren't protected, who are immunocompromised, who haven't been infected before.
• 13:06
  SPEAKER_00: Herd immunity can be achieved two ways.
• 13:09
  SPEAKER_00: The first way is vaccinations, the second way is natural infection.
• 13:14
  SPEAKER_00: If we talk about natural infection, if you think about the measles that's highly contagious, you need about 95% of the people to be immunized against measles.
• 13:24
  SPEAKER_00: And we've had all these outbreaks because we've dropped the herd immunity.
• 13:29
  SPEAKER_00: So people were getting infected with measles again, you know, in places such as California.
• 13:33
  SPEAKER_00: So the natural infection vaccination sometimes for measles came together because the lack of vaccinations increased people getting infected.
• 13:41
  SPEAKER_00: But for COVID-19, for vaccinations and natural infection, it's very complex because for COVID-19, it's a relatively new virus that we don't know much about.
• 13:53
  SPEAKER_00: But if it behaves like some of the other coronaviruses that we have seen, research has shown that reinfection can occur even though they have mild symptoms, because people don't become completely immunized or the virus mutates slightly.
• 14:07
  SPEAKER_00: If we go with natural infection, we need about 70% of the US population to become infected, which is about 200 million people.
• 14:18
  SPEAKER_00: If we have that many people infected at once, the US health system will become overwhelmed.
• 14:24
  SPEAKER_00: And we don't have ICU beds or hospital beds to take care of so many people infected at once.
• 14:31
  SPEAKER_00: Again, even if you become infected and get your symptoms resolved, we don't know if you're going to be immune to future infections.
• 14:40
  SPEAKER_00: So it's sort of like a catch-22 here.
• 14:43
  SPEAKER_00: The idea is can we possibly get a vaccine before we get herd immunity through natural infection?
• 14:49
  SPEAKER_00: Yes, it's more than likely, but then with vaccinations, we have people who don't believe or object to getting vaccinations due to religion, fear of possible risk.
• 15:01
  SPEAKER_00: And these groups of people may tend to live in the same area.
• 15:05
  SPEAKER_00: The other thing with vaccinations is that they may wane over time.
• 15:09
  SPEAKER_00: So if you get the vaccine this year, will it be effective in one, five, ten years?
• 15:15
  SPEAKER_00: I know there are some vaccinations like the TAP that we get every 10 years.
• 15:20
  SPEAKER_00: So we don't know exactly how long this vaccine that comes out in the future will last.
• 15:26
  SPEAKER_00: As far as vaccinations in minority community, there's been plenty of research that's shown that people in minority communities tend not to get vaccinated as high as non-Hispanic or white counterparts.
• 15:40
  SPEAKER_00: In 2012, when you think about the vaccinations, when you adjusted for socioeconomics, there was a study done that showed that 31.2% of non-Hispanic whites versus 28.7% of non-Hispanic blacks versus 33.5% of Hispanics between the ages of 19 and 64 got vaccinated.
• 15:59
  SPEAKER_00: The Office of Minority Health on their website for the influenza vaccination from 2014 showed that non-Hispanic whites, 48.5, would get vaccinated, whereas in the Black community it was 37.7, whereas the brown community was 33%.
• 16:17
  SPEAKER_00: So even if we had a vaccination, we have people who aren't buying in or becoming vaccinated.
• 16:24
  SPEAKER_00: And there's different ideas as to why that may occur.
• 16:28
  SPEAKER_00: There's still the fear from the black and brown communities of discrimination.
• 16:34
  SPEAKER_00: So those who have been discriminated in healthcare settings, research has shown they're 50% less likely to receive an influenza vaccination.
• 16:42
  SPEAKER_00: And so when you take all of these ideas into effect, how do you get the communities to trust the healthcare system?
• 16:50
  SPEAKER_00: One has been having physicians of color, but 6% of physicians are from the black community.
• 16:57
  SPEAKER_00: I think the number may be about the same for the brown community.
• 17:00
  SPEAKER_00: So we're just not present in the medical profession.
• 17:04
  SPEAKER_00: There's inappropriate and ineffective outreach to our communities.
• 17:09
  SPEAKER_00: For the brown community, there's language barriers.
• 17:12
  SPEAKER_00: When you set up a vaccination program, what is the time you're going to have these vaccination programs?
• 17:18
  SPEAKER_00: If you have the time between 8 a.m.
• 17:21
  SPEAKER_00: and 5 p.m., most of the people work.
• 17:24
  SPEAKER_00: So the cost of missing work to grab the vaccination.
• 17:27
  SPEAKER_00: Some of the communities who are in lower socioeconomics don't have the ability to miss work, don't have sick pay, and thus can't make it to a vaccination location.
• 17:39
  SPEAKER_00: So the challenges to vaccinations are huge.
• 17:43
  SPEAKER_00: But I think with COVID-19, because it's been very publicized and the dangers of it have been televised, I'm hoping that people will obtain the vaccine, but I think there might be some hesitancy in the beginning.
• 17:56
  SPEAKER_01: Great.
• 17:56
  SPEAKER_01: That's going to be something to overcome.
• 17:58
  SPEAKER_01: Are there areas related to COVID-19 where more research would inform how disparities in infection prevention impact people of color?
• 18:07
  SPEAKER_00: Currently, I don't think there's specific areas of COVID-19 where we are looking at disparities.
• 18:14
  SPEAKER_00: I know in the ICU as an intensivist, I have looked at health disparities, and there's not a lot of strong studies focused on just health disparities in the ICU.
• 18:24
  SPEAKER_00: There have been studies in other aspects of medicine where we are looking at people of color tend to get less pain medications in the emergency room when they've had a trauma.
• 18:36
  SPEAKER_00: I know in the Black community, the maternal fetal health mortality is increased in comparison to other communities.
• 18:43
  SPEAKER_00: So I think as far as research, I think we need to look at, you know, why people in the brown and black communities have a higher risk of contracting this disease and why they have a higher mortality.
• 18:58
  SPEAKER_00: You know, are they coming to the hospital sicker?
• 19:00
  SPEAKER_00: Do they have more comorbidities?
• 19:03
  SPEAKER_00: Are they controlled comorbidities?
• 19:05
  SPEAKER_00: I think it all stems back down to looking at the health disparities from preventative medicine and how that may play into, you know, by the time I see the patient in the ICU.
• 19:17
  SPEAKER_02: I agree.
• 19:18
  SPEAKER_02: If there are ways in which we can prioritize health disparities, particularly with COVID-19 treatment and preventive measures within black and brown communities, I think that would be a good goal for an organization like Shay.
• 19:34
  SPEAKER_02: And then also just a prior point, supporting everything that was mentioned regarding vaccinations, vaccine hesitancy, somewhat valid with the Black and Brown community because of the historical ways in which vaccine research was done.
• 19:49
  SPEAKER_02: So I think going forward, ensuring that the cost of vaccines and access to a COVID-19 vaccine is about as equitable as we can make it, which may mean free in some cases, or at the very least, handed out in maybe not our typical ways where it's centralized vaccination versus going out to communities and providing vaccination access by people that are from those communities and with people that have done research that are from those communities.
• 20:18
  SPEAKER_01: Great, thank you.
• 20:19
  SPEAKER_01: Dr.
• 20:20
  SPEAKER_01: Marcellen, what is it like taking care of patients as a physician with the knowledge that this disease is affecting some ethnicities or races more than others?
• 20:29
  SPEAKER_03: This has been something that has been weighing pretty heavily on me as I am seeing these patients in our hospitals and also taking in all of the news that is coming to me via social media or just reading the different news outlets, but also just seeing the people on our COVID list.
• 20:50
  SPEAKER_03: So, for example, in Omaha where I live, there is a huge majority of our patients that are on our COVID list are non-English speaking patients, either from Spanish-speaking communities or Nepali-speaking communities.
• 21:08
  SPEAKER_03: And it's really sobering to be a physician that is a part of an institution.
• 21:15
  SPEAKER_03: Medicine is the institution overall that seems to not be as open about the roles that medicine and healthcare has played in general in perpetuating systemic racism that has led us to these conditions in the first place.
• 21:35
  SPEAKER_03: And I think about, again, back to the access that individuals have to care and the access that they have to just communication about what's happening in their community and in the world around them.
• 21:49
  SPEAKER_03: Many of these communications are in English.
• 21:53
  SPEAKER_03: We tell people we have all of these great infographics and webinars and all of this fantastic solution.
• 22:00
  SPEAKER_03: Media material, but the majority of it is just coming through in English and English and English.
• 22:06
  SPEAKER_03: And it seems like translating it into a different language is often an afterthought and not something that is thought of in the beginning.
• 22:16
  SPEAKER_03: And that tells me, A, that they're not non-English speaking people at the table creating these sort of communications, which is something that needs to change.
• 22:26
  SPEAKER_03: But when I see the patients and have to talk to their families over Zoom or over the phone, and they don't quite understand how their loved one got exposed to this, it really signals to me that we have failed as a medical community to really take care of these communities who are at highest risk.
• 22:50
  SPEAKER_03: And so one of the things that I've been doing is whenever I get asked by my institution to co-author or be interviewed for an institutional communication about COVID-19, the first thing that I do is say, can this be translated into Spanish?
• 23:07
  SPEAKER_03: Can it be translated into Nepali?
• 23:09
  SPEAKER_03: Like what other language can we do this in and try to find other of my colleagues who are able to give an interview in their native language to be able to reach those communities?
• 23:22
  SPEAKER_03: And I shared that with one of my colleagues who is Spanish speaking, and he shared it among his group, and the feedback that he got from them was so profound to me.
• 23:34
  SPEAKER_03: People were saying, wow, I didn't really know it was this bad because this thing that I had written had all of the numbers in the Hispanic community, and they really did not know how bad it was because they weren't getting that information in the language that they understood.
• 23:51
  SPEAKER_03: That's a huge failure on the part of the medical establishment, and that's the thing that I reflect on the most when I see the patients in the ICU.
• 24:01
  SPEAKER_01: That's really sobering.
• 24:02
  SPEAKER_01: Thank you.
• 24:03
  SPEAKER_01: How can everyone in infection prevention stewardship make a positive impact in our work and healthcare specifically as it relates to people of color?
• 24:12
  SPEAKER_03: So there's a lot of ways that we can help individually.
• 24:17
  SPEAKER_03: You know, taking a step back and thinking broadly about how we got to this place where we're seeing these disproportionate impacts of COVID-19 in minority communities and linking that back to the structural racism that got us here in the first place, I think the most important thing that individuals can do is consider what role they may play in perpetuating structural racism themselves.
• 24:44
  SPEAKER_03: And I don't mean it to say that, you know, everybody in the world who is not a minority individual is racist.
• 24:51
  SPEAKER_03: That's not where that's going.
• 24:53
  SPEAKER_03: It's if you have benefited from this system in any way, be it potential preferential treatment or be it just being able to have access to healthcare resources when others may not, then that means that you can play a role in recognizing your own privileges and asking questions in whatever context that you live and work in about whose voices are not being heard, whose contexts are not being considered, and as we're making policies in hospitals about infection control and antimicrobial stewardship, are we considering how these policies may be either implemented in resource-limited areas and how we may target minority communities for some of these policies and procedures that we perceive to be helpful towards mitigating COVID-19?
• 25:54
  SPEAKER_03: And how can we ensure that any sort of things that we do can be communicated in a culturally congruent manner?
• 26:02
  SPEAKER_03: And then challenging our leaders to really think about all of the perspectives that need to be considered in any sort of decision making, whether or not an individual perceives that particular decision to have any impact on a minority community, there should still be a consideration of how can this affect people who don't look like me.
• 26:26
  SPEAKER_03: I think those are things, very specific things that we can do within our world of infection control and antimicrobial stewardship.
• 26:35
  SPEAKER_03: But you know, in general, I encourage people to learn more about what these healthcare disparities mean, what is structural racism, and what are my individual roles that I might play in perpetuating it, and talk to other people that are not like you.
• 26:52
  SPEAKER_03: Find minorities that you can have honest conversations with.
• 27:08
  SPEAKER_03: So the important thing that people need to realize is that talking about these healthcare disparities and the cause of it being related to systemic racism and really addressing systemic racism head on is a topic that will make most people very uncomfortable.
• 27:30
  SPEAKER_03: And it's important to recognize that discomfort, to push through that discomfort and continue having those conversations and continue learning about it.
• 27:40
  SPEAKER_03: But it's also important not to center yourself and center your discomfort and recognize that the discomfort that you may be feeling now as we're talking more about these things is nothing compared to what people in the black community have been experiencing for decades and centuries.
• 28:03
  SPEAKER_03: It's something people need to just recognize okay, this is uncomfortable.
• 28:08
  SPEAKER_03: I get it, I'm gonna keep talking about it because it's important, and I won't let that discomfort dissuade me from having those important conversations and then asking more questions and holding our leaders to higher standards.
• 28:24
  SPEAKER_01: Okay, the final question is how can Shay support diversity and inclusion moving forward?
• 28:30
  SPEAKER_01: Do you guys have any ideas?
• 28:32
  SPEAKER_00: I think for myself, I come from humble beginnings and you know, I was always go to college, go to college, and and I always wanted to be a physician.
• 28:41
  SPEAKER_00: I didn't really learn about public health until I did a research program in college.
• 28:46
  SPEAKER_00: And that interested me, and hence why I pursued a master's in public health afterwards.
• 28:51
  SPEAKER_00: But I think, you know, as far as supporting diversity and inclusion, it comes down to outreaching and outreaching people in the black and brown communities at a younger age, where telling kids you can grow up to be someone in the healthcare profession, you can be someone who can help your communities and have the organization's name out there.
• 29:12
  SPEAKER_00: I remember some of the organizations that came out to support my community in junior high and high school, still after all these years.
• 29:20
  SPEAKER_00: I think the other thing that Shay can do is ask, you know, medical associations if they can participate in their conferences.
• 29:26
  SPEAKER_00: Because I know the National Hispanic Medical Association has a yearly conference, the Latino Medical Student Association, the Student National Medical Association, SNMA, they all have yearly conferences.
• 29:38
  SPEAKER_00: And I think it would be great to see leadership from Shay come out and speak to us about different areas of infection prevention and diseases and how it is impacting our communities.
• 29:49
  SPEAKER_02: Yeah, so I think SHA as an organization has started down the path of ensuring that their actions and activities and policies, white papers, all of that reflect their values.
• 30:00
  SPEAKER_02: And I think they've done that successfully.
• 30:02
  SPEAKER_02: And I wonder if, as we move forward, ensuring that the value and the core tenet of diversity and inclusion is part of everything that's turned out of shade.
• 30:11
  SPEAKER_02: So if it's a white paper, how does this impact certain communities?
• 30:15
  SPEAKER_02: If it's resources for research, if it's speakers, if it's conference planning, I think those are more passive and maybe subtle action steps.
• 30:24
  SPEAKER_02: But I think as a whole, any organization has a platform that it can use for good.
• 30:29
  SPEAKER_02: And I like the idea of reaching out as early as possible to a number of different communities to see how an organization focused on preventing infections, improving care across the world can better move people to participate both in our organization and get through all of the training that's required to finish a medical training to join the organization, either as a physician, nursing, um, infection prevention.
• 30:55
  SPEAKER_02: It's just ensuring that we're breaking down barriers to getting in.
• 30:58
  SPEAKER_02: Because I would say for me, I certainly am grateful that I had a strong mentor that helped pave a path to show what research in infection prevention can look like, to show what clinical care can look like.
• 31:11
  SPEAKER_02: And that wasn't necessarily a mentor that looked like me, but it was someone that was willing to be a sponsor, be a mentor, and open up a door and say, here you can walk in.
• 31:20
  SPEAKER_02: And that's I what I think organizations need to do.
• 31:23
  SPEAKER_02: It has to be a little bit more upfront than maybe we've done in the past, because there are just so many layers of inequities, and the only way to address them is to start tackling them one by one.
• 31:33
  SPEAKER_02: We need to make this a movement.
• 31:36
  SPEAKER_02: And I think a lot of people have kind of struggled with the attention that's focused on one, the pandemic, which I we can't help but focus on that.
• 31:44
  SPEAKER_02: But I think largely also focusing on the mistreatment of black and brown people in the United States, in medicine, across the world, and ensuring that whatever conversation we're having right now is not just included in the lens of this month or even this year.
• 32:01
  SPEAKER_02: If there's a way we can ensure as a group, this is part of a more longitudinal plan to ensure that this is a steady movement so that we can actually start to see change.
• 32:14
  SPEAKER_03: So I've been thinking about this for a while, and I think the most important thing that Shay can do is having the discussion in the first place, right?
• 32:27
  SPEAKER_03: And so this podcast is a fantastic springboard to keep this discussions in the spotlight, but I think it goes beyond that looking at the leadership of Shay from the executive leadership all the way through to committees and membership and really taking a good hard look at what is our organization representative of?
• 32:54
  SPEAKER_03: Who is it representative of?
• 32:55
  SPEAKER_03: Are we including all the people that need to be included?
• 32:59
  SPEAKER_03: From a professional standpoint, I think Shay has been very good at professional diversity, you know, with physicians and pharmacists and nurses and infection preventionists and microbiologists.
• 33:14
  SPEAKER_03: And I think that is something that is a really good thing.
• 33:18
  SPEAKER_03: And so now we need to take it to another level where we're thinking about what is our race and ethnic diversity.
• 33:27
  SPEAKER_03: There's been lots of good movements from a gender diversity, uh gender equity standpoint, but really looking at the leadership.
• 33:37
  SPEAKER_03: And I think the IDSA has created a great model with the IDANE task force, the inclusion, diversity, access and equity task force, which I am a member of, that really had an opportunity to take a look at the society and give recommendations on how the organization can model every single policy, procedure, decision making through an equity lens.
• 34:07
  SPEAKER_03: I think at the end of the day, if diversity and inclusion and equity is sort of an afterthought, okay, don't forget we've we've got to do this.
• 34:17
  SPEAKER_03: If that's the way it's approached, it's never going to be done right.
• 34:20
  SPEAKER_03: The way that it really needs to be done is that it permeates through every single decision that is made.
• 34:28
  SPEAKER_03: Everything, everywhere you go throughout the Shay organization, people need to have a sense of this organization is committed to diversity and equity.
• 34:39
  SPEAKER_03: So I would love to see Shay develop a similar group, committee, task force, et cetera, to really look at what is Shay's history and what can we make Shay's legacy become by looking at everything that is done in the organization through an equity lens.
• 34:57
  SPEAKER_03: I've been hoping that that's kind of the direction that things are going, and so looking forward to see what that future might hold.
• 35:06
  SPEAKER_01: Thank you.
• 35:07
  SPEAKER_01: I want to thank our speakers for sharing their perspectives and personal experiences on this critical topic.
• 35:13
  SPEAKER_01: A sincere thank you from Shay to all healthcare personnel for all that you're doing to respond to COVID-19.
• 35:19
  SPEAKER_01: She leadership is taking this discussion very seriously and ensuring that we are working to address racial disparities across the organization and as we recruit and retain the next generation of professionals.
• 35:30
  SPEAKER_01: This podcast can be accessed on Shay's online education center learning CE under the Rapid Response Program.
• 35:36
  SPEAKER_01: You will find additional resources such as recorded webinars, healthcare facility outbreak preparedness in the Shay COVID-19 town halls.
• 35:44
  SPEAKER_01: Additional resources available on Learning CE pertinent to this pandemic include Shay CDC Outbreak Response Training Program or ORTP and the Prevention Course in HAI Knowledge and Control or Prevention Check.
• 35:55
  SPEAKER_01: This concludes this episode of the Rapid Response Podcast.
• 35:57
  SPEAKER_01: Thank you for tuning in.