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How COVID is Exposing Racial & Ethnic Healthcare Disparities · The SHEA Podcast

• 0:08
  SPEAKER_01: Welcome to the Rapid Response Podcast, brought to you by the Society for Healthcare Epidemiology of America, Shay, promoting the prevention of healthcare associated infections, antibiotic resistance, and seeking to advance the fields of healthcare epidemiology and antibiotic stewardship.
• 0:22
  SPEAKER_01: I am Dr.
• 0:22
  SPEAKER_01: David Bannock from the University of Connecticut, and I will serve as today's podcast moderator.
• 0:27
  SPEAKER_01: Discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:35
  SPEAKER_01: Shay is excited to launch this episode of the podcast, COVID-19 updates, What We Know Now.
• 0:40
  SPEAKER_01: Today's discussion will focus on how COVID is exposing our racial and ethnic healthcare disparities.
• 0:46
  SPEAKER_01: Our speakers today are Dr.
• 0:47
  SPEAKER_01: Eliseo Perez Stable, Director of the National Institute on Minority Health and Health Disparities at the National Institute of Health, and Dr.
• 0:55
  SPEAKER_01: Anthony August, Assistant Director of Infectious Disease and Site Director of Epidemiology at Hartford Hospital.
• 1:01
  SPEAKER_01: Thank you for joining us today.
• 1:02
  SPEAKER_01: Before we start our discussion, I would like to turn it over to Dr.
• 1:05
  SPEAKER_01: Ishrat Kamal Ahmed to get us started with a brief news and guidance update for the week.
• 1:10
  SPEAKER_00: Hello everyone.
• 1:11
  SPEAKER_00: We'll start with a global update.
• 1:13
  SPEAKER_00: As of the 27th of May 2021, there have been 168 million confirmed cases of COVID-19, including 3.5 million deaths reported to the World Health Organization.
• 1:25
  SPEAKER_00: A total of 1.5 billion vaccine doses have been administered.
• 1:30
  SPEAKER_00: There were many studies published in the last several weeks, therefore, we have narrowed down our updates to vaccine breakthroughs and post-COVID symptoms.
• 1:39
  SPEAKER_00: In an early released article in MMWR on May 25th, 2021, the CDC reported on the COVID-19 vaccine breakthrough cases that occurred in the United States between January 1st through April 30th.
• 1:52
  SPEAKER_00: Despite the high level of vaccine efficacy, a small number percentage of fully vaccinated persons will develop symptomatic or asymptomatic infections with SARS-CoV-2 virus.
• 2:02
  SPEAKER_00: For the surveillance, a vaccine breakthrough infection is defined as the detection of SARS-CoV-2 RNA or antigen in a respiratory specimen collected from a person 14 or more days after receipt of all recommended doses of an FDA authorized COVID-19 vaccine.
• 2:19
  SPEAKER_00: When possible, genomic sequencing is performed on respiratory specimens that test positive for the virus.
• 2:26
  SPEAKER_00: CDC concludes that the number of COVID-19 cases, hospitalizations, and deaths that will be prevented among vaccinated persons will far exceed the number of vaccine breakthrough cases.
• 2:37
  SPEAKER_00: To date, the age and sex distribution of reported vaccine breakthrough infections reflects the fully vaccinated US population.
• 2:45
  SPEAKER_00: The proportion of reported vaccine breakthrough infections attributed to variants of concern, including B117, B1429, B1427, P1, and B1351 has also been similar to the proportion of these variants circulating throughout the United States.
• 3:01
  SPEAKER_00: During March 28 through April 10, 2021, the variant of concern accounted for 70% of the weighted estimates of SARS-CoV-2 lineages submitted to CDC's National Genomic Surveillance.
• 3:14
  SPEAKER_00: CDC also mentions two limitations to this report.
• 3:17
  SPEAKER_00: First, the number of reported COVID-19 vaccine breakthrough cases is likely a substantial undercount of all SARS-CoV-2 infections among fully vaccinated persons.
• 3:27
  SPEAKER_00: The national surveillance system relies on passive and voluntary reporting and data might not be complete or representative.
• 3:33
  SPEAKER_00: Many persons with COVID vaccine bractory infections, especially those who are asymptomatic or who experience mild illness, might not seek testing.
• 3:41
  SPEAKER_00: Second, SARS-CoV-2 sequence data are available for only a small proportion of the reported cases.
• 3:47
  SPEAKER_00: Beginning May 1st, 2021, CDC transitioned from monitoring all reported COVID-19 vaccine bractory infections to investigating only those among patients who are hospitalized or die, thereby focusing on these on the cases of highest clinical and public health significance.
• 4:04
  SPEAKER_00: Now for the post-COVID symptoms-related studies.
• 4:08
  SPEAKER_00: An article published on May 26th in the New England Journal of Medicine attempted to answer the question: what are the frequency and variety of persistent symptoms after COVID-19 infection?
• 4:20
  SPEAKER_00: A systematic review of studies was done and persistent symptoms were defined as those persisting for at least 60 days after diagnosis, symptom onset, or hospitalization, or at least 30 days after recovery of the acute illness or hospital discharge.
• 4:36
  SPEAKER_00: In this systematic review of 45 studies, including more than 9,000 patients with COVID-19, the median proportion of individuals who experienced at least one persistent symptom was 73%.
• 4:50
  SPEAKER_00: Symptoms occurring most frequently included shortness of breath, fatigue, and sleep disorder.
• 4:56
  SPEAKER_00: However, the studies were highly heterogeneous and needed longer follow-up and more standardized designs.
• 5:03
  SPEAKER_00: The authors feel that it is imperative to reliably estimate the long-term morbidity among individuals of all ages for improved patient care, prognosis, quality of life, and development of public health policy.
• 5:16
  SPEAKER_00: Another study on the same topic, published on May 17th, 2021, in the Lancet Regional Health Europe, added new information about post-COVID syndrome by this time including non-hospitalized patients with a milder course of infections.
• 5:32
  SPEAKER_00: In this prospective cohort study, the researchers established a post-COVID outpatient clinic at the University Hospital Cologne in Germany.
• 5:41
  SPEAKER_00: SARS-CoV-2 convalescent patients were invited to present regularly to investigate the development of SARS-CoV-2 immunity, the screen for potential plasma donation, and perform checkup visits on COVID-19.
• 5:54
  SPEAKER_00: Researchers observed that substantial numbers of SARS-CoV-2 convalescent patients complained of symptoms months after acute infection and had not returned to their initial health state prior to infection.
• 6:06
  SPEAKER_00: At least one characteristic symptom was present in 27.8% and 34.8% at months 4 and 7 post-infection, respectively.
• 6:17
  SPEAKER_00: Characteristic symptoms included shortness of breath, loss of smell, loss of taste, and fatigue.
• 6:23
  SPEAKER_00: Additionally, lower baseline level of SARS-CoV-GIGG, loss of smell, and diarrhea during acute COVID-19 were associated with higher risk of developing long-term symptoms.
• 6:36
  SPEAKER_00: These findings show that long-term health consequences may occur even after very mild COVID-19 infection in the outpatient setting, and it can be expected that post-COVID symptoms will affect a larger number of individuals that initially assumed.
• 6:52
  SPEAKER_00: This might pose a major medical concern and social and economic challenges.
• 6:57
  SPEAKER_00: These are the updates we have for today, and thanks for joining.
• 7:00
  SPEAKER_00: Until next time.
• 7:01
  SPEAKER_00: Thank you.
• 7:02
  SPEAKER_01: Thank you, Dr.
• 7:03
  SPEAKER_01: Kamal Ahmed.
• 7:04
  SPEAKER_01: I now want to move into the discussion with our speakers.
• 7:06
  SPEAKER_01: So both Dr.
• 7:07
  SPEAKER_01: Perez Stable and Dr.
• 7:08
  SPEAKER_01: Augustit, thank you for joining us.
• 7:11
  SPEAKER_01: So I am interested in hearing both of your perspectives.
• 7:14
  SPEAKER_01: Both of you sort of come from different types of environments.
• 7:18
  SPEAKER_01: And I'd like to hear about what your roles have been throughout the COVID pandemic.
• 7:22
  SPEAKER_01: And even more broadly, what are some of the initiatives that you're working on as they pertain to healthcare disparities in your different roles?
• 7:29
  SPEAKER_01: So maybe if you can give a little bit of background also as to what your current roles are with regard to addressing health disparities.
• 7:34
  SPEAKER_01: So I'll start with Dr.
• 7:35
  SPEAKER_01: Perez Stable.
• 7:37
  SPEAKER_03: Yes, thank you very much for having me today for this podcast.
• 7:39
  SPEAKER_03: I, you know, in March 2020, the world changed for us.
• 7:44
  SPEAKER_03: And at NIH, it has been nonstop efforts.
• 7:48
  SPEAKER_03: What is going to be our response?
• 7:50
  SPEAKER_03: Dr.
• 7:50
  SPEAKER_03: Collins has really led us in this effort.
• 7:53
  SPEAKER_03: And I remember spending several days, you know, in brainstorming sessions.
• 7:58
  SPEAKER_03: What are we going to do?
• 7:59
  SPEAKER_03: Initially I thought, well, I'm the director of the National Institute on Minority Health and Health Disparities.
• 8:03
  SPEAKER_03: We don't do vaccine research.
• 8:05
  SPEAKER_03: We don't do development of new drugs, or what are we going to discover with this?
• 8:10
  SPEAKER_03: And clearly, as it became evident that we had disparities as a consequence of the pandemic, we had an economic impact that was dramatically affecting our populations.
• 8:20
  SPEAKER_03: We had issues of mental health, exacerbated substance use.
• 8:23
  SPEAKER_03: So all kinds of behavioral issues that we were in large part experts in.
• 8:28
  SPEAKER_03: So our role was heightened as a consequence.
• 8:31
  SPEAKER_03: And thinking about science and the kind of research that we would do, what kind of programs would we do?
• 8:36
  SPEAKER_03: So partnering with other institutes, the National Institute on Mental Health and the National Institute on Aging, we launched programs on social behavioral and economic consequences of COVID.
• 8:45
  SPEAKER_03: Then came the congressional allocation to do more testing and Dr.
• 8:50
  SPEAKER_03: Collins' decision to allocate a significant portion of that to underserve populations.
• 8:55
  SPEAKER_03: So my time has been taken up a lot with COVID in standing up programs for dealing with the social behavioral consequences, funding programs to promote testing and underserve communities, underserved and vulnerable communities, and then standing up a whole community engage program to emphasize community engagement participation in trials and now vaccine uptake since we have the vaccines since December.
• 9:19
  SPEAKER_03: So I'll stop there.
• 9:20
  SPEAKER_01: Great.
• 9:20
  SPEAKER_01: Thanks for sharing that.
• 9:21
  SPEAKER_01: It sounds like your center at NIH has been critical in so many different aspects of addressing uh the health disparities from COVID.
• 9:28
  SPEAKER_01: Dr.
• 9:28
  SPEAKER_01: Augusta, you you come from a slightly different perspective, a large academic health center.
• 9:34
  SPEAKER_01: Do you want to kind of share what your experience has been like?
• 9:36
  SPEAKER_02: Yes, absolutely.
• 9:37
  SPEAKER_02: So it's a large academic center with a community spin.
• 9:40
  SPEAKER_02: So we're more clinicians, and what we've focused more on, or myself and some of my colleagues, is more so when this pandemic first broke, just educating the underserved population on what this disease is, what to expect, what the symptoms are, how will it disproportionately or may not disproportionately affect them?
• 10:02
  SPEAKER_02: When it came out to vaccines, there was a lot of vaccine hesitancy.
• 10:05
  SPEAKER_02: So setting up Zoom calls with different community advocates, going to churches, basically putting our faces out there.
• 10:13
  SPEAKER_02: Some people may speak Spanish.
• 10:15
  SPEAKER_02: So if it's a Spanish community, sometimes you want to associate with your provider, having somebody who could speak Spanish, if it was somebody who was African American or somebody from the Caribbean, having that provider kind of discuss their experience and educate the population on what this is, what to expect.
• 10:32
  SPEAKER_02: So that's been more of our approach, more feet to the ground.
• 10:36
  SPEAKER_01: Yeah, and I think it's it's important to look at this from that broad perspective in terms of policy making and outreach that public health has implemented, but also the boots on the ground approach, like you mentioned, Dr.
• 10:47
  SPEAKER_01: August.
• 10:48
  SPEAKER_01: So, you know, thinking about your backgrounds going into January 2020 when COVID started to really take off in the US.
• 10:56
  SPEAKER_01: What were the main issues that you saw in healthcare disparities?
• 10:59
  SPEAKER_01: And then how did COVID really highlight and emphasize some of the things that we were seeing in the community, sort of pre-existing disparities and challenges?
• 11:07
  SPEAKER_01: So I'll start with Dr.
• 11:08
  SPEAKER_01: August.
• 11:09
  SPEAKER_02: So thinking about the underserved specifically, the key areas of social determinants of health contribute to racial and ethnic minority groups disproportionately was affected by COVID.
• 11:20
  SPEAKER_02: And you know, I'll break it down.
• 11:21
  SPEAKER_02: Say, for instance, some of our patients, let's look at neighborhood and physical environment.
• 11:26
  SPEAKER_02: Some of these patients live in very, very crowded areas.
• 11:29
  SPEAKER_02: So they're in crowded apartments and they have lack of access to reliable transportation.
• 11:35
  SPEAKER_02: So some of the fears that we had is they're in these crowded environments.
• 11:39
  SPEAKER_02: Seven or six people may be in a two-bedroom apartment.
• 11:42
  SPEAKER_02: If two people have COVID, how do you social distance?
• 11:45
  SPEAKER_02: So those are some of the concerns.
• 11:47
  SPEAKER_02: The other thing is just occupation and job conditions.
• 11:50
  SPEAKER_02: A lot of racial and ethnic minority groups are disproportionately represented in it as essential workers.
• 11:55
  SPEAKER_02: So, you know, they're represented in healthcare facilities, factories, grocery stores, public transportation.
• 12:02
  SPEAKER_02: So that in itself puts them more at risk for exposure to COVID and the uncomfortable or untoward consequences of sequella of getting it.
• 12:10
  SPEAKER_02: So those were some of my concerns.
• 12:12
  SPEAKER_01: That's interesting.
• 12:13
  SPEAKER_01: I think an important backdrop to what has sort of led into some of the challenges that we saw with COVID.
• 12:18
  SPEAKER_01: So, Dr.
• 12:18
  SPEAKER_01: Perez Stabla, you've spent a lot of your career focusing on health disparities even pre-COVID.
• 12:23
  SPEAKER_01: Can you share sort of what you were seeing pre-COVID and then how that carried into the COVID pandemic and maybe emphasized certain pre-existing challenges that were already in play?
• 12:32
  SPEAKER_03: Right.
• 12:33
  SPEAKER_03: Thanks for reminding me.
• 12:34
  SPEAKER_03: I am a general internist by background.
• 12:36
  SPEAKER_03: So although it's been almost six years since I saw a patient, so I'm more removed from that now.
• 12:41
  SPEAKER_03: But I I totally agree with Dr.
• 12:42
  SPEAKER_03: Antoine's comment because I think there is a misperception that the reasons minorities were more affected by COVID was, oh, the comorbidity.
• 12:51
  SPEAKER_03: There's more diabetes, more obesity, that's why, or more asthma or whatever.
• 12:55
  SPEAKER_03: And yes, that contributes to more severity and perhaps higher mortality initially, but it's really structural issues and structural inequities that led to higher infection rate.
• 13:05
  SPEAKER_03: And then lack of insurance or underinsurance led to less likely to go see a clinician when they started getting ill.
• 13:12
  SPEAKER_03: Don't underestimate the importance of broadband, right?
• 13:15
  SPEAKER_03: Most of us take it for granted or unlimited data on your smartphone.
• 13:19
  SPEAKER_03: A lot of people don't have that.
• 13:21
  SPEAKER_03: They don't have a computer, they don't have broadband at home, they use their phone for internet access and they don't have unlimited data plans because they can't afford it.
• 13:28
  SPEAKER_03: So they can't do telemedicine very effectively.
• 13:31
  SPEAKER_03: So it it exacerbated some of these structural inequities.
• 13:34
  SPEAKER_03: Now, healthcare has adjusted since.
• 13:36
  SPEAKER_03: And telemedicine is a good thing to incorporate into our routine.
• 13:40
  SPEAKER_03: But in those initial months of March, April, May, June, as before we kind of adjusted that, there was structural disadvantage for these populations that led to probably more severe cases coming to the hospital because of that.
• 13:52
  SPEAKER_03: So that definitely is something I witnessed and experienced.
• 13:56
  SPEAKER_01: Yeah, thanks for reflecting on that.
• 13:57
  SPEAKER_01: And I really appreciate that distinction that you made regarding the differences and structural inequities and how that influenced COVID in the US.
• 14:05
  SPEAKER_01: Now, you know, we've talked a little about some of these health disparities that were pre-existing, structural challenges in our healthcare system.
• 14:12
  SPEAKER_01: But how about trust in the healthcare system?
• 14:14
  SPEAKER_01: This has been raised throughout the pandemic.
• 14:17
  SPEAKER_01: We had initial concerns regarding trust with sort of overall understanding of the pandemic and infection transmission and the early interventions, mostly the non-pharmaceutical interventions.
• 14:28
  SPEAKER_01: And then that carried a little bit further into pharmaceutical interventions and then eventually vaccination.
• 14:33
  SPEAKER_01: We'll get to that as well.
• 14:34
  SPEAKER_01: But I was hoping that you both may be able to share some thoughts on trust among different communities and how that may have contributed to the impact of the pandemic on these different groups.
• 14:45
  SPEAKER_02: Yeah, so uh definitely a very strong impact on the community.
• 14:49
  SPEAKER_02: I've definitely had conversations with multiple patients.
• 14:52
  SPEAKER_02: You know, I'll just focus right now on I'm thinking of one patient in particular, you know, an African American.
• 14:58
  SPEAKER_02: So the medical establishment, as we know, there's a long history of mistreatment of certain groups, for instance, black Americans, you know, there have been gruesome experiments on enslaved people, forced sterilization.
• 15:10
  SPEAKER_02: We all know about the infamous Tuskegee syphilis study.
• 15:13
  SPEAKER_02: So a lot of the patients that I came in contact with who were African American or even from the Caribbean, if they had mistrust, their response to me with this pandemic would be, why would I take a vaccine?
• 15:27
  SPEAKER_02: Or I don't even believe that this disease exists.
• 15:30
  SPEAKER_02: It's the government that's trying to kill us.
• 15:32
  SPEAKER_02: And I would prod them and ask, you know, why?
• 15:34
  SPEAKER_02: And they would go back into history and say, Well, you remember when this happened, remember what that happened.
• 15:39
  SPEAKER_02: So it's not surprising that just approximately 42% of black Americans, I think this was in the fall, said that they would be willing to take the COVID 19 test.
• 15:48
  SPEAKER_02: So mistrust is very, very significant in how people approach medicine, how they approach or don't approach healthcare.
• 15:56
  SPEAKER_02: And it's something that we as providers need to keep in the back of our minds because it may change the interaction that we have with these patients.
• 16:04
  SPEAKER_02: Instead of saying things like, hey, I opened up a vaccine clinic and only 20 of the scheduled 150 patients showed up.
• 16:13
  SPEAKER_02: And so some providers may say, You see, we tried and no one came in.
• 16:17
  SPEAKER_02: But you have to prod and ask yourself, what is that coming from?
• 16:21
  SPEAKER_02: And address that mistrust.
• 16:23
  SPEAKER_02: Because when that's done, I have seen some positive results when the mistrust is addressed, it's discussed, education is given, it does make a change.
• 16:32
  SPEAKER_02: So I've definitely seen the mistrust in multiple communities.
• 16:35
  SPEAKER_02: I just focused on the African-American community because a patient just popped up in my head, but it's definitely there.
• 16:41
  SPEAKER_01: And Dr.
• 16:42
  SPEAKER_01: Perestable, I'm interested in your thoughts, you know, from the sort of broader public health context.
• 16:46
  SPEAKER_01: You know, you've mentioned all of the outreach activities that NIMHD and NIH have done in the pandemic response.
• 16:53
  SPEAKER_01: But what are what are your thoughts on trust within different communities, minority groups, and what we can do from the public health perspective to help reestablish any trust where there may be some challenges and distrust?
• 17:05
  SPEAKER_03: So thank you.
• 17:06
  SPEAKER_03: I let me start by putting it in context.
• 17:09
  SPEAKER_03: The the level of disparities from COVID-19 are incredible.
• 17:14
  SPEAKER_03: 50% of cases, 45% of deaths, when only a third of the population make up these particular racial, ethnic, minority groups.
• 17:22
  SPEAKER_03: And I'm leaving Asians out because of the data are more mixed there.
• 17:25
  SPEAKER_03: This is astounding.
• 17:26
  SPEAKER_03: We just don't see anything like this in other diseases.
• 17:28
  SPEAKER_03: And we just don't.
• 17:29
  SPEAKER_03: And so that's number one.
• 17:31
  SPEAKER_03: I mean, this this is this and it hasn't changed.
• 17:34
  SPEAKER_03: You know, we're into month 15, and the data coming out of the CDC are very similar.
• 17:39
  SPEAKER_03: And probably hopefully as the vaccine uptake improves, we'll we'll see some leveling off of that.
• 17:43
  SPEAKER_03: As was mentioned by Dr.
• 17:45
  SPEAKER_03: Antoine, the mistrust is exacerbated, it's highest in the African-American community.
• 17:50
  SPEAKER_03: And it is institutional mistrust.
• 17:52
  SPEAKER_03: This is exacerbated by the dissemination of misinformation through social media and false narratives and conspiracy theories that people listen to.
• 18:03
  SPEAKER_03: And our effort really was to trust science, trust your local expert.
• 18:08
  SPEAKER_03: So we would go to doctors in local areas and say, you be the spokesperson.
• 18:13
  SPEAKER_03: This is not going to be the government who's going to speak for the vaccine or for the studies or to give correct information.
• 18:19
  SPEAKER_03: We'll provide you with the tools.
• 18:20
  SPEAKER_03: We're always willing to do a podcast, town hall, participate in an interview, but we really needed the community of professionals of color and faith leaders and community leaders to stand up and speak for science and promote trust because otherwise our people are going to continue to die disproportionately.
• 18:39
  SPEAKER_03: And the professional community responded.
• 18:41
  SPEAKER_03: You know, there have been spectacular town halls with 30,000, 40,000 people present, physician leaders all across the country.
• 18:48
  SPEAKER_03: And the needle on vaccine hesitancy among African Americans did move completely to more or less the average, you know, 30% or so of people who say, oh, maybe I don't think I want a vaccine or absolutely don't want one.
• 19:00
  SPEAKER_03: And that's been true for Latinos and also for Asian Americans.
• 19:03
  SPEAKER_03: So I think that we put an effort into turning the tide, and many, many people contributed.
• 19:09
  SPEAKER_03: What NIH and the Department of Health and Human Services did is to push in that direction.
• 19:14
  SPEAKER_03: But it's really been the folks on the ground that have really made the difference because we can overcome the mistrusted institutions with personal outreach and individual communication by trusted voices in the community.
• 19:27
  SPEAKER_01: Yeah, no, I think that's terrific.
• 19:29
  SPEAKER_01: You know, moving closer to engaging communities and community leadership and sort of an all-hands-on-deck approach to developing relationships with the community to help address the trust challenges seems to be have really paid big dividends.
• 19:41
  SPEAKER_01: I don't know, Dr.
• 19:41
  SPEAKER_01: August, anything to add to that in terms of your experiences with regard to what's been effective in addressing mistrust and vaccine hesitancy in the communities with which you work?
• 19:51
  SPEAKER_02: So to just to underscore what Dr.
• 19:52
  SPEAKER_02: Perez Fable said, it's exactly what he said putting the providers that look like the members of the community out there.
• 20:00
  SPEAKER_02: Like I said, I've had done multiple Zoom calls or just well, most of them have been Zoom calls, we can go in person.
• 20:06
  SPEAKER_02: I did recently a woman's group and they were a sorority, mostly African American women, some Latino women as well.
• 20:13
  SPEAKER_02: And, you know, they didn't know what I looked like.
• 20:15
  SPEAKER_02: They had no idea.
• 20:16
  SPEAKER_02: I was just a name on a flyer that they got.
• 20:18
  SPEAKER_02: And then when I got into the Zoom call, and then they see that this is an African American provider who's, you know, acknowledging the fact that there is distrust in that community and kind of educating them about the fact that I got the vaccine, the safety of the vaccine, going through the trials, acknowledging fear and distrust.
• 20:36
  SPEAKER_02: It made a difference.
• 20:37
  SPEAKER_02: And the reason why I say it made a difference is after that Zoom call, I got multiple emails from some of the women who had said, Oh my gosh, thank you so much for coming and representing us, having this discussion because I was on the fence and because you spoke to us and you gave us your experience, I went and got my vaccine or I scheduled for the vaccine.
• 20:58
  SPEAKER_02: Now that they follow through, I don't know.
• 21:00
  SPEAKER_02: But I know that that on the ground, seeing someone who looks like you moving with the community, that makes a big difference.
• 21:07
  SPEAKER_02: So that's been my experience.
• 21:09
  SPEAKER_01: Yeah, no, thanks for sharing that.
• 21:10
  SPEAKER_01: I think that's been a great way to approach some of these challenges.
• 21:14
  SPEAKER_01: No, I'm interested in both of your thoughts, you know, as we move through COVID and hopefully eventually into a post-COVID era, you know, these these disparities are not going away.
• 21:22
  SPEAKER_01: And I think it's become pretty clear.
• 21:24
  SPEAKER_01: And I'm interested to hear both your thoughts on where to go from here in the future.
• 21:28
  SPEAKER_01: Dr.
• 21:28
  SPEAKER_01: August, I know you're very interested in infection prevention and antibiotic stewardship, which is a big focus of a lot of the audience.
• 21:35
  SPEAKER_01: So do you have any thoughts as to what the future might look like in both of those areas with regard to addressing some of the health disparities that COVID has sort of emphasized and really brought to the forefront?
• 21:45
  SPEAKER_02: Yeah, so health disparities is, you know, in quotes a hot topic right now, and we focus on how it relates to healthcare access.
• 21:53
  SPEAKER_02: But there's a dearth of information on how it relates to antibiotic stewardship and infection.
• 22:00
  SPEAKER_02: Prevention, a dearth of information, which is necessary.
• 22:03
  SPEAKER_02: So I I think the best approach would be to call the data, get the data, let's start at a baseline to see what is out there.
• 22:10
  SPEAKER_02: We can make assumptions and say something like, okay, most African Americans don't get prescribed X, Y, and Z.
• 22:19
  SPEAKER_02: But is that a good thing or a bad thing?
• 22:21
  SPEAKER_02: Because there's multidrug resistant organisms, they're C diff.
• 22:25
  SPEAKER_02: So is it a good thing that they're getting less antibiotics prescribed to them or not?
• 22:29
  SPEAKER_02: So I think the data we need to call to see where are we at?
• 22:33
  SPEAKER_02: Definitely something that needs to be pursued.
• 22:35
  SPEAKER_01: Totally agree.
• 22:36
  SPEAKER_01: I think you know, we we have some understanding as to maybe geographic differences with regard to antibiotic prescribing, maybe unnecessary antibiotic prescribing.
• 22:45
  SPEAKER_01: But I think if we can hone in a little bit more on specific communities, even specific groups of minority, different minority groups, we'll be able to really understand some of the disparities and the impact they have on these different communities.
• 22:56
  SPEAKER_02: And you know, just some background information myself, my family's from the Caribbean, and you know, you know, some family members, when they go back to their country, you know, getting antibiotics, you don't need a prescription.
• 23:06
  SPEAKER_02: You just go to the pharmacy and you know, you go in, you get your CIPRO, you get your penicillin, needed or not needed.
• 23:12
  SPEAKER_02: So, as providers, understanding that depending on some where someone is coming from, that may make a difference as to what their UTI may be or their pneumonia may be, it may be an ESBL as opposed to just a regular strep or a Maraxella, knowing that makes a difference as well.
• 23:30
  SPEAKER_02: So I think the research is needed.
• 23:31
  SPEAKER_01: I agree 100%.
• 23:32
  SPEAKER_01: Dr.
• 23:33
  SPEAKER_01: Perez Stable, any thoughts on both the fields of infection prevention, but even more broadly in terms of addressing health disparities?
• 23:39
  SPEAKER_01: And this is your passion.
• 23:41
  SPEAKER_01: Where do you see us going from here?
• 23:42
  SPEAKER_01: You know, having sort of made our way through the COVID pandemic, but knowing that there's a lot of uncertainty about the future.
• 23:47
  SPEAKER_01: So, what do you think we've learned from COVID and where do we move from here?
• 23:51
  SPEAKER_03: Thank you.
• 23:51
  SPEAKER_03: I I think it has changed everything in many ways.
• 23:55
  SPEAKER_03: So I think it it made everyone understand that, oh, these disparities are real.
• 24:00
  SPEAKER_03: So my colleagues, everybody said, Oh, oh, wow, yeah.
• 24:03
  SPEAKER_03: Uh and now they go, Yeah, it's hitting you in the face.
• 24:06
  SPEAKER_03: So that was number one.
• 24:08
  SPEAKER_03: Second, the murder of George Floyd triggered overall recognition that, oh, racism, yeah, we we haven't resolved that issue yet, have we?
• 24:17
  SPEAKER_03: And structural racism.
• 24:18
  SPEAKER_03: And so NMHD had been talking about this, and many scientists have for years.
• 24:23
  SPEAKER_03: And all of a sudden, Dr.
• 24:25
  SPEAKER_03: Collins, who I admire tremendously, you know, said, this is important.
• 24:29
  SPEAKER_03: We all got to pay attention to this.
• 24:30
  SPEAKER_03: And we've now focused on this.
• 24:32
  SPEAKER_03: And we have an initiative on research in structural racism, not just describing it and linking it to causes of bad outcomes, but also and what can we do to intervene?
• 24:42
  SPEAKER_03: And I and I think this is an opportunity that has not existed in my lifetime to address this in a at least from a science perspective and hopefully eventually lead to a policy.
• 24:51
  SPEAKER_03: So briefly on infectious diseases.
• 24:53
  SPEAKER_03: Well, COVID has taught us that yes, we can get people vaccinated.
• 24:57
  SPEAKER_03: And you know, we're at 60% of adults.
• 24:59
  SPEAKER_03: We don't get, we get barely 60% of adults getting the flu shot every year.
• 25:02
  SPEAKER_03: So we've learned something about how to get people vaccinated.
• 25:05
  SPEAKER_03: We can we can do better with influenza when when we're really post-COVID.
• 25:09
  SPEAKER_03: In childhood immunizations, we get over 90% of all kids for the measles, mumps, rubella, and tetanus and diphtheria.
• 25:16
  SPEAKER_03: And yet there is no racial disparity there.
• 25:19
  SPEAKER_03: There is no socioeconomic disparity.
• 25:21
  SPEAKER_03: So we we know we can do this, so we should work on it.
• 25:25
  SPEAKER_03: And then the other topic is the HIV epidemic.
• 25:28
  SPEAKER_03: Maybe in some not too distant future, we'll talk about an HIV vaccine.
• 25:32
  SPEAKER_03: But right now, we have effective treatments both for preventing transmission and for suppressing HIV.
• 25:39
  SPEAKER_03: And we know that if you suppress someone completely, they have a normal life expectancy and they cannot transmit the infection.
• 25:46
  SPEAKER_03: 70% of all new infections from HIV are in men who have sex with men and who are men of color.
• 25:53
  SPEAKER_03: So, you know, this is a huge disparity that has been staring at us for some time.
• 25:57
  SPEAKER_03: We have a program to end it by 2030.
• 26:00
  SPEAKER_03: That's a government-wide program, and I think we we need to focus on those individuals as well to try and make advance.
• 26:06
  SPEAKER_03: There's others, you know, the other one is hepatitis.
• 26:08
  SPEAKER_03: We can cure hepatitis C.
• 26:10
  SPEAKER_03: You know, it's curable.
• 26:11
  SPEAKER_03: And yet, well, where's the program to do that?
• 26:13
  SPEAKER_03: Eventually we'll see less and less B if all the all the babies get immunized.
• 26:18
  SPEAKER_03: And we've made huge progress there in the last 30 years.
• 26:21
  SPEAKER_03: But those are, I think, the the high, the highest priorities for coming from my perspective at NIMHC and infectious diseases.
• 26:28
  SPEAKER_01: No, thank you for sharing that.
• 26:29
  SPEAKER_01: I mean, I think I'll conclude with one final question.
• 26:31
  SPEAKER_01: You know, a lot of our audience consists of direct healthcare providers, physicians, nurses, infection preventionists who want to know, you know, what can we as individuals do at this phase?
• 26:40
  SPEAKER_01: You know, we know that there are these huge structural challenges, you know, structural racism and healthcare is an issue, healthcare disparities are an issue, but you know, sometimes as individuals, we feel like we we have limited power.
• 26:52
  SPEAKER_01: So I I'm interested in both of you sort of speak to our listeners as individuals.
• 26:56
  SPEAKER_01: So I'll start with Dr.
• 26:57
  SPEAKER_01: August.
• 26:57
  SPEAKER_01: What can an individual physician, nurse, you know, public health practitioner do to begin to address some of these important topics that we've covered during the podcast?
• 27:07
  SPEAKER_01: Any any thoughts on that?
• 27:08
  SPEAKER_02: So I I think the most important thing is looking at the individual.
• 27:12
  SPEAKER_02: The first thing is recognition and admitting that there are health disparities and that they exist.
• 27:17
  SPEAKER_02: That's the first step.
• 27:18
  SPEAKER_02: The other one is to recognize that there is a lot of mistrust in different communities and for different reasons.
• 27:24
  SPEAKER_02: Also to empathize.
• 27:25
  SPEAKER_02: And we may feel compelled to try to dispel a patient's conspiracy beliefs, but hearing and validating the patient's concerns before offering any education or new information may be a more helpful, more positive approach to building trust.
• 27:40
  SPEAKER_02: So that's what I would say.
• 27:41
  SPEAKER_02: I would say recognize that there's an issue, empathize, and then meet the patient at their level, and then we can grow from there.
• 27:48
  SPEAKER_01: So thank you.
• 27:49
  SPEAKER_01: Uh, and I'll I'll let Dr.
• 27:50
  SPEAKER_01: Perez Stable conclude.
• 27:51
  SPEAKER_01: So, thinking of your experience as a physician, what what do you think?
• 27:55
  SPEAKER_01: What can you speak to us as individuals?
• 27:56
  SPEAKER_01: What can we do to help address some of the many challenges that you that you've brought to our attention on the podcast?
• 28:01
  SPEAKER_03: Well, I think that Dr.
• 28:03
  SPEAKER_03: Agusa said it well.
• 28:05
  SPEAKER_03: As individual clinicians, we all contribute.
• 28:07
  SPEAKER_03: It all adds up, not only at your institutional organization, but also over time.
• 28:12
  SPEAKER_03: And people do respond to people.
• 28:15
  SPEAKER_03: Just because someone's a different color, gender, age, orientation, culture, doesn't mean you can't connect with them as a professional healthcare provider.
• 28:23
  SPEAKER_03: And I think that's important.
• 28:24
  SPEAKER_03: You know, show your humanity, keep the patient's best interest in mind and build that trust because it is therapeutic.
• 28:31
  SPEAKER_03: I believe that good clinician-patient relationships over time do promote good health and do save lives.
• 28:38
  SPEAKER_03: And every bit works.
• 28:39
  SPEAKER_03: Now, you can also work with your organization, make sure that people don't think that talking about injustice or race or inequality is impolite conversation and therefore it doesn't belong in in the C-suite of uh of an institution.
• 28:52
  SPEAKER_03: I think the times have told us that just ignoring it or letting time go by doesn't resolve it.
• 28:57
  SPEAKER_03: So I I do encourage everyone to continue.
• 28:59
  SPEAKER_03: And uh it has been uh an incredible year for the entire world, really.
• 29:04
  SPEAKER_03: But healthcare clinicians and and staff have really, really been on the front lines.
• 29:09
  SPEAKER_03: You've put your lives on the line in a way that can't be recognized enough for what has happened, not just in this country, but around the world.
• 29:16
  SPEAKER_03: And I want to thank everyone for having been there.
• 29:19
  SPEAKER_01: All right, well, thank you both for joining this podcast.
• 29:21
  SPEAKER_01: I think you both shared terrific perspectives and a lot of thoughtful ideas on how we can approach this really challenging topic.
• 29:27
  SPEAKER_01: So thank you again.
• 29:29
  SPEAKER_02: Thank you for having us.
• 29:30
  SPEAKER_03: Thank you, David.
• 29:31
  SPEAKER_03: Thank you for having us.
• 29:32
  SPEAKER_03: Yes.
• 29:32
  SPEAKER_01: So thanks to our speakers for sharing their valuable perspectives and experiences.
• 29:37
  SPEAKER_01: This podcast can be accessed on Shea's online education center, learning CE, under the Rapid Response Program.
• 29:43
  SPEAKER_01: You will find other resources which include recorded webinars such as advising schools during COVID-19 and the SHA COVID 19 town halls.
• 29:52
  SPEAKER_01: This concludes this episode of the Rapid Response Podcast.
• 29:55
  SPEAKER_01: Thank you for tuning in.