Responding To Our Most Vulnerable Populations Globally and Domestically

Last week we explored the impact of COVID 19 on inner city communities in and around Baltimore, Maryland. Some populations around the globe are being hit harder than others; globally our response to this pandemic has been less than adequate. We were especially unprepared to mitigate the impact the pandemic, that have devasted much of the world, had on the economically, socially and medically vulnerable. Slowing the spread depends, in large part, on how we respond to these populations. The Global Health Security Index: Building Collective Action and Accountability report, dated October 2019, articulates essential recom- mendations for global governments to consider as a means for the prevention, detection and rapid response to enormous public health threats. Are these recommendations the answer? Will they assist us with post pandemic preparedness to respond to our most vulnerable populations?

Show Topics and Highlights

Do you have some thoughts around how we have dealt with this pandemic at a global level?

“How do you think the US has done compared to other countries in response to this?”

“We have to set aside all politics and set aside all the ideology and look at what this virus actually doing to us.”

One thing that we do know now, for those who didn’t know it before, the COVID-19 pandemic certainly educated us that viruses know no borders.

“There's an amazing effort that was actually a grassroots effort in Baltimore called the Baltimore neighbors network, where hundreds of volunteers are calling thousands and thousands of people at home to check on them.”

How is Detroit’s response to the global pandemic?

The problems that arise when healthcare professionals are put in a position of having to make these difficult decisions with little or no guidance.

There's also an opportunity for us to do the work to impact policy. There are so many remote systems set up right now for those with the proper skill set to help.

“This is an opportunity, also where we get to see who can see the best of people sometimes in the darkest of situations.”

Profound Conversations Executive Producers are the Muslim Life Planning Institute, a national community building organization whose mission is to establish pathways to lifelong learning and healthy communities at the local, national and global level.   MLPN.life

The Profound Conversations podcast is produced by Erika Christie www.ErikaChristie.com

Full Transcript

Linda Howard

Okay, so we're are going to jump right in today I am going to moderate this discussion. And I'm Linda Howard and I'm the Chief Compliance and impact officer from listening life planning Institute. And today is our fifth episode of profound conversations. jumping right in, we are going to look at some of the issues that were revealed in the in the global health insecurity index. And when I when I looked at that report, it reviewed about 195 countries and One of the profound statements that came out of that report was national health security is fundamentally weak around the world. No country is fully prepared for epidemics or pandemics in every country has important gaps to address. And this is the report for 2019. So a lot of this work was done pre COVID-19. Now, while the US overall score ranked at number one out of 195 countries, that number does not break down to us by communities. And what we what we know and what has come out through some of our other profound conversations is that the Coronavirus pen pandemic is amplifying pre existing social connections Woody's tie to race class and access to health care systems. So we're going to break down the parts of the US we're looking at it at a global level, but we also want to break down the parts. And today we will add to the discussion, Detroit. The last couple of sessions. We had speakers that talked about some of the issues in the Baltimore area, but today we're going to bring in another part of the country into the discussion. So I want to start with Dr. Josh Sharfstein

who is with us

from john hopkins and I will allow dr Sharfstein to just give us a little bit of information about what you do and why you do it.

Dr. Joshua M Sharfstein

Thank you so much. And thank you for having me on. I am the Vice Dean for public health practice and community engagement at the school public. at Johns Hopkins, I'm also a pediatrician. And before I came to the school, I was the Health Commissioner for Baltimore and the health secretary for the state of Maryland. at the school, I teach classes, including class on the opioid epidemic class on public health policy and a class called crisis of response in public health. And so I'm very interested in public health crises not just as emergencies, but as opportunities to understand where there are needs for major improvements in our public health infrastructure. And, you know, I've been tracking the COVID pandemic from the beginning and, you know, both trying to understand with my students, you know, how the responses going and the weaknesses in the response. But I think the point you made is very important that epidemics and crises, expose and amplify existing inequalities and inequity. And, but they're also provide a path for people's understanding of those and hopefully a path for a better approach that can close some of those gaps in the future.

Linda Howard

Thank you. Dr. sharpstein. Are you familiar with some of the findings of the global health and security index?

Dr. Joshua M Sharfstein

Yes, at a broad level, I am I was involved in putting that report together, though.

Linda Howard

I know john hopkins was involved, but you, but you were not personally. And so if you think about some of the statement that I made in the beginning is that, you know, no country is really prepared. All of the countries, the hundred and 95 countries left something to be desired and your gaps. And this was pre COVID-19. Do you have some thoughts around how we have dealt with this pandemic at a global level?

Dr. Joshua M Sharfstein

Well, the reason the United States was first in that survey is because of the fact that we have a very technologically advanced healthcare system. That's not to say that it is a fair or equitable healthcare system, but very technologically advanced. We have a lot of ventilators, for example, relative to other countries, as you may know, there's some countries that have zero ventilators there's some countries where the ratio of intensive care unit bed, so the population is like one per million, whereas ours might be, I think, in that order of one per several thousand. And so, so what I'm worried about. So they're different. They're different risks in every setting. And there's just an enormous global risk from this illness, which we're seeing in different countries. You know, India is having very fast growth, and there are a lot of people who live in India, Iran had a very serious problem. There, there's a huge risk to countries with with a lot of people, particularly a lot of people living close together, and not very technically advanced in the sense of many hospital beds. And that that keeps a lot of people including myself, you know, up at night worrying about what can happen there. But one interesting aspect is that many of those countries have reacted a little quicker with the public health measures. than we have in the United States. So it has not been immediately such a big challenge in a lot of countries because they very quickly enacted social distancing. And some of those countries actually have very robust public health systems, for example, from going after a bola, and other infectious diseases. So in some respects, some other countries are better off than us. But on the other hand, as cases start to rise, and you really need more advanced medical treatment, and it's very worrisome.

Linda Howard

So how do you think the US has done compared to other countries in response to this?

Dr. Joshua M Sharfstein

You know, I think there are strengths and weaknesses of the US response. I think the strengths are that we were able to turn our lives around very quickly. And in doing so we averted the collapse of our healthcare system. I mean, there's no doubt in my mind that if we just kept doing what we were doing, we would have seen like what happened in Italy happened the United States where, you know, people were expressly rationing ventilators or many people died with other diseases because they couldn't get any care and that kind of pastor fee, we were able to avoid and that was because people really did do what they needed to do to, to physically distance from each other. So, I mean, I would put that in that good relatively, you know, positive category. But at the same time, I think we have not reacted as quickly to set up the structures that we need to be preventing illness. In particularly in in the most at risk communities. We we have not had protective equipment for healthcare workers and other essential employees for grocery store workers for bus drivers that we need. We've been way behind in that we have not been able to set up testing very effectively. We've had political disputes and all kinds of, you know, finger pointing instead of, you know, national leadership to work. together. And I think the result of that has been a choppier response than we really needed to have. So I think the US response could improve a lot, I really hope that we're able to find effective treatments and a vaccine as quick as possible. But we can't, we can't bet on that we have to assume that we won't and that we're gonna need to find a path to working together, you know, to address these, these challenges that are now clear and right right in front of us.

Linda Howard

Now, when I look at some of the things that have been happening, and certain communities throughout the US with the pandemic impacting particularly black and brown communities, in a way that it has not impacted other communities, and I know we have not seen the wave in some countries around the world, but when you look at the the index in terms of the rest Venus for pandemics, we have a lot of countries who are ranked very low and who are not prepared at all, for if there was a pandemic, and I'm wondering what what is it that we could do differently? Learning from some of the mistakes in what might be some things that some of the countries can do that are ranked pretty low with respect to their readiness?

Dr. Joshua M Sharfstein

Well, in terms of what we can do for our mistakes, I think we have to take up, set aside all the politics set aside all the ideology and look, what is this virus actually doing to us? Where is the virus causing problems? And just like you said, there are communities that are hitting much harder than others. What can we do to help them what are the underlying causes of that increased risk? How can we address those? And I see Dr. Cooper is here. So she I'm sure we'll talk about that we've written about this song. You know, I think we have to stare these things right in the face and sometimes in be united states we haven't been willing to do that the the housing crisis for example that keeps people unstable the house or living close together the food crisis where so many people are food insecure the transportation challenges which keep people you know stuffed in, in buses for long periods of time instead of more easily able to move around these things are risk factors now. And the fact that low wage workers are often treated so poorly. These are things that put us all at risk from the virus. And so I think it's important to be talking about these things. There are other issues too, how prisoners are treated. You know, that's a huge risk for infection, how nursing home residents are treated and are very, you know, unstable system, you know, with a lot of problems that we've had in taking care of older adults. Now it becomes this huge weak spot and how the homeless people experiencing homelessness are treated. It's these are things that don't dominate the headlines, you know when there's a pandemic, but it is really important to pay attention to them, you know, Singapore had is an interesting case, because Singapore is had one of the best public health responses to the virus. And in the first way, they were able to control it entirely through a fantastic public health system. But they've had a huge surge in cases, thousands of cases, and they've had to shut down their whole country to deal with it. And essentially, all of those cases are an immigrant workers who turns out live in dormitories, 10 to 20 people per room. And so, you know, I'm I'm imagining that those workers were not, you know, front page news before this all started, you know, that like some of the different areas of the United States that it wasn't just it wasn't a big focus people probably just took them for granted and maybe I'm, I'm surmising too much. But this is a virus that seeks out you know, any opportunities to transmit? It does Doesn't know who's socially favorite and who's not socially favored. We've got to be able to take off all of our preconceptions and really focus on where the risk is if we're going to be able to be successful, you know, to your other question about countries that are really in harm's way because they don't have the resources. I think it's really important for the global community to stand by them and help and try to get them low cost ventilators try to get them protective equipment for their healthcare workers, otherwise we could have a total devastation of their healthcare systems.

Linda Howard

Yeah, and one thing that we do now what I think if people did not know before, the COVID-19 certainly educated us that viruses know no borders. And so when we talk about what what do we need to do for the US, when we leave out the global community out of the discussion, it's, it doesn't recognize that we are we are one world And what is happening in one part of the world will ultimately impact other parts of the world. And I see we have Lisa Cooper that have joined has joined us in Lisa, Dr. sharpstein has a limited amount of time, but I do want to prepare you. Because I will ask, I know that you have some experience in working in sub Sahara Africa. So I will, you know, ask you to kind of weigh in on what may be happening, what may be happening in that part of the world. And Patty is back with us. And Patti is in Detroit. We know that Detroit is also a real hot spot. So we're going to have this discussion at a global level. And we want to have it at looking at some of looking at some of the communities so I will just tell ask the two of you to really get ready To be able to join in on the conversation.

Because Dr. Sharfstein has about 10 more minutes And his time is short with us because he's out there doing the work. And I know you've had a number of meetings and I think you've been doing some work with the, in the state of Maryland as well. Can you talk a little bit about maybe what you're doing?

Dr. Joshua M Sharfstein

I can just say, you know, the other meeting has to do with a report that we've worked on for the National Governors Association, which makes some of the points that I just made that says states really do have to use the science look at where the virus is, and and rethink some of the, you know, really invest in approaches that are going to be successful so that we have a release of that report coming up in Maryland. And in Baltimore. Johns Hopkins is very, very involved and Dr. Cooper can speak to this also, we've set up in Baltimore a public private partnership with the city. Its involves Johns Hopkins, University of Maryland, and others working closely with the city and a bunch of different areas. In involves clearly coordination around medical issues like Johns Hopkins Hospital, the establishment of an alternate care site at the convention center. But it also includes things like a call center for people who may not have access to health care to their doctor, maybe they don't have a doctor, but they can call the call center and they can get a telemedicine doctor right away and get referred for a test and and eventually treatment. So we're creating past treatment for people who may not have them. Otherwise, there's also a big effort to support the social stability and of people in in Baltimore, including through efforts to expand access to food. And the university is one of the city's partners in that, as well as emotional and mental health support. There's an amazing effort that was actually a grassroots effort in Baltimore called the Baltimore neighbors network, where hundreds of volunteers are calling thousands and thousands of people at home to check on them. And there are also volunteer therapists who are on call in case people, you know, really sound like they're in trouble to bring in a professional to help. And there are many, many students at Johns Hopkins and elsewhere who are participating in that. So it's a it's a broad range of things. There's a lot of work going on with the City Health Department, the state health department. It's a kind of an all hands on deck moment for our region as it is for the science of what what can be done to address infections.

Linda Howard

So if you mentioned a couple of ways that people can volunteer, so if someone on this call wanted to Do that, how would they? How would they go about it?

Dr. Joshua M Sharfstein

That's a good question. I think if it's somebody who is living in Baltimore, the best thing to do would be to probably call 311. And ask, you know, for volunteer opportunities, if they'd have a particular area that they're living in, in the city to probably talk to the neighborhood association, because they may have different activities going on. There's also it's possible to sign up for the mayor's messages which talk about different events that are happening. So I think I know that there are many, many people around the city volunteering in different ways.

Linda Howard

And I know you mentioned, you know, therapists and i and i know we have quite a few in the mental health space that join our discussion. So is there is there another number or would you also recommend them to call the 311?

Unknown Speaker

You could look up the bottom or neighbors network and there's also something called pro bono counseling. I had a chance to talk to the person who runs that and that is the organization for counselors who can volunteer for exactly this sort of thing.

Linda Howard

Okay, and then, before I ask if there's any questions, I just have one more question for you. Can you say a little bit about the contact tracing?

Dr. Joshua M Sharfstein

Sure. So the idea behind contact tracing is, we want to prevent the virus from jumping from one person to another. So, if somebody's sick, then we can tell them that they need to isolate themselves and support them in isolating themselves. So then they won't give it to anyone else, but they may have already given it to someone. And so you look back and you go, like, who did they have contacts with? reclosed contact during that period of infectiousness? So let's say there are five people 10 people, they say, Oh, well, you're talking about the last four days here, the people I really spent time with. Then someone from public health, calls those 10 people and says, hey, you've been with someone They're close enough with them, that you may be at risk for infection. You know, I'm not gonna tell you who it was, as you know, the public health won't won't do that. But you know, you have been potentially exposed. And we were going to recommend based on the nature of exposure, we'll let you know that, that you quarantine yourself for two weeks. And so people have to do to stay out of harm's way and the person goes out pointing myself for two weeks, I don't have any food. It's like, you got to be able to provide food. You got to say, Okay, we'll get you food, here's how we're going to do it. You got to be able to support people in both isolation and quarantine. But if that person will quarantine themselves, then they can't pass it on to anyone else because they're not having any cut off the ability of the virus to jump to someone else. So you isolate the contacts, you isolate the cases, you trace their contacts, and you quarantine the contacts and what you've accomplished is you made it very hard for the virus to find more people that jump into.

Linda Howard

How far back do you do the trace?

Dr. Joshua M Sharfstein

You know, some of those details are being worked out, it's probably two days before the onset of symptoms. So if if I'm the patient and you're the public health worker, and I go, Well, I just found out I was positive today and today is Thursday. Right? And they will When did your symptoms start? My symptoms started Monday. All right, let's start on Saturday. Tell me who you're with on Saturday. So I think that's probably more or less what they're gonna do.

Linda Howard

Patti, if you have any questions that a question that you want to ask Dr. Sharfstein before . .

Dr. Patti Magyar

Okay, is it okay? Yes. Okay, good. Pleasure to meet you. And really excited about considering our entire world truly as our community That level, because there has been probably very expeditious sharing of information. . .

Linda Howard

I think the point she was making is that scientists have been sharing quite a lot of information. And that is absolutely true. I've interviewed some scientists who say every day they get on, and there are scientists around the world who are communicating about their Coronavirus and what's now now.

Dr. sharpstein, I will allow you then, to give a final word before you run off

Unknown Speaker

Well, thank you again for having me, you're doing a really important service to get good information out to people. And I hope everyone who's listening and is able to be a source of knowledge and information for those around them. And that's how we fight the virus is with the spread of good information. So thank you very much for having me.

Linda Howard

Thank you so much for joining us.

Dr. Joshua M Sharfstein

Take care.

Linda Howard

All right. Dr. Cooper, you're on. So we started out the discussion, asking Dr. sharpstein to tell them A little bit about what he does and why he does it. So I will ask the same question of you.

Dr. Lisa A Cooper

Okay. Well, I'm a physician trained in internal medicine. And I'm also a social epidemiologist. So that means I study how diseases affect populations, but specifically how social factors so things like the quality of housing or the the social environment, the kinds of relationships people are in and the kinds of social connections they have and their exposure to skirt discrimination and things like that, how that actually impacts their health. But as an internist, I, I've treated people with chronic conditions like heart disease and diabetes and kidney disease and asthma. And so I've been really interested in basically unpacking why there are racial and ethnic disparities in health and especially Those chronic conditions and what we can do to address them on multiple levels, you know, so all the way from the individual behaviors that people engage in to the health systems in which they get their care to kind of like the policies that we have that impact the social environment and the physical environment. Now, you do work in that equity, what is it equity and health health equity? I do I do I direct a Center for Health Equity. So in that center, we do research, we do training and then we actually actively engage with community organizations and community leaders to make sure that we are using the research to actually impact change and action to improve health.

Linda Howard

I will ask that you help us maybe bridge the discussion. And I mentioned that You know, I know you've done some work and sub Sahara Africa, I have started out talking about the, on the global health insecurity index, and how the US was actually ranked number one. And the majority of the African countries fall very low on that scale. And, and, and I know, I know you have a connection to Liberia.

Dr. Lisa A Cooper

I do. I'm actually a native of Liberia.

Linda Howard

And Liberia was was ranked 111 out of 195.

So not great.

But it was in the company of a lot of other sub Saharan African countries. So can you talk a little bit about kind of the readiness of, of the sub Saharan African countries For diseases like COVID-19,

Dr. Lisa A Cooper

Well, a lot of those countries don't have sophisticated healthcare systems, right? A lot of them don't have a lot of the technology and the equipment and the numbers of staff with experience and clinicians with experience to deal with a pandemic like this, you know, where thousands of people might be ill at the same time and might really need some sophisticated medical treatment to deal with it. So I think that's a big part of the problem. But they do have other other things that can benefit them and Josh, Dr Sharfstein alluded to some of those things, and that is, many of them do have a pretty strong and robust public health system, you know, so they do have a lot of those people that do go out and do a lot of the contact tracing. You know, we know that during the Ebola epidemic, for example. One of the reasons Liberia was able to get that epidemic under control in a reasonable amount of time was because they did such an effective job of like not once identifying a case, it's to do all of the contact tracing, and to keep those people from spreading further. So I would say that that's the sort of the silver lining of this cloud is that if those countries are able to effectively use some of the public health strategies they've used before, that they should be able to effectively contain this epidemic. But again, a lot of it is going to depend on how, how able they are to do that. And you know, some of it, frankly, is going to be some of the other things they did, which is really to work with community leaders to get the correct message out, and to have people who are trusted by the communities so that those community members would listen and would engage in the right practices. So I think, you know, building on those That's a real advantage. If not, if they don't do that, then they're going to run into the situation where their healthcare delivery systems cannot accommodate the number of sick people. And that would really, really be a tragedy.

Linda Howard

Now, how would you compare that to what we're seeing in some of the lower income neighborhoods in the black and brown communities in the US, in particular, because I know you've been doing a lot of work in Baltimore, and having that experience of working in sub Sahara Africa. Is there similarities? Are there differences?

Dr. Lisa A Cooper

I would say there are definitely similarities. You know, a lot of the same issues that have caused people in black and brown communities in the US to become sick are the same issues that play for people, but that's for use of terminology that have really, you know, been a serious challenge to people in developing countries. So, you know, it's things like not having high quality housing, or not having safe water to drink or, you know, having enough like healthy food to eat, you know, it's having not having enough money, you know, to pay for basic resources, it's not having access to high quality education so that they can get jobs that pay a decent wage. So a lot of those things are very similar in Sub Saharan Africa and in black and brown communities in the United States. That the mistrust of authorities is something that we've seen in Sub Saharan Africa as well as in the US, you know, there's a whole legacy of discrimination in this country and even you know, to this current day, and so many people in black and brown communities don't actually trust what's being told to them, they don't believe that this is a real virus or they may not actually believe that it's necessary for them to do this. Things that they're being asked to do. So we've seen some of those same kinds of issues of mistrust. And, you know, all of the challenges I mentioned to you across the board, the difference is us. We do actually have resources, we do actually have healthcare systems that are there to deliver the care, so that if we actually could get people to the right place, and if these resources were distributed more, you know, equitably, that people wouldn't have those challenges. You know, that's different, you know, in Sub Saharan Africa, where really, there are inequities there, but the truly, they don't have the capacity to handle all of the people that might need care. So I think those are the main differences and similarities that I see.

Linda Howard

Patti I'm hoping that your internet connection is back?

Dr. Patti Magyar

You should hear me now.

Linda Howard

Yes. So Patti has been doing the work in Detroit. And we've talked over the last couple of weeks a lot about Baltimore. Can you just tell us a little bit about what's happening in Detroit in terms of the in terms of the health care of the COVID-19 and how it's impacting communities there?

Dr. Patti Magyar

Absolutely. Well, as you suggest, and no, Detroit has been very hard hit. And we've had strong leadership with our governor, as well as the mayor of Detroit. But it's helpful to know that in Michigan, the African American population is 13.6%. But also in Michigan, very sadly. 40% of the COVID deaths are happening. African American. So that has raised many questions to which the governor's response has been in it will not only be this, but very importantly, she has designated her lieutenant governor who is an African American man to lead a group coalition actually, that is looking at racial disparity, and COVID-19. Because we've done a lot of great data tracking, in terms of total numbers. But we haven't necessarily been real clear at this point. And perhaps not many places, if any in the country in terms of how that breaks down, in terms of races, socio economic, we know something about zip code, all of that's broken down and our website for Michigan. michigan.gov is wonderful in terms of resources and information. But obviously in a place like Detroit, many of the same things have been experienced. Early on four weeks ago, we were really dealing with the dilemma of bus drivers being very threatened, because they did not have protective equipment. And they were very afraid. And then one person actually did get infected. And it really created a lot of concern and a change in what was happening with bus driving. So we've tried to have very ready responses that had meaning. But to jump into the bigger issue in terms of the governor's Task Force, they actually have a very ambitious agenda to within 90 days have real time solutions that will be operationalized as they go forward. And that really holds some promise for me, especially as we anticipate there could be Research of COVID-19 in the fall, I hope not, as we all do, but we got to use the time in between to truly prepare and start to put fixes on these major gaps and prioritize well.

Linda Howard

Dr. Cooper do are we seeing similar numbers and Maryland, that Patti shared that the disparity between the percentage of the population and the percentage that is being impacted or dying from COVID-19?

Dr. Lisa A Cooper

Well, I would say across Maryland, we're not seeing quite that level of disparity. It looked like there was a somewhat of a disparity among African Americans and whites on the state level with African Americans representative representing about 40% of the deaths relative to their representation in the population which is around 30%. So not as much of a gap there. In the city of Baltimore, I think that the gap between blacks and whites and between Hispanics and whites is a little bit greater and looking a little bit more like Michigan, but not quite to that extent.

Linda Howard

I know Maryland was a little slower in terms of releasing that data. So has the has that data broken down in a way that we can really look at what is happening in Baltimore, in particular,

Dr. Lisa A Cooper

It has, so the data has been broken down by race and ethnicity across the state and then also by county and zip code. So we are able to look at that and we have seen that zip codes that have a higher proportion of minorities are having higher rates of infection, and deaths, and that's in Baltimore City, but across the state as a whole, we're not seeing as much of a gap.

Linda Howard

Now, when we put together this particular this particular profound conversations, we we said we wanted to look at the readiness in terms of the post pandemic situation. But when I'm we do know that there is a prediction that there may be another wave coming into fall. So we may not actually be looking at just the post, but the kind of the in between, which means that we have a very short window of time to to respond and to address some of the inequities that we've seen with this first wave. And I'll ask that question of either one of you. Is there something that you think that we should be doing at a policy level, what we should be doing at a community level, and what maybe the health system should be doing in order to address some of the inequities that we've seen in this first way So that was a compound question you got you got anything you could pick from you can pick from an equity

level community level.

Dr. Patti Magyar

Dr. Cooper I'll just share briefly and then I'll let you expound because you've got a lot of wisdom with this. I know, I think that we really need to look at our vehicles of communication. And I think we've done a good job in many respects, because radio and television are probably the most reachable for most people. But we are fooling ourselves if we think that smartphones or computers and websites are the way because again, we have to think about access, and how do people obtain and how can they digest and trust the information that they get. So I would hope that socially we really engage with leaders of various communities who are trusted. To help empower them with information so that they can then provide hope, as well as commitment from people in diverse populations so that there can be compliance. Because even when I look at the list of the four things that you can do to prevent an infection, wash your hands distance from sick people. Well, how do you do that second one, especially if you In fact, are in an apartment with multi generations, or you don't have food, many, many different compounding factors. So Dr. Cooper, I don't know what you would think about working with leadership in that way, within various groups and I think identification of key groups is important.

Dr. Lisa A Cooper

Yeah, I actually Patty, I do agree with what you're saying completely. I think that communication is key, and also connection with community leaders. I think using the right vehicles and the right messengers in that case, in some cases, it could be religious and faith leaders and other cases, it might even be artists or other people who are well known and well respected, you know, in these communities that look at people of different age groups, and different cultures and backgrounds, different religious orientations to be out there giving the messages. So I think that that's going to be critical. I also think not waiting for people to come to us, but going to them. So a lot of the testing centers have been set up in places where people have to, you know, travel to get to them. I think by using some of the data we have, we can identify which neighborhoods and which areas are more in need of testing centers, putting them there, so people can come and drive through But also like having testing resources that are available by mobile vans, for example, to drive over to people's neighborhoods where people don't have cars and it might be easier for them to just walk to get to. So I think working to do those kinds of things, working with policy makers around, setting up resources for those kinds of efforts is important. I also think it's going to be really important to, you know, on a state level to expand Medicaid to allow people to be able to apply for Medicaid, especially people who have lost their jobs during this time. I think making sure that there's adequate unemployment insurance provided to people during this time is going to be critical, I think, again, working with lawmakers around the legislation around not the laws around not allowing people to be evicted at this time but then also working with the landlords because many of them are saying, you know, they need access to some of these loans and financial resources so that they don't go under as well. So I think a lot of those efforts will be important at this point in time, as well as working with small businesses and people who provide food in these neighborhoods, really a lot of grassroots work and a lot of working with community based organizations and businesses. So I'm really looking for leadership on the local level and on the state level. And and, you know, in Maryland, fortunately, we've seen a lot of that. So I'm optimistic about it, but it's going to take a lot of work and we can't sort of just relax because we see a slight flattening of the curve.

Linda Howard

So, I'm,

I'm going to ask you a little bit about the medical community because you are a physician. So what would you say to your fellow physicians in those other clinical people, in terms of what we might be able to do? You better at a clinical level at hospital systems positions to prepare ourselves for this potential next wave that may be coming.

Dr. Lisa A Cooper

Well, you know, this is a really, really difficult time for people in the health professions and so many of them are sacrificing a lot. This point in time, a lot of them are away from their families because they don't want to spread infection to their families. And but at the same time, they're so committed to the work and to care patients that they're, they're willing to do those things. They're willing to put themselves at risk, frankly, you know, because knowing that a lot of hospitals and healthcare systems don't have adequate personal protective equipment at this time, but I think it's kind of the message to our my colleagues is is I have to be compassionate and empathetic towards them at this point in time. I think people are, are working under extreme conditions. You're making a lot of sacrifices. I think Basically a message basically a message of the fact that we are all in this together, we're going to work to help each other many of us who don't do hospital based work may actually step up to begin to do some of that so that our colleagues don't burn out. I think making sure that we've worked with the leaders, the administrators to procure the equipment that we need, is going to be really important. I think that we want to make sure people guard against what happens when they are overly fatigued and stressed that sometimes they might end up taking shortcuts on their fair decisions, or, you know, tweeting certain people differently. You know, but just we need to acknowledge with them and validate, you know, the real dilemmas in which they find themselves because you know, if there's a shortage of treatment or pressure equipment and how are they going to decide like which patient gets what and how much they audit how aggressive they ought to be with some patients versus others. This is a very, very difficult situation. And I think we should just tell them that we're here for them. That we are, you know, in this together, and that we are going to advocate advocate advocate for everything that we need. So we don't put ourselves in the position where we are the ones that have to decide who lives and who dies, because nobody wants that kind of responsibility.

Linda Howard

That is the subject for one of our next shows, is to really just talk about some of those ethical considerations. And I know, I know, Patti, you've been doing a lot of work in that space as well, just looking at, you know, those kinds of issues when, when the healthcare professionals are put in a position of having to make these difficult decisions with little or no guidance.

Dr. Patti Magyar

Yes. Well, and I want to end interject that I'm very proud of Henry Ford health system in Detroit because the communication has been at least twice a day, very clear and transparent. But to add to the complexity of health care, is that yesterday, it was announced that because of the very serious budget Attack of the caring for this preponderance of COVID-19 patients in Michigan, by our system at Henry Ford, as well as the Beaumont health system, and the two of us have been the most heavily hit, we've had to each furlough 2500 healthcare workers within our system, effective yesterday. And so the complexity there especially is the fear and the suspicion that arises in that kind of situation and we have a very collaborative, pretty trusting environment and yet they starts to get very personal. And at this point, I don't know. And it probably wouldn't be appropriate for me to share what kind of positions and people are affected. But even there, I immediately was concerned because we have such a heavy black population in Detroit. 80% of Detroit is black. And so a very heavy preponderance of our staff are very ethnic, ethnically, have a lot of diversity in their ethnicity. Sorry, it's getting late for me. But I think it's important to realize that there are even different kinds of complexities and issues that are on the horizon. And then to anticipate that we might have to prepare for another swoop of this is almost mind boggling. And yet we can't get into that mindset. We need to be always ready

and become more ready as time goes on.

Linda Howard

In what I've heard from this discussion is That, you know, there's opportunities want to support the physicians and other clinicians looking at some of the stresses that they are under. There's also an opportunity for us to do the work to impact policy. And so I'm actually appealing to some of our listeners, that if you have that skill set, where you can have an impact on policy, where you can provide, you know, clinical support to those that are out there on the front line, as you know, doctors and doctors and nurses that you look for ways that you can do that. And of course, right now, a lot of this work is being done remotely, but there's so many systems that set up now, to be able to do some of that work remotely from, you know, telemedicine and in the zoom conferences that we're doing here, um, I just clicked over to look at some of our attendees so we'll have I happen to be familiar with some of the the individuals that are on the phone. And I know we do have at least two physicians. That is that are on that's on the line. And one of them will be our speaker next week. And that's Dr. Mark Pettis, which was out of was out of Massachusetts. And, and we also have another physician, Dr. Anthony Thomas, who's on the call who's who does work in, in Maryland, in Baltimore, Maryland. So I just want to thank all of you that are out there on the front line, I'm doing the work, because it's difficult work. And I just want to acknowledge that and give and personally give thanks to the work that you're doing. So, and I think we also have Dr. Hill who's on the line, as well. So thank all of you, and and I'm kind of scanning I'm scanning through the list. So if I missed anyone Please accept, you know, please accept my apologies for that. Well, we have about eight minutes left for the call. And if anyone has any questions, if you can type those, if you can type those questions, type those questions in to our chat, or the question the question option. And while I'm just waiting for some of those questions to come, don't be shy about the questions. Even some of the doctors who I've mentioned, throw some questions out there for us. But I just want to also just do a really, really special thanks to to judge you because j is J shoe has really supported the profound conversation in Muslim life planning Institute. You know, Dr. Hale from JSU, we've had Dr. Sharfstein/ Dr. Cooper. Last week we had, you know, Dr. G, so I'm really We're really thankful for for the support that you have the support that you've given. I know some of you are from john hopkins, here in Maryland, some are from from Bayview, Somerville, Bloomberg, but it's all one family. So thank you. And Patti, who is with Henry Ford. We've been doing a lot of work with like planning Institute has been doing a lot of work with with in Detroit, and Henry Ford hospital system have been very supportive of the work that we've that we've been doing in Detroit. So wanted to also acknowledge that. All right, and I did all that talking. And I don't see any questions.

Dr. Lisa A Cooper

We have some shy people out there.

Dr. Patti Magyar

Yes. Let me just share that something that we're doing it Henry Ford, and even within transplant where I currently am working full time, we are having twice a week, meditation sessions, as well as psychological get togethers that I really focused on a very narrow topic. It's only a half an hour. So it doesn't require a lot of people's time. And then we have many different ways of people connecting on staff to help lines as well as through other support groups. And it's just been phenomenal to see all of that evolving very quickly, quite honestly. And it's so necessary because people are fatigued and devastated when they're having these close up. contacts with death and the threat of death day in day out.

Dr. Lisa A Cooper

Right. I you know, I couldn't agree more and I didn't mentioned but Johns Hopkins has a lot of those similar things going on the Meditation, my mindfulness sessions, actually morning, noon and evening. You know, all kinds of support services that are being offered. And even community members who are having sort of group sessions for a group counseling or just people being able to share you know, grief groups. So it's been really an outpouring of, you know, compassion in a lot of people sort of putting themselves out there and offering themselves to be supportive to not only health professionals but also to their family members and family members of people who have been ill because you know, so many of them are going through so much at this time, not actually being able to visit with loved ones. But so there's a lot that's being done for people letting people know that that health professionals are actually there with their loved ones. And, you know, reaching out to them by by cell phone, by zoom or whatever, so that they can speak to their loved ones during this time, I've just seen, this is an opportunity, also where we get to see who can see the best of people sometimes in the darkest of situations.

Linda Howard

Well, I want to thank both of you for joining us in this profound conversations today. And also, we have to give our thanks to our team, the team that that makes this all happen. And those are my business partners and my brothers, Karim Ali and Samuel Shareef, who were part of the LPI executive team. We also have Erika Christie, who is our who is our engineer, and Erika does a lot of the work behind the scenes to make all of this happen. I know she sets up our calls with our, with our presenters to do the test before forehand, so thank Erika as well. And we look forward to help. So it looks like we have one question and the question is "Thank you, Linda." (laughing)

So,

yeah, thank you very much for for all of your for all that you do to make this happen. And next week we will continue this discussion. And we have two presenters next week, which is Dr. Pettus and Dr. Galea. So, if you have not reached out to us to make sure your name is on our mailing list, please do so. So thank everyone for joining us.

Dr. Patti Magyar

Thank you.

Dr. Lisa A Cooper

Thank you.