School of Public Health

HSC researcher, colleagues investigate intersections of COVID-19, TB control and global economics among immigrant communities

By Sally Crocker

Thaddeus Miller
Dr. Thad Miller

The world’s attention has been laser focused on COVID-19 for months, but the current pandemic isn’t an isolated problem threatening the health of communities, points out one HSC public health researcher.

“Many other infectious diseases, like tuberculosis, share similar characteristics and present dire health risks, require equal consideration of resources and prevention, and may, in fact, offer insight into models for controlling contagion and saving lives from COVID-19,” said Dr. Thaddeus Miller, HSC Associate Professor and co-author of a recent editorial for The Union, a scientific-based lung health organization, prior to publication in the International Journal of Tuberculosis and Lung Disease.

TB has long been a public health focus area for Dr. Miller, who leads one of the CDC’s 10 select U.S. research sites, based at HSC.

“There are epidemiologic overlaps between COVID-19 and TB,” Dr. Miller said. “Both are passed through close contact, both impact the respiratory system, and both diseases are more serious for already at-risk individuals and populations.”

“Anybody’s health is everybody’s health in a pandemic, and to deny that is to risk the health of everyone,” he said.

Immigrant populations, especially from countries at higher risk for TB, have long been a focus in the U.S. for testing, treatment and prevention, and may be more vulnerable to COVID-19 as well.

Language barriers, economic challenges and healthcare access can be contributing factors for risk, as well as fear of seeking resources among undocumented populations, employment or living conditions where close contact is more common and less opportunity to quarantine without serious financial hardship.

“The community spread of COVID-19 into the existing U.S. immigrant population mix of poor healthcare access, higher poverty rates and political disenfranchisement creates a perfect storm,” wrote Dr. Miller and colleagues from Drexel University and the University of Utah, “threatening an epidemiological disaster about which there appears to have been little to no discussion by policymakers.”

In these populations, the demographic risks for COVID-19 run almost in lock step with the risks for TB, Dr. Miller said.

“Ignoring the parallels between these two infectious diseases would be somewhat like a neighbor who sees fire ants next door but doesn’t consider the other family’s problem as his problem too.”

According to Pew Research Center, the United States has more immigrants than any other country in the world, with more than 40 million people living in the U.S. who were born in another country. Pew reports that most immigrants, about 77%, are living in the U.S. legally, with about 23% unauthorized.

“Failing to consider the impact of COVID-19 on those who don’t live here legally can increase the risk for everyone. The goal should be for all those living in the U.S. to be inside our safety net,” Dr. Miller said.

The authors are also concerned that with COVID-19 requiring so many resources, important TB efforts may suffer, as well as other public health needs with far-reaching global impacts.

TB killed 1.5 million people worldwide in 2018 and infected millions more, and even with COVID’s astounding climb, TB is still expected to account for a higher number of deaths globally in the years to come.

“As we continue fighting the flames of COVID-19 ahead of us, it’s important to not turn our backs on the other fires still smoldering behind us,” Dr. Miller said. “They’re not going away, they won’t wait on us to start paying attention again before flaring up.”

World economies also rely in large part on U.S. immigrant populations, who often help support families in other countries.

“The health of U.S. immigrant populations has far-reaching impacts at home and on the global community, both in terms of the resources they need to stay healthy and productive here, and the meaningful ways they contribute funds and goods back to their extended families and economies around the world,” Dr. Miller said.

“The consequences of poor health have a great affect on all of society.”

“Problems like COVID-19, TB and other public health concerns show how much larger the world’s health is than where a person comes from, how much money they make or the resources they have,” he said. “Reducing the risk for one population reduces the risk for all of us.”

Thaddeus Miller
School of Public Health

HSC dedicates musical tribute to healthcare heroes

By Sally Crocker

Stephan Davis Aupha

Layer upon layer, a music video is developed, as is a heartfelt message of utmost respect and gratitude.

Such was the case when the HSC School of Public Health planned a special tribute to the healthcare industry, recognizing the many challenges that hospitals, providers, staff and support workers have faced over the long months since the COVID-19 pandemic first barreled into states and communities across the U.S.

“Now, with COVID-19 resurging to unprecedented highs over the summer, it is an even more important time to thank the nation’s healthcare leaders and providers who are working in difficult and dangerous situations to fight the pandemic and help stop the spread of this highly infectious disease,” said Dr. Stephan Davis, Director of HSC’s Master of Health Administration program.

Working with staff from the Association of University Programs in Health Administration (AUPHA), Dr. Davis and Dr. Arthur Mora, Chair of the HSC Department of Health Behavior and Health Systems, pulled off a surprise opening to this year’s AUPHA annual conference, which was moved to a virtually-attended and recorded event this year.

The AUPHA network includes colleges, universities, faculty, individuals and organizations dedicated to the improvement of health and healthcare delivery in healthcare management and policy education.

Making a music video isn’t an easy process, or a quick one, but as this year’s AUPHA Conference Tribute Sponsor, HSC wanted to do something very special to show how much healthcare professionals are valued in these challenging times.

“The HSC School of Public Health is lucky to have a very talented musician on our faculty, and Dr. Davis was more than willing to select and arrange a well-known song we could make our own for this event,” Dr. Mora said.

A longtime composer and saxophone performer, Dr. Davis found just the right musical material, creating his own version of “Hero,” originally made famous by Mariah Carey.

After finding a high-quality background track, securing copyright approval and scheduling time at a local recording studio, he consulted with a videographer he had worked with before.

With in-studio social-distancing protocols in place, Dr. Davis played saxophone over the background to create the first musical layer. Additional layers of embellishment were then recorded over the song’s final chorus, to build on the melody and create the sound of multiple saxophones playing together.

The audio file was mixed and emailed to Dr. Davis, allowing him to develop the third layer – the video portion – from his own living room at home.

“Even though we weren’t recording for sound at that point, I upped my speakers and played along with the studio mix so the visuals could be realistically captured, as though actually playing live in that moment,” he said.

This method of visually “playing along” enabled Dr. Davis to shed the neck strap, headphones and microphone typically needed for audio production.

Overall, the video was produced in record time – less than two weeks from top-secret idea to finished product.

“We wanted to create a storyline highlighting the roles and sometimes competing priorities of various frontline healthcare workers, so in the finished video, you see different characters, including a wife, mother and professional as she goes through different aspects of her day, caring for others both on the job and at home,” Dr. Davis said.

The story unfolds through cinematic background footage, with the musician’s face as the only live performer recorded.

Dr. Daniel Gentry, AUPHA President and CEO, said the video both moved the organization’s members and took them by total surprise.

“I can’t think of a better way of opening our virtual meeting than with HSC’s tribute to healthcare heroes everywhere,” he said. “We thank HSC, Dr. Mora and the entire team, and especially Dr. Davis, for this tribute and sponsorship of our Annual Meeting.”

The amount of work that goes into an endeavor like this, Dr. Davis noted, “is far exceeded by the emotions and deep gratitude so many Americans are feeling right now for our nation’s healthcare workers.”

“I haven’t felt this moved and inspired in a very long time,” he said.

View the video: Healthcare Heroes

Stephan Davis Aupha
School of Public Health

New research points to far-reaching public health concerns of pandemic stress drinking

By Sally Crocker

Covid Drinking

 

There’s a lot of drinking going on during COVID-19.

Dana Litt
Dr. Dana Litt

Takeout, home deliveries and curbside pickup of beer, wine, liquors and other alcoholic products have increased significantly – from 40-50%, according to different sources – over the months since the U.S. first locked down over coronavirus concerns.

“There is a tremendous amount of psychological stress associated with the pandemic, and a lot of people are really suffering,” said Dr. Dana Litt, a faculty researcher with the HSC School of Public Health who studies drinking patterns and develops alcohol preventions and interventions.

“People are drinking more than normal, and what’s concerning is that we’re not likely to see those numbers go down anytime soon, since COVID-19 will probably be with us for a long while,” she said.

Dr. Litt joined social psychology researcher Dr. Lindsey Rodriguez from the University of South Florida-St. Petersburg and Dr. Sherry Stewart, Canada Research Chair in Addictions and Mental Health at Dalhousie University’s Faculty of Medicine, to examine the ways that COVID-19 psychological stresses are impacting drinking behavior among men and women ages 18 and older.

The results of their study – surveying 754 U.S. adults split equally between males and females, with an average age of 42, who were working either part- or full-time during the April 17-23, 2020, time period when the pandemic and state lockdowns were hitting most Americans hard – will be published this fall in the peer-reviewed journal Addictive Behaviors and is in early, online release now to the scientific community.

Dr Lindsey Rodriguez
Dr. Lindsey Rodriguez

Participants were asked about their alcohol use and their thoughts and feelings on the COVID-19 pandemic.

The research investigated how worried and afraid people were about the virus, how stressed they felt about being around others, and whether the pandemic was impacting their psychological well being and making them feel depressed.

These feelings and reactions were correlated to respondents’ self-reported alcohol use during the month leading up to and including the week of April 17-23, giving the researchers a point-in-time look at peak and typical drinking behaviors and their relations to people’s psychological distress about the pandemic.

Significantly, this time period overlapped with the beginnings of COVID-19 widespread awareness in the U.S. and into the first early weeks of stay-at-home measures, rising virus rates and breaking news coverage that consumed most media reports.

The researchers found that the more stress people felt about COVID-19, the more heavily they were drinking.  This was particularly true for the women surveyed, such that at high levels of COVID-19 psychological distress, their drinking caught up with that of men’s.

“We discovered that women’s heavy drinking was more impacted by psychological distress around the pandemic than was men’s heavy drinking,” Dr. Rodriguez said. “This is very concerning, given that adverse health effects, like liver and heart disease, happen at lower doses of alcohol use for women than men, suggesting that women are catching up with men’s drinking at high levels of distress – this data is of grave concern.”

Dr Sherry Stewart
Dr. Sherry Stewart

Various internal and external pressures are running high during the pandemic.

“The increased stresses that many parents have been feeling while navigating their jobs, facing possible financial and family health concerns, keeping up with the household, trying to homeschool their children and keep them engaged, have all been significant on their psychological overload, demands on their time and conflicting responsibilities, which likely contributes to more frequent and heavier drinking,” Dr. Litt said.

“It’s a very unique time and context for everyone – we’ve never been in this type of situation before – and people have been making tremendous sacrifices at a time when there are so many unknowns.”

“Our findings may have reflected more solitary, coping-related alcohol consumption, not like having dinner and drinks out with friends,” Dr. Stewart said. “Pandemic drinking at home appears to be more about people’s responses to the uncertainty and anxiety many are faced with at this time.”

The researchers emphasize that these findings are worthy of attention, especially with COVID-19 again spiking in many U.S. states.

“The public health impacts are of great concern right now, especially for women,” Dr. Litt said.

“As the pandemic continues to evolve, it’s crucial to include and work on COVID-19  -related stress as a health concern that also requires resources and solutions,” she added. “Habits that are formed right now could have far-reaching consequences for the future.”

Covid Drinking
School of Public Health

What you need to know while awaiting COVID-19 test results

By Sally Crocker

Covid19

As virus rates continue surging nationwide, a growing number of people are getting tested for COVID-19, and many have important questions on what to do while they await results.

Diana Cervantes. Assistant Professor Biostatistics & Epidemiology
Dr. Diana Cervantes

According to Dr. Diana Cervantes, faculty epidemiologist with the HSC School of Public Health, if you feel concerned enough about symptoms or recent exposure to seek coronavirus testing, the safest bet is to self-isolate right away while waiting to hear your results.

“People should stay at home, away from others, for 10 days after the first signs or symptoms of possible COVID-19,” she said.

“If you have no symptoms but had reasons for getting tested – because you think you may be infected with the virus due to recent exposure, such as being in large groups of people or being in other high-risk situations – you should still isolate as a precaution for that same 10-day period, even if you have not yet heard back on your results.”

If you remain symptom free after 10 days – or if your condition improves after at least 10 days, including at least three days with no fever – you can end self-isolation. It’s not necessary to wait for follow-up from the testing center or your provider in order to do so. At that point, you are no longer considered contagious.

“The growing number of people seeking tests is adding more strain on the systems, resulting in delays,” Dr. Cervantes said. “There are only so many labs available to test for COVID-19 infection, so in some cases, we are seeing a 6- to 7-day wait time for results.”

If you don’t immediately begin self-isolating, Dr. Cervantes said, you could unknowingly infect others while you’re waiting.

“Every day that goes by can be critical,” she said, “as the virus can be passed to others up to two days before having symptoms and up to 10 days after.”

Several factors make COVID-19 testing important, starting first with the patient, and expanding from there to protect others in the community.

Testing identifies whether or not someone has the virus, and helps rule out other possible health conditions that might share some of the same signs, symptoms or concerns.

The results also help health providers outline the best plan for medical care.

Individuals with confirmed, positive results will be advised to quarantine for a full 10 days starting from the day they began experiencing symptoms or, if they have no symptoms, from the day the test was collected.

In addition, guidance will be provided for close relatives living in the same household and others who have been in recent, close contact.

Anyone who tests positive or is even suspected of having the virus should do their best to inform others they came into close contact with up to two days before having symptoms and up to 10 days after, so those individuals can also take precautions to keep away from others. Close contact involves anyone who is six feet or closer to you for at least 15 minutes.

The larger public health contact-tracing efforts are also very important.

Contact tracing leads the public health department to others who may also have been exposed.

“That’s why everyone is urged to respond to calls from the health department, to help us learn more about the chain of potential transmission and reach out to others who may have been affected,” Dr. Cervantes said.

“By providing as much information as you can about where you’ve been and the people you’ve come in contact with, you can go a long way in helping prevent further community illness and saving the lives of others.”

In either case, if confirmed positive or awaiting results, your employer will also want to know, to help you with any necessary accommodations.

“It’s especially challenging right now, because we are also in the middle of allergy season, so if you don’t feel well and are unsure about any signs or symptoms, talk to your health provider right away,” Dr. Cervantes said.

The key, as always, she said, is to be vigilant.

“Wearing a mask, practicing good handwashing, maintaining distance from others in public and indoor spaces, and avoiding large groups and situations that you know could be risky, continue to be very important right now, especially as the virus rates remain high,” she said.

Likewise, it’s an important time to also look out for others.

“If you’ve recently traveled, been around a lot of people or have been in other types of high-risk situations – or if you just don’t feel well but you’re not yet sure why – it’s not the time to go visit your grandma,” Dr. Cervantes said. “Be safe … and help others stay safe too.”

Covid19