School of Public Health

COVID-19 adds double threat to U.S. drug crisis

By Sally Crocker

Emergency

 

The last two years had brought small but significant victories to the nation’s opioid crisis, with slow, steady declines in opioid use and deaths marking a positive change to this major public health problem.

That was until the COVID-19 pandemic hit, bringing months of an uncertain and unsettling new normal to people around the world.

As the pandemic continues to stretch on with no clear end in sight, the U.S. rates of anxiety, depression and drug use are all on the upswing.

“Tighter drug monitoring, recovery programs and medical treatments were all making a difference,” said HSC Regents Professor Scott Walters, PhD, who serves as Steering Committee Chair for the HEALing Communities Study, an aggressive, National Institutes of Health (NIH) trans-agency effort to speed scientific solutions to the national opioid public health crisis.

Other factors had also been helping.

Many states began to make naloxone, a rapid-acting overdose antidote, accessible to the public through pharmacies or by mail without the need for a prescription. Some states also began distributing this lifesaving medication to people at risk for overdose, such as those being discharged from jail or prison.

“These changes have greatly helped people who are trying to quit, or to stay clean, achieve more successful outcomes,” Dr. Walters said.

But now, there is worry that these gains are being lost due to the anxieties, stresses and negative mental health consequences of COVID-19.

In an August 2020 report, the CDC estimated that as many as 40% of U.S. adults have struggled with mental health or substance use during the pandemic. The study, which looked at a one-week sample period in June, found that 31% of participants had suffered with anxiety and symptoms of depression; 26% had trauma or stress-related symptoms; 11% had seriously considered suicide; and 13% had started or increased substance use.

“The pandemic has really complicated our efforts to address these problems,” Dr. Walters said.

In July, the New York Times reported that drug deaths for 2020 had risen an average of 13% over last year, with warnings that, “If this trend continues for the rest of the year, it will be the sharpest increase in annual drug deaths since 2016, when a class of synthetic opioids known as fentanyls first made significant inroads in the country’s illicit drug supply.”

“Supply and demand in the illicit drug industry was impacted early on by COVID-19,” Dr. Walters said. “Some states initially experienced decreases in drug use because supply chains were pinched – chemicals were harder to get, shipping was slowed, and people couldn’t produce or deliver the product – in this case, illegal drugs.”

“But then it came back with a vengeance. Homegrown, locally-manufactured drug supply took over.”

With drugs like fentanyl, where even the slightest changes in chemical compounds or dosing can mean the difference between intoxication and death, the results can be tragic.

Users who are unable to get illicit drugs because of supply chain slowdown, Dr. Walters noted, will also have lower tolerance when reintroduced to drugs, which could put them at serious risk for overdose, even if they are using their usual amount.

Treatment services and recovery groups have also suffered disruptions during pandemic closings and social distancing, leaving users in a perilous place for support.

“Most of these services are online now,” Dr. Walters said. “It’s more challenging to connect with a provider, especially for treatment programs requiring an initial in-person assessment or follow up, as with methadone programs. Many of the usual safety networks are operating differently now.”

“Other likely contributors to the increase are people having more time on their hands without much to do, social isolation, substances being used to cope with the anxieties of COVID life, employment concerns, loneliness, fear, personal or family issues,” he added.

With Texas overdose rates mirroring other states around the U.S., at about 18% higher for the first six months of 2020 compared to 2019, the big question is, where do we go from here?

“Federal guidance waiving in-person requirements for drug disorder visits will continue to be important, as will the programs that have already started to support at-risk populations,” Dr. Walters said.

“Most people who start using opiates get them from someone’s medicine cabinet, so securing prescription medicines at home, using socially-distanced drop off programs in your community to get rid of old medications, or even flushing medicines on the FDA’s approved list might make the difference in saving a life,” he said.

When community take-back options are not available or impacted by a crisis like COVID-19, the U.S. Food and Drug Administration offers a listing of specific drugs that may be flushed, including fentanyl and oxycodone.

Community programs like HSC’s new partnership with Deterra pouches by Verde are also helping to distribute tools that destroy drugs when warm water is added to bags containing deactivating pods.

“Responding to this public health threat is even more critical right now,” Dr. Walters emphasized, “as communities struggle with the realities of COVID-19’s impact on mental stress and substance use. The actions we take now will affect today’s outlook as well as tomorrow’s.”

Emergency
School of Public Health

Sally Crocker named PR Daily’s Nonprofit Communications Professional of the Year

Npawards 300x250 WinnerSally Crocker, Communications Manager for the HSC School of Public Health, has been recognized with the Grand Prize: Nonprofit Communications Professional of the Year Award in PR Daily’s 2020 Nonprofit PR Awards, for her work this year during the COVID-19 pandemic.

“Sally Crocker was among the many faculty and staff at the University of North Texas Health Science Center who began working from home on March 13, 2020, as the coronavirus began its devastating path across the U.S.,” Ragan Communications reported. “Sally set out to reinforce key messages (including the fact that science is important).”

To achieve those goals, Ragan said, she researched COVID-related topics and developed a list of articles and website content ideas that could provide helpful information to the public.

“She conducted countless interviews and assembled visuals to accompany articles and help promote them on social channels, resulting in ongoing press pitch opportunities and news coverage for the University,” the judges noted.

Crocker HeadshotBetween March 18 and April 24, Crocker produced and published 10 School of Public Health articles on the pandemic, two Dean’s e-newsletters, and shared content with HSC News Team colleagues and community partners for extended communications outreach.

Article topics were intended to help the public understand the pandemic, offer expert advice from faculty researchers on staying safe and emotionally well in a challenging time, reflect on history and science, address important public health concerns and perspectives, separate COVID facts from fiction and share real stories involving HSC’s commitment to the community.

“We congratulate Sally on her remarkable achievements,” wrote Brendan Gannon, Marketing Manager of Awards Programs for Ragan Communications and PR Daily. “Well-deserved recognition!”

Npawards 300x250 Winner
School of Public Health

COVID contact tracing uncovers the stories behind the numbers

By Sally Crocker

Sujita AdhikariBehind the numbers of COVID-19 are real people. Real stories. Real experiences.

In her final term as an HSC School of Public Health student, Sujita Adhikari joined Tarrant County Public Health’s (TCPH) contact tracing team, calling quarantined, COVID-positive patients to track their connections to other community members who may also have been exposed to the virus.

This major community health effort was quickly set up in March as the pandemic spread across U.S. cities and states.

Adhikari was one of the HSC students involved in the COVID response collaboration between the University and the public health department.

“Our HSC students were ready to step up and respond to the call when needed,” said Dr. Dennis Thombs, SPH Dean. “They were able to put their public health training to work in a very real way, serving the community at a time of crisis. For many of these students who joined the effort, the work still continues.”

Adhikari said that even with a full schedule finishing up for graduation – toward her MPH in Maternal and Child Health, leading to a Program Manager position with HSC’s INCEDO office of continuing education – it was “really important to get involved” in the community’s COVID contract tracing efforts.

During April and May, she called approximately 60 COVID-positive patients, both asking and answering questions, listening to their experiences, sometimes working with a translator to gather needed details.

She rejoiced with those who were recovering and feeling very thankful.

She offered support and resources to those who felt concerned and afraid.

And she was there for patients who were lonely, sad, not doing so well – and for those who were missing their families, those who had no families, individuals out of work, and the people who were unsure if they would have a home to go to when they left the hospital.

“Some days were emotionally exhausting,” Adhikari said. “Our supervisors encouraged us to take breaks in between calls to clear our minds and just breathe, maybe go outside for a few minutes to process it all and put our work into perspective.”

“I talked to people who trusted me so much. I couldn’t stop thinking about those conversations at the end of the day.”

Others didn’t want to talk or disclose their personal health information. Some couldn’t recall their experiences, how they might have contracted the virus, or others they may have come in contact with.

“It was very challenging to create a connection within a few short minutes. You have to develop a rapport right away. Some people were open to that, while others were more guarded, or even angry about the overall circumstances of the pandemic,” Adhikari said.

Contact tracers also risked calling people who were resting and didn’t want to be disturbed, or those who were having a really bad day.

Contact tracing isn’t an easy process. It takes time, and investigators like Adhikari are only the first step that leads to other team efforts like reporting and monitoring, infection control and those who follow up with close contacts of infected patients.

Investigators like Adhikari asked questions about where people worked, if they had traveled recently, large gatherings they might have attended, people they may have come in contact with, their signs and symptoms, risk factors and underlying conditions, and if they suspected where they might have been exposed to COVID.

They gave advice on protocols, whether retesting would be required, when quarantine could end and when patients could feel safe being around others. If someone needed a thermometer, it was arranged.

“People had so many questions and weren’t sure where to reach out,” Adhikari said. “We were all learning and navigating the situation as we lived through it.”

Working as a contact tracer has its own personal challenges too. The nature of the job calls for employees to be at the public health department. Social distancing was well enforced, with computers stationed six feet apart and masks required.  Temperatures were taken daily, and student shifts were designed to accommodate classes, job interviews for positions after graduation, and other obligations.

For Adhikari, the opportunity to serve the community at such an important time was “a privilege.”

She moved to the U.S. from Nepal after completing her pharmacy degree and working in the field. She was led to HSC because of her interest in maternal and child health and her desire to work closely with the community and impact public health on a broad scale.

“Being able to help North Texas during the COVID-19 pandemic was an important experience for me. I feel as though I was really able to help others and be a part of finding solutions,” she said.

“It felt really good to feel trusted by so many patients who are relying on us during this very challenging time.”

Sujita Adhikari
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
School of Public Health

Navigating through July 4th and the summer of COVID-19

By Sally Crocker

Backyard Barbecue

 

“Wear a mask. Wash your hands. Stay six feet apart from others in public. And stay home if you can.”

The Texas Governor’s Office issued an updated Executive Order on June 26, closing bars and certain other businesses and reducing indoor restaurant capacity to 50% around the state.

In light of these new recommendations for Texas and a growing number of other states seeing dramatic, recent increases in COVID-19 cases, how advisable is it to go through with July 4th cookout plans, gatherings with family members outside your immediate household, and other activities that make summertime so much fun?

Cervantes Diana
Dr. Diana Cervantes

“The top three factors contributing to virus transmission have to do with how many people you are around, how close you are and for how long,” said Dr. Diana Cervantes, HSC Assistant Professor and Director, MPH Epidemiology Program. “Smaller periods of time around small groups of people are less risky.”

If you’re partying outside, with good air circulation, there is less concern, she noted, but the more time you spend around others, especially when alcohol is involved, the more people can lose inhibitions and neglect safe social distancing.

“It’s hard to rate any activity as high, medium or low risk, as it all depends on the situation,” the epidemiologist said.

In general, distancing outdoors in groups of 10 or less is better, and it’s important to not share food, drinks, utensils or cups.

That means no bowl of potato salad with a giant serving spoon; no snack platters of burgers, hot dogs or chips where everyone can dig in; no shared lemonade jugs or iced tea pitchers; or other similar setups.

Paper plates and plastic utensils are a really good option, although Dr. Cervantes said it’s okay to bring out your own too, as long as there’s no sharing and you wash them well afterward.

Disposable party cups are pretty much a staple of outdoor gatherings anyway, and they work well to keep germs from spreading, especially if everyone writes their name on the cup.

Should people bring their own food?

“COVID-19 has not been shown to be a foodborne virus, so that shouldn’t be an issue,” Dr. Cervantes said.

Is it risky for party guests to come inside for the bathroom?

“That shouldn’t be a problem, as long as you’re doing routine cleaning and washing your hands,” Dr. Cervantes said. “There is potential to pick up germs from surfaces, so good handwashing is very important.”

Many people have found that having a small safety network of specific people they come in contact with – others who are not taking unnecessary risks or going many places beyond quick trips to the store for essential items – can relieve stress and loneliness and help them feel more positive right now.

“It’s good for your own mental health to engage safely with the people who are close and important to you,” Dr. Cervantes said. “Just don’t mix groups, and be open in your conversations about others that your networks may be in contact with, including through their jobs, roommates and other conditions.”

“The higher risk is being around people you don’t know, or even large groups of people you do know, for prolonged periods of time.”

Much of the summer guidance for communities remains the same as over the last few months:

· If you must grocery shop in a store, go on a weekday when it’s less likely to be crowded; wear a mask; wash your hands before and after and again when you get home; and don’t linger, as every moment you’re there increases your potential risk.

· Try to not obsess too much – if someone just walks past you without a mask, that’s a very low risk, Dr. Cervantes said.

· Being closer than six feet to someone else in public for 15 minutes or more is high risk. “At a salon and in similar situations, the conditions can stack on top of each other the longer you’re there and the more you engage,” she said. “Evaluate what the business is doing to minimize risk and how transparent their precautions are.”

· How helpful are gloves? “Gloves can give you a false sense of security – they get just as dirty as your hands, and then what do you do with them afterward? They are not impenetrable – germs can still get in through micro tears in the material, so don’t completely rely on them. If you’re washing your hands well, including under the fingernails, they’re not really necessary,” she said.

· How safe are playgrounds, amusement parks and water parks? “Social distancing in these situations is hard, even if facilities are doing their best to reduce the risk, and you have no way of knowing all the people you’ll come in

contact with, or their levels of exposure. I would avoid these types of activities right now,” Dr. Cervantes said.

“We all remain susceptible to COVID-19, and it’s likely to stay with us for a while, even though it seems like a lifetime since it first became a global health crisis,” she said. “We’ve learned a lot but we are still learning, both about the immediate effects and the longer-term impacts the disease can have, including potential chronic health conditions later down the road.”

“For me right now, and for my family, if a situation involves too many people, being too close to each other for too much time, I’m out,” Dr. Cervantes said.

Backyard Barbecue
School of Public Health

Food insecurity concerns heighten for many as COVID-19 again surges

By Sally Crocker 

Food Insecurity Food Bank

 

New HSC faculty member Charlotte Noble, PhD, MPH, and her family moved from Florida to Fort Worth in the early days of the COVID-19 pandemic, when little was yet known about the reach of the virus, its outcomes and how long it would last.

Months later, as states like Texas and others are seeing a serious resurgence of the virus, leading to heightened concerns for the public’s safety, many families and communities struggle with issues impacting health and basic daily living.

Charlotte Noble
Dr. Charlotte Noble

Dr. Noble, an Assistant Professor for the HSC School of Public Health, has spent the last 14 years focusing her teaching, research interests and service on the impact of food insecurity and nutrition on the day-to-day experiences of living with infectious and chronic disease.

When she and her family arrived in Fort Worth in mid-March, they found businesses closing and grocery store shelves mostly bare. Schools like HSC were extending spring break and in discussions to move classes online.

Under normal circumstances, a two-day caravan across several states in three cars, with furniture and moving pods sent ahead, would be pretty stressful, but in the middle of a pandemic, it was quite intensified for the family.

“There was a lot of panic at that time – things were happening fast,” Dr. Noble said. “Gas stations along the way were still open, but there were questions about safe food options, using public restrooms and the possibility that state borders might close.”

When the family arrived, there was no bread or milk to be found, and meat cases were wiped out. Essential canned goods were sparse. People were already starting to avoid others in the grocery aisles, trying not to get too close.

“That first shopping trip was kind of scary, not at all like we had expected for arrival at our new home. Luckily, we were able to find some rice, beans, tortillas and a few other healthy options to get us by for a while,” Dr. Noble said.

Many people found themselves in this unfortunate position in March, scrambling for food and supplies like the Nobles and worried about what would come next.

With the recent summer surges of COVID-19 in a growing number of states, community food banks and other providers are working overtime to keep up with demand. Loss of jobs and the U.S. economic downturn have led many families to seek assistance.

From worker infections at processing plants, through delivery services and all along supply chains, the problems are compounded as many Americans find less food and fewer options while continuing to brace for the unknown duration of the virus.

College and graduate students, too, are among the growing number of people seeking resources, as university food pantries around the country, like HSC’s and so many others, continue collecting and distributing food donations and personal care products at record numbers.

Under the shadow of the pandemic, some of country’s biggest public health problems are revealing weak spots for low-income and marginalized populations that suffer from these types of stresses on an everyday basis. The new COVID-19 reality communities are facing is showing just how vulnerable our world is.

“Hunger and food insecurity have been critical issues for a long time, and they have now become COVID-19 concerns as well,” Dr. Noble said.

Dr. Noble studied anthropology as an undergraduate. During her graduate program, working on a dual MPH-Global Health Concentration and MA in Applied Anthropology, followed by her PhD, she began examining the health of vulnerable populations through a social determinants of health lens.

Her research on the relationship between food and housing security, mental health and HIV in the U.S. and abroad has looked at communities in Florida and taken her to places like Costa Rica, Haiti and the country of Lesotho in Southern Africa.

“Health disparities and social, political and economic circumstances are very much linked to food insecurity,” Dr. Noble said. “Physical, social and economic barriers all have an impact on individual health behaviors and how people are able to live.”

“There is a certain degree of knowledge that most people have, knowing what they need and what they need to do to stay healthy, but they may not always have access to those things because of the surrounding environment and conditions.”

COVID-19 is the perfect example that illustrates this point.

“There are so many issues that people may be going through right now – loss of jobs, risk of eviction, lack of transportation, being able to find healthy food close to where they live, having the personal protective equipment to go out for what they need and having a safe way to get there. For communities already suffering before the pandemic, these problems are intensified,” Dr. Noble said.

“Perhaps now more than ever before, these common threads are bringing people together across communities, as we all try to successfully navigate as best we can and help each other get through.”

“It’s an important time for strategizing on where things go from here, both through the remainder of the pandemic and beyond,” Dr. Noble said, “to focus on the bigger, longer-term issues that need all of our attention.”

Food Insecurity Food Bank
School of Public Health

HSC professor working to safeguard against oral cancers

Dr Stacey GrinerBy Sally Crocker 

What’s known is that 66% of oropharyngeal cancers are HPV-related. In mid June, the FDA approved the HPV vaccine, Gardasil 9, for the prevention of certain HPV-related head and neck cancers.

What’s still to be explored is why HPV vaccine rates remain low – despite strong public health recommendations in favor of this important protective measure – and how oral health providers can take the lead in encouraging their patients to immunize.

HSC School of Public Health Assistant Professor Stacey Griner, PhD, is seeking solutions to these issues by connecting with other health investigators and scientific mentors through a program of the National Institutes of Health (NIH) Training Institute for Dissemination and Implementation Research in Cancer (TIDIRC), supported by the National Cancer Institute.

She was selected earlier this year for this highly competitive, health investigator-training program and will move on to the next stage of her research when the 2020 TIDIRC session completes in August.

“Dental providers can be instrumental in recommending the HPV vaccine to their patients,” Dr. Griner said.

“Having been there myself earlier in my career, working as a Registered Dental Hygienist for many years, I see ways that dentists and their staff can be a good resource for patients who don’t know about, may have questions or may have hesitations about the HPV vaccine,” she said.

Dr. Griner worked as a Dental Hygienist for 10 years and always had an interest in teaching and doing more related to research and prevention.

At one point along the way, a dentist she worked with suggested that public health might be something she would want to look into.

She decided to pursue a Master of Public Health degree, then her PhD in Public Health, joining the HSC faculty in 2019.

“Dental hygienists focus on prevention, so it was a natural for me to move into public health,” Dr. Griner said. “Since many oral cancers are linked with HPV, it’s a unique opportunity to look at the information oral health providers can share with their patients to prevent these types of cancers, including recommending the HPV vaccine.”

While the American Dental Association, American Academy of Pediatric Dentistry and other related societies have recently released policies in support of the HPV vaccine for oral cancer prevention, questions remain as to how informed oral health providers are on this new guidance and whether they have implemented recommendations with their patients.

There is also work to be done, Dr. Griner said, on ways of best conveying the policies to dentists and dental hygienists.

“Right now, it’s not clear how many oral health providers are aware of the HPV vaccine policies from their professional organizations, or how they learned about them if they are aware,” she said. “This work will explore the ways these providers want to receive the information and how they want it framed, so they can incorporate the recommendations into their daily practice.”

The long-term goal for Dr. Griner, with SPH research colleague Dr. Erika Thompson, will be to assess providers’ current awareness, acceptability, adoption and practices related to HPV policies, to ultimately reduce the rates of HPV-related oral cancers among their patients.

Dr Stacey Griner