School of Public Health

To go or not to go? So many questions on navigating the health system during COVID-19

By Sally Crocker

Drs Office Waiting

The gradual rollback of COVID-19 social distancing guidelines in Texas and across the U.S. has many vulnerable populations, including adults 65 and over and those with underlying health conditions, asking questions.

This is an especially scary time for our aging population and those dealing with chronic medical conditions, says Kayla Fair, DrPH, MPH, BSN, RN, HSC Assistant Professor of Public Health Education.

K Fair
Dr. Kayla Fair

Prior to joining the HSC School of Public Health, Dr. Fair has done “a little bit of everything” as a nurse caring for patients in settings that include critical care, pediatrics and transplant, as well as working to improve the health of communities as both a researcher and practitioner.

“Older adults and those managing chronic medical conditions may experience challenges navigating the many recent changes in our healthcare system in response to COVID-19, including transitions to telehealth visits,” Dr. Fair said. “This can be further complicated if they are not comfortable with technology and/or online health platforms, or have limited access to computer or internet service.”

“As a nurse, I have had several conversations with family members and friends about whether they should go to previously scheduled appointments now or wait it out. Ultimately, this is a conversation that patients should be having with their providers, as every situation is unique. Your provider’s office can supply additional information about the best course of action.”

Sometimes a phone call can take care of prescription refills and other needs between office appointments.

Patients should also utilize the expertise of other healthcare team members, including local pharmacists, Dr. Fair said.

“Your pharmacist is another good resource for medication questions and the specifics on your insurance plan’s approved refill schedules. The pharmacy may also have information on discounts or prescription coupons to help with out-of-pocket costs.”

Providers are continuing to give updated guidance, especially now as communities move into the summer months, on how appointments are being managed, what to do on arrival, whether patients should wait in the car until they are called, how companions and special assistance accommodations are being addressed, whether masks and gloves should be worn to the office, if temperature checks are required at the door, and what to do if you have any cold, flu, COVID-19 or other potentially infectious symptoms before or on the day of an appointment.

“It’s an important time to communicate with your provider, especially for those who may be immunocompromised, recovering from surgery or undergoing chemotherapy, radiation or other cancer treatment, and any patient with questions,” Dr. Fair said.

“I am concerned about recent reports that many patients are delaying or avoiding emergency medical care due to fears about being exposed to COVID 19.  If at any time you feel that you or a loved one is experiencing a life threatening or rapidly deteriorating health status, please seek care immediately. Do not delay,” Dr. Fair advised.

Signs and symptoms that you or someone you know may be in need of immediate medical care can include shortness of breath or difficulty breathing, chest or abdominal pain, facial drooping or uncontrolled bleeding.

Any concerning change in health status should be addressed immediately. Call 911 for any life-threatening emergency.

Resources for high-risk groups, including those older than 65 and those managing chronic health conditions during COVID-19, include:

CDC Recommendations for High Risk Groups, for adults over 65, people with asthma or chronic medical conditions, and HIV patients.

When to Seek Emergency Care – never avoid emergency rooms or wait to see doctors if you feel your symptoms are truly serious

American Heart Association: What Heart Patients Should Know About Coronavirus, for patients with heart disease.

American Cancer Society: Coronavirus, COVID 19 and Cancer website for cancer survivors.

American Diabetes Association: Coronavirus and Diabetes for individuals with diabetes.

US Department of Health and Human Services: Interim Guidance for COVID 19 and Persons with HIV.

Stay Safe and Informed about Coronavirus Disease, offering resources and weekly webinars/information sessions for patients with chronic lung conditions.

Asthma and Allergy Foundation of America: Coronavirus: What People with Asthma Need to Know, for those with asthma and allergies.

The University of North Texas Health Science Center at Fort Worth Center for Geriatrics, an interdisciplinary Center guided by values and committed – through education, research and patient care – to improving the quality of life and promoting optimal aging for older adults.

Caregiver Action Network: COVID 19 and Family Caregiving, a resource for caregivers, including guidance on communicating with medical providers.

Alzheimer’s Association: Coronavirus: Tips for Dementia Caregivers, offering coronavirus resources for caregivers of dementia patients.

Drs Office Waiting
School of Public Health

SPH names 11 honorees to Delta Omega Public Health Honor Society

By Sally Crocker

Delta Omega Logo

This year, two HSC School of Public Health alumni, one outstanding Tarrant County community member and eight graduate students are being inducted into Delta Omega National Honor Society, Alpha Sigma Chapter, recognizing and encouraging public health education, practice, research and related professional achievements.

Alumni Honorees

Brittany MarshallDr. Brittany Marshall
Dr. Marshall is a CDC Foundation Program Manager based in Atlanta who also serves as Adjunct Assistant Professor of Clinical Research and Leadership for George Washington University.

Dr. Marshall has held various public health leadership positions during her career, including as past Chair of the American Public Health Association (APHA) Student Assembly, representing 7,500 public health students on APHA’s Executive Board.

She has been named as an Emerging Leader by the Society for the Analysis of African American Public Health Issues; was presented with the YoungGov40 Award from Young Government Leaders Atlanta; was recently named as a “40 Under 40 in Public Health Leader” by the deBeaumont Foundation; and was selected as a 2019 “Top 10 Outstanding Atlantan.”

Dr. Marshall currently holds an APHA Executive Board position, with term ending in 2023.

Kent Palmore
Palmore holds a Bachelor of Biomedical Science degree from Tarleton State University and a Master of Health Administration degree from HSC. He has seven years of experience in healthcare, developing, coordinating, implementing and facilitating continuous quality improvement activities.

Palmore was recently named as a Certified Professional in Healthcare Quality (CPHQ).

His primary focus is on healthcare quality, monitoring and interventions for Value-Based Purchasing, Hospital Acquired Conditions (HAC) Reduction Programming and Hospital Readmission Reduction Programs.

Palmore’s work on CMS Core Measures and the HAC Reduction Program contributed to Baylor Scott and White – All Saints Medical Center’s 2018 five-star hospital rating, recognizing the highest quality of patient safety for a non-profit, acute care facility.

Palmore has also mentored HSC MHA and MPH students in healthcare improvement and quality, to build a new generation of SPH students prepared to enter the healthcare workforce.

He was named SPH MHA Alumnus of the Year in 2014.

Community Honoree – Misty Wilder

Misty WilderHSC Healthy Start Program Director Misty Wilder is Chair of the Tarrant County Infant Health Network, Co-Chair of the Tarrant County Birth Equity Institute and has taken on numerous other community leadership roles during her career.

Nominated to Delta Omega as a “leader in the Tarrant County public health and MCH field” by SPH Assistant Professor Dr. Erika Thompson, Wilder serves as a site supervisor for HSC MPH students.

“Misty is dedicated to reducing disparities for African American mothers and babies, as well as lifting up Black health professionals in the field. Her dedication to reducing health disparities in our community is an inspiration and motivation,” Dr. Thompson said.

“I’ve also seen Misty train our MPH students – she provides them with excellent networking and professional development opportunities and truly mentors our students to succeed,” Dr. Thompson added.

“Misty is the personification of a public health leader in Tarrant County, and I could not speak of her more highly – she is a wonderful collaborator and strong public health advocate.”

Student Delta Omega Honorees

The 2020 SPH Delta Omega student inductees are Julia Aiken, David Kauvar, Joy Jackson, Traci Murray, Michael Petrus-Jones, Idara Akpan, Julian Rangel and Smriti Maskey.

Julia AikenJulia Aiken
MPH student Julia Aiken has assisted the HSC Pharmacotherapy Department with mental health outcomes analysis for cancer patients and has assisted in collaborations with the North Texas Eye Research Institute on a pediatric vision screening study.

She authored a United Way of Tarrant County Community Needs Assessment, assisting community members with secondary data to inform their work on behalf of the local community.

During her academic career, Aiken has been committed to research and projects aimed at reducing sexual health disparities.

Her work has led to presentations at APHA and the Society for the Scientific Study of Sexuality annual conference.

She also initiated a project with data from the National Survey of Family Growth, to explore sexual coercion and assault of men, and the respective association to health outcomes.

Idara Akpan
Second-year MCH student Idara Akpan was nominated for Delta Omega by SPH faculty member and MCH Program Director Dr. Erika Thompson.

“I have had the privilege of teaching Idara in three courses, serving as her faculty advisor for practice experience and as her program advisor,” Dr. Thompson said. “Idara was previously a pharmacist in Nigeria before entering our public health program. Her passion for addressing health disparities and needs is what drove her to training in public health.”

“Idara is thoughtful, inquisitive and driven to succeed. What I appreciate most is that she is not here just to get a grade, but rather to have a meaningful understanding of the issue at hand,” Dr. Thompson noted.

“She has also done phenomenal work with her practice experience, engaging with the refugee population to understand health disparities among this group. Moreover, Idara goes above and beyond to receive additional training outside the classroom, including with MCH organizations, as well as lectures and other events. She is going to be an outstanding member of the public health workforce, and I look forward to seeing her future career.”

Dr. Joy Jackson
Jackson holds a PhD in Microbiology and currently serves as Assistant Professor of Practice in the UT-Arlington Biology Department.

She previously served as Assistant Professor of Biology for the University of Arkansas at Pine Bluff.

Dr. Jackson became interested in a public health career as a way of building on her laboratory experience to research, analyze, conduct surveillance and create ways of decreasing and eventually eliminating bacterial and viral spread in communities.

With a desire to play an integral role in building healthier communities, she has been recognized for her work with robotics training for 6th to 8th-grade math/science teachers and as a STEM Saturday Instructor.

She has also been involved with Million Women Mentors: Advancing Women and Girls in STEM Careers Through Mentoring; Ladies STEMulated to Learn (Girls in STEM); and was named as a University of Arkansas, Pine Bluff, Faculty Honoree for her teaching, mentoring and community outreach.

Lt. Col. Dr. David Kauvar
Lieutenant Colonel Kauvar currently serves as Attending Vascular Surgeon and Associate Professor of Surgery for the U.S. Army Medical Corps, and as Officer-In-Charge and Surgeon, Combined Joint Special Operations Task Force in Afghanistan, Task Force 115th Combat Support Hospital, Camp Cropper, Iraq.

SPH Senior Associate Dean Dr. Matt Nolan Adrignola nominated Lt. Col. Kauvar for Delta Omega in recognition of his research on morbid obesity and his other work in public health.

As a vascular surgeon, Dr. Kauvar treats complex patient conditions reflecting a cross section of the world’s most pressing public health concerns, including smoking, hypertension, obesity and diabetes.

“He is an individual who embodies strong family values, a sense of duty and self-sacrifice for his county,” Dr. Adrignola noted, “and possess an unyielding commitment to military medicine and graduate medical education.”

Smriti Maskey
Smriti Maskey, a second-year HSC MPH student with concentration in Maternal and Child Health, began examining public health issues affecting maternal and child health populations while living and working in Nepal.

At HSC, she has led an innovative project to explore sexual health needs among adolescent patients and has been an outstanding student in her MCH classes – “a true pleasure to have in the classroom and asks critical questions,” according to nominating faculty member Dr. Erika Thompson.

Maskey has been involved in local community trainings on MCH topics and has worked with the HSC Pediatrics Department to explore HPV vaccination, adolescent sexual and reproductive health, and other child health issues.

“She is a stellar student in the classroom, always giving 100 percent to her work. She will make an outstanding public health professional,” Dr. Thompson said. “I have been impressed with how Ms. Maskey is able to integrate her past international public health experiences with the principles and topics discussed in class – this has provided for rich discussions with her fellow classmates.”

Maskey was awarded a Dean’s Scholarship to pursue her MPH degree and has since worked with different SPH faculty members on grant applications and other research activities.

She has volunteered for the local MLK Community Center, Tarrant Area Food Bank, Trinity Habitat for Humanity and others.

Maskey was one of three SPH students selected for the Texas Public Health Association’s oral competition at the group’s 2020 education conference.

She is currently working on a manuscript in collaboration with faculty from the London School of Hygiene and Tropical Medicine and is in discussions with a Victoria University PhD candidate on a public health cohort study to be conducted in Nepal.

Traci MurrayTraci Murray, PhD, BSN
Dr. Murray began the HSC MPH Professional Option degree program while working in a remote New Mexico community for the United States Public Health Service (USPHS) Indian Health Service, providing culturally appropriate outpatient and family education focused on health promotion and disease prevention.

She has been recognized with the USPHS Achievement Medal for her work as a Nurse Educator.

Dr. Murray has also worked as a Public Health Associate for the CDC.

During her career, she has been deployed twice to Florida’s State Bureau of Epidemiology for Zika Response, and was deployed during her HSC MPH program last year to the Texas-Mexico border to assist refugee populations.

She is a local chapter member of NAACP, and focused her PhD dissertation on the role of faith-based organizations on African American health outcomes.

Dr. Murray completed the MPH in 19 months, as a full-time student in a part-time program while on full-time, active duty for the USPHS.

Without breaks, she managed a deployment to the border, relocated from New Mexico back to Texas, and transitioned into a new USPHS administrative role.

Michael Petrus JonesMichael Petrus-Jones
After earning a BA in Psychology, Petrus-Jones pursued clinical mental health experience, holding positions as a psychiatric nursing assistant for a state hospital and as a research assistant for a psychiatric clinical trials company.

He began HSC graduate studies in 2015, earned his Master of Science in Medical Sciences in 2016 and began medical school that fall. He is now a 4th year DO/MPH dual degree student graduating in May 2020.

Petrus-Jones will begin pediatric residency this summer, with emphasis on community outreach, advocacy, mental health, diversity/inclusion in medicine and treating underserved populations.

He was inducted into the national Gold Humanism Honor Society and has dedicated his career so far to serving vulnerable populations, such as the LGBTQ community and underserved children.

He has been a member of the HSC SPH Academic Community Partnerships Advisory Board since 2017, and as the Board’s first student member, has helped provide student insight into questions concerning public health curriculum and community outreach.

In 2019, Petrus-Jones helped organize a statewide LGBTQ medical/healthcare conference for Texas medical schools and health science centers.

He served as President of the HSC LGBT and Allies Association during the 2017-2018 academic year, expanding the organization to include student representatives and members from programs outside the medical school, including the SPH.

While at HSC, he has given many volunteer hours to health outreach and education programs for local children, including health fairs, after-school programs, bicycle safety events, underinsured medical evaluations and high school health careers mentorship events.

Julian Rangel1Julian Rangel
Rangel, graduating MPH–Public Health Practice student, who also holds a BS in Biology with minor in Political Science.

He is currently a Development and Engagement Public Health Intern at Tarrant County One Safe Place.

Rangel is a member of the HSC Public Health Student Government Association and has served as a School of Public Health Ambassador since 2019, fostering relationships with potential and newly-admitted SPH students, answering questions for those interested in enrolling, and helping to create and promote SPH media content, while supporting other student-oriented efforts.

Rangel recently joined the HSC TESSA (Technology Enhanced Screening and Supportive Assistance) program, supporting victims of interpersonal violence.

He has also collaborated on an LGBTQ service panel for the Tarrant County Council on Family Violence, to assess knowledge, beliefs and attitudes related to the LGBTQ community and domestic violence/intimate partner violence, and has worked on other local efforts in this area.

Rangel is a recent member to the Tarrant County HIV Taskforce, Prevention Workgroup.

Delta Omega Logo
School of Public Health

New MHA Director joins HSC at critical time in healthcare leadership

By Sally Crocker

Stephan Davis HscAt 17, Stephan Davis, DNP, MHSA, FACHE, left St. Louis for New York City to study jazz performance. It wasn’t long, though, before he was so moved by the people and needs he encountered there that his career path and life ambitions turned to serving others through nursing and ultimately healthcare leadership and education.

“Music seemed the most important thing in my life back then, but as I became exposed to some of the greatest needs in public health, I wanted to be part of the solution,” said the new Assistant Professor and Director of HSC’s Master of Health Administration (MHA) program.

Dr. Davis has joined HSC at a most significant time, as the world looks to healthcare and public health for guidance, answers and leadership during the COVID-19 pandemic.

“Perhaps more than ever before,” he said, “professionals in these fields are being called to lead the world in new ways to transform healthcare delivery and discoveries.”

In his new HSC role, Dr. Davis works with graduate students preparing to lead health systems, long-term care organizations, hospitals and health-related corporations. He will also work with local, state and national communities, alumni and partnering organizations that provide SPH students with internships and experiential learning opportunities.

During a 2019 campus interview, Dr. Davis saw a familiar Martin Luther King quote on healthcare and equality in the School of Public Health and experienced “one of those moments when you realize you might really belong somewhere,” he said.

The quote took him back to his early dreams as a young saxophone player who became so inspired to help others that he changed his life to pursue nursing.

“The works and words of MLK and other leaders of his time have great significance to this day with regard to social justice and health equity for all, and were especially meaningful to me as a young person wanting to do my part in creating positive change for the world,” Dr. Davis said.

From those early NYC days to the present, he has blended a unique harmony of musical inspiration with a desire to build healthier communities through leadership, advocacy, teaching and service.

Today, he holds a Bachelor of Science in Nursing (BSN) degree, a Master’s in Health Systems Administration (MHSA) from Georgetown, and a Doctor of Nursing Practice (DNP) degree in Executive Leadership and Policy from Yale University.

These educational and career experiences have led Dr. Davis to different professional opportunities with hospitals, health systems, the insurance industry, healthcare task forces and national boards.

Along with his new role at HSC this spring, he also assumes a key national leadership position with the American College of Healthcare Executives as Chair of the ACHE LGBTQ Forum, advancing diversity and inclusion in healthcare leadership.

He views this as a critical position right now, given that historically underrepresented and excluded groups have been most vulnerable to the devastating health and economic effects of COVID-19.

“The pandemic has really brought home the need for health system and public health leaders,” he said. “There has never been a more important time to be called to lead change and advance health.”

Because great passions are never left far behind, Dr. Davis has always found ways to keep music in his life, and especially so during COVID-19.

He still plays and composes, and after moving to his new home in the DFW area, is now taking comfort in playing saxophone from his balcony for neighbors that he looks forward to meeting in person soon.

“COVID-19 has reminded me of how much music can uplift the soul at challenging times,” he said.

He’s experienced some real musical highs during his lifetime, and up until now it’s been hard to compete with being called “Coltrane” by the late, great Aretha Franklin after Dr. Davis performed “Amazing Grace” in prelude to her finale at a 2009 Kennedy Center MLK celebration.

“There are moments when everything just comes together and seems so right, like the way I felt then and do now as part of the North Texas and HSC community,” Dr. Davis said.

“For me today, those initial inspirations are harmonized with my current melody and mission to improve public health and the well-being of communities locally, nationally and around the world.”

Stephan Davis Hsc
School of Public Health

Epidemiologist’s advice for helping kids understand their role in COVID-19 prevention

By Sally Crocker

Cervantes Daughter1Family grocery shopping is a different adventure when your mom is a public health epidemiologist called “Dr. Microbe” by her friends and colleagues.

When her daughter was very young, Dr. Diana Cervantes, Director of the MPH Epidemiology program at the HSC School of Public Health, would play a little game of “let’s pretend,” where the whole store was covered in invisible creepy, grody, nasty stuff.

Mom devised the game this way: see if you can walk completely through the store with your hands crossed under your arms, don’t touch or put anything in your mouth, keep your fingers away from your eyes and your hands off your face, and let’s sanitize twice – once when we get back in the car and again when we get home.

Her daughter is almost 12 now, and while they might not visit the store together as much as in the old days, the two still continue this playful exercise when they do.

“Kids being kids, it’s hard to keep them away from germy or potentially infectious situations, but it’s important to know that they do play a key role in disease transmission,” Dr. Cervantes said.

COVID-19 is a big concern for children, especially as cities and states begin slowly re-opening certain business categories and continue monitoring and adjusting their public health guidance.

“While we have seen some COVID-19 cases reach children, for the most part, kids are more apt to have no signs or symptoms, or maybe only minor indications, yet are still are able to pass the infection on to others,” Dr. Cervantes said.

“It’s not unusual for kids to have runny noses or the occasional low-grade fever based on a variety of considerations like teething, ear infections or the common cold, so parents might not always get those red flag alerts to warn of such life-threatening diseases as COVID-19.”

Cervantes DaughterEven though public health authorities still recommend caution, activities that have been postponed or cancelled might be coming back with COVID-19 community changes ahead, including play dates with friends, summer camps, sports practices and other group or close contact get-togethers.

As with many families, Dr. Cervantes’ daughter has looked forward to summer camp each year since she was 4, and registration for the upcoming August program was secured back in November. Parents may be wrestling right now with ways to proceed safely should these types of events go on in the coming months.

Dr. Cervantes’ infectious disease research and leadership experience with the Texas Department of State Health Services, Tarrant County Public Health and health provider infection control has taken her over the years to schools, parent-advisory groups and other informative presentations where she’s taught easy ways to help kids practice germ protection.

“The vampire move is very popular with kids. They like pretending they’re wearing a spooky cape while practicing safe cough and sneeze etiquette into their sleeve or elbow,” she said.

“Schools and public health educators have also used Glow Germ powders and other teaching tools to show kids the bacteria they might not realize exists on their hands.”

Handwashing and good hygiene can be fun for children with a little creativity, she said.

Liquid or foaming sanitizer that smells nice, bar soaps in interesting shapes and colors, tricks like singing the “happy birthday” song from beginning to end twice, even rhymes for remembering to toss a tissue into the trash after using can all keep kids engaged.

There’s a lot parents can do to keep children motivated, and sources like the CDC have online tips for making handwashing a family activity that sticks.

“After a while, it becomes routine and helps establish good habits that kids can practice all their life,” Dr. Cervantes said, “even when you’re not watching.”

It’s also helpful for parents to remind kids about potential germs on surfaces and objects that might pose a risk, while encouraging them not to share utensils, foods or drinks with others.

It can be a challenge, but the more kids know about ways that germs are passed from person to person, the less they might groan about having to “think about clean stuff all the time,” Dr. Cervantes said.

How safe are grandparents as COVID-19 restrictions possibly ease up?

Families might want to continue exercising more caution with older relatives, Dr. Cervantes said, because children, especially very young kids, thrive on lots of close attention, like hugging, kissing and other expressions of affection that are very near the face.

“Social distancing is just harder with kids, but what we do know is that infectious disease outbreaks have occurred before, and the more parents can create and reinforce routines, the better,” she said.

“Wash your hands before you eat, after you play, at the end of the day and at other important, defined times – for centuries, this parental advice has continued to be one of our best public health tools for healthier communities.”

Cervantes Daughter1
School of Public Health

What impacts one affects us all

By Sally Crocker

Migala Covid Story2


Earlier this year, HSC alumnus Witold Migala, PhD, MPH, was busy wrapping up his leadership year as President of the Texas Public Health Association (TPHA), typically culminating in the organization’s annual conference and passing of the gavel to a new slate of officers.

This year, however, was very different.

As alerts about a quickly developing, new strain of coronavirus, COVID-19, became increasingly concerning to public health officials around the world, TPHA leaders were faced with a dilemma.

What information and guidance would be most helpful to the hundreds of TPHA members across the state as they prepared to face a quickly unfolding, potentially life-threatening pandemic? Could the conference even go on as scheduled as a model for hosting safe public gatherings, and if not, how could TPHA best support those on the front lines of the state’s public health response?

“Our initial plan was to hold the conference as scheduled, addressing the new situation by having attendees focus on social distancing, personal protective practices, personal hygiene and other interventions for preventing spread of the disease. However, it soon became apparent that the event would have to be cancelled,” Dr. Migala said. “The best course for TPHA was to support our membership in other ways.”

Lessons from experience

Migala Covid StoryDr. Migala is no newcomer to the science of infectious diseases and disease prevention. The epidemiologist has traveled to some of the most remote communities around the world on behalf of the CDC, World Health Organization and United Nations, administering vaccines to fight polio and supporting response efforts to outbreaks of cholera, guinea worm and typhoid fever.

“COVID-19 has definitely emphasized the universality of disease and how what happens in other places can affect us all. Disease is the great equalizer, and a unified response is key, because we are all in this together,” he said.

Public health has faced and effectively responded to a number of emerging threats in the recent past.

The mosquito-borne Zika virus, first discovered in Uganda in 1947, primarily affected Africa and Asia, but by 2016, its spread had been reported in more than 20 countries as travelers began carrying infections worldwide.

“In the last three years, researchers have found less correlation between Zika and birth defects than initially thought, with possible other factors, like environmental exposure, that could have impacted mothers and children. However, the reaction to this potential threat demonstrated how pervasively disease can affect day-to-day life,” Dr. Migala said.

West Nile virus, discovered in 1937 in eastern Africa, is still with us today, spread globally from infected birds to mosquitos and then humans. Surveillance and prevention efforts for most communities are now ongoing, especially during warmer months, as is the case with HSC’s partnership with the City of Fort Worth and Tarrant County Public Health.

Ebola, another life-threatening infectious disease, discovered in Africa in 1976, became a global epidemic from 2014-2016 when it spread across borders to the U.S. and other parts of the world.

“The worldwide spread of Ebola is an important example of social injustice,” Dr. Migala said. “Here’s a disease that has ravaged a number of third and fourth-world countries for years, but once it jumped into Western countries, it took only a year to develop a viable vaccine.”

“The lesson here is that regardless of who is immediately affected, globalization requires that disease be treated as if it affects everyone … because ultimately, it does.”

The view today

With COVID-19, Dr. Migala said, we all may have to live with the virus threat for a while as viable treatment, a cure or vaccine is developed.

A major concern is that many people can have COVID-19 and never feel sick, passing it on to others without knowing.

There is also what scientists call the RO, or “R-naught,” factor. R naught is a mathematical term regarding how contagious an infectious disease can be.

“With seasonal flu, the R naught is roughly 1.3, or about a one-to-one-person transmission potential. With COVID-19, it was at first thought that one person could possibly infect 2-3 others, but scientists are now seeing that it could go as high as 5 to 6,” Dr. Migala said.

Estimates vary, depending on length and frequency of exposure and certain other factors, and it’s important to note that RO is not necessarily a constant number. What helps to lower negative outcomes, as the CDC advises, is to limit personal contact while scientists work on solutions.

“Right now, we have to err on the side of caution, to do all we can to interrupt transmission and extinguish the spread of this disease,” Dr. Migala said. “On a reassuring note, most cases are moderate and are resolving themselves as people stay home. Test kits are becoming more accessible for those most seriously affected.”

Doing our part

Knowing what we face and learning how to do our part is an essential element of public health problem solving, he said.

“The ‘public’ in public health is our greatest resource. A time-proven model when faced with a public health challenge is to establish a rapport with the public that creates an atmosphere of trust,” Dr. Migala said.

“Traditionally, this is best done by explaining the situation, accurately presenting the risks and resources, and providing demonstrable reassurances. This transparency helps enlist the public’s support and cooperation, making interventions more effective,” he said.The public health tools currently being employed have worked in the past in controlling the spread of many infectious diseases, including typhoid, tuberculosis, diphtheria, tetanus, whooping cough, cholera, plague, SARS, MERX, the seasonal flu and others.

Efforts are most effective when in coordination between communities both local and distant, Dr. Migala said.

“History has taught us that by working together we will eventually overcome this disease,” Dr. Migala said. “The social justice and health equity issues related to protecting all populations are critical in preventing and responding to disease. As such, no community is isolated.  This is especially true in the contemporary global community. Only when others are healthier, so are we all.”

Migala Covid Story2
School of Public Health

COVID-19 significantly challenges children and families

By Sally Crocker

Children Families Covid


A high number of Americans – about to 40 to 59 percent – live financially close to the edge, with few resources available for emergency backup.

Just one rough patch has the ability to throw families off their feet, impacting their ability to make the rent, buy groceries, pay bills, access needed healthcare services and see their way through a crisis.

“For many in our community, COVID-19 is proving to be that factor,” said Erika Thompson, PhD, HSC Assistant Professor and Maternal and Child Health MPH Program Director. “In a time like this, as with other serious impacts on health, those most vulnerable tend to be the most seriously affected populations in the community, making it especially concerning for children and families during this pandemic.”

As a researcher, Dr. Thompson works to find public health solutions to some of the most pressing challenges facing children and families. One of the local organizations she partners with is Center for Transforming Lives (CTL), a Tarrant County agency providing homeless services, early childhood development, childcare, economic stability programs and other resources to those in need.

Dr. Thompson and CTL’s Executive Director, Carol Klocek, recently discussed some of the biggest community concerns right now.

What are the challenges for families during COVID-19?

Dr. Erika Thompson
Dr. Erika Thompson

Dr. Thompson: “My biggest concern is for families living on the edge or in poverty. Loss of a job, reduced income, limited resources for childcare and transportation can all economically harm families without the financial savings to weather a crisis or stock up on goods to make it through.”

Klocek: “The vast majority of the 3,000 people our agency sees each year are single mothers already on the edge, and families experiencing homelessness also face unique challenges during this pandemic. Community providers like the Tarrant County Homeless Coalition and others are doing a remarkable job of coordinating the shelter flow process with enhanced health and safety precautions, as well as reaching out to feed large groups of people living on the streets. The Fort Worth Convention Center opened its doors to the homeless in March, providing additional assistance, although there are still many people afraid of living in shelter conditions right now, who are choosing to remain on the streets or in tents.”

What are the special concerns for children?

Dr. Thompson: “While children may not be the most susceptible to the infection compared to the elderly, the social, educational and economic consequences may negatively affect the future path of their lives. There are a range of unique circumstances for families with children, including access to educational resources, safe childcare and access to food. For example, not all parents have the ability to work from home, so older children may be taking on caregiving responsibility for siblings while a parent continues working or picking up additional shifts at their job. Essential-worker parents may be struggling to find alternative childcare options. Parents who can work from home are trying to manage their childcare along with employment in a different way. Taking care of the children can become a stressor on the entire family.”

Klocek: “A significant number of children also rely on schools for several meals a day. While many schools are offering meals, there are families with young children struggling due to lack of transportation, so they are relying on agencies like ours to deliver food to them.

CTL’s homeless shelter and family housing center are currently at capacity, and we have retooled our Early Head Start services to get food and essential items to others who need them. Safety concerns are also high right now. Medical centers are reporting increases in severe child abuse cases during this stressful period of social distancing and isolation, and children living in unsafe situations may be more exposed.”

What about school?

Dr. Thompson: “Some families may lack stable internet connections, computers or technology resources. Having more children at home engaged in distance learning can place additional strain on internet connectivity, and delivery of education at home means having a parent with the time and ability to support children at multiple grade levels while also managing their own responsibilities. This can be overwhelming for any parent.”

Klocek: “Several local agencies like CTL are offering educational resources and support as a safety net for families. We are also providing hotspots and device coordination, to support families’ engagement with our educational programming, and for school-aged children in our homeless services to link with their school districts.”

What are the longer-term impacts of COVID-19?

Klocek: “Some employment is being reduced as businesses deal with uncertainty, potentially resulting in more families facing hunger, instability and future homelessness. I’m also concerned for single parents who may be ill or worried about becoming ill and need options for their children. Their stories are heart-wrenching.”

Dr. Thompson: “There is also tremendous stress on first responders, healthcare workers and professions on the front lines delivering goods and services, increasing risks to their health and the health of their families. Mental health concerns, anxiety, fatigue, burnout and other stress-related conditions are also high right now, with the strains of working under COVID-19 likely to remain with our community and others for a long time into the future.”

How can we all cope?

Klocek: “We are all struggling right now to get through. Many people want to help, and there are numerous ways to do so. Words of encouragement mean a lot to anyone feeling stressed or unsure. Our communities have come through world wars, other major health threats, the tragedy of 9/11, natural disasters and so much more in history, that we know together we can figure out the next right steps and make them happen.”

Dr. Thompson: “This is an opportunity to reexamine how as a community we can support children and families. There are many ways to help. Look for those ways and express thanks to the various local organizations working hard right now to provide resources – appreciation may be just what they need to get them through. Continue following social distancing and other recommended safe health behaviors, and consider the spectrum of families and children across our community facing this pandemic. We all have our challenges during this crisis, and COVID-19 presents an opportunity to come together to support all children and families.”

Children Families Covid
School of Public Health

When family members become coworkers in a brave new work environment

By Sally Crocker

Walters And New Coworkers

One recent afternoon, HSC Regents Professor Dr. Scott Walters was working from home like most North Texans who are socially distancing right now as a result of the COVID-19 pandemic.

He was leading a Zoom meeting when things really heated up in his closed-door office, not because Dr. Walters was sparking new ideas, but because the family’s temporarily adopted reptiles basking on heating pads were making their own good vibes in cages near his desk.

“I think a lot of people are finding that what we envisioned about working from home isn’t quite the way it’s turned out,” Dr. Walters said. “Most of us now have partners, spouses, kids, pets and other people as our new coworkers. It’s a whole new way of working and living for everyone.”

Right now the household includes Dr. Walters and his wife, both with their own workspace; son Will, 11, who is in the fifth grade; 8th grader Jocie, 14; one cat; two dogs; and a bearded dragon, three snakes and two leopard geckos, all vacationing with the family while the school animal science lab is closed.

“We call my dad’s office the snake room,” Jocie said. “With the door closed, it’s the safest place away from the cat.”

Both kids are familiar with online learning, having already worked in the Canvas platform for their classes. While they are missing friends and the daily rhythm of school, they have also found a lot that they like about the current situation.

“It’s a lower level of stress because there is so much more time to work on assignments,” Jocie said.

“School feels easier,” Will agreed. “It’s not so rushed and most of my work is due at the end of the week, so it feels calmer. And our pets love that we are at home all the time now.”

A big benefit is that there’s time during the day for both kids to take a break when they want, grab a snack, walk outdoors and refresh their minds for a few minutes, as opposed to a strict campus schedule.

Dr. Walters has also found that the extra half hour he would spend driving to work each morning can now be spent reading the news outside to begin the day.

He’s also sleeping a little longer each morning, with the family getting started at a more relaxed pace before classes, calls, emails, online meetings, Jocie’s voice and piano lessons and Will’s drum practices begin.

“Just as in any work environment, people are doing different things and need their own space. There’s community time and work time, and everyone has their own work style to be respected,” Dr. Walters said. “At the beginning, when both kids popped in their ear buds to start their schoolwork, I was skeptical, but now I understand that what works for me isn’t necessarily what works for them.”

The work-from-home guidelines that most families are managing right now, he said, could be equated to experiencing the five stages of grief.

“At first, there’s denial – this isn’t really happening. Then panic, frustration or anger over the uncertainties and loss of what’s familiar and routine. Missed time with friends, school and office activities on hold, outings and big occasions postponed all feel so overwhelming,” Dr. Walters said.

“The stages of bargaining, depression and finally acceptance all enter the picture as you coordinate each other’s needs, make a plan and find your balance. Time spent together is as necessary as time spent apart, and we’ve settled into a rhythm now that accommodates both.”

Moving through the stages isn’t easy.

“Truth be told, we’ve had some relapses back to anger here and there,” Dr. Walters said.

While family members can certainly be an unexpected group of coworkers, the situation could be with us for a while.

“We’re all playing a longer-term game than we expected early on, and there will be adjustments as communities move forward over time,” Dr. Walters said. “Find what works for your family and make the most of it.”

“I’m in the acceptance stage right now with my new office pals. As summer approaches and the temperatures climb, I’m finding that they are actually some pretty smart thinkers and interesting companions.”

Walters And New Coworkers
School of Public Health

Empathy, communications most important for businesses now

By Sally Crocker

Joyce HoodThrough innovative thinking in the wake of COVID-19, there’s now a Dallas-Fort Worth restaurant supplier on a new course, delivering fresh-baked bread products directly to consumers’ doorsteps.

The hotel industry has been among one of the hardest hit business sectors during the pandemic, yet Marriott International has been widely praised for sharing updates and messages of support to employees in a forthright, emotional, humble and hopeful way.

Healthcare workers around the DFW Metroplex are working overtime, strengthened by their teamwork and resolve, while other front-line services and businesses band together to get the job done, even when it’s risky and difficult.

At universities around like country like HSC, students, staff and faculty are working alongside community organizations, healthcare providers and public health agencies to lend an extra hand where needed, as classes have moved online in new and different ways.

“As we continue to be challenged by the COVID-19 pandemic, these and similar examples of leadership and commitment say a lot about how much business-as-usual has changed in just a few short weeks,” said Joyce Hood, DrPH, MPH, HSC alumna, who currently teaches management and leadership courses for the School of Public Health MHA and MPH programs.

“In times like these, we see true leadership emerge, and the businesses adapting to the changing needs of their communities are the ones best positioned for making it successfully through,” she said. “Showing that you care is more important than ever before, as is out-of-the box thinking.”

Regardless of whether employees are delivering direct goods and services or working from home, there are ways that companies can provide support and reassurance during tough times, Dr. Hood says.

Provide honest, timely information. Keep communications ongoing.

“Employees have a lot of questions right now. Will we keep our jobs? How can we best manage these temporary, extended or perhaps even longer-term changes to our business practices? How do we maintain coworker networks and access information, technology and other needed services? It’s vital to inspire confidence and address what people need to know to continue doing their jobs in this new environment,” she advises.

Recognize employees’ personal challenges right now.

“Businesses should be asking, what can we do to support our people,” Dr. Hood says. Where possible, some companies are giving raises or bonuses to recognize hard work that is going above and beyond. Others are providing an extra hand to their workers, like the many restaurants now on takeout operations, who are also ensuring their employees get a hot meal or groceries for their own families. Healthcare organizations and others are following suit by serving lunch or dinner to the shifts working long hours to serve others.

Address safety and mental well-being.

“In short, take care of people,” Dr. Hood says.

That means providing essential resources and protections for doing the job, as well as support services for team members’ physical and mental health.

“Pay attention to the people factors in business. Is someone worrying about an elderly relative living alone, or taking care of pets that also need food or supplies? There may be ways managers and companies can lend a hand,” she says.

Beyond that, Dr. Hood says, an email, phone call, video chat, text or handwritten note all go a long way in letting someone know that you care.

“There are many ways to show concern. The work environment right now has much to do with the heart of who we all are as people.”

Empower employees to do what’s right.

“Give team members the tools to make decisions that fit the parameters of your business model, and then let them do it,” Dr. Hood says. “Typical management strategies may not work right now, so give employees flexibility and the support to make independent, quick decisions as needed.”

Model the behaviors you value in your teams.

As a nurse leader who worked for decades in critical care, systems management and occupational health, Dr. Hood assumed a key role during the 2009 H1N1 influenza pandemic, directing programs for the overall safety and health of thousands of healthcare workers and providing guidance to school districts around the area, while also working alongside hospital team members to care for patients.

“We were all working nonstop days,” she said. “When times get tough, be willing to pitch in and do the same things you’re asking your employees to do,” she advises.

“Whatever it takes to get the job done, take care of each other and serve the community, that’s where employers should be focused right now.”

Draw inspiration from other leadership examples.

TED talks, LinkedIn articles and similar online resources are helpful, as are ideas from within your own company’s management teams, she recommends.

Lead with heart.

“Analysts are predicting that the changes we are going through now will have a definite impact on how people work, engage professionally and do business in the long term,” Dr. Hood said.

“It’s never been a more important time for business leaders to operate with innovation, integrity, transparency and empathy. Messages of reassurance and support help us all cope and be more resilient. In business and other situations, be kind to each other, because the little things are very important right now.”


Dr Joyce Hood
School of Public Health

Quarantines work: what history has taught us

By Sally Crocker

Spanish Flu Quarantine
The notion of COVID-19 social distancing seems so strange to most of us, yet quarantines for the good of public health have been around since the Middle Ages and perhaps even earlier.

The practice of separating the sick to keep other populations well was, in fact, a very early public health measure that has been credited through history for saving lives and slowing the spread of deadly diseases.

“The word quarantine comes from an Italian phrase, quaranta giorni, meaning 40 days,” said Dr. Thad Miller, Associate Professor of Health Behavior and Health Systems at the HSC School of Public Health. “During the bubonic plague, ships arriving in Venice from infected ports were required to sit at anchor before landing, to keep them at bay until the time seemed safe.”

Ships were first required to stay offshore for a 30-day waiting period, and when the outcome wasn’t as effective as expected, the time was moved to 40 days.

Sailors and passengers who remained healthy by that time were presumed to be infection free and were permitted to dock.

“Sounds familiar, doesn’t it? Some of the key cornerstones of public health are rooted in this notion of quarantine,” Dr. Miller said. “Even before the germ theory of disease was discovered, it was found that if we isolated people against infection, we could stop the spread and safeguard the health of those who had not been affected.”

During the 1918 Spanish Flu, long considered the deadliest pandemic in history, killing an estimated 30 to 50 million people worldwide, social distancing was found to be the best way of flattening the curve of infection rates. There was a greater chance of keeping people healthy through temporary separation, history shows.

Health safety isolation measures taken since then, such as those initiated during the 2003 SARS epidemic and 2014 Ebola outbreak, further reinforce this idea.

Today, with much of society working from home and going out only for basic essentials, the World Health Organization continues to advise that the course of the current COVID-19 pandemic can be changed if we all follow public health guidance.

“This centuries-old concept of quarantines to save lives is still one of the best things we have going in partnership with treatment and other prevention efforts, and every now and then we are reminded of the key role that public health plays,” Dr. Miller said.

With all eyes and ears fixed on evolving COVID-19 public health guidance right now, it seems the lessons of the past indeed have some very important bearing on the present.

“When public health is working well, it seems invisible,” Dr. Miller said. “But every now and then, in times like these, we are reminded of how important it is to our lives, and we gain a greater appreciation of its value. It’s really during the times of greatest need that public health moves to the forefront.”

Spanish Flu Quarantine
School of Public Health

COVID-19: separating facts from fiction

By Sally Crocker

Covid 19 MythbustersFinding the truth has never been more important than in the current times, when people are searching news reports, social media and other resources for COVID-19 advice and information that might help in protecting their health and saving lives, says HSC researcher Erika Thompson, PhD, MPH, Assistant Professor of Health Behavior and Health Systems and Director of the School of Public Health Maternal and Child Health MPH program.

For years, Dr. Thompson has studied the effects of misinformation related to children’s immunizations and the HPV vaccine. Misleading suggestions and false claims incorrectly promoted as legitimate news have led people to make decisions detrimental to their health and the safety of their families and communities.

Now, Dr. Thompson and other public health scientists are seeing similarities in many types of COVID-19 recommendations and social media links being shared among groups in well-meaning but misinformed online posts.

“It seems we are all on overload right now, searching for the most up-to-the-minute coronavirus information we can find,” Dr. Thompson said, “but who do you trust and how can you verify that what you’re reading, hearing or seeing is fact-based and truly accurate?”

It is especially in times like these, she stresses, that placing your trust in evidence-based information is critical to taking care of our population’s health and well being.

“Many of us have seen stories on our newsfeed about how to hold your breath to determine if you have coronavirus, how to avoid catching the disease by taking a hot bath or spraying yourself with alcohol or chlorine, and other myths like that,” she said, “but before trusting those types of suggestions, people should first take a step back to verify the sources of the information.”

That means looking to reputable sources like the CDC, World Health Organization (WHO), your local public health department and personal health providers for guidance, as well as educational, medical, scholarly and federal government agency resources.

HSC’s SaferCare Texas, dedicated to improving the quality and safety of healthcare and serving as a resource for professional and community education, is so concerned about online misinformation that a section of the department’s website is focused on teens, one of the largest active social media user groups today, who researchers say have doubts regarding how to verify truth and accuracy in the information they find online.

Studies have found that 70% of youth use the internet as their first source of health information, and SaferCare Texas has taken steps to give educators, librarians and other community members tools to help teens distinguish reliable from unreliable resources through a program called WebLitLegit. The program’s slogan is “Know Truth from Trash.”

“All of us, at any age, should be working hard right now on our health literacy skills to find, understand and apply health information on the COVID-19 pandemic in a way that grounds us to truth and accuracy,” Dr. Thompson said.  “We are constantly bombarded with information during this public health crisis, and while it’s easy to be lured into the flashiest or most interesting story, it’s incredibly important to get to the true facts to guide us.”

Based on her research regarding parent internet verification skills related to vaccines and immunizations, Dr. Thompson offers these suggestions for fact-checking online information:

  • Check to see if the information is up-to-date.
  • Ask yourself if the information is complete and includes all you need to know.
  • Consider whether the writer is giving facts or opinions.
  • Check other resources to see if the information can be verified.
  • Consider why the author posted the information and who owns the website. Is there contact information? What is the author’s expertise on the topic, or qualifications of those being quoted in the story? What other types of information can be found on the site?
  • Seek recommendations from reliable others you know, like your health provider, the CDC, or WHO.
  • View different resources to give yourself a broad perspective of news and information.
  • Consider consequences before taking action. Guidance like “wash your hands” follows basic good recommendations we’ve all been taught before and helps, not endangers, your health. Trying something risky and unknown, like the elderly Arizona couple that ingested a poisonous substance from fish treatment as an attempted COVID-19 preventive measure, has the potential for very serious, even deadly, results.
  • For a list of common COVID-19 myths, visit the WHO public health mythbusters website to check facts versus fiction.

“Verification skills are important for any health concern, but in a time like this where information is constantly changing, it is incredibly important to be sure you are relying on facts you can trust,” Dr. Thompson said. “It’s critical to our individual health, the health of our families and friends, and our world.”


Covid 19 Mythbusters