Science Says Sunday – A COVID Summer

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Every summer, our family takes 2-3 weeks and heads to LA to visit family. We live in Alabama, so visits to LA aren’t too frequent otherwise. This summer – the summer of COVID-19 – we are unlikely to make our usual trip to LA, but similarly unlikely to do many of the the things that we are used to doing during the summer.

Our family has chosen to ‘stay home’ since our stay-at-home order was put in place. That means, no trips to LA, no summer camps, no sports, no visits with elderly grandparents. We stay home for several reasons:

1. Although we are young-ish and healthy-ish, we too are at risk for getting sick, possibly hospitalized, maybe even face death. Data from the US suggests that our hospitalizations and deaths are affected young, relatively healthy people, but in general, younger people than have been affected in other countries. This is possibly due to co-morbidities like type 2 diabetes, cardiovascular disease, for example. However many young people have gotten sick, hospitalized, and died due to covid-19 too. Take a look at the statistics for Alabama below:

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2. Even if we didn’t get SUPER sick, being out and out and mingling with others increases the risk of infecting others and possibly, infecting someone who COULD get super sick and die. We’d rather not have that on our conscience…so we #stayhome. Remember this?

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3. We are teaching our kids that there are is value in being responsible members of society. We are teaching them that it’s important to not be selfish. Even though they may not get super sick, they could very well get others sick, who can get someone who is vulnerable, sick. The domino effect is what we are trying to stop by staying home. This virus is going to run through the population until we have and effective treatment and vaccine. There are enough people out there continuing business as usual. The least we can do is stay home and reduce the number of people who are potentially exposed and at risk for getting sick/getting others sick. Not to mention, to help flatten the curve, remember?? We owe it to our health care workers to slow our roll. The right thing to do isn’t always the easiest thing to do.

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Staying home does not mean social isolation. It means we limit our interactions with others, visits to stores only for essentials and work. Socializing has become largely virtual or at a distance with neighbors and friends who have been strictly social distancing as well. We also take bike rides, play outside a lot, take car rides, play board games, try new recipes, read books, spend quality family time together that we otherwise haven’t had for years, complete home projects. SO MANY THINGS! We have yet to get bored, but we’re lucky. We have lots of space at home, and lots to keep us busy. For some that means, being in an apartment all day or a home with multiple generations of family members, for example. That can certainly take its toll on people.

For some that means ‘quarantine fatigue‘. You’ve been super adherent to public health recommendations, but this has taken an emotional toll on you? I get it. And public health experts like Dr. Julia Marcus say that ‘An abstinence-only approach to #COVID19 will have unintended consequences.’
What does that mean? It means that you can continue to live life while reducing harm for COVID-19 infection and transmission. How?

For socializing, it means you need to consider what Dr. Bill Miller calls Time/Space/People/Place:

This video suggests you keep the following in mind:
⏱️Time
📏Space
👥People
🌳Place
⏱️Spending less time together is better than spending longer periods of time together. Helps decrease the amount of time you may be exposed to someone who is sick or presymtomatic/asymptomatic.
📏Space. Keep 6 feet of distance between you and others at all time, indoors and outdoors. If indoors, wear a mask. Wear a mask outdoors if you can’t ensure 6 feet of distance between you and others.
👥People. Who are the people you are around? Have they also been good about social distancing? If so, it’s safe to be around them for a short period of time, outdoors, while keeping 6′ between you and others. If you have been social distancing and the other people have been social butterflies, you may want to wait a bit longer to hang out with those people. Monogamy works well here. Seeing multiple groups of people who have been social distancing increases your risk for infection.

Note: Don’t let people try to convince you they are safe to be around because they ‘think’ they have had covid-19. NYC has the highest seroprevalance to date and even there, more than 80% of the population remains uninfected.
🌳Place. Outdoors is better than indoors. Indoors you have to think about how well ventilated the space is and what surfaces you may touch that will be touched by others. If indoors with people outside your household, consider wearing a mask.

In Alabama, Arizona, and other high risk states, essential outings only and limited person-to-person interactions are best until the local outbreaks get under control.

How do you know how your state is doing? Check out this NPR webpage:

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But in case Time/Space/People/Place isn’t specific enough, consider the guidelines below. In addition to adhering to the recommendations above, consider the following for:

Sports

Swimming

Summer Camp (CDC Guidelines)

Summer Camp (Expert opinion)

Daycare

Summer activities in general

Even advice on how to be physically intimate during the pandemic!

CDC Guidelines for everyday life (a must read)
Remember, we will get through this. Just like people got through the Polio epidemic (another Polio article here) and the 1918 Flu Pandemic. It wasn’t easy back then and it’s not going to be easy today. But knowing you have some things in your control, that science has moved at warp speed to find the source of infection and ways to slow the spread, should be reassuring. So, adhere to public health recommendations and take care of the ones you love. Stay healthy and be well, friends.

Science Says Sunday – Racism and Health

Screen Shot 2020-06-07 at 10.18.34 PMIt may come as a surprise to some, that scientists have documented the effects of racism on health outcomes. In fact, scientists have shown that racism can have significantly negative effects on a person’s health. Given the recent events we’ve experienced as a society, it’s important we cover just how racism affects the health of individuals who are on the receiving end of racism.

Science says that the impact of race on health stems largely from “differences in access to resources and opportunities that can hurt or enhance health”. These are systemic inequities that prevent individuals from equal access to health, resources, education, etc. that ensure they are secured with the best chance at good health. Scientists have also determined that racial and ethnic discrimination can not only have negative effects on health across the lifetime of individuals, but also across generations. Several studies have documented inequities in health outcomes, including some that are drastically persistent and significant.

For example, science says that some underrepresented groups (like blacks and hispanics) are at increased risk of heart disease, stroke, diabetes, low birth weight or premature birth and other serious conditions compared to non-black and non-hispanic individuals. Within the past few years, we have heard a lot about infant mortality in the news, and the fact that babies born to black mothers have been shown to be more than twice as likely  to die before reaching his or her first birthday as babies born to a white mother. Despite only recently making the news, these negative outcomes date back as far as 1950 in large published studies.

In 2010, social scientist, Dr. David R. Williams, shared a great review of what had been studied over the years in his article titled “Understanding Racial-Ethnic Disparities in Health: Sociological Contributions”, found here. Since then, numerous studies have documented the effects of racism on health, and some organizations have built archives of resources and scientific findings describing the associations between racism/discrimination and health. See an example list of those here.

In 2019, Dr. Williams published another article titled “Reducing Racial Inequities in Health: Using What We Already Know to Take Action”, where an overview of the scientific evidence pointing to critically needed steps to reduce racial inequities in health is presented.

“First, it argues that communities of opportunity should be developed to minimize some of the adverse impacts of systemic racism. These are communities that provide early childhood development resources, implement policies to reduce childhood poverty, provide work and income support opportunities for adults, and ensure healthy housing and neighborhood conditions. Second, the healthcare system needs new emphases on ensuring access to high quality care for all, strengthening preventive health care approaches, addressing patients’ social needs as part of healthcare delivery, and diversifying the healthcare work force to more closely reflect the demographic composition of the patient population. Finally, new research is needed to identify the optimal strategies to build political will and support to address social inequities in health. This will include initiatives to raise awareness levels of the pervasiveness of inequities in health, build empathy and support for addressing inequities, enhance the capacity of individuals and communities to actively participate in intervention efforts and implement large scale efforts to reduce racial prejudice, ideologies, and stereotypes in the larger culture that undergird policy preferences that initiate and sustain inequities.”

Recently, a colleague of mine, Dr. Chandra Ford, wrote a book titled “Racism: Science & Tools for the Public Health Professional”.

“This important publication builds on the racial health equity work that public health advocates and others have been doing for decades. They have documented the existence of health inequities and have combatted health inequities stemming from racism. This book, which targets racism directly and includes the word squarely in its title, marks an important shift in the field’s antiracism struggle for racial health equity. It is intended for use in a wide range of settings including health departments, schools, and in the private, public, and nonprofit sectors where public health professionals work. It will also benefit students still in training and will also serve as a practical reference text for courses and workshops. In this way, this book anticipates acting as a bridge connecting public health professionals, students, community members, as well as policymakers.”

The e-book is now available for purchase here.

Finally, Boston University Dean Dr. Sandro Galea gives a great talk on the “Healthiest Goldfish”, a story about story of Blind Willie Johnson, a blues singer who died in 1945.

While his cause of death was officially malaria, he actually died from the effects of racism and poverty, which created the conditions for his disease. Through his story, I argue that we cannot be healthy as a society until we have addressed the systemic racism that consigns so many people, like Blind Willie Johnson, to lives of poor health.

Finally, structural racism and inequities in the context of COVID-19. Data shows that blacks and hispanic are dying due to COVID-19 at disproportionate rates compared to non-blacks and non-hispanics in the US. Dr. Nancy Krieger is another scientist that has studied structural racism and its effects on health. Her lecture here, discusses the many ways structural racism negatively affects health and health outcomes. Most recently, she was part of a panel along with Dr. Mahassin Muhajid and Dr. Corinne Ridell.

Professor Nancy Krieger (Harvard, UCB Alum) along with Professors Mahasin Muhajid and Corinne Ridell (UCB) will engage in conversations about the impact of racial discrimination, social class and place on the excess disease and death rates from COVID19 among African American and other communities of color. The session will focus on some of the thorny issues related to collecting and analyzing relevant social data on COVID19; and also on advancing a social justice agenda in addressing racial/ethnic disparities in disease rates. The conversation will be moderated by Professor Rachel Morello-Frosch.

https://youtu.be/ZdItzcTiSCo

So how do we address racism as a society, so as to ensure better health for all? We start with ourselves, and address any actions that may inject racism into our communities and environments. Parade recently published “The Anti-Racist Starter Pack: 40 TV Series, Documentaries, Movies, TED Talks, and Books to Add to Your List“. Because many of my readers are avid Instagram users, here is a list of Instagram accounts you can follow as well.

To close, let me say that ending racism starts with us. With our children. With our loved ones. One small step can make a big difference. It is never too late to reflect, to assess ones own racism, and find ways to make a change. Start today.

Science Says Sunday – Summer Safety

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This past week I was asked by Univision Noticias to give insight into what people should do as states begin to lift stay-at-home orders. Many people are interpreting this in two main ways:

  1. That everything is fine now and we’re good to go “back to normal”. While that would be amazing, in many states, we’re not quite there yet. In fact, some states in the US – Alabama included – are just now starting to surge, with an increase of cases seen daily. Here’s a good link where you can determine how your state is doing and determine what activities are safe to resume if you are still seeing a lot of COVID-19 activity in your state: https://coronavirus.jhu.edu/data/new-cases-50-states.
  2. That lifting the orders happened too soon and the state is not ready for a return to “normal”. This may be the case in states where there hasn’t yet been a decrease in case and death counts. This applies to Alabama. In this case, people want to know how they go grocery shopping, for example, safely, since a lot more people are out and about now.

Either way, you’re likely experiencing what many are calling “quarantine fatigue”. You haven’t seen your friends, your family, your coworkers, or your neighbors. You likely haven’t been to a restaurant or movie theater in months. Perhaps you, like me, have only been out of the house for essential items and the occasional takeout meal and then straight back to the safety of your family and/or home. With the lifting of stay-at-home orders, and honestly a completely disregard by some to follow public health recommendations, it is highly uncertain if we will ever get this virus under control, so we need to figure out ways to start to find some normalcy in our lives, while being SAFE. How do we do that?

Below are two great articles that describe the risk associated with a number of activities that you may consider this summer.

From Camping To Dining Out: Here’s How Experts Rate The Risks Of 14 Summer Activities

How to weigh the risk of going out in the coronavirus pandemic, in one chart (see below)

Table showing how different places present more risks during the coronavirus pandemic: Your home is the safest place. Outdoor environments present moderate and higher risk. Indoor spaces with people you don’t live with present the highest risk.

The bottomline is that you should try to avoid the three C’s:

COVID-19 Information and Resouces

Crowded places

Closed spaces

Close-contact settings

This means that outdoor activities can provide some much needed reprieve this summer. Go for a bike, a run, a hike, perhaps an not so crowded lake or body of water, to get some fun in the sun and some much needed activity. Here are some tips that have been adapted from the CDC, Seattle Children’s, and the NIH.

Sun Safety

  • Protect yourself and your children from getting too much sun. The sun’s rays are strongest between 10 a.m. and 4 p.m., so be extra careful during that time.
  • Use sunscreen with a sun protection factor (SPF) of 15 to 30 and apply 30 min before going outside or in the water. Reapply every two hours and after being in the water or sweating. This one is tough with littles, so be creative about this step. Often, this is a good time to go over pool/beach/lake rules.Choose one that protects against UVA and UVB rays.
  • Keep children under 1 out of the sun as much as you can. Dress babies in lightweight, light-colored clothing with long sleeves and long pants, and always cover their head.
  • Note that when it is 90° or above and humid, it is recommended that children should not play outside or exercise for more than 30 minutes at a time. This means you should…

Travel Safety

  • Always wear a seat belt and strap kids into an age/weight/height appropriate seat accordingly. You can always check with your pediatrician about what that seat may be, and stop by the fire department if you need help fitting one into your rear seats.
  • Never leave children alone in a car, even for a minute. Children left in cars are at risk for heat stroke, which can lead to death. Other risks are setting the car in motion and getting injured by playing with power controls.

Riding Safely

  • Wear a helmet! Make sure kids wear one as well.
  • Teach kids about road safety, especially those who will be allowed to ride around in the neighborhood this summer. Look both ways, look for cars…they may not see you!

Water Safety

  • Never leave children alone in or near the water, even for a minute. You have to watch kids, but also adults closely. The latter is especially important when drinking. Lots of horrible accidents happen on boats when people are drinking and having a good time on lakes/oceans, etc. Be diligent. Call 800-336-BOAT for additional information on boating safely.
  • Make life jackets a cool thing to wear! Even the most experienced swimmers can tire, so when in doubt, and when in groups, especially with kids, consider wearing a life jacket.

COVID-19

  • Continue to wear a mask when going out of the house, wash your hands frequently, and continue to practice physical distancing from others.
  • Outdoor is best, and continue to limit interactions outside your household if possible. Some, done safely (refer to chart) may be possible, but stay vigilant.
  • Finally, we are all witnesses to the injustices faced by the African American community in the past weeks, months, years. This week you may have heard about many protests and you may be wondering, what about COVID-19? Hats off my to my friend and colleague who put together these recommendations for keeping safe while protesting:

Continue to be safe friends. We’re in for a long summer, but together, we will get through this. I close with a quote from Dr. Martin Luther King, Jr.:

The time is always right to do what is right.

And now, is the time, to do just that.