Created with Sketch.
Texas A&M Health Talk
47 minutes | Dec 18, 2020
Supporting military members and veterans in nursing school
Transcript coming soon.
47 minutes | Nov 19, 2020
Tips for balancing being a parent, teacher and professional during the pandemic
Lindsey Hendrix: We bring you advice and compelling insight on the latest in health, medicine and scientific discovery. From tips for getting better sleep to discussions about major issues like health disparities in America, we’ll talk about it. You’re listening to Texas A&M Health Talk, part of the Texas A&M Podcast Network. Hello, and welcome to Texas A&M Health Talk. I’m your host, Lindsey Hendrix. Today we’re going to talk about something that a lot of American families are facing right now during the pandemic, and that is balancing being a parent and helping support your children through virtual school. Some parents have decided to pull their kids out of school altogether and are homeschooling and balancing all of that with being a professional in their jobs and their careers. We have a couple of excellent guests from Texas A&M today to talk about this. First up, we have Dr. Kelly Sopchak, who is a psychologist with the Telebehavioral Care program here at Texas A&M Health. She is the program manager of TCHATT, which stands for Texas Child Health Access Through Telemedicine. That’s a program that provides mental health services to school children through telehealth. Did I get that right, Dr. Sopchak? Kelly Sopchak: You did. Thanks for having me. Lindsey Hendrix: Thanks so much for being here. And also joining us is Dr. Karen Rambo-Hernandez. She’s an associate professor in the Department of Teaching, Learning and Culture at the College of Education and Human Development here at Texas A&M. Welcome, Dr. Rambo-Hernandez. Karen Rambo-Hernandez: Thank you so much, Lindsey. Lindsey Hendrix: Thanks for being here. So, we’ve got two experts on a couple different sides of the equation. We have our mental health professional, our psychologist, and we have the education professional. Dr. Rambo-Hernandez was also a teacher in the classroom for 10 years, and does some really cool research related to curriculum that is accessible to all children. Is that correct? Karen Rambo-Hernandez: Yes. That’s a good nugget of what I do. Lindsey Hendrix: Yeah. Just a little sliver. I’m going to start by just setting the stage. Dr. Sopchak, you are seeing parents and students in school right now that are dealing with this situation. What are some common trends that you’ve noticed? Do you see that the stress levels seem to be higher than normal? Kelly Sopchak: Absolutely. I was going to say the common trend is stress across the board. Our students are experiencing more stress because they’re dealing with learning in a new style. For a lot of our kids, even if they’re in school, they’re still learning on a laptop, and it’s still virtual. They’re just doing it in the classroom. Then for our parents, they’re having to juggle work, and teaching, and still being a parent, and still trying to have some fun family time when your day is booked from the beginning to the end because while you want your child’s education to be everything they need it to be, you’re also struggling with the, “I’ve got to get my work done. I’ve got to meet these deadlines. I want to keep my job, especially right now.” Lindsey Hendrix: Oh, yeah. People who have a job right now are pretty fortunate, in all honesty, because there are families that are balancing all of this and on the hunt for a job, right? Or have recently gotten laid off or are experiencing unemployment. So, I can just imagine the stress levels are crazy. Kelly Sopchak: And that stress level, it comes out in different ways. We’re seeing an increase in kids acting out, having behavioral issues. Then we’re also seeing an increase in family conflict because when people are stressed out, the littlest things irritate them or set them off. So, they’re really at the time in which some grace is needed, and letting yourself not be perfect with everything because we’re not perfect. Lindsey Hendrix: That’s right. That’s what makes us human, and I think it’s comforting, too, to know that we’re in this together. There are a lot of families, millions of families who are going through this. So, if you are listening right now and you are dealing with this in your day to day, know that you’re not alone. In fact, both of you both have children who are school-aged children, right? What does y’all’s situation look like at home right now? Karen Rambo-Hernandez: We did things a little bit unconventionally. I have a four-year-old who is in pre-K and a seven-year-old who is in second grade, and we actually opted out completely, and we are homeschooling our kids. I never thought I would be a homeschool mom, but here I am in the middle of a pandemic. But we changed things up a little bit, and I am writing lesson plans on the weekend, and we hired an education undergrad student to come in and work with our students during the week. So, I write the lesson plans, and then we have this undergrad student who delivers them with our kids Monday through Friday. I recognize that’s a very privileged position that we’re in, but it’s what we had to do to make this pandemic work for my husband and I because we’re both academics. Lindsey Hendrix: That’s awesome. I love that you can provide that for your kids, and I can imagine even though you have somebody who is working with your kids during the week that you’re still very much involved in the education of your children. Karen Rambo-Hernandez: Yeah. I’m actually more involved than I think I’ve ever been because I know what they’re doing. The dinner conversations look very different because I can ask them pointed questions about what they were supposed to be learning that particular day. The school day doesn’t just run from 8:00 to 3:00. We actually spend quite a bit of time after dinner working on games, and literacy activities, and math practice and things to try to reinforce those skills. So, the line between school and home is very blurred right now. Lindsey Hendrix: Right, and how about you, Dr. Sopchak? What are you doing right now with your kiddos? Kelly Sopchak: We have a four-year-old who would have been going to pre-school this year and a two-year-old who thinks she deserves to be in school, so she’s very disruptive to our school days. I work, as you can see, in my bedroom. I shut the door and lock it, and they know if Mommy comes in here, it’s not a time to disrupt. My husband runs their programming. We run pre-K programming with them, and sometimes I get to go out and assist because while I’m not an educator, I’m great with those behavioral disruptions. So, I peek out throughout the day, and then in the evenings, similarly, we go over what they’ve learned today. We try to put it into play, whether it’s through games or activities, and then a lot of outside time when we can, when the weather permits, to try to get them engaged with nature, and learning about frogs, and dirt, and bacteria, and how that happens, which maybe not be pre-K, but we go through that. Then I end up making up for my workday at night. Once the kids go to bed, that’s when I’m back in doing my work, catching up on notes, catching up on paperwork, dealing with whatever writing and different aspects that I have at my job that have to get done. So, the day is much longer, but there’s a piece of it that I love because I see my kids during the day, and I’m more involved in their daily activity, and I don’t feel like I’m missing out on a lot. So, there is that. Lindsey Hendrix: Yeah. There are definitely silver linings in all of this, but like you said, I mean, we don’t know how long this is going to go on. Balancing all of this, almost trying to squeeze every minute out of every day, people are working from the moment they wake up in the morning until they go to bed at night. I can imagine that can have an impact on your mental health, and then also that of your children’s, too. If they’re used to going to school from 8:00 to 3:30 or 8:00 to 4:00, and now they’re extending their academic day into the evening and sometimes in some cases on the weekends as well, this is the tricky question, right? The key question is how can parents try to manage their own stress and anxiety level while also tending to the needs of their kids? Kelly Sopchak: Yeah. It’s a tricky balance. It really is, and one of the key things that I talk to my parents about and that we implement in our lives is schedule. There is an increased anxiety when we don’t know what to expect. There’s increased stress when we don’t know what’s coming, right? As humans, we like to be in control and we like to know what’s coming. It gives us a sense of safety and security, and a schedule is a great way to do that. You know when you’re going to get up. You stick to the schedule every day, and I think it’s been a little bit easier for kids coming back this year as opposed to when it got transitioned in the middle of the year. Lindsey Hendrix: Oh, that’s true. Kelly Sopchak: So, they’re a little bit more prepared, right? Being prepared, having a schedule, having a set agenda for today can be extremely helpful. Also, taking breaks throughout the day. When we’re working in an office or working on a job, you get breaks. There are natural breaks that occur. You talk to your coworkers. You go get coffee. You get up and get water. Whatever it be, you’re interacting with people and there’s natural breaks. Right now, we don’t have that and our kids don’t have it either. For younger kids, maybe they work for 20 minutes, and then they have a 10-minute physical activity, watching a video on YouTube that’s dancing and exercise or going outside. Whatever it may be, getting them up, getting them moving, getting them back engaged. It decreases some of their misbehaviors, and it also gives us a break. I’ll go and dance with my girls for 10 minutes and have fun, and then get back into my work. So, having those natural breaks, and then doing things that are healthful for us. Eating healthy, exercising, going to bed on time and getting plenty of sleep can be beneficial, but also taking breaks to maybe do some deep breathing or guided meditation during the day, and having the kids do it with you. Right? It’s okay to be open and honest with them about, “This is stressful. Mommy’s struggling. Mommy misses being with family, and friends, and doing different things. There’s a lot on our plate right now, and we’re going to handle it together, so let’s do this coping skill together.” It’s a great opportunity because we’re teaching the kids the coping skills that they may not have learned otherwise because most of the time we go through our day, and we have our things we do to make it through the day, but we don’t talk about it. Talking about it and teaching our kids that helps them to de-stress. It helps us de-stress, and it makes it a more cohesive group. Lindsey Hendrix: I love it. I love it, and then what if, say… and I don’t have kids in public school right now. My kids are five and three, and they’re both in a Montessori school environment, and they are fortunate to be able to attend face to face. I’m personally not dealing with this right now. I was when the pandemic first started and school was closed, right? So, there’s a struggle there. What can parents do to balance the roles of being a child’s parent and being a child’s educator? Because those, although seem like they should go hand in hand, often don’t work out quite like we would hope. I can be my son’s parent all day long, but when it comes time to sit down and do some math homework, it can really be a struggle because he doesn’t want to listen to his mommy when it comes to school. He’s used to listening to his teachers when it comes to school. So, do you have any tricks up your sleeves, or strategies that you’ve implemented that seem to work? Karen Rambo-Hernandez: Yeah. I was a classroom teacher for 10 years, and I loved it. I had a ball with it. I have won awards for my teaching. I’m good at teaching, but when it comes to working with my own kids, it’s a totally different ballgame. So, I just want parents to know that you’re doing something really hard. It is a very different place to be from being the parent to being the teacher. One of the things that I have found to be really helpful is what was successful for me as a classroom teacher was really working on building relationships with my students, and if I focused on the relationship side, then they cared more about what they were learning, and they had a safe space if they made mistakes, and it wasn’t the end of the world. I was a math teacher, and so there’s a lot of anxiety that goes around learning mathematics. I’ve had to remind myself when I am teaching my kids—we’ve had some disruptions in our care due to COVID exposures, and people getting COVID, and the whole thing so there have been times where I have been the full-on teacher—is that I need to also focus on the relationship side with my kids and not just on, “This is what we’re going to learn and this is how you’re going to do it.” But to keep in mind that they have needs, and they have a desire to connect with me in addition to just learning whatever it is that we need to learn for that day. Lindsey Hendrix: Yeah. I think it’s easy for us who are not professional teachers and aren’t in the classroom all the time or studying education to be really rigid in our approach to how we tackle problems, right? How I was taught to tackle a math problem, for instance, or a writing assignment. So, what are some ways that we can be a little bit more flexible and maybe get creative in our approaches with our kids as our students now, essentially? Kelly Sopchak: I cheat. While I’ve never been an educator, working in schools, I have been in so many classrooms doing observations. I see these amazing, wonderful, creative professionals doing awesome things. I struggle with my two, right? They’re managing like 26 of them. Lindsey Hendrix: Right. Kelly Sopchak: I’m like, “Oh.” But they have tricks and they have trades like, “One, two, three, eyes on me,” to get kids to pay attention. The teacher will say, “One, two, three, eyes on me.” The kids are like, “One, two, eyes on you.” It gets them back into the zone of attention. I’m like, “That’s amazing.” Right? There’s also behavior motivation, right? We’ll tell kids if they’re not doing what they’re supposed to do, “Clap your hands. Pat your head. What’s two plus two?” Right? Or, “Write your name.” You get them to do something that you know they’re going to do, and it activates it. It’s an activating technique to get them on task. Also, giving them stickers, or check marks, or smiley faces like, “Oh, you completed this one. Good job. Let’s go on to this next step.” All of those things are really helpful, and it helps kids see that they’re achieving and they’re doing something, right? It’s also great to encourage them on the things that they’re good at. When they’re dealing with a difficult task, they’re going to be less likely to engage. Something that’s hard for them, it doesn’t feel good to struggle. It doesn’t feel good to not be successful, so encourage them. I really like the way they’re doing math, right? They may be getting the answers wrong, “I really like the way you’re writing your numbers so neatly.” Right? It’s finding what they’re doing well, and supporting that, and then telling them, “It’s okay to struggle. That’s the point of it. When you make a bad grade on a test, sure. You want to make great grades all the time, but when you make a bad grade, that’s what tells us what you need to learn. I don’t want to just teach you stuff you already know. I need you to make mistakes so I know where you need to get help.” Just coming at it from a positive mindset because, yes. They are going to behave worse for us than they do for their teachers. It’s the nature of the beast. They don’t have the peer expectations around them either, right? “I don’t want to get in trouble in class because Johnny’s going to see it.” They don’t have that at home. They can be their authentic selves, and so it makes it a little bit more difficult, but there’s tons of great websites that teachers use because they are super creative, and they come up with amazing ways to teach our kids. So, I would encourage parents to spend a little time online and find different resources that can be helpful. Lindsey Hendrix: I love it. I love it, and you brought up a really good point about that peer motivation that I hadn’t considered before, your behavior being reflected back to your friends and having almost that positive peer pressure to behave and perform. Right? Now, you were talking about potentially your kids not doing well on a math problem, but what can a parent do to check in and gage how their students are doing with the curriculum overall? Say a parent sees that their kid is consistently struggling with the curriculum or on the other end, they’re just breezing through it like it’s a piece of cake. It’s something that they’ve already mastered, right? Neither of those are optimal scenarios, so what can a parent do to work with the teacher to find that sweet middle ground? Kelly Sopchak: I encourage my parents to talk to the teachers. I mean, the more communication you have with them, the better it is. We know from research over the years that parent engagement is a factor of child achievement. The more engaged a parent is, generally the better the kid’s going to be doing in school. Your teachers have tons of knowledge in the area of education and getting learners engaged, so if your kid is struggling, reach out to them. A lot of my teachers have been absolutely thrilled to work with my parents to help teach them the concepts, right? Because if I go to teach fourth grade math right now, I’m going to fail at it. Math was not the same for me when I was taught fourth grade math. It’s totally different now and I’m not going to be great at it, but the teachers are working with parents. I’ve got some of my teachers that they’re having after school tutorials with the parents to teach them how to teach the concept, which I think is amazing. They’re just complete rock stars, so reach out to them. If your kids needs harder curriculum, they’ve got it, and I’m sure they’re happy to share it because for a teacher, it’s so uplifting and revitalizing when your kids are doing well, right? You want them to learn and you want them to thrive, so they’re happy to help facilitate the learning to the child. Karen Rambo-Hernandez: I think part of what you can do also is realize that we’re all trying to figure this out at the same time. The teachers have not previously taught both in-person and online, and so they’re figuring things out the same time as we’re trying to figure things out as parents. As you approach the teacher, keep that attitude in mind that, “Hey, we’re in this together. We’re trying to figure this out.” When you are communicating with that teacher, ask questions. I know as a classroom teacher, I get excited when I get questions because it means that the person is engaged. So, ask questions of the teacher. It’s okay to offer some ideas about some different things that you think might work better. I was teaching last night with one of my night classes, and one of my students said, “Hey, can I make a suggestion? I have something that I think would make the format a little bit better.” It was just about rearranging my screen so he could see my screen better on his laptop at home, and it was such a simple change, but it made such a huge difference for his ability to engage in the class. So, suggestions are welcome. Just frame them in a really positive and open way to the teacher whenever you engage with them. Lindsey Hendrix: Yes. I think that’s a really good point that we haven’t really brought up yet, is that teachers are also navigating this. In a lot of instances, teachers are also parents, right? Dealing with their own children’s education and trying to support them. I think my question, we’ve hinted at it, but say a student is in school and all of their education is happening virtually. They’re sitting in front of a computer during the day. Typically I think when I was in school, I would go to school during the day, and then I’d come home, and that was home time. Right? We maybe talked about what I had learned that day, and I would do my homework. Maybe my parents would help me with that, but should parents have more of an engaged role with their kids now? I know that’s beneficial all the time, but is it more important now than ever? Kelly Sopchak: Absolutely. I think whenever we’re struggling with something, whenever something is different or stressful, we have a tendency to isolate. Increasing that engagement we know will decrease stress. Engaging with them, whether it be during their school day, after school, making sure to make time for still just family because it can become, “It’s all about the education, right? We’ve got so much to do. You’ve got your education and I’ve got my work. We’ve got to get it all in in these hours.” But it’s important to have that boundary and still have the family time, still have the fun time. Watching a movie with popcorn. Going on a walk, whatever it may be, and not talk about school. Talk about something else. Talk about their favorite video game, or their things that they’ve seen on YouTube, or how much they want to be with their friends because staying engaged, staying supportive, baking things together, whatever it may be. Having that family time will allow you to get some stress relief as the parent and also allow the kid. Karen Rambo-Hernandez: Yeah. We have been intentionally walking a lot more at night. The kids go on their… We call them their Wheely devices. They pick whatever Wheely device they want to take for the night, and we go around, and we take a walk. Then we’ll come back and we’ll continue having conversations. One thing that we did, and I don’t think we talked about this before, we actually have really restricted their tablet time unless it is specifically associated with school so that in the evenings, they are spending more time playing. They’re engaged in more imaginative play. They’re learning how to interact with each other a little bit better. So, that has really lowered our stress level, which I did not expect. I thought taking away their tablets was going to be a punishment to me, but after we got through just a few days of saying, “We’re taking this away not because you were misbehaving, but because we want the time to really engage with you as people, and we have some things we want to work on with you,” they were like, “Oh, okay.” They just rolled with the flow, and that removing of the tablets has really been helpful outside of the school time. Lindsey Hendrix: That’s awesome. Really that almost tactical real-world education can be so beneficial for especially young kids, right? What are some strategies for recognizing our own needs as parents, as individuals, and then on the flip side recognizing your children’s needs and when to put one above the other? It sounds weird, I think, for a lot of parents to think that they could put their own needs ahead of that of their children’s, but I think sometimes it’s probably necessary, right? Kelly Sopchak: Yeah. It’s good to have the boundaries. When you notice that you’re struggling and you need a break, there are times during the day where I tell my husband, “Hey, I got no meeting here to here if you need to go walk around, if you need to go check on our neighbor, whatever. If you need a break, I can give it to you then,” because it’s working as a team to try to figure out what works best. Maybe that’s getting with friends who they’re struggling with the same thing, and letting the kids go on a walk, and have them up ahead, and you can talk about adult stuff. Whatever it is for you, but there are definitely times when you need to take care of you. So, even going in a room. I am blessed that I can come in my room and lock the door, right? And have my space. So, setting that up, and kids are resilient. They can do things on their own, and you can give them activities that they enjoy that they don’t have to be monitored on so, “You know what? This is time to go in the playroom. Go to the playroom for a little bit. Mommy and Daddy need a break. We need grown-up time. We’re going to have a grown-up conversation. Y’all go to the playroom.” That’s okay. It’s good for them because like you said, Dr. Hernandez, you get that imaginative play, right? You get that engagement and social engagement, and they behave completely differently when we’re not around, and that’s good for them. They’re learning it. Yeah. Taking care of yourself. You cannot… What is it? When you go on an airplane and they’re like, “You put the mask on yourself first, and then you put the mask on them.” They reiterate that with you because if you don’t take care of yourself, you’re not going to be able to take of them. Right? You have to care for yourself, do what you need to do so that you’re in a good place mentally so that then you can support them because if you have nothing to give, they get nothing. Lindsey Hendrix: Mm-hmm. Karen Rambo-Hernandez: Yeah. There’s a phrase that I’ve heard several times that more is caught than taught, and so our kids are watching us to see how we’re handling the stress, and what we’re doing to make sure that we maintain our sanity through this crazy pandemic. Just this week, one of my kids accidentally spilled all of the spaghetti noodles that we were going to have for dinner on the floor, and I had no backup spaghetti noodles. I got so frustrated that our spaghetti was all over the floor, and so I was pretty… This little thing just really threw me through the roof, but I tried to model for my kids what I needed to do to calm back down and move forward with our dinner without our spaghetti noodles so they can see that, yes. I’m a real person. I get frustrated. They see the good, the bad, and the ugly, but there are some tactics that you can do to bring yourself back and not let it ruin your entire day. Lindsey Hendrix: I love it, and then also unfortunately kids can also pick up negative stress management and anxiety management skill… Well, I don’t know. Strategies or however some people do things in an unhealthy way, so I think it’s important to know that eyes are always on us even when we’re not aware of it, right? I mean, I think about my three-year-old picking up language I wouldn’t approve of him using, and I don’t recall using it around him, but they seem to hear everything you’re saying. So, just always being cognizant of that. I think modeling is a good approach. Are there any other stress management strategies for kids in particular? I know it can be tricky to think about kids under 10 implementing stress management strategies on their own, so is there anything in particular that you can do as a parent to help support or introduce for them that could help them feel better? Kelly Sopchak: The easiest one to teach is going to be deep breathing or diaphragmatic breathing. On YouTube there’s one called Jelly Belly. I love using it with kids. It’s awesome. They have a aquarium, so they’re watching fish, and it’s telling them how to fill their jelly bellies because your belly is wiggly and it can go out really big and it can go in. It’s pretty cool. Another one that’s pretty easy is 5-4-3-2-1 where you have the kiddo list off five things that they see. So, five things around them they see. Then they list off four things that they can feel, so I can feel the chair underneath me. I can feel my hair hanging down. Four things they can feel on their body, and then three things that they can hear. Maybe it’s the buzz of the computer, the air conditioner, and the birds outside. Then two things that they can smell, so paying attention to that sense, and then one thing they can taste. You go through that and it brings them back to the moment. Yes. There is all kinds of stuff going on in the world, and there is all kinds of stress surrounding us every single day, but 5-4-3-2-1 gets you back grounded into the place where you can be okay right now because we’re safe, and we’re all here, and it’s good. It’s a really useful technique for parents too. Lindsey Hendrix: I was going to say I think I could use that. Kelly Sopchak: You’d like it. You’d like it, and there’s some great visuals of it to where they can do it on their own, where even if your kiddo isn’t reading yet it’s like five and it’s the see, and four and it’s the feel. It guides them through it, and it’s a great thing to be able to do together and just discuss what it’s like being at home. Karen Rambo-Hernandez: Yeah. I would also add just moving, making sure that your kids are getting regular breaks to move around and wiggle. I taught my kids the wiggle water game where I say, “Wiggle water,” and they wiggle, wiggle, wiggle as much as they possibly can and run around. Then I yell, “Still water,” and they freeze in whatever position they’re in. So, just doing that for two to three minutes to get them physically moving around and not just sitting still all day. Lindsey Hendrix: Those sound like pretty good strategies, not just for little kids under 10, but pretty much all age groups, right? I could even see teenagers getting… Yeah, and me too. Yeah. Getting the opportunity to just act silly, right? To just de-stress a little bit. Karen Rambo-Hernandez: I used it with middle school students when I was a classroom teacher and they loved it. Lindsey Hendrix: Oh, I love that so much. In the same vein, what are some ways that we can help our kids develop that emotional intelligence? I know adults struggle with this. I struggle with this personally, recognizing why things make me feel the way that I am feeling, and then communicating that with people around me. What are some strategies to not only help ourselves do that, but also help support our kids? Kelly Sopchak: The easiest way is to see it in someone else first, right? When you’re working with kids on trying to gain that skill, reading stories and pausing and saying, “So, how do we think she feels right now, or he feels or how does the bear feel?” So that they can start putting names on it, and then naming it for them. Right? I have a two-year-old that will tell you, “I’m feeling very frustrated,” because Mommy says, “Oh, you seem like you’re frustrated. I see your hands are clenched or I see the facial expression that you’re hiding right now. What’s going on?” When kids can’t name it yet, we name it for them. Then using different avenues. Maybe it’s a show that they like to watch, and pausing it and saying, “How is she feeling? What can she do? Why is she feeling like that?” And having the discussion around feelings. Having the discussion around it, and then checking in with them, right? So, “I know today has been a really hard day. How are you feeling? What’s going on? What are your thoughts about this assignment or this struggle that you’re having?” So that we can have those corrective moments because a lot of kids, when they’re struggling with something, their thoughts are going to be, “I’m stupid. I’m dumb. I’m not good enough.” We don’t want them having those thoughts because, “No. You’re learning. You’re trying something hard, right? You’re enduring and you’re going to get there.” Right? It’s just a process. I think it’s great to have those conversations, and to teach our kids, and to work with them because, again, it’s a difficult time where our kids are feeling bigger emotions than they might have felt having not had COVID. They’re feeling more stress than they would have felt, and so there’s an added pressure to that need of helping them to identify what they’re going through. Karen Rambo-Hernandez: Yeah. I love Daniel Tiger. His whole show is about dealing with emotions. My kids are getting a little bit old for it and I’m kind of sad because I really like Daniel Tiger, but he also has a lot of songs that he uses to deal with different emotions. I have an app on my phone that has a bunch of Daniel Tiger songs. It’s the Daniel Tiger app. We can go in and play the different songs when there are different emotions that the kids are struggling with, or getting used to, and being able to name. So, I recommend Daniel Tiger. Lindsey Hendrix: I love it. I love it, and I feel like it’s really hard to get through the schooling and the academic part of it without addressing the emotional and mental part of it. I think that’s a good strategy for setting that foundation so the kids can then move on and excel academically. Now, I asked this question a little bit before, but say your kid is struggling through math, but they seem to be doing really well with, say, writing or something like that. Are there ways that you can leverage their strength to then bring up their weakness, so to speak? Karen Rambo-Hernandez: My son in particular, he loves math. He will do that all day long, but ask him to put pen to paper and do some writing, and it is just not what he enjoys doing. Yeah. He’s flying through his math homework and he is just struggling with his writing. One thing I have tried to do is to connect what he enjoys with his writing more and because I’m homeschooling, I have that flexibility. One of the things he was learning was about a particular fable, and so I had him write a script about that fable, and then he got to use his computer to video a little puppet show, but he had to use the script that he wrote. So, trying to find ways to connect what your student loves to do with the things that they may need a little more practice on so that it’s not quite such a drudgery to do it. Lindsey Hendrix: I love that creativity. Kelly Sopchak: You can tell you’re a teacher. You have the creative eye, but yeah. I think it’s important. Preferred task, right? You can use a preferred task to get them started and engaged, and then go to a more difficult task and, “You know what? When we get this done, we can do this other preferred task.” Yeah. It’s important. You meet them where they’re at. It’s that relationship piece, right? Parents know their kids. You get to learn your kids in a new way, and then now you can use that to help them learn because, yeah. Teachers are creative. They make it work, and they work it on the kid’s skills, and what the kid likes, and knowing their students. It’s so much work, and they’re so amazing in so many ways, but it helps to know what your kid likes and to be able to work outside the box. If you’re struggling, reach out to the teacher and ask them like, “Hey, how can I do this?” If there is a difficulty to it, if you’ve come up with a solution, sharing that might also be helpful because your teacher can then use that with other kids that they’re working with because your kid’s not the only one struggling, right? A lot of our students are… We have straight-A students that are now Ds and Cs because they’re not used to learning virtually. It’s a very different type of learning style, so collaborate. Lindsey Hendrix: I love that. Collaboration, really communicating with the teachers, and the schools, and working together. I feel like maybe now we’re going to be doing that more than ever, even though I think ideally it should have always been happening all along. But I don’t quite understand how a teacher could really get to know their students this year if they’re seeing them on the screens and not getting to interact face to face. I feel like a parent almost needs to be that liaison so to speak with, “I understand my kid and here are some trends, or here’s what I understand about their personality, and their likes, and dislikes, and things like that.” For parents who are worried that their kids are going to get really far behind this year, they’re going to be stressing about all of the standardized tests and all of the things that kids do to demonstrate their understanding and readiness to progress to the next grade level. Is there any research that shows that kids are resilient or that they can rebound from an interruption like this? Karen Rambo-Hernandez: Yeah. I was actually just looking at some recent research that came out of the Katrina hurricane, and what the research was showing is that there was this major disruption to the kids’ schooling, and they did eventually bounce back, but it took a couple of years. So, I think we just need to do the best we can, and keep moving our kids forward. Focus on growth and not on absolute achievement, but make sure they’re always making progress. Then the achievements, the absolute achievement will eventually come. It might be a year or two before we’re back to that homeostasis where we would have been and that’s okay, but focus more on the growth and less on the absolute measures of achievement. Lindsey Hendrix: Got it. Kelly Sopchak: Yeah. For a lot of the Katrina kids, I was at HIC at the time, and a lot of them came into HIC, and they came in without records, too. So, we didn’t know where they were academically. I think I’m hopeful that even in this situation, the kids will rebound a little bit faster than that because we have their information. We know where they are. They’re in our schools and we’re working with them, so hopefully they’ll rebound a little faster, but it’s the same as summer vacation. Kids come back from school and there’s a learning curve every year, right? But they catch up, and they get back on track, and they get back into it. Our brains are extremely resilient, and they’re making new dendritic connections, and learning things, and storing things, and kiddos can catch up. Work hard, and I think you’re absolutely right. Go with the growth. Achievement testing is not always accurate anyways as far as our child’s ability to learn and grow. Whether it be the STAR test or GRE, it doesn’t tell you what they can do. It just tells you these concepts and have they been obtained or not? Kids can learn them. Whether it’s for this STAR test or the next one, they can learn them. Lindsey Hendrix: We talked about rebounding academically. What about socially? I mean, kids aren’t in classrooms together. They don’t get that time in between classes in the hallways to interact with their peers, or going to football games, or extracurricular activities and things like that. What are some strategies for helping our kids socially right now? Karen Rambo-Hernandez: We have another family that is pretty aggressively socially distancing as well, and so they’re our little pod. We get together every weekend and the kids play together. We do LEGO League with them so they have more of a structured environment, and then after that it’s always a play date. So, being really intentional to have those play dates, find the people that we feel comfortable being around at a more particular level of social distancing. Kelly Sopchak: Yeah. We do a similar thing, but online. We don’t have, I guess, the set social group in the area. We moved here a week before A&M shut down, but we do Zooms with… We connect the TV to the computer so it’s big, so the kids can see it. We have set times where their friends that are in Houston, “We’re going to play Play-Doh, or we’re going to do coloring, or we’re going to do this arts and craft thing.” We get it together so that then they can interact. My kids are running Zoom. It’s fantastic. Karen Rambo-Hernandez: That sounds better at Zoom than I am. Lindsey Hendrix: That’s awesome. I know. My kiddo found… Oh, I was setting up my home office when all this started, and I couldn’t get my computer to correctly hook up to my monitors. I would plug it in, and they wouldn’t work. My three-year-old, who was two and a half at the time, it’s already been six months, came to sit on my lap and work with me. He was fidgeting with buttons and stuff, and he somehow managed to get my monitors to work, and they’ve been working ever since. I’m like, “My little two-and-a-half-year-old IT tech.” It was amazing. We talked a lot about some silver linings. I don’t think this is all gloom and doom. I think some good things will come from this. It sounds like families might get tighter. It sounds like we’re going to discover new coping mechanisms that we maybe didn’t have to tap into before that could benefit us from now and for the rest of our lives, and for our kids’ lives, too. Are y’all recognizing any other silver linings in this that we can end on a hopeful note? Kelly Sopchak: Well, we know whenever kids, or adults, or anyone goes through trauma, which this has been deemed as a long-term trauma, right? Lindsey Hendrix: Mm-hmm. Kelly Sopchak: Because it’s just a constant state of stress. We know the benefit to it is we get resiliency, right? We become able to handle little things so much better. Even when big things face our kids, first struggles that they’ll have as adolescents or as young adults, and facing rejection, and dealing with all the negative in life, we’re going to have a generation of kids that has higher resiliency than the one before, and higher skills, and higher ability to deal with that stuff. In the workforce, that’s an amazing thing. I would think this generation has the potential to really make some changes, to really make a difference in the world, and maybe we leave the rat race of America a little bit, right? Because they’re going to see the importance of being with your family, the importance of spending time together, the importance of these things. So instead of going to school for seven hours, and coming home with homework, and being taught that, “Yes. You should take your work home every night, and you should continue to work even once you get home,” they’re going to learn a balance. They’re going to learn some boundaries, which I think could change the face of how we come to work and how we engage economically and educationally in our nation, which would be beneficial. Karen Rambo-Hernandez: Yeah. On a much smaller scale, I know I’m being much more intentional about the activities that I engage my kids in, the time that I spend with them, and I feel like I just know my kids better. I like that. I wish it didn’t take COVID for that to happen, but I think that the relationships that I have are stronger as a result. Lindsey Hendrix: Yeah, and maybe this is just the beginning. Hopefully we’ll get better at this as time passes. I know we’re a ways off probably from a vaccine, so this is kind of what our world looks like right now. Some people are rocking it. Others are struggling and dealing with additional traumas on top of just this crazy situation that we’re all in. I think for me, it just gets better with time and practice, and I think we’ll end up for the better on the other end for all of the reasons that y’all just stated. Well, thank you both so much for being here today. This was an awesome conversation. I learned a lot of cool new strategies that I’m going to start implementing with myself and my kids, so thank you for all of your knowledge, and good luck with everything as you’re both navigating this along with the rest of us. Kelly Sopchak: Thank you so much for addressing this topic and spreading information for people. This has been an absolute pleasure meeting with y’all today and talking with y’all. Karen Rambo-Hernandez: Yeah. Same here. It was really a joy to talk about what’s going well and what’s not going well, and hopefully provide a little bit of perspective to whoever’s listening that we’ll get out of this somehow. Lindsey Hendrix: Absolutely. Well, thank you both. Y’all have an awesome rest of your day. Tim Schnettler: Thank you for joining us on Texas A&M Health Talk, a product of the Texas A&M University Health Science Center. Visit us on the web at vitalrecord.tamhsc.edu where you’ll find answers to all of your health questions. Until next time, stay healthy.
29 minutes | Oct 28, 2020
Can you get flu and COVID-19 at the same time?
Lindsey Hendrix: We bring you advice and compelling insight on the latest in health, medicine, and scientific discovery. From tips for getting better sleep to discussions about major issues like health disparities in America, we’ll talk about it. You’re listening to Texas A&M Health Talk, part of the Texas A&M Podcast Network. Lindsey Hendrix: Hello, and welcome to Texas A&M Health Talk. I’m your host, Lindsey Hendrix, and joining me today is my co-host, Dee Dee Grays. Hey, Dee Dee. Dee Dee Grays: Hey, Lindsey. Glad to be here again. Lindsey Hendrix: Glad to have you. I think we did a really good job last time, so I’m looking forward to this next interview. Dee Dee Grays: I think we did an awesome job. Lindsey Hendrix: Yeah. Dee Dee Grays: We have to pat myself on the back. Lindsey Hendrix: Today’s episode, we’re talking about flu, which we’ve talked about in our communications at the Health Science Center. Every year, we talk about it, time and again, but I felt like it was a very timely topic, not just because we’re entering flu season, but it’s also 2020, and this flu season is going to look a little bit different. Dee Dee Grays: Oh, definitely. With COVID-19, I think there’s a lot of questions that are out there that people need answered because the convergence of the flu and COVID, and with the symptoms being so similar, I think the more information we can put out there to help people, the better. Lindsey Hendrix: Yeah, absolutely, and I think we picked the perfect guest for this. Dee Dee Grays: Oh, yeah. Lindsey Hendrix: Yeah. Dr. Neal was great. Yeah. He is a family medicine physician, so he sees cases from the very young to the very old and everything in-between. He also rotates through the hospital, so he gets to see a lot of that stuff, and I thought he brought a lot of really cool knowledge to this, not only because of his clinical experience, but he’s also doing a really cool study on COVID-19. Dee Dee Grays: Oh, yes. He’s very knowledgeable, and I think the information that he provided is going to be valuable for all of our listeners out there, so real excited to have such experts. Lindsey Hendrix: He brought a lot of great knowledge to the table, and a lot of it is not surprising because it’s about the flu in general and we know that getting a flu shot is the best way to prevent it, but he also talks about what this flu season might look like with COVID-19 and flu converging. So let’s go ahead and start the show. What do you think, Dee Dee? Dee Dee Grays: I think we’re ready. Lindsey Hendrix: Awesome. Hey, Dr. Neal. Welcome to the show. Dr. Gabriel Neal: Thank you so much for having me. Lindsey Hendrix: I want to start it off just by asking: We always say that flu season occurs in fall and winter. Is that because of the cooler weather? Why does flu and cold season come around this time of year? Dr. Neal: Right, so historically, the flu has been more active in the winter, and there are some very good reasons for that. Part of it is the weather, but the flu, or influenza, has become a year-round illness. But it is far more active in the winter than it is in the summer, mainly because the protective coating around the virus is more stable in colder temperatures than it is in warmer temperatures, and so we see more people becoming infected with influenza during the wintertime because the virus can survive longer outside of the host bodies and then be passed on to other host bodies in the wintertime. Lindsey Hendrix: That makes sense. I never knew that. Thanks for clarifying. So, we can have flu all year long? Dr. Neal: That’s true, and we still occasionally see a case and we have to think about it when we have patients present with flu symptoms, even in July. I think that there is more to it, though, than just the protective capsule around them. We often are more social and we’re around more people in closed spaces and we have our holiday parties and we have our family get-togethers, and so there’s just a stronger chance, or better chance, of transmitting any particular type of viral infection in the wintertime. Dee Dee Grays: I know around this time, they really start pushing to go ahead and start getting your flu shots. I know there’s different strains of the flu, and I’ve heard that they base that off of, I guess other countries have flu season at a different time than we do. Can you explain, how do they determine what flu strain we should be getting at this time, then? Dr. Neal: It’s not an exact science when it comes to choosing the flu vaccine. Frankly, some years, the flu vaccine does not really match up with the flu virus that occurs, but then there are years where it matches really well and you get excellent efficacy. We can talk about efficacy in a minute, but the scientists that are developing the vaccine have to guess a little bit, and it’s not just a blind guess, they make an educated guess. They are trying to monitor the way that the various flu viruses, particularly in Asia, are mutating, and there’s different ways flu viruses can mutate. There’s a lot of different permutations that the flu virus can have, and when there’s this major shift, then you see then that the vaccine that they may be developing in anticipation of a small change then doesn’t work at all. It’s a little bit of a guess. There are really smart people sorting what type of vaccine they need to develop every year, but there definitely are years that are more hit or miss. Lindsey Hendrix: Even if it’s not predicted correctly, is there still a benefit to getting the flu vaccine? Dr. Neal: Oh, absolutely. I mean, you’d be crazy not to give it a shot, literally or figuratively, however you want to think about that. We don’t necessarily know year to year how effective it’s going to be, but on average, it’s about 40 to 50 percent effective, and that may not be the kind of percentage that gets everyone excited, but what that translates into is tens of thousands of fewer hospitalizations and thousands and thousands of fewer deaths every year because of the flu vaccine. So, I like to say that, look, don’t just get the flu vaccine for yourself, get it for the people around you, because I think that is a very noble reason to get the flu vaccine, and the flu vaccine has been demonstrated to be incredibly safe to get. Dee Dee Grays: We know generally they emphasize everyone to get and recommend everyone to get their flu shot in October. If I get my flu shot in December or January, is that too late? Is there such a thing as too late to get your flu shot? Dr. Neal: December or January is not too late. Typically, we stop giving the flu shots out in April or May because at that point, the season has passed, and usually at that point, the vaccine supply has kind of dwindled, but you still can get it. There’s no harm in getting a flu vaccine in April or May or June, there’s not. But the earlier you can get it, right, the more protection it’s offering you during the flu season. Really, the flu season in Texas, but certainly nationally, can peak in different areas at different times, and so some parts of the U.S. might see a November, October, November, early surge of flu cases. Other places might have more of a January, February flu surge, as it is the case in Texas. S,o even if it’s December, January, you’ve forgotten to get the flu shot, get it because at least locally where we’re at, there still is a lot of value in having it for those January, February, March months. Dee Dee Grays: Symptom-wise, what are the symptoms? I also have horrible allergies, so I think I’m sick with everything at that time, so what are those symptoms that we should be looking out for and when do you think that someone, “Hey, you’re serious enough to where you really need to go see a doctor”? Dr. Neal: Flu symptoms can vary a lot, but the classic presentation of the flu is fever, muscle aches, and fatigue. Those three symptoms are very common to influenza, and for anybody who’s ever had influenza, you know what I’m talking about. I’ve had it myself once and was basically in bed for three days and I’m a pretty healthy person, so it was rough. You can have runny nose, you’re going to have sore throat, you can have cough. Influenza can cause pneumonia and shortness of breath and even coughing up blood can all be symptoms of influenza, but fever, muscle aches, and fatigue are the classic triad. Dr. Neal: When you get tested, of course, it’s basically, well, when you’re running a fever and you have muscle aches, or you have a cough when you go in to see the doctor. Being tested for the flu is really just based on that suspicion, and so you could have the flu and just have a fever, you could have the flu and just have a fever and a cough. You could have a flu with just muscle aches and a cough, any one of those permutations, right, could potentially be influenza. Why this might matter with getting tested and having that diagnosis confirmed is that there are medications that you can receive from your doctor that can shorten the duration and severity of the flu if that medicine is initiated early enough in the illness. Dr. Neal: Now, this poses a little bit of a challenge, because what we’re looking to do is start that antiviral, anti-flu medication within 24 hours of the onset of fever. That’s the hallmark for that particular medication, and so a lot of times when the flu season really ramps up and doctors are aware that the flu is prevalent in their community and when patients have those symptoms, they essentially do not do flu tests anymore. They say, “The flu prevalence here is high. You have the symptoms. There’s no reason to suspect that it’s not the flu, so here’s your medication.” Dr. Neal: I mean, that’s a very reasonable approach when the prevalence of the flu is high enough and the patient’s symptoms are consistent enough. What doctors have to do, though, is consider other possibilities, and that’s where going in and being seen by the doctor and talking to them and examined by them can be very important so that they don’t miss something like mononucleosis, or this year, COVID, right, to name a few that can mimic influenza and need to be diagnosed separately. Lindsey Hendrix: Yeah, that brings up the next point I was going to make which is those symptoms seem awfully familiar with all of the symptoms that align with COVID-19, so I assume that would be another reason to go in to see your doctor and get tested. Dr. Neal: Right. This winter is going to be really tricky because influenza is going to be present, COVID is going to be president, respiratory syncytial virus is going to be present, other adenoviruses. There’s just a whole host of other possibilities that are hard to differentiate from each other, and so going in and seeing your doctor and being tested makes a lot of sense, and so there’s going to be a lot of doctor visits and a lot of testing this winter, but it won’t just be for COVID like it was through the summer, it will also be for influenza and respiratory syncytial virus and others. Dee Dee Grays: What can people start doing now to help prevent getting the flu beyond just getting the flu shot? Dr. Neal: Right on. Well, again, getting the flu shot’s a big deal and encouraging their friends and families to get the flu shot, because the more people that you have around you regularly that are protected offers you protection. That’s that herd immunity idea that we know. Then all the things that we’re doing to protect ourselves from the coronavirus are also effective at preventing the spread of influenza, so wearing masks, washing our hands, and social distancing are all things that can absolutely reduce the spread of influenza and protect you from getting influenza as well. So, my big advice to everybody is get your flu shot and then keep doing all the things you’re doing to protect yourself from COVID. I’m hopeful that we’ll have a lighter year, a lighter flu year. I’m not talking about the severity of the strain, because that has nothing to do with our efforts that we take to prevent illness, but in terms of just the number of cases and the spread of influenza, that could really be dampened by the efforts we’re making for coronavirus. Lindsey Hendrix: Yeah, I think that’s good news for this flu season, is people are already taking a lot of those measures to prevent all kinds of infectious diseases. I mean, not just influenza. Like you said earlier, there’s all kinds of respiratory and infectious diseases that could be going around this fall and winter. Dr. Neal: I want to add to that, that I think doctors and providers are really going to be in a tricky spot this year, worse than usual. Let me give you an example. A patient two years ago would call in, in the middle of January, say, “I’ve got fevers, I’ve got muscle aches, and I feel terrible. I’m really tired,” and the doctor or the nurse might talk to them over the phone and say, “Are you having a sore throat?” “No.” “It sounds like you have the flu. We’ll send in a prescription for the anti-flu medication,” right? They take the medicine and they get better and then they’re on their way, right? If they get worse, they come in and get checked. That’s not a real complicated decision. Dr. Neal: But this year, that same patient calls in, the doctor or the nurse is going to say, “We need you to come in and get tested,” right? Because we need to check you for COVID. We need to check you for influenza and sort this out because we’re not going to be doing you any favors with influenza medication if you have COVID, and if you have COVID, we’ve got to isolate you longer than if you have influenza. Typically, with influenza, we’re going to say, “Stay home until your fever is finished for a day and you’re feeling better and you go back to work,” but with COVID, it’s like you got 10 days, plus fever-free, plus the symptoms getting better, and it’s a much longer time out of school, out of work, out of their life, basically. And that’s been one of the hardest things about COVID that’s different than influenza is that COVID seems to stick around longer and cause symptoms longer and spread longer, and so isolating people once they have COVID is an important step that we’re taking. Then isolating those contacts, we don’t normally isolate flu contacts, right? Lindsey Hendrix: Right. Dr. Neal: If your child has the flu, we don’t say, “You can’t come to work,” but now with COVID, your child has the COVID, you’re probably home. They’re not going to be allowed to come in and you’re isolated for 14 days, according to the CDC guidelines. So I think we’re actually going to see a big hit to gross domestic product, to productivity for businesses across the country, across the world because of the steps that are necessary to separate people with COVID from otherwise healthy people. Dee Dee Grays: We also know that holidays are probably going to look a lot different for a lot of families this year with COVID and the flu, and a lot of the recommendations that are out there that even I’ve seen Dr. Fauci even talk about how his kids may not even be coming now, and I know other experts have also talked about how maybe our gatherings need to be smaller than what they normally are. It’s just going to be a whole different situation, I think, for this holiday. I know even my family has where my sister may or may not be coming in because she has to fly, so that’s a huge different now this year with the flu and COVID. Dr. Neal: Yeah. I think that there’s a lot of benefits to social isolation when you have COVID and when you’ve been in contact with COVID, you’re an exposure. The challenge with profound isolation in a low-risk setting—what I mean is, there’s no known exposure, you don’t have symptoms—is the psychological impact and the mental health impact of social distancing. And so, what Dr. Fauci says, of course, makes sense. We’ll probably need to be a little more careful. However, I think that there’s a lot of depression and anxiety and just profound loneliness that are causing mental illness that is just as bad as COVID, in some ways, if not worse, that I think just like you weigh the effects of a treatment, right, and sometimes patients and people will say, “I don’t want the treatment. I will take the disease. The treatment really is worse than the disease.” Right? That’s okay for them to make that decision, so I think we have to temper our low-risk social isolation with the mental health aspect of being isolated. Dr. Neal: I don’t have a perfect algorithm. I don’t have an equation you can apply. These are decisions that we sort out ourselves on an individual level. Certainly, people are going to do dumb things, they’re going to have 50-person parties, just go crazy and spread COVID, and that’s a mistake. But I think that, “Do I go visit my parents for Thanksgiving?” Yeah, I probably would, right, unless I was worried about giving my parents COVID. I know that that’s affected my family. My parents would love to go visit my brother’s son and his family out of California, but the risk associated with that is something that they’re having to weigh. Lindsey Hendrix: Speaking of the COVID-flu connection, we were talking about the flu vaccine earlier, but you’re also involved with the development of a different kind of vaccine, which is for potentially application to COVID-19. Can you tell us a little bit about that? Dr. Neal: There is a tuberculosis vaccine that has been around for decades and is given to millions of children every single year. Billions of doses have been given many decades to people all over the world to protect them from tuberculosis. The way that the BCG vaccine works is that it creates a sort of permanent innate immune response to tuberculosis that has a generalized effect on the body’s immune response to lots of other organisms as well, and through the decades, research on people who’ve been vaccinated with the BCG vaccine has demonstrated that the BCG vaccine benefits them whenever they get sick from other things as well. People don’t tend to get as sick from other viruses, and it boosts the effect of other vaccines when they get those, such as with the yellow fever vaccine. Dr. Neal: The type of immunity that the BCG vaccine develops in our bodies has been postulated to help prevent death and severe illness related to COVID. And so, the study that we’re doing is we are taking health professionals, firefighters, policemen, and paramedics right now, and we are either giving them a placebo injection of saline or giving them the BCG vaccine, and we’re tracking them over a six-month period to see if they get severely ill from COVID or not. Dr. Neal: We’re comparing those two groups, and our hypothesis is that the BCG vaccine will help protect them from severe illness and death and days missed of work related to COVID, and so the nice thing about this is that the BCG vaccine is already proven to be very safe to give. Lots and lots of people have had this vaccine over decades, and so we’re repurposing a known vaccine for potential protection from coronavirus, and that is something that could be done more rapidly than the development of a specific and novel vaccine for coronavirus directly. It’s not going to keep you from being exposed to the virus, right? That’s not it. It’s about how seriously ill do you get once you have been exposed to the coronavirus. Lindsey Hendrix: Yeah, that is so cool. I love that you can use a- Dr. Neal: Yeah, re-purposing other treatments or new things is awesome. Lindsey Hendrix: … Yeah, seriously. Like you said, it really accelerates the whole process, which is cool. Dr. Neal: Right on. It’s something that people have asked me is, “If I get the BCG shot in your study, can I still have the flu shot?” and of course, the answer is yes. It’s very likely that folks who get the BCG vaccine will have a better response to this year’s flu vaccine as well, so we’re excited about that possibility. We just haven’t used the BCG vaccine in the U.S. the way that they have in other countries, so it’s been harder to measure that kind of effect. Dee Dee Grays: If someone did receive the BCG, let’s say they’re from another country, came over here, and they had it as a child, is there any studies, or do you know if whatever they had, if they got it in the past, that it would still possibly help protect them now? Dr. Neal: Right. There are researchers looking into that question right now, and it’s sort of a mixed bag. I’ve seen reports of studies suggesting that in countries where the BCG vaccine is given to every child, that it would appear that they have less morbidity and mortality related to the coronavirus, but there’s also been some studies, or analysis of those studies, that have suggested there’s not really, so I don’t think that it’s clear yet whether having a childhood BCG vaccine protects you from COVID, okay? It may. I’ll be interested to see as more and more data emerges on that, whether that proves to be true, but we’re hopeful that people who receive a BCG vaccine as an adult in our study do see a benefit from the BCG vaccine. Lindsey Hendrix: Is the BCG vaccine one of those where it’s like one and done, or is it more like the flu vaccine where you have to get it annually or boosters every so often? Dr. Neal: In terms of its indication for tuberculosis prevention, it’s a one-and-done shot. You get it as a young child and you get a little scar usually on your arm where they give it to you and then you’re done, there’s not an indication to have it a second time. But there’s no harm in having it a second time, and there are people in our study who had it as a child, but then were able to either get placebo or the BCG vaccine as part of the study again. So, having a prior BCG vaccine was not an indication to having it as part of study. Dee Dee Grays: With the convergence of the flu and COVID, can you get both of them at the same time? Dr. Neal: Certainly. You can certainly have coronavirus and influenza at the same time. We don’t know just how bad that is, but there’s real concern that having both at the same time. We don’t know yet, but if you get the flu and you get over it, but then a week later, or a month later, you get coronavirus, are you more likely to have a more severe illness related to the coronavirus because you recently had lung inflammation from the influenza virus? Possibly. If you get coronavirus and you recover from that, you still have inflammation occurring in your lung that’s mild and you get the flu, is that putting you at a higher risk for influenza hospitalization and death? Maybe. There’s just a real concern that the confluence of these two viruses, particularly because they affect the lungs, both of them so much, that it can be a real disaster to have them both at the same time or to have them back-to-back. The truth is we don’t know. We don’t know yet. There’s not enough data to say, but I think it’s pretty reasonable to think having two serious respiratory illnesses in the same winter would be bad. Dr. Neal: Then, of course, there’s the question of, does having coronavirus increase your risk of death from bacterial pneumonia? Does it increase your risk, you know what I’m saying, for other viruses, like adenovirus, as an example that can cause pretty bad colds and pneumonia in children? There’s also a virus called the respiratory syncytial virus that affects young children, so if a young child has coronavirus and then has the flu and then has respiratory syncytial virus, or all three at the same time, what’s that look like? Bad, right? We’re going to see this winter what happens, but this is why having the flu shot, getting back to that, is important because it is one of the things we can do to try and prevent serious illness, at least from influenza, and then depending on how that affects the coronavirus illness or respiratory syncytial virus illness, we’ll have to see. Lindsey Hendrix: I think wrapping it up in a nice, pretty bow, just get your flu shot and keep doing everything you’re doing to prevent COVID, and hopefully, hopefully that can help prevent all of these convergences and all of the mess that could happen with the health care system if people are coming in with all of these viruses at the same time. Dr. Neal: Right, and hopefully in the near future, we’ll have some other preventative measures we can take. I mean, who knows what will come of our study and who knows how the COVID vaccine development’s going to go? None of us have a crystal ball for that, but we can keep our fingers crossed and hope for the best there. Dee Dee Grays: If we do have some listeners, though, that want to be part of the trial, how would they go about doing that? Dr. Neal: Well, that’s a great question, Dee Dee. There’s a link that we can provide that takes them to the screening questionnaire, right? They can complete the questionnaire and that will tell them whether they’re eligible for the study or not, and so happy to provide that. There’s a link on the Texas A&M website, the Health Science Center. We’ll be circulating this information on Facebook as well, but it’s just a link to a survey, they take it, and then they take off from there. Lindsey Hendrix: If you’re not in front of your computer or device right now, I happen to know the URL at the top of my head. It is health.tamu.edu/bcgtrial, so that’s where you can go to take that questionnaire. Dr. Neal: Right on. I’ll throw out my email for any of the listeners. It’s email@example.com, and if they want to send me an email, I will email them the link. No problem. Another way to get it. Lindsey Hendrix: Fantastic. Good question, Dee Dee. Well, you’re doing amazing work, both in the clinics, at the hospitals and in the research lab, so kudos to you and good luck with everything. Dr. Neal: Thank you so much. It’s been a real pleasure to be on the program today. I’m very grateful and would be honored to ever come back. Lindsey Hendrix: Oh, absolutely. We will most certainly have you back. Well, you have a great day, Dr. Neal. Thank you. Tim Schnettler: Thank you for joining us on Texas A&M Health Talk, a production of the Texas A&M University Health Science Center. Visit us on the web at vitalrecord.tamhsc.edu, where you’ll find answers to all of your health questions. Until next time, stay healthy.
41 minutes | Oct 7, 2020
Why do Black Americans experience health disparities?
Lindsey Hendrix: We bring you advice and compelling insight on the latest in health, medicine, and scientific discovery from tips for getting better sleep to discussions about major issues like health disparities in America, we’ll talk about it. You’re listening to Texas A&M Health Talk, part of the Texas A&M podcast network. Hello and welcome to Texas A&M Health Talk. I’m your host Lindsey Hendrix. We’re going to continue the discussion about health disparities in America. Last episode we dove into disparities faced by the LGBTIQ+ community and we talked about ways that Texas A&M Health is trying to better prepare future health professionals to care for LGBTIQ+ patients. If you haven’t listened to that one, go back and listen to the last episode we published. Lindsey H.: In today’s episode we’re going to talk about health disparities related to race, specifically, disparities faced by Black Americans. To help me with this interview, I have asked my coworker and friend, Dee Dee Grays to join me as a co-host. Hey, Dee Dee. Dee Dee G.: Hey, Lindsey. So excited to be here today, not only to talk about this topic but also I’m excited being your first co-host. Woohoo. Lindsey H.: Yay. I know. I’ve been talking to Dee Dee about this behind the scenes a lot. I have promised her that she would come on as a co-host and I just feel like this topic really needed Dee Dee’s perspective. I can’t talk about this from a personal perspective but Dee Dee does bring some insight. She had an experience with her sister. I know that she’s experienced some stuff with her family. Thank you so much. Dee Dee G.: No. I’m grateful to be here for this conversation. I think that especially Black Americans run into this issue a lot and if you don’t have a personal experience, either a family member or a friend has this experience, and so I think it’s very important that we all talk about it so that we can find solutions on how can we make it better? How can we make the health care system better to where we don’t have these problems when someone of color does have to visit a doctor or have any kind of medical issue? Lindsey H.: Yeah. How great was Dr. Holyfield? I think she brings so much wisdom into this issue. She’s done so much amazing work at the College of Dentistry. Dee Dee G.: No, I agree with you. She has a load of experience and a lot of knowledge that she can share on this and the work that she’s doing at the College of Dentistry is awesome in helping students understand what health disparities are out there and how they can kind of fight these biases that they have that they may not even realize that they have. Lindsey H.: Yeah. I thought that was a really good point that she made is that we really need to do the work to help identify what innate biases we might have that we’re not even aware of. What’s really cool is after we recorded this episode, the College of Dentistry was announced as a 2020 HEED Award Winner from INSIGHT Into Diversity magazine, which is really awesome. HEED stands for Health Professions Higher Education, Excellence in Diversity. That is one of the most prestigious awards that institutes of higher education can get for their work in diversity. Congrats to the College of Dentistry for that. Dee Dee G.: Yes. Very much so. Congratulations, College of Dentistry. Lindsey H.: Yeah. Well, without further ado, let’s get into the episode. Yay. Dee Dee, as our first guest host on Health Talk, which I hope you’re as excited about that as I am, would you do us the honor of introducing today’s guest? Dee Dee G.: I would love to. Our guest today is Dr. Lavern Holyfield. Dr. Holyfield is the assistant dean for diversity and faculty development at the Texas A&M College of Dentistry. Welcome, Dr. Holyfield. Lavern Holyfield: Thank you. Lindsey H.: Thank you so much for being here, Dr. Holyfield. Let’s go ahead and dive right on into this topic. We’ve got a lot to cover. Let’s get started. First of all, let’s set the stage with some facts. What does the data tell us about health disparities related to race and ethnicity in America? Dr. Holyfield: Well, when compared to mainstream population, minority populations bear a significantly higher burden for disease, poor quality health, and less than optimal health outcomes. The United States ranks lower than most peer nations on infant mortality, age-adjusted death rates, life expectancy and others and racial and ethnic disparities exist in quality and in length of life among U.S. residents. For any particular disease, you will find that ethnic minorities actually have a higher rate or higher incidents of problems related to health care and overall health outcomes. For instance, African Americans have a greater incidence of liver and stomach cancer. In terms of oral health, African American males are more likely to die from oral cancer than any other population. It’s mostly because of their race and their ethnicity. When you rule out differences such as socioeconomic status, access to care, and try to put them on an equal footing that still doesn’t help. The disparities continue to persist. Lindsey H.: What got you interested in addressing this issue? I know you’ve done a lot of work at the College of Dentistry. You’ve been working on this issue at the Health Science Center for quite some time. What inspired you to start addressing this? Dr. Holyfield: Well, for obvious reasons, I am an African American, and when I learned that people who look like me are having disparities in health care and health outcomes it piqued my concern. I started teaching cultural competence and the purpose for that was to help make sure our students understood that they needed to be sensitive to the needs and preferences and health seeking behaviors of all people, not just folk who looked like them. In doing that, I started to look more and more into health disparities and what really concerns me is the fact that when everything else is on an even playing field there are still disparities among African Americans and other minority populations. It just became a passion of mine to do everything that I could in terms of educating our students, our future health care providers, about the things that they needed to do to try and help overcome this situation. Dee Dee G.: Why do you feel that especially in the medical field there is this… especially when it comes to African Americans more so on different biases? I know there was a study that came out several years ago where med students were surveyed and they were saying that they still believe that African Americans had a higher pain tolerance or they thought that their skin was a little bit thicker. Where do these notions come from? Dr. Holyfield: Well, these are all steeped in racism and discrimination, these beliefs and a lack of education and a lack of the desire to educate for people to understand that these things are myths and they are not true. When you look at the way African Americans, in particular, are viewed, we’re viewed as less than human by many folk within this country. When you don’t give a person their humanity, you don’t care about what’s wrong or what’s happening with them so you don’t want to study, you don’t want to find out any differences or anything that needs to be corrected because it doesn’t matter, they’re not human anyway. It’s that racism and that discrimination that is the root of the problem. Dee Dee G.: I know that there are many I think, especially in the African American community and even in other minority communities, where they have stories of where they’ve gone to the doctor and the doctor didn’t believe they were having these symptoms or they felt that they were over-exaggerating or, in my instance, my sister had some issues and one nurse actually changed her pain medication over what the doctor said because she didn’t think she needed it. It’s amazing how many people you know have … If it’s not personal to them, it’s happened to someone they know. Dr. Holyfield: A lot of times stereotypes come into play rather than taking the time to individuate, to learn and understand what’s happening with one individual. Health care providers tend to look at the group and that means that they’re overlooking something in that particular individual. A lot of this can be traced back to implicit bias. They don’t intend to be biased, and in fact, if you ask a health care professional, I’ll bet you that the majority will say, “Oh, no. I’m not biased” but bias is innate. Implicit bias they may or may not even be aware of. What we teach our students is to learn your biases, learn about yourself, think about those things that you’ve been taught or that you’ve observed or learned about other groups but remember that what happens for a group or within a group does not necessarily mean that it’s for that individual that’s presenting to you. If we can get everyone to think like that, I think we will have a good hold on solving this issue. Lindsey H.: I know you as an educator and a lot of the faculty that you work with at the College of Dentistry are working to combat some of these implicit biases that you just described. What are some of the specific measures that you’re taking with dental students at the Texas A&M College of Dentistry? Dr. Holyfield: We have embedded throughout our entire curriculum for dental hygiene students, for every pre-doctoral or dental student and for our graduate student in residences, training in cultural competence, in cultural sensitivity, where we actually take them through scenarios. We help them to understand the importance of being not racially blind, no, but paying attention to the race because race can make a difference in the way things work for people but to treat every patient individually based upon their specific needs. We look at cultural and racial preferences and things of that nature as a starting point and we build from there. Throughout the curriculum, we have different coursework that helps to build … From the very beginning, it builds up until they finish their matriculation. Students in their third and fourth year have to report to us a culturally related experience, an experience for a patient who’s culturally different from them in any way. It could be age, gender, ethnicity, race, any difference, and what they did to overcome those challenges that those different experiences presented. In that way, I understand a perspective one patient at a time, how it has affected or had an impact across the board in terms of clinics, that’s something that we need to really look into. Dee Dee G.: Do you feel that, especially as the younger generations are coming in, do you feel that they’re not as complicit with some of these biases or that they seem to have a greater understanding and not so much as the older generation has? Dr. Holyfield: I think they’re more accepting because they have been in diverse situations most of their lives. They may hear about some of the disparities and be completely surprised and many of them will say, “Well, that’s not going to happen on my watch because I’m not that way.” We urge them to understand that this is innate and they need to do everything they can to recognize where there may be a bias, where there may be a stereotype that affects what they’re doing but I would think that for the most part, and I guess I can say for the most part, I can see some differences. We’re getting less pushback when we teach these subjects than we did before. I can look at course evaluations and see they’re not quite as angry with me when I talk to them about these differences and the problems as they were five, 10 years ago. Dee Dee G.: It’s a sensitive subject and I think sometimes you’re having to push into subjects that a lot of people just don’t like talking about. I can see where those surveys are probably like, “Okay, these are interesting.” Dr. Holyfield: Yes. Yes. Lindsey H.: Yeah. I mean, you’ve got students coming into the dental school in Dallas from communities all over the state and nation so you’ve got so many diverse backgrounds, you’ve got people who are coming from areas that maybe aren’t as diverse as other areas and so it could be a different cultural experience altogether when you move to a big city like Dallas. Dr. Holyfield: Well, we have one of the most diverse student populations of any dental school and I dare say that at one time we had the most diverse population and that’s thanks to programs like our pipeline program that helps to prepare underrepresented minority students for dental education. That diversity is good because we learn from each other. We help each other understand our differences and our preferences and it makes it more palatable and it helps to strengthen us in terms of being able to look at our biases and our perceptions and work through anything that’s negative so that we can build stronger clinicians. It’s a good thing that we’re as diverse as we are. Lindsey H.: Yeah. Totally. We talk a lot here at Texas A&M Health about the importance of interdisciplinary education, right? Learning how to work in health care teams. I think this falls in line with that. The more diverse a team is, I think, the better the outcomes are going to be, the better the care is going to be and the better the scientific perspectives will be. I mean, bringing different cultures together to look at a common problem with different perspectives I think is really valuable. Dr. Holyfield: I agree. Dee, go ahead. Dee Dee G.: I also think that helps with patients as well because you get a lot of people who like to have a doctor at least see a doctor that looks like them and gives that perception of, “They understand my problem,” not necessarily, “If I go to someone else, you understand my culture so you can understand some of the barriers or issues that may come up when dealing with health care issues.” Dr. Holyfield: Dee, that statement about wanting to find a health care provider who looks like me, is so profound and that is the main reason we have to teach our students to be culturally sensitive, because it’s unfortunate that the number or the percentage of health care providers who are African American or Hispanic is so low in comparison to their percentages within the population and because people want to go to health care providers who look like them, the fact that there may not be one should not negate the fact that they can get health care by someone who is sensitive to their needs and their preferences. That’s why health educators need to be sure that we are teaching our students to understand that and to understand different priorities, different preferences, and to be accepting and nonjudgmental when we are treating patients and when we are learning about them and to actually take their cultural preferences into account when we are making recommendations and treatment plans because you can plan all you want for them. If it’s not within their scope of preferences then they may or may not accept and comply with that treatment. You have to negotiate the treatment based on what they are willing to undertake or allow to be done. Lindsey H.: What can patients do to locate a culturally competent or a culturally sensitive provider? I know that can be really hard to find if you’re just searching the web. What are some things that patients can do? Dr. Holyfield: Other than knowing of a provider’s background in terms of ethnicity, the best way for a patient to learn about a provider who is going to be culturally sensitive is through word of mouth. It’s usually going to be someone who has gone to an office and has found that that dentist is compassionate, caring, and culturally sensitive. That patient is going to leave there and go tell a friend or family member and so that’s going to just trickle on down through the community. That’s the only way. I don’t think anybody advertises … Somebody may advertise that they’re bilingual or that they speak a certain language but nobody is going to advertise that they take care of all patients based on preferences. At least, I’ve never seen that. It’s really word of mouth. Dee Dee G.: What can a patient do or what can we do when we’re going to a doctor to advocate for ourselves? I mean, it’s a lot different … Like the example I gave with my sister, I mean, the good thing is that my mom was there and so she could advocate for her when she has an issue. If you’re alone and you may be on medication and not really quite … In your right mind, to some degree, but not exactly because you’re on medication, you’re not really able to advocate for yourself so they’re not really going to listen to you. What can someone do to help advocate for themselves? Dr. Holyfield: I would think that the best thing to do is to make sure they have a full understanding before any treatment is rendered, if that’s possible. In emergency situations, that may not be possible but to have a conversation so that you and your health care provider get to have an understanding and he or she gets to know you, your preferences and we teach our students to ask if they have any cultural preferences or is there any practices that could be a problem with what we’re asking them to do or what we’re asking to do for them. It’s about communication, being able to communicate cross-culturally and make sure that there is a mutual understanding. The African American race, and I will speak specifically for my family, I recall that there was no one in my family who ever went to the doctor and especially who was hospitalized where they were ever alone. My mom or someone was always going to be there because that was their role to advocate for that family member. While that’s probably not the practice today, sometimes it may be necessary. As a health care provider myself, when I’m going into an emergency situation I don’t go alone. I’m going to make sure somebody goes with me. Dee Dee G.: Honestly, I know that’s how a lot of my family members they make sure that there is someone else with them. Like I said, my mom she was there the whole time, stayed in the hospital, made sure that everything was done correctly because I think it’s that fear they’re not going to be taken care of properly without that person there to advocate for them. Makes a huge difference. Lindsey H.: If minority patients are encountering these biases and they’re experiencing that kind of communication breakdown with their health care provider, do you think that that can contribute to some of the health disparities that we see in minority populations? Do you think that maybe because of these issues they’re not seeking that proactive health care as often as the white majority or the majority in a given population? Dr. Holyfield: That certainly can be a factor. That lack of trust, if you will, is a factor and because we don’t have practitioners who look like us then a particular race of people will be less likely to go to get the care that they need. Certainly, that can factor into health disparities but that’s just one of the factors. Dee Dee G.: Especially in the African American community, there’s definitely historical issues that go along with trusting health care professionals from the Tuskegee, those groups, I know gynecology and how the founding of that got started. There’s just a lot of incidents and evidence of why, especially the African American community just does not trust medicine, medical professionals. Dr. Holyfield: Yeah. That goes back to the fact that we are not necessarily viewed as human. Let’s talk about experimentation that’s sanctioned these days. It’s usually sanctioned to use animals in that experimentation but when you have a group of human beings that you decide are subhuman then it’s okay to experiment on them, it’s okay for them to get diseases or to die when they could very well have been treated and overcome these things because it doesn’t matter. That’s where the problem comes and I dare say that things like the Tuskegee experiment are fading, in terms of knowledge and memory as we grow older and further away from that but there’s still going to be that deep seated lack of trust or skepticism at the very least to make sure. I went to the emergency room myself and I just wrote my name down, first and last name, Lavern Holyfield, and it was one of the ladies who was registering, the intake coordinator, she asked me to come back to her desk and she said, “You’re a doctor” and I said yeah. She said, “You need to put doctor on there.” That said to me that she knew that differences were going to be made based on who I was, treatment that may not have been rendered. When she said that to me, it kind of sparked some thoughts and it kind of scared me. I remember saying to the health care provider, everyone that came in, I said, “Listen, don’t worry about the payment. I’ve got two insurances. Just do what you need to do to make me okay” and to this day, they don’t know what caused the issue that I was having but right now I’ve got a team looking at me constantly and they keep up with what’s going on. That’s a good thing but had I just been Joe Blow from the hood, maybe now. Dee Dee G.: I do find how you said that you had to tell them, also, that you have insurance, you have two insurances, that you were okay, that you can pay for it, which I think is also one of the things that comes up a lot too. It’s like, “You don’t have insurance” but it is interesting. Same with, like I said, my experience is more with my sister’s issue but she did as soon as they found out what she did and where she worked, they totally changed their attitude towards her and it was just the craziest thing I had ever seen. It’s like that’s not how every patient should be dealt with as though they are one of the richest people in the world. Dr. Holyfield: I say to my students, treat your patients the same, treat them equally and I don’t mean give them the same care because they have different needs but what I’m saying is be as open and honest to them, to each one of them and to make sure that you’re offering them the best care possible regardless of who they are, where they come from, or what they have. Lindsey H.: Yeah. I said this in the last episode, I’ll say it again. I mean, if you’re not in the health profession to provide compassionate care to patients and to value human life, I just feel like maybe you’re not in the right business. You know what I mean? Don’t do it for the money. Do it for the humanity of it, right? Dr. Holyfield: I agree. It’s more important that we are there to render the care that a patient needs than it is to get rich. Nobody goes into dental school to be poor for the rest of their lives. They want to have a profession that’s going to sustain them and that’s with any health care profession. That shouldn’t be the primary thought when you’re taking care of a patient. “How much can I get if I do this versus that?” Or, “I’m not going to do this because they probably can’t afford it.” You need to be compassionate and concerned enough to want to render the best care possible for a patient. If you see that a patient may not be able to afford it or it’s out of your scope then make sure that they get to the right place. There are clinics across this country that take care of patients who have low incomes. If, for some reason, you just can’t do it, don’t just dismiss them, don’t just disregard what it is that they need. At least, have a decent referral system to help them get to where they need to go. Lindsey H.: What can white allies do in the fight against health disparities in America? Dr. Holyfield: That depends on what their role is. If they’re health care providers then they need to make sure that they have examined themselves, that they understand their biases, implicit and otherwise, and that when they are treating someone who is different from them, they bring those biases to the front of their minds so that they can manage them as opposed to allowing those biases to dictate how they proceed. If it’s the insurance companies, make insurance available to all people. If it’s politicians, make rules that are going to make it wrong and against the law to withhold treatment from people because of who they are, what they look like, or what they have. It takes a whole group. I dare say that African Americans, in particular, have been struggling a long time and we’ve cried out against these struggles. Sometimes it’s been controlled, sometimes others have gone a little beyond what we want to see. African Americans alone, Hispanics and African Americans together, are not going to be able to make the differences that need to be made without the help of our white counterparts. We need the help of everyone who cares enough to make sure that everyone is getting treated fairly to speak up, speak out, and do everything within their power to help change the situation. Lindsey H.: I think that starts with just awareness. I think it’s easy for people to ignore it or to be in denial or just to be naïve to it. It doesn’t happen to me so how can it be impacting other people, right? I think it’s important for people to educate themselves, read the articles, listen to the podcasts, watch the documentaries. I mean, listen to our Black brothers and sisters who are saying that this is an issue, because it is an issue. Dr. Holyfield: You know, I try to find a silver lining in things and that is a silver lining in COVID-19 because even though African Americans and other minorities knew that we suffer disproportionately, there were our white brothers and sisters who may have heard it but it just didn’t register until we find out that 60 percent of the people who are dying are of color. It’s not that we have been crying wolf. There really is a problem. If COVID-19 has done nothing else, it’s made more people aware of our plight. I’m grateful that it’s made more people or has given more people an incentive, a motive to get up and to help champion our cause. Again, COVID-19 is not the best thing that could have happened to any of us but there is that silver lining. Dee Dee G.: As you said, there’s a silver lining. As you’ve been teaching the new generation of medical professionals, do you see it changing? Do you see that the skies are starting to open up and that we won’t have this problem in the near future anymore? Dr. Holyfield: I wish I could say, yes, I see that, but in all honesty, I really can’t see it because I’m not out in the communities looking at what our students that have finished are doing. I just have to have faith that they’re taking what we’re doing to heart. I do know that one of the questions we ask them as they are preparing to graduate is if they will be treating patients who are different from them and the majority of them, 90+ percent of them say yes. Based on that, I think there is going to be a difference. I think there already is one and that it’s to improve but I have no data to support that. Lindsey H.: If we’ve got current practicing health care professionals listening to this, what is an exercise that they can do to identify some of those implicit biases or steps that they can take to improve their treatment and care of patients who are different from them? Dr. Holyfield: I guess one thing would be to look at someone from a different group and think about everything you’ve heard about that group and see what it is that that one individual, how that one individual does not conform with what you really think that group does. I mentioned the term individuation earlier. When you start individuating, you’re looking at a person for who they are, not for who they belong to, what group they belong to but what that person is all about. When you start looking at individuals as opposed to looking at groups based on those stereotypes and generalities that you grew up with, and a lot of these things we brought from childhood on, then you have a better chance of learning to think about each patient as an individual instead of a patient who belongs to a group. Dee Dee G.: I know one of the issues that always comes up also is access to care and so especially within majority minority neighborhoods there’s an access to care issue. Do you think that also contributes a lot to the issues? I know a lot of those neighborhoods don’t have mass transportation in their area so they can get to where they need to go, I mean, there’s also food deserts and things like that, which all contribute to health issues but a lot of it also is those issues are really concentrated in minority areas. I don’t know what can be done for that. I see some groups come in and try to help that out but a lot of that, that’s a greater problem within cities and states. Dr. Holyfield: You’re correct. Access is a problem. To health care and nutritious food. It is a socioeconomic problem as well. What happens is when an individual finishes their training as a health care professional, they are more likely to setup shop, open an office in an area that’s more affluent and so that just exacerbates the issue. Transportation is a problem. If you’re not feeling well, you don’t want to stand on the bus line or sit down and wait for a bus. You probably can’t afford the cost of a taxi to get from where you are to where help is. Now we have ride shares that still may be outside of what an individual can afford. Yes. This all contributes. Access to care is a major contributing factor to health disparities. Dee, even if somebody had access and we ruled out that as a problem, we made access … Everybody was able to access the care they needed, health disparities still persist among minority populations. It is a racial and discriminatory issue that has to be changed. Lindsey H.: Yeah. We talked earlier about the mistrust that, especially, the Black community and minority communities have in the health professions and currently there are a lot of companies and organizations who are running clinical trials for a COVID-19 vaccine, that’s one of the main initiatives across the globe right now is getting a COVID-19 vaccine to market. You know, you see headlines, at least I see headlines almost daily that they’re struggling to get representation in those clinical trials from the minority communities. Is there something that we can do to improve that? I know we talked about all of the things that have led to this. There’s that historical mistrust. I imagine it’s going to take a long time to get to where we need to be where everybody is equally represented and that everybody is getting the compassionate and quality care that they deserve but is there anything that you think we can do to improve the participation of minorities in these clinical trials. Dr. Holyfield: I can think of nothing that can be done immediately. Even having town hall meetings where health professionals come and talk to minority groups, that historical distrust is a factor. I don’t see that anything is going to happen to change that any time soon. Dee Dee G.: I’ve seen, obviously, we have some trials going on ourself and I think that’s an FDA requirement is that they have a certain percentage of minorities when they do these trials as well. Yeah. That’s a struggle because then it goes back into, which you keep hearing, if there is a vaccine that comes out with COVID do you trust it and will you take it? That’s going around as well, which I think is going across the board but I know specifically within minority groups they’re like, “I’m not going to be the guinea pig for you today.” Is there a way to get past that? Like you said, I think it’s just going to take some time. Dr. Holyfield: Yes. I agree. It’s just time I think. Dee Dee G.: I think also as we get more minorities within research, jobs, as the different health professions because the health profession does not always just mean the doctor, lawyer. You have researchers that are also there in the … They’re just in the back end side of it. I think if we get more representation within those communities, you may have more of a trust situation where they may go ahead and sign up for the trial. Dr. Holyfield: I wish I had the answers but I don’t because erasing years of concern, of mistreatment, experimentation and just a lack of recognition as an equal being, it’s going to take a while. That’s a lot to erase over a long period of time. I hope that I get to see it in my lifetime but I can imagine it’s not going to be overnight but hopefully it will happen someday. Lindsey H.: Thank you so much for this conversation. It’s such an important discussion to have and we’re going to continue this conversation for years to come as long as it takes. I know we’re doing as much as we can at academic and research level to try and address these issues and anybody out in the communities who are listening in on this, Dr. Holyfield outlines some things that you can do to advocate and really get out there and make a difference so thank you very much. Dr. Holyfield: You’re welcome. Thanks for having me. Tim Schnettler: Thank you for joining us on Texas A&M Health Talk, a production of the Texas A&M University Health Science Center. Visit us on the web at vitalrecord.tamhsc.edu where you’ll find answers to all of your health questions. Until next time, stay healthy.
56 minutes | Sep 21, 2020
Why we need better LGBTIQ+ education in the health sciences
Lindsey Hendrix: We bring you advice and compelling insight on the latest in health, medicine and scientific discovery. From tips for getting better sleep to discussions about major issues like health disparities in America, we’ll talk about it. You’re listening to Texas A&M Health Talk, part of the Texas A&M podcast network. Lindsey Hendrix: Hello and welcome to Texas A&M Health Talk. I’m your host, Lindsey Hendrix. I hope you’re all doing well as we continue to navigate the COVID-19 pandemic. Here at Texas A&M Health, we’re doing our part. We’re wearing our masks when we’re out in public, physically distancing, washing our hands and doing everything our public health professionals have advised, and I hope you’re all doing the same and that you are staying well. Today we’re going to veer away from the COVID-19 topic a little bit and talk about an ongoing effort at Texas A&M Health, and that is addressing health disparities. Nobody should have difficulty accessing health care or receiving quality care in the United States. Unfortunately though, that is a reality faced by too many Americans. We’ll talk about many health disparities that are impacting various different populations in episodes to come, but today we’re going to focus on the LGBTIQ+ community. My guests today are amazing. They’re working on an exciting and very important project here at Texas A&M Health to address LGBTIQ+ health disparities and I’m so excited about my conversation with them. Dr. Alison Pittman is a clinical assistant professor at the College of Nursing, and Dr. Faizan Kabani is a faculty member and assistant director for diversity and faculty development at the College of Dentistry. We had a terrific conversation. I learned a lot. I hope you learn a lot from this discussion as well, and I’d like to see the entire community move this issue forward and make progress toward a better health care experience for our LGBTIQ+ friends and family members. I hope you enjoy listening to our discussion. Thank you both for joining us, welcome. Dr. Faizan Kabani: Thank you for having us. Dr. Alison Pittman: Yes, thank you. We’re looking forward to the discussion. Lindsey Hendrix: Awesome. Well, I think let’s just go ahead and dive right on into it. We’re going to be using these terms throughout the show, so I want to start by defining some of these terms that we’re going to be talking about. First of all is LGBTIQ+. This is a term that has evolved as awareness has been risen throughout the nation and the world. So, help define that for our audience. Dr. Alison Pittman: Well, it’s kind of an alphabet soup and it changes a lot. There’s not a full agreement about what the full acronym should be, but you’ll see a lot of times LGBT is probably the most common. Each of those letters stands for a subsegment of the population that we’re talking about. So, L is lesbian, G is gay, B is bisexual, T is transgender. We in particular like to throw I in there before the Q. I stands for intersex, so someone who genetically or biologically is not binary in their gender. And then Q stands for queer which is really, a lot of times, is perceived as an umbrella that represents everyone in the community, so that is often included. The plus is often there just for anyone else who maybe doesn’t fully identify with any of those possibilities but still identifies as part of the community, for example an ally of the community. Does that, you know? And you’ll see lots of different alphabet soup. Sometimes not all those letters are included, but that’s the one that we typically use. Lindsey Hendrix: That’s very helpful. That’s very helpful, and I know it continues. It continues to evolve as time moves on. Then the next very important term that we’re going to talk about is health disparities. I know that can be a little confusing from time to time. People have heard health inequities, health inequalities, but we’ll be talking specifically about health disparities, so help define that for us. Dr. Faizan Kabani: Sure. Health disparities in general are pretty much health differences between different groups of people, and it can include a variety of different elements such as premature morbidity or sickness, mortality or death. It can include aspects such as even access to care and more. It’s really not just focused, although popularized with race and ethnicity, it also includes other aspects such as geography, sex, gender, sexual orientation, disability, socioeconomic status and more. Actually, back in 2016, the LGBTQ community was actually identified as a health disparity population by the National Institute on Minority Health and Health Disparities of the NIH. Particularly, part of it at least, that they identify is because the group has been shown to have less access to health care. Dr. Alison Pittman: In addition, the Institute of Medicine, which is really a governing body in the United States in terms of health care providers and physicians, came out with a large report in 2011 that also identified this community as being underserved and a vulnerable population in terms of health. So, the discussion’s been out there for a while. Lindsey Hendrix: Yeah. What does the data tell us about health disparities and the LGBTIQ+ population in America? What are some of the disparities that this group faces? Dr. Faizan Kabani: Well, we know from both research as well as from practice, that LGBTQ+ communities actually experience quite a disproportionate amount of health inequalities including negative experiences with some health care providers in the system, inadequate health insurance coverage and benefits, social violence and bullying, higher psychological distress and more. Unfortunately, as we’ve come to learn through the literature as well as in our practice that there is actually quite a bit of lack of knowledge among health care providers on these unique health disparities. Lindsey Hendrix: Why do we think these disparities exist? We like to think, or at least I like to think, that all people are created equal, that they’re all treated equal. I know unfortunately that is not the case, so what are some of the issues that have led to this? Dr. Alison Pittman: The one that I think is most concerning is that a lot of studies have come out in the last 10 years or so, maybe not even that long, looking at the literature that we’re using to improve our practice is that a lot of folks in this community have experienced discrimination when seeking health care. This can vary from just nonverbal discrimination, like looking people up and down or staff in health care provider offices. For example, in particular, transgender folks tend to say that they’re called by the wrong name. A lot of folks who are transgender are in the process of changing their name legally, changing their gender identity legally, and that takes a lot longer but they still want to be called by their preferred name, the name that they’re changing to, the gender that they’re changing to, the pronouns that they want to use. And even after asking people to call them by that name, staff will deliberately call them by the wrong name or the wrong pronoun. When they’re with a provider and trying to seek health care help, the provider is often either uncomfortable or outright discriminatory. There’s even reports in a lot of studies of assault and just inappropriate touching, and things like that. So a lot of it unfortunately comes from societal norms and the way that people are treated when they seek health care. I’ll let Dr. Kabani elaborate on some of the other ones. That’s the biggest one to me that’s most concerning. Dr. Faizan Kabani: I would echo what Dr. Pittman is saying, but I’d also add that a lot of the reasons why I believe health disparities exist among the LGBTQ+ communities is that it is actually externally imposed onto the community. So for example, we already know that access to quality health care and adequate health insurance coverage is a major limitation, so we know that. But now, if we pair restrictive health benefits and lack of education, training and research for health care workers with social discrimination as well as institutional bias, we end up having a major gap when trying to really provide a safe, supportive and equitable environment for the LGBTQ community. Lindsey Hendrix: What are some of the health benefits that the LGBTIQ+ community wouldn’t be a beneficiary of? Dr. Alison Pittman: A lot of it has to do with health insurance coverage. For example, a lot of health insurance companies will not cover beneficiaries unless they’re married. It wasn’t until very recently that we had same sex marriage, and there’s still a lot of barriers for same sex couples, for example, if one is employed to have coverage for the spouse if they’re in a same sex marriage. There’s still a lot of barriers to that. Unfortunately, there are a lot of socioeconomic disparities for this population as well. There’s been some studies that have come out that say particularly among young people, youth and young adults, they have more difficulty getting employed, they often suffer from more mental health issues, there are increased rates of homelessness. So, those particular socioeconomic barriers mean that they may not have access or be able to afford health care. It can be something as simple as getting tested for COVID or having treatment for an infection or an illness. They oftentimes will have more barriers to getting health care. Lindsey Hendrix: Yeah. That’s something I hadn’t really thought about is how difficult it could be for a couple in a same sex marriage to benefit from their partner’s insurance. And then I guess all of these social biases are really playing into what is happening on the health care side. Dr. Alison Pittman: Yeah. If I try to seek health care and I feel discriminated against, I feel like someone mocked me or made fun of me or didn’t respect my freedoms and my identity, then the next time I get sick, am I going to want to go to the doctor again? It goes so far as to some preliminary studies saying that we see increased rates of heart disease, cancer. We don’t know for sure, but one of the associated factors is that people in this population may have those signs and symptoms of oncoming chronic disease just like anyone else, but they don’t seek the treatment because of the discrimination that they have experienced, and so those early signs of chronic illness are missed and it’s something that we really need to fix. Lindsey Hendrix: What can health profession schools do to help prepare students to better care for the LGBTIQ+ population? Dr. Faizan Kabani: That’s a really great question. Fortunately what we’ve been able to uncover with our group cohort of educators is that health entities, including the American Dental Education Association, American Medical Association, American Nurses Association, American Public Health Association and the American Pharmacists Association actually all agree that better LGBTIQ+ health research and education is needed. All of these particular organizations have position papers or actually statements that endorse this position. However, these are all pretty much siloed recommendations within each particular profession and therefore, the bigger need and solution really, and this is where we’re working as a group, is to provide the solution at the interprofessional level, such as the Health Science Center level. It’s more ideally situated for improving culturally competent patient care, particularly for LGBTIQ+ communities. What’s alarming, too, is when you look at the literature on interprofessional studies, we find that the average health profession student actually gets between zero to five hours of LGBTIQ+ health education throughout their entire program of study. Lindsey Hendrix: Wow. Dr. Faizan Kabani: That’s very alarming when you look at the particular statistic. So unfortunately, there’s really no institution within the state of Texas that provides this form of interprofessional LGBTIQ inclusive curriculum, which unfortunately then ultimately leaves health care providers and students lacking the training, the knowledge and the experience to really be able to provide culturally and clinically competent care to LGBTQ patients. So perhaps health profession schools can collaborate at a broader, perhaps national, level to really organize and to teach health curricula focused on caring for such patients. I know that there are several organizations that we in the academy can reach out to for help and guidance, such as the National LGBT Health Education Center, among others who can perhaps light the way for us in being more inclusive in our education. Lindsey Hendrix: What percentage of their patients can a health professional expect to see in their career, in their practice? Dr. Alison Pittman: That are LGBTQ? Lindsey Hendrix: Yes. Yes. Dr. Alison Pittman: Yeah. Studies vary. When we look at our general population, the population that we serve. Statistics, surveys, this is always based on survey data, anywhere from 3.5 to eight to 10 percent, depending on the community where you live. A lot of times LGBTQ folks will often want to be in a community where it’s more welcoming for them, so some cities might have larger percentages than others. But the general population typically, reports vary anywhere from three to about eight percent. Lindsey Hendrix: That’s very significant, so it’s really important to prepare health professionals to care for this population. What is Texas A&M doing specifically to address this issue? Dr. Alison Pittman: Well, Dr. Kabani and I are both part of a team that was really sort of a grass roots effort among faculty within all the different colleges to get together and talk about the problem. I think, gosh, it’s been a little over two years now that I sort of put out a call. I was seeing this as being a big issue. I’m a pediatric nurse by trade, and it’s always been a big concern for me particularly because youth and young adults tend to be particularly underserved within this population. I was seeing a lot of disparities and a lot of struggle, especially among teenagers. A lot of times we just see a problem and start reaching out. I reached out to faculty and leadership in all the different colleges within the Health Science Center, and Dr. Kabani was truly one of the first ones to say, “Yes, I see this, too. I want to be a part of helping this out.” We started looking within the state of Texas. We have several health science centers, but no one’s really doing this sort of innovative idea of first of all, increasing the amount of curriculum we have in all of our students within the Health Science Center, but also doing something interprofessionally. Dr. Alison Pittman: I know you’ve covered in other podcasts how important and meaningful interprofessional education is to students within our colleges. So we decided we were going to start researching, start looking at how to make it happen for Texas A&M to really hopefully be the first health science center within the state to provide this. Eventually we want to allow health care providers within the community of the state of Texas to be able to get additional training, because as Dr. Kabani mentioned, a lot of the nurses, physicians, pharmacists graduate and don’t really get that education, but we can always provide it if they want to come back and get it. Dr. Faizan Kabani: I would simply add that in our endeavor, our deans and many of our leaders have been providing a lot of support resources towards this important cause, so we have support from top down to be able to help make this not just theory but a practical application. So we are working progressively towards that and we are very fortunate to have made strides in it, and we’re looking forward to making even more strides as we continue. Dr. Alison Pittman: You can tell, we’re super passionate about this. In our Zoom sessions when we get together, I know Dr. Kabani feels this way because we’ve talked about it, it’s the highlight of our week because it’s something that we’re really passionate about making a difference about. We’re basically volunteer time devoting to this. It’s funny, we just smile a lot because it’s really meaningful work for us. Lindsey Hendrix: It is. It’s exciting. Dr. Alison Pittman: Yeah. Lindsey Hendrix: Dr. Pittman, you mentioned why this is an important issue for you, you witnessed it in your practice as a pediatric nurse. Dr. Kabani, how about you? What got you interested in addressing this issue? Dr. Faizan Kabani: Well, I know since I’ve joined the college and being a part of clinical faculty at the College of Dentistry, I have had firsthand experiences where students under my care have been providing care to patients that belong LGBTIQ communities, and I was able to observe the students having a sense of gap in understanding and knowledge and perhaps, not necessarily compassion but just not sure how to perhaps provide this care in the best possible manner. You’re often taught the science, the intellectual, but one needs to be able to foster the heart and to build that in clinical care. When I was able to observe this gap in my local contacts, I knew that this was not an isolated incident, nor is it a very rare experience amongst health profession schools. So it became something that needed to be addressed not at the local level, but really at the broader in a professional level. It almost was like I thought of it and then I was reached out about it, so one of those things where you know there has been an intervention or reason. Paths have crossed for a reason to make a difference for a reason. Lindsey Hendrix: Yeah, absolutely. Where is the group now in developing this curriculum? I know you all have had meetings. Where are we? Dr. Alison Pittman: Well, we kind of started by sort of figuring out the issue, the gap, and doing a lot of literature review. We’re currently in the process of doing a survey of what our Health Science Center needs, so we’re currently in a process of preparing some surveys that are going to go out to faculty and to students amongst all the colleges in the Health Science Center to ask them what their knowledge level, their comfort level is caring for this population and also what they feel like the gaps are in terms of their education. Dr. Alison Pittman: Once we get that data, we really want to create a curriculum that’s specific to the needs of our college, because there’s a lot out there—well, not a lot. I think we need a lot more data, but there is some evidence out there about what the gaps are in education within each profession. There’s some developing evidence, but we want to really meet the needs of providers within our state and students within our state. So once we get that survey data back, that’s really going to guide us in developing the curriculum that’s specific to our students. Lindsey Hendrix: I think it’ll be really interesting to see what that data reveals and hopefully shed some light for other institutions in other areas on the need for this kind of curriculum and education across the health professions. We touched on it briefly, you’re hoping that you’ll eventually be able to engage current practicing health professionals so that they can benefit from this education and so that their patients can benefit from them getting this education. Right now though, what can practicing health professionals do to get that insight, to get the education so that they can better care for the LGBTIQ+ patient population? Dr. Faizan Kabani: I would say that the Dalai Lama said it best where he said that love and compassion are necessities, not luxuries and without them humanity cannot survive. So the need for LGBTQ friendly health care is quite clear, and it’s actually a critical issue at hand. Really the desire for nonjudgmental care, compassionate care is not something that is specific to the LGBTQ community, rather it’s a basic human need and really a right for every patient out there. So really, to answer your question about what can health professionals do to better serve LGBTQ patients, I think one of the first steps that we can do is to really spend quality time learning and being sensitive to the unique personal and health circumstances really that are crucial to properly caring for patients in this context. Many we’ve talked about earlier already. I would say a second step and equally important really is cultivating a sense of empathy when caring for LGBTQ patients. When caring for these patients, health care providers should really not be afraid to respectfully ask questions, request and engage in feedback, communicate clearly, honestly and really make a concerted effort to learn from their patients’ experiences. We know that studies have long linked health care provider empathy to greater patient satisfaction as well as better health outcomes. So in sum, really take the time to learn and build the heart. Lindsey Hendrix: Yeah. To me, you really nailed it on the head with you’ve got to have empathy and you’ve got to come at this with a caring heart. After all, isn’t that what health professionals should be in this business to do, is to care for patients? So, why develop a curriculum specifically for the LGBTIQ+ population? I think if you’re engaging in that compassionate care and you’re asking those questions, you should be able to do that across your entire patient population, so what kinds of information is going to be in the curriculum? What are the health professionals going to learn specifically for the LGBTIQ+ patients? Dr. Alison Pittman: I think we start with essentially the concepts that Dr. Kabani was just talking about where each individual human that is in a caregiving role needs to sort of self-examine and think about and explore their own values, their own thoughts, their own possible implicit, explicit biases. You want to talk about implicit biases, biases that I have towards people that I don’t even realize I have and just our views. Each of us, each profession that we serve in the Health Science Center takes some sort of commitment or pledge. We have our standards of practice in each of these professions. In nursing, we take the Nightingale Pledge, from Florence Nightingale, where we vow to keep matters committed in confidence and to devote ourselves to the welfare of those in our care regardless of their background and where they come from, and we really have to do better. The reason that this important and that we are really focusing on this population as underserved is that we’re not doing a good job. The evidence shows us that we’re either really demonstrating discrimination or just not knowledgeable enough to treat folks with the respect and the knowledge and communication, the ability to communicate with them in a respectful way. Honestly, in my glass half full heart, don’t believe that people often are doing it intentionally. It’s just not really knowing how or being comfortable in communicating effectively. Dr. Faizan Kabani: Let me add as well, I concur with Dr. Pittman. I would just add the fact that in our health profession schools we learn of certain vulnerable populations, certain underserved populations that experience a disproportionate amount of burden in terms of health and health care. We spend the time to learn about them because they require that additional knowledge and that additional expertise to be able to provide the right care, quality care, and so the LGBTQ community is no exception to that. We know from evidence. We know even with the NIH being able to designate this group as a health disparity group that we’re not, like Dr. Pittman said, we’re not doing a good enough job. More progress, more effort needs to be done in this area, and that’s why there’s just cause for us being able to build and work towards building curriculum in the health profession schools that help us and help future professionals, caretakers of our society, actually be quality caretakers in an inclusive manner. When we look at the research, when we look at evidence, we know that LGBTQ populations have unique health care needs and experience a disproportionate amount of health burden across the lifespan, children, adults and elderly. We’re talking about a disproportionate amount of mental health issues, social isolation. We know that the literature also suggests increased rates of cancer, particularly breast and cervical cancer, obesity, eating disorders, heart disease, suicide, suicidal thinking, sexually transmitted infections, and a whole host of other issues, and that it is very important that curriculum be made to help in better understanding these unique health care needs. But also, what can we do to help this population as well? Lindsey Hendrix: Yeah, absolutely. Dr. Alison Pittman: It can be a little overwhelming. I think we often as health care providers feel a calling to be an advocate or a voice for those who don’t have one. I think, folks in the LGBTQ community have been voiceless for a very long time. As a community member, but even more importantly as a health care provider, we can at least be a voice for their need for adequate health care, for health equity, which is kind of the opposite of health disparities. We want everyone to have equal access to competent health care, so I think that’s the underlying motivation for a lot of us is just to be a voice for people who have not had one in this arena. Lindsey Hendrix: We talk about the importance of interprofessional education. I know that’s a big initiative here at the Health Science Center. We know that health care is not provided in a silo. More and more we’re seeing the team-based approach to health care out when you’re in practice. Why is it important to develop an interprofessional curriculum rather than individual colleges creating their own curricula? Dr. Alison Pittman: I think the simplest answer is when we get out and start working, we’re not working in silos, so why are we learning in silos? We work in teams. Regardless of whether you’re in a hospital, a clinic, out in the community, you’re not working just with your profession. You’re working with physicians, nurses, pharmacists, dentists, public health, community members, family members. Everyone has to work together to improve health, and so I think the health professions are finally realizing we need to learn in that environment as well. Dr. Faizan Kabani: Absolutely. The success of interprofessional collaboration and practice is highly dependent on interprofessional education. So if you’re wanting it to be successful in practice, it must be fostered and cultivated in the classroom and the clinical experience [inaudible 00:31:22] their student, so it becomes part of their fabric as they become health care providers. Dr. Alison Pittman: And just from personal experience, our students all love it. They get so excited when an interprofessional opportunity comes up, particularly simulations. It takes a lot of time and effort and scheduling to make that happen, because our schedules and calendars don’t always jive. But when we have the opportunity to schedule an interprofessional simulation where we’re working alongside other team, other colleges, students from other colleges, the students get so excited and when we get the feedback from the students, it’s always, “We need more of this, we want more of this.” That’s most meaningful, is that the students find it to be a valuable experience. Lindsey Hendrix: That’s great. How do you see this interprofessional curricula playing out between all of the colleges, separated by discipline and in a lot of cases by geography? Because the Health Science Center has campuses all over the state of Texas, a large state, so we can be hours apart from each other. Have you all thought about how that’s going to be implemented? Dr. Alison Pittman: We have. We know that not every profession within the health sciences is going to provide the same type of care, so our vision based on what we see being innovated in other institutions and what the research says is to really start with an interprofessional group to talk about respectful and knowledgeable communication with all patients, just basic patient and client communication with folks in this population, the right terms to use, the right way to start a conversation to be comfortable in that conversation and also, as I mentioned, just exploring your own thoughts, beliefs within each individual person, our biases and our views of folks in society. Then the way we think the curriculum might flow is that a lot of that general communication and patient care will happen in an interprofessional realm and then specific treatments. For example, in dentistry, dental hygiene versus what nurses do versus what physicians and pharmacists do, will happen in sort of breakout session type ways so that education or curriculum specific to that profession can be provided. Again, we’re a work in progress. I don’t know what Dr. Kabani envisioned. We’ve talked about it, but I’m interested to see what his thoughts are as well. Dr. Faizan Kabani: I would only add the fact that one of the things that COVID has taught us is that we can still move forward in a virtual platform. So when we’re talking about interprofessional education, we know that we’re able to connect. This podcast is a case in point of an example where individuals from various different parts, located in different cities, are able to come together for a shared cause. So if the cause is from an educational perspective, you can sure bet that there’s going to be a lot of educators that are willing to provide this care, provide this knowledge, share this knowledge with students in other areas through a perhaps virtual platform if a physical space is not available or practical in time being. We have seen the success across, not just health care, but across a variety of industries, and that’s what one of the main things, like I mentioned, COVID has taught us. So if anything, we know that we can build upon this platform as we go into the future. Dr. Alison Pittman: That’s a great point. I completely agree and as an example, when you talk about what existing providers can do to further their education of caring for LGBTQ folks, we have to seek out sort of our own continuing education. I went to nursing school in the ’90s and we got nothing in terms of this curriculum, and so I have to give a shout out to the University of Louisville in Louisville, Kentucky. They have a post-graduate certificate that is interprofessional on LGBTQ health care. There were some online modules that we could do, but there was a simulation that was live. Fortunately I was able to travel there to do this interprofessional simulation of LGBTQ health care, and it was outstanding. Since COVID happened, the university has moved a lot of that online, and so one of the silver linings, I think, of COVID is that these things are so much more accessible. You don’t have to travel, get a plane, get a hotel room to get this continuing education across all health professions. A lot of it is available online, and that makes it more accessible. Dr. Kabani is right. We’re actually kind of rethinking, if we continue to live or even if we don’t live in a pandemic world any longer. If this is effective way of learning, why can’t we provide this in a virtual environment and still have the same learning outcome. Lindsey Hendrix: This makes me think, too, when we’re talking about interprofessional education is that this isn’t just about communication with the patients, this is also communication within the professions, right? We say that three, upwards to 10 percent of the general population in areas identify as LGBTQ+. How is that represented in the health professions? How many of your future colleagues or colleagues in your educational program identify as LGBTQ+? Dr. Alison Pittman: That’s where I see a big gap, and I’m sure Dr. Kabani can speak to his profession, but in nursing there’s not a lot of data. That’s one big research interest I have, is there’s just not a lot of evidence out there on what percentage of the nursing profession is LGBTIQ. We have an idea of what our population that we serve is, and we always strive, all at least within nursing and I know all other professions, we strive to reflect the population that we serve in terms of ethnicity, race, background. We want patients who we’re caring for to see us in them, see them in us. In looking at this question and looking at the literature, there’s really not any hard data for nursing. What about you, Dr. Kabani? Do you have any data on yours? Dr. Faizan Kabani: Unfortunately, I’m not aware of any particular official source that provides this particular information, but I would imagine, just thinking, that there’s probably a shortage of health care providers who identify as sexual minorities. In some instances, I’m sure that there are health care providers who perhaps do not publicly disclose their sexual identity. But a general principle, however, whenever we look at the literature for any kind of data that may be containing sensitive information, we know that the data is often under-reported. In other words, the reported shortage is probably underestimated in reality as well, which actually kind of touches upon another relevant and important point that Dr. Pittman also mentioned which is the need for role models. People need role models in every field, so be the patients to be able to see us them and them in us. They need someone to be able to look up to, to seek guidance from, comfort from and potentially to build a similar career like. So we need more advocates, allies, supporters in the health professions so we can really build for a more positive future. Lindsey Hendrix: Yeah. I think if a youth or adolescent who is struggling, being a teenager is hard anyway. Dr. Alison Pittman: Yes, indeed. Lindsey Hendrix: If you’re struggling with your sexual identity and you encounter a negative experience with a health care professional who is supposed to be caring for you, I would imagine to see a health care professional that you can identify with, who identifies in a similar viewpoints, background, orientation, all of those things that go into the individual person. I can imagine that would be inspiring for that youth to then pursue a career so that they can provide better care for future patients, so that their experience is not repeated in the future. So I think it is important for people to be open, right? Dr. Alison Pittman: Yes, absolutely. Dr. Faizan Kabani: Absolutely. Dr. Alison Pittman: Yeah. Med Pride is an organization here on our campus. The College of Medicine student body has really been a forerunner in terms of attention to the LGBTQ community. They did an event not too long ago and they repeat it every couple of years where students from all professions can come into our clinical learning center and they have a waiting room, a simulated waiting room that is LGBTQ friendly and a waiting room that is pretty much the standard, which is not very friendly. Everything from the form that you are handed to fill out, is it respectful of your identity? Are the gender boxes simply male and female, or is there another option? Does it ask about your sexual orientation? Are there welcoming signs that say that it’s an inclusive and welcoming office and organization? Anything from are there magazines that have depictions of LGBTQ folks on the cover? I think that a lot of the effort that I’ve seen in my experience has come from the bottom up. We can’t wait for leadership in any entity, from government on down, to make these changes for us. We really have to push for them where we work in our everyday lives. So I think a lot of that is truly comes from wanting to make things better or make them change. That’s really what a lot of it comes from for me. Lindsey Hendrix: I think as a larger social issue, the media has been trying harder to represent minority populations in media and communications. How is that seen or witnessed in health communications specifically? If you’re on WebMD or you’re doing a Google search for a health care issue, are you being represented in that communication, or do we have work to do there? Dr. Faizan Kabani: In just my experience, I know that we have been able to make pretty significant strides, particularly in the electronic medium, I think, where the LGBTQ community friendly health communication is getting out there, and a lot of the credit really has to go with the grass roots efforts of a lot of the LGBTQ friendly organizations. However, we are nowhere near done. We have a lot of progress that still needs to be made in this area to really make it an integral part of mainstream communication. Dr. Alison Pittman: I would agree, and one thing that we are looking at is we have our prospective students that are trying to decide where they’re going to go to dental school, dental hygiene school, nursing school, med school. A lot of times we surf the web, and when people are shopping for where to go to school, when they go to our website, when they go to the website of the school, do they see themselves represented in the photographs that are there, in the representations of the student body? I would say that patients are going to be a same way. When they’re seeking health care and they’re shopping, and they are consumers, do they seem themselves as being represented in what they view as that patient population or within that entity, that health care provider’s organization? Because if they don’t, they’re going to keep shopping and go elsewhere. So I think we need to think about especially when we put out communication as providers, are we being inclusive and welcoming to all persons when we put ourselves out there as providers in the care that we provide? I don’t have my badge with me but the caduceus… I can’t ever say the word right, that’s like the little symbol for health care and medicine with the two snakes around the pole. There are little pins that are that symbol but that they’re rainbow. So it can be something as subtle as having that on your name badge saying, “I am an ally. I am welcoming to any and all questions. You’re welcome to discuss your status with me and I can do my best to get the health care that you need.” Something as simple and nonverbal as that can be a powerful symbol and a message to LGBTQ folks who are seeking health care. Dr. Faizan Kabani: Health care providers or even academics, we have different ways in which we can demonstrate that we are allies, that we are a safe zone area. Some of the ways that we’re doing it at the College of Dentistry is as we do ally trainings, we can post the ally safe zone on our office doors. I know that there are an increasing number of faculty who are listing what their pronouns are as part of their digital signatures, and so as these correspondences are going out to different groups, it is a marker, a symbol of showing that we are an inclusive environment, I am an ally and I am a supporter of being an inclusive member of the society. Lindsey Hendrix: What are some ways that LGBTQ+ patients can find a health care provider who is well equipped to care for their individual and unique needs? Dr. Alison Pittman: I would start by saying, again, it’s grass roots in a lot of places where community organizations put together a list of LGBTQ friendly providers, businesses, service professions. As an example, here locally in Bryan-College Station, the Pride Community Center has just within the last couple of years put together a great list. We’re not a big community, and I think historically being completely transparent, a lot of LGBTQ folks in Bryan-College Station have felt the need to go elsewhere for health care, larger cities like Houston or Austin, and we’re finally seeing some providers who have sought out that extra training and the ability to provide specific health care to folks within our community. That’s just an example. I think a lot of times the GLMA and other organizations have lists that are sort of nationwide, but a lot of times those are limited to large cities. So within smaller communities, centers sort of had to create their own list, just by word of mouth is what a lot of it is. Lindsey Hendrix: Right. Dr. Faizan Kabani: I would also add that in addition to the directories that are out there, in addition to word of mouth, we also have the ability to explore the provider’s website. A lot of the times, health care providers now have websites and kind of to what Dr. Pittman was mentioning earlier, being able to look at their forms that they put online, the verbiage that they use online. Are they giving a lot of gender identity markers? Are they being more inclusive in their terminology? You can always go back to old school, which is picking up the phone and calling the office and being able to talk to them and asking, is the health care provider comfortable or regularly working with patients of LGBTQ affinity, or even questions such as if the facility has a gender-neutral bathroom. Some of these important aspects serve as major and key indicators to see if the environment is welcoming, the provider is welcoming, or not. Lindsey Hendrix: That’s great advice. That’s great advice. We talked a little bit about allies, so what can allies who are not necessarily health care professionals do to raise awareness or to fight the health disparities that their LGBTQ+ friends and family are facing? Dr. Alison Pittman: I think, honestly, we need to be brave. Allies need to be brave, and when we see clear disparities in terms of health or societal discrimination, we need to be brave enough to call it out in a respectful and a professional way, just saying we as a profession can do a better job. We as health care providers can be more welcoming and more inclusive and rather than be critics, just be contributors and say, “I noticed this. Let’s think of a way that we could be more welcoming and more inclusive.” That would be my idea of a first step that allies can take. Again, I keep coming back to this, but just being aware of your own views, your own perceptions of the profession and what being professional means, maintaining confidentiality and being respectful to every patient that walks in their door regardless of their background, I think is an important underlying foundation to being a good ally in the profession. Dr. Faizan Kabani: I would add that really allies should really try to remain informed on current issues that are being faced by the LGBTQ community and really to take a stand with them. This includes really being aware of changes in legislation or policies and being able to advocate for health care reform that is really LGBTQ friendly. I would also add that allies can help by standing against institutional as well as systemic discrimination, and really one can fight ignorance with knowledge, phobia with love and despair with activism. Lindsey Hendrix: I’ll say as a marketing and communications professional, I think I’ll be reaching out to you all to see how we can do a better job of representing the LGBTQ+ community in our communications at the Health Science Center for prospective students and the general public that we serve through our health communications, so I would appreciate your feedback on that. Dr. Alison Pittman: Absolutely. We’re happy to help. Dr. Faizan Kabani: We’d love to. Lindsey Hendrix: Awesome. It sounds like there’s hope. It sounds like the issue is being addressed. I think we’re raising awareness here with this podcast. You all have raised awareness across the Health Science Center with faculty and students, so are we seeing this start to improve? Dr. Faizan Kabani: Yes. There is always hope. In fact, there is more than hope, there’s progress and I would argue that more than ever before in our history, we have stronger networks, resources and allies that move our agenda forward towards building a more inclusive environment. Unfortunately, we have also observed recent unsuccessful attempts by certain senior political leaders in this country to reverse nondiscrimination protections for LGBTQ+ people when it comes to health care and health insurance. Undoubtedly, we live in a delicate context where we must continue to be united in our efforts to progress the status quo as well as make our country and the world a more inclusive place that we can call home. Dr. Alison Pittman: I completely agree. The main thing that I would also add is that a lot of times when we talk about health disparities, we’re talking about all of the negative things, all of the problems that a particular percentage or a little group of the population has, and that is only one side of the coin. I also want to focus on the fact that there is so much resilience in all humans, the ability to overcome challenges and discrimination and disparities and obstacles, and it’s no different for the LGBTQ+ population. That’s where I think we all as a team have talked about that we find that hope. Dr. Alison Pittman: We can’t focus on the disparities without also focusing on the resilience and the hope that each individual person who is a member of this population brings when we interact with them, when we try to help them. Being kicked out of your home from your parents because you identify as gay and not having a place to live and couch surfing and still creating a meaningful, happy, healthy life with all of those obstacles being in your way, that’s a hero to me. That’s someone that is a role model for me, and I can’t help but draw inspiration from the people that we care for on an individual, everyday basis. They are truly hope for us, and it’s our goal as we develop this curriculum to not just focus on the negative but focus on the positive and the resilience that each human, regardless of whether they’re in the LGBTQ+ population or not, if they’re part of that community or not, the resilience that they bring and the hope that they bring to us as a community. Lindsey Hendrix: I love it. Those are amazing messages, and I always like ending a show on a positive note. I’m so happy to see progress and like you said, we’ve got so many heroes in this story and I think we should do a better job of celebrating that and celebrating the successes, and the two of you and the group at the Health Science Center who are working on this curriculum are no exception. I think you all are heroes in this story as well, so thank you for all the work that you’re doing. Dr. Alison Pittman: Thank you so much, and thanks for having the conversation. It’s meaningful to us. Dr. Faizan Kabani: Absolutely. Thank you for inviting us and letting us be a part of this process. Lindsey Hendrix: Absolutely. I look forward to getting updates along the way as you’re building out this curriculum, so we’ll be in touch. I’m sure this won’t be the last time we talk about this. Dr. Alison Pittman: Great. We look forward to it. Lindsey Hendrix: Awesome. Dr. Faizan Kabani: Til next time. Lindsey Hendrix: Til next time. Thank you both. Tim Schnettler: Thank you for joining us on Texas A&M Health Talk, a production of the Texas A&M University Health Science Center. Visit us on the web at vitalrecord.tamhsc.edu, where you’ll find answers to all of your health questions. Until next time, stay healthy.
59 minutes | Aug 6, 2020
COVID-19 mythbusting with epidemiologists
Lindsey Hendrix: Hey guys, Lindsey here. Before we get into this interview, I just wanted to give you a heads up and apologize. We had a little bit of a technical issue toward the middle of the show. We had internet lag, which I’m sure most of you are familiar with at this point. We apologize that some of the audio got a little bit broken up, but it was still an amazing conversation. I think you’ll still get a lot out of this. These two experts in public health and epidemiology are amazing and they provide so much valuable information. Please bear with us. We apologize for that little glitch, but enjoy the show. Lindsey Hendrix: We bring you advice and compelling insight on the latest in health, medicine and scientific discovery. From tips for getting better sleep, to discussions about major issues, like health disparities in America, we’ll talk about it. You’re listening to Texas A&M Health Talk, part of the Texas A&M Podcast Network. Hello and welcome to Texas A&M Health Talk. I’m your host, Lindsey Hendrix. Today, we are so, so, so, so lucky to have these two guests with us. They’ve been on the media tour all over the country, so you’ve seen them on national news, state news. We’ve got a couple of celebrities here with us. We’ve got Dr. Angela Clendenin and Dr. Rebecca Fischer. They’re both professors over at the Texas A&M School of Public Health. Thank you both so much for being here. Angela Clendenin: Oh, you’re welcome. Rebecca Fischer: Thank you so much for having us. Lindsey Hendrix: Can we just take a moment to appreciate and bask in what rock stars public health professionals are right now? Oh my gosh. Y’all are in high demand and y’all are just crazy, crazy busy right now. Rebecca Fischer: Well, I’m super excited that people now know what public health is, and recognize it, and hopefully recognize it’s value. Angela Clendenin: I used to tell people that, this is something that public health students have been training for and even public health practitioners have been training for all their lives. It’s like the public health Olympics. This year, we’re going for gold and we’re going to get it. Lindsey Hendrix: Oh, yes. Y’all are doing amazing work and I know y’all are probably losing a lot of sleep right now, so I appreciate you joining us here early in the morning on a Thursday. Obviously, we’re going to talk about the big public health issue that’s going on right now with COVID-19. I just want to start by setting the scene a little bit. We’re at the end of July, this will air at the beginning of August. How are we doing right now in the state of Texas, as far as COVID-19 goes? There was a headline just yesterday in Newsweek that said, “Texans are dying every six minutes from COVID-19.” It seems like it’s worse here than in any other areas of the nation. Would you say that’s accurate? Rebecca Fischer: I would say Texas is in a really precarious situation right now. We watch the data on a near daily basis, particularly in Texas and then in our local counties where we live and work. We really saw the number of cases and the number of deaths accelerate in Texas and that’s something … That’s a metric that we really looked at, more than just the raw numbers. Of course, every person, if it’s 10 fatalities in an area, that’s significant. That’s important to public health professionals and to the public. But when we see those numbers really skyrocket … We saw something like a 30 percent increase in cases one week recently and that slowed down a little bit, which I think is giving us hope. Angela Clendenin: And one of the things that is also really concerning, is when you look across Texas, obviously Texas is a really large state with a very varied type of population and some of the hottest spots are in areas where we have extremely vulnerable populations. These are populations that typically have more comorbidities that lead to more severe illness. They are ones that have either socioeconomic or cultural language barriers to testing and access to health care. It’s always concerning when you have an increase in cases, but when you also see that it seems to be targeting some of these really vulnerable areas and vulnerable populations, that’s additionally concerning as well. Lindsey Hendrix: Yeah, absolutely. Here, I live in South Texas. Actually, in Corpus Christi. I know our area is experiencing a surge in cases. We’ve called for health care workers to come help with surge capacity at our hospitals and ICUs. I know it’s pretty bad down here. Are there other parts of the state? I know y’all are in Bryan-College Station, which is where our university is. How are other parts of the state looking? Rebecca Fischer: Lindsey, we’re really concerned about our rural populations. In particular, counties that don’t have their own health departments and are sort of watching and waiting to get their information from the news on the state about what’s going on in their local communities. That’s really a challenge. Our rural communities might have delayed access to health care or delayed access to testing, if at all. We worry about under-reporting, so cases that are there that don’t get diagnosed, don’t get counted, deaths that don’t get attributed to COVID-19. Then, I will also echo the South Texas piece. Our southern members of Texas A&M University that we’re a part of, but their communities at large. There’ve been quite a lot of data just emerging about the effect on our Hispanic communities and we don’t fully understand why we see Hispanics affected more than we anticipated initially. In particular, the young age of Hispanics who are affected. We hear a lot of the news about the older age being so vulnerable and it looks like in our Hispanic populations, the younger ages are heavily effected and that will be something important to understand. Angela Clendenin: Lindsey, you hit on something really important too about how communities are calling in for health care workers to provide surge support. Hospitals across the state are required to have an emergency management plan to deal with surge capacity, large surges in numbers of patients. In some places, that surge plan is working really well. They have the beds and they have the physical capacity to expand the number of patients that they’re able to take on and to deal with, even at the higher acuity level that sometimes needs intensive care, or perhaps ventilation. However, in order to care for those patients, those beds require a staffing-to-patient ratio that we’re not able to maintain in some places because those people that have that higher level of certification to take care of a higher acuity patient are in short supply. Hospitals are looking and they’re saying, “We have the beds, we have the physical capacity, but we’re very concerned about our staff and the ability to staff those beds.” Lindsey Hendrix: Yeah, absolutely. And so, we’re here at the Health Science Center educating people as well as we can, as quickly as we can to get them out there to make sure that we don’t run into a situation like this again in the future. I saw a graph the other day that shows the United States as a whole is up there in the ranks as far as cases go. I saw that we were up there with Brazil, India, Russia and there were some other South American countries on that. Now, let me qualify this by saying, I am not a statistician, I’m not an epidemiologist or public health professional, so I might be reading this graph completely wrong. I’m sure there’s other people out there, like me, that are pouring through this data and are being given this data on a daily basis. Nonetheless, I’ve heard that the U.S. is experiencing more cases than most other countries, in particularly more than any other wealthy countries. Why do y’all suppose that is? Angela Clendenin: One of the things that I like to focus on when people ask about things like that is, two things. One, Americans typically have a very strong sense of independence. As individuals, we value individual freedoms and liberty. We don’t have a strong central federal government, or even a strong central state government in many states to mandate things that would help us engage in the appropriate behaviors. But at the same time, I feel like we have some really densely populated areas and in those areas, they typically tried to do a phased opening and the actions that we took in doing so, I think people took that to mean we were in the clear and we were okay and it was okay to behave in ways that led to increased transmission and spread. And so, I feel like we are in a time period where we’re trying to put the cat back in the bag, and I don’t know that necessarily we’re going to be able to do that very effectively. Rebecca Fischer: That’s so true. This is happening to us in a very strange time. There’s a lot going on in our country. There is a lot of discussion. Something that is really important for this response is a sense of collective responsibility and accountability, some unity. Even the messaging and the information, the scientific information people are getting is so discordant at times, and politicized, and polarized. And so, that climate makes it tough for us to know what to do and how to pull together. All of the public health guidance that is coming out about how to protect ourselves and others against COVID-19 are tried and true methods, that we’re applying it and learning how to use for COVID-19. We don’t have all the scientific answers, so we don’t have absolute pieces of information about how effective each strategy is. But, we have viruses that we know a lot about. We have outbreaks and epidemics that we know a lot about. And so, applying these tools to COVID-19 is our most effective strategy, but it really requires everybody to pitch in and do their part. We don’t have a vaccine yet. We don’t have effective treatments across the board. The only thing we have is working together for prevention. That’s really, I think, key because it is something that relies on individual behaviors. Lindsey Hendrix: Yeah, I think it’s wild. I’ve never seen a health issue be so politicized and I think maybe it’s because we’re in an election year or something. I’ve never seen people question the science so much. Have you guys experienced that before? Rebecca Fischer: I always think that a healthy amount of debate … And scientists will even agree. Some debate, some healthy banter, even verbal wrestling. We see this all the time. Scientists disagree with each other, but this is how we move forward. This is really in the basic tenets of science and scientific discovery, so that is frankly encouraged in our field. But, I think when we get outside of that scientific realm … And so, politicians are arguing about the science. That becomes a bit different. Angela Clendenin: It’s one of those things, Lindsey, where science and scientific evidence should be informing the political process, not telling the politists to create and implement evidence-based policies. Unfortunately, emergency management and emergency preparedness tend to get very political in nature because it involves resources, it involves spending. The things that we do have a very definitive economic impact. They have a very definitive social impact. And so, you can’t always extricate what you need to do for public health and emergency response from that political side of things. The fact that we’ve had a few missteps early on, at the very beginning of this thing, has somewhat opened the door for that increased banter and politicization of the process. It’s also not just the disease that we’re battling, but we’re also battling the public opinion as well. Rebecca Fischer: Angela, you make me think about the fact that as an epidemiologist, I’ve been involved with many disease outbreaks and epidemic response and investigations. As epidemiologists and public health practitioners, we sort of know what needs to be done. We don’t usually have politics stepping into the process, so I think public health practitioners out there probably have their heads spinning thinking, “What is going on? How do we operate in this new environment?” I think it is challenging to the public health, having local health authorities responsible for making decisions, but then have political outcomes, and ramifications, and economic, and all of these things that we don’t consider on a day-to-day basis, or we don’t have such a big thing to handle on a day-to-day basis. That everybody, I think, is sort of reeling. Lindsey Hendrix: Yeah. But, like you said, there are tried and true things that the public can do to help slow the spread. Let’s go down that list of things. I mean, we’ve heard, “Let’s wear a mask when we’re out in public and can’t physically distance. Wash our hands frequently. Watch our distance.” And then there’s contact tracing, which you both are involved in. Can you dive into those a little bit and explain why we should do those things and how important it is for this? Rebecca Fischer: Sure. I’ll start at the top of the list with wearing face coverings. This primarily is protective for the person who is … Or the primary barriers for the person who’s doing the exhaling, or the coughing, or the talking. The person, as well, wearing the mask to prevent droplets from entering their respiratory tract is also protectant somewhat. We encourage the use of these as really an added bonus to all of the other things. This is an added physical barrier to that physical separation. Physical separation is also rooted in the basic science and what we know about transmission. Again, it’s a droplet primarily that we’re concerned about that will travel, that will exit through coughing, breathing, talking, singing. If we can all sort of maintain that bubble, which is really tough and awkward for us, because we’re not used to doing that and we don’t really know how to do that in most of our interactions. Rebecca Fischer: But that six foot bubble is where we expect … If we are infected and we are exhaling something, then we have this barrier around us where it’s going to fall and hit the ground and be inactivated. It can’t infect anybody. Now, I will say, important to remember is that what we know about this disease presentation is up to half of individuals who are infected and are going through the disease course do not show signs or symptoms. What that means is that any one of us could be infected, if we had an exposure, and not know it. This is really important, and the masking, and the physical distancing, and all of these prevention measures because we could be the one out there who is transmitting the virus. And the hygiene, washing hands and using hand sanitizer, really cleaning those common touch surfaces. Rebecca Fischer: We always tell our COVID-19 patients that we interact with, those toilet flushers, and fridge doors, and faucets. Things that get touched a lot that don’t have a lot of time in between and maybe we’re not cleaning every few minutes. Because there is some, although we think smaller risk of transmission. Smaller than through the respiratory route, that a virus could be deposited onto, say, a fridge door from a sick family member and then somebody else in the family would pick it up and inadvertently place it into their eyes, ears, nose and mouth. I mean, this is how we see flu passed and colds. Think of all the things mom taught us about how to stay healthy in the winter, this is exactly what we need to do. Angela Clendenin: And so, to add to what Dr. Fischer’s saying, it’s about transmission. The way that we end an epidemic or a pandemic is to break that cycle of transmissions, so there’s a lot of behavioral types of things that we can do, that Dr. Fischer just covered. But the other side of that is the actual case investigation and contact tracing. And the principle behind that is taking people who have the disease, they’ve been diagnosed with COVID-19 and getting them isolated away from the rest of the population to stop that cycle of transmission from a diagnosed case to the population. But, we realized that the time that they become contagious to the time that they get diagnosed, they’re in contact with a lot of people. And so, we investigate the case and we get the information on who have you been around, considering they need to be less than six feet away from you and longer than 15 minutes. Angela Clendenin: Then we want to reach out to those people and let them know that they’ve been potentially exposed and we want them isolated, so that they … While they may be pre-symptomatic and not contagious, that we’re getting them out of the population and we’re watching them and we therefore stopped any potential spread from them, while we’re waiting to see if they develop the disease or not. It’s another way of being able to stop that cycle of transmission by taking those who have the disease, those who have been potentially exposed to the disease, getting them isolated out of the community until they either recover from the disease or they don’t develop the disease. Then, we just ended that cycle of transmission. But what Dr. Fischer indicated, with 50% of the people being asymptomatic, not only are they not getting diagnosed, but they don’t know that they’ve been in contact with other people, so they’re not going to identify who their close contacts were so that train of transmission continues. Lindsey Hendrix: People [crosstalk 00:19:39] who aren’t experiencing symptoms can still transmit the disease? Has that been proven? Rebecca Fischer: Yes, that’s correct. We think that that infectious period can begin up to two days before you have symptoms. Then remember, not everybody’s going to develop symptoms or their symptoms are going to be so mild they think they have allergies, or a little bit of fatigue, or “I didn’t get much sleep,” or, “I drank too much the night before.” These are all the things that we hear, so these are real people with COVID-19. It’s just tough to tell in the beginning. And so, somebody may not be infectious on day one when they’re exposed, but that person can become infectious very quickly within a couple of days. Lindsey Hendrix: Amid all of this, all of the spikes in COVID-19 cases and schools are talking about reopening. Here at Texas A&M, we have committed to reopen in the fall in just a couple of weeks. A lot of our students are going to be coming back to campus and about 50% of the course selections at A&M will be offered face-to-face. And I think officials estimate that about 75% of our student body will have at least two classes in person. How is the university going to do this and welcome all of these students, faculty, staff, collaborators, visitors back to campus while keeping the campus community safe? Rebecca Fischer: Well, we don’t know everything that the provost of the university has up their sleeve, but we are privy to some of it and we know that the university is taking really extensive measures for protection. Some of those are physical measures. And so, students will be sitting separate from each other, so that physical separation in the classroom. They’ve doubled up twice a day classroom cleanings. And then as faculty members, of course, we encourage that our students can use all those protective behaviors to protect themselves and others. Dr. Clendenin and I are engaged with a self-reporting form, so individuals have the opportunity to confidentially report if they think they have been exposed to someone with COVID-19, or if they have symptoms, or if they themselves tested positive and it allows … Again, a confidential way for us to reach out to them and help provide them with the information and then initiate, if we need to, the case investigation and contact tracing. Rebecca Fischer: I just wanted to add to what Angela said a few minutes ago about the contact tracing. We really want people to see this as a health promotion and education opportunity. We’re not really … It is not our goal to collect details of it amass these details and little bits of information on people. Gosh, we wish we didn’t have to, but we want to reach people and provide them with information and give them the opportunity to feel empowered over their own health. When somebody with COVID-19 is sharing the information with us about their contacts, please know that we are going to reach out to those individuals with really the intent to help them and provide them with information that they need to take their health into their own hands. And then, when we are contacting you as a contact, a potential exposure, we try to put anxiety and fear aside and really try to get to information, and resources, and health promotion. That is the goal of this portal. That, we are doing for Texas A&M members across the state. Angela Clendenin: It really is important, to highlight what Dr. Fischer was saying about reaching out to contacts, particularly when we’re dealing with the cases and especially when they’re college students. Sometimes they don’t feel like they have permission to give somebody someone else’s cellphone number, or email address, or contact information. But in this instance, it’s almost like you’re doing them a favor by giving [inaudible 00:23:53] 19, not realize it, and not have access to information and resources that could really help them. And so, everything is confidential. We cannot stress that enough. It is not released to anyone that doesn’t need to know and when we call a contact, we are not allowed to share information about the person who’s the case, or even enough information about the potential exposure where they could identify who the case was. That case confidentially is absolutely protected as well. Rebecca Fischer: These are trained people on the phone. The folks in our Ops Center, our COVID Operations Center, they receive training in SARS-CoV-2 and COVID-19. They receive training in what clinical presentations are likely. They receive some virology lessons and immunology, so they’re equipped to handle some of these questions. These are largely individuals with health backgrounds, so we have a lot of graduates, epidemiologists and folks from other health backgrounds. Then, they also receive training on how to ask questions in a sensitive manner, how to be empathetic and how to be communicators. We really are trying to put good folks out there to talk to and provide a good and reliable source of information so that you can trust us when we call and talk to you. Lindsey Hendrix: When you are calling somebody, how do they know that it’s you guys or that it’s the county calling to conduct the contact tracing and case investigation? What are some fail safes that people can do to protect themselves, in case there are scammers out there? Because I’m sure there will be. Angela Clendenin: That’s a great question and it’s something that we’ve struggled with for a long time. When the county was calling people, our county in particular bought a singular phone system for every department within the county. And so, it’s not unique to any one department and we realized not quite early on that people were getting calls that showed up on caller ID, depending on how their phones were set, as Brazos County Court. And so, what we would do in that case is we’d leave a voicemail saying who we are. We’d give a name and a number that they can call back, which is usually the main number for the Brazos County Health Department, and we tell them to ask for either the individual or ask for a member of the epi team to be able to return their call. Now, when we’re calling from our Ops Center that Dr. Fischer referenced, it shows up on caller ID right now as Texas A&M Direct. We’re trying to get that fixed so it’s Texas A&M HSC. Angela Clendenin: But depending on a person’s settings, it could still show up as unknown. But they should always be able to leave a voicemail identifying that they’re calling from either Brazos County health district, or their local health authority, or they’re calling from Texas A&M and this is why they’re calling and here’s a number to call back. Then that serves kind of as that dual verification process. One other thing that we’re doing is we’re creating a co-op website that will have information, like what Dr. Fischer was talking about, that empowers people to help them understand the disease, and why we do the things that we do, and what sorts of behaviors they should be engaging in. But it’ll have our pictures. It’ll have a description of our team. It’ll have a number. Things that they can use to see that we are real, we are legitimate. And we should not be asking things like social security numbers. We should not be asking things like bank accounts, anything financial. Angela Clendenin: We’re HIPAA compliant, so we do try to identify the person that we’re speaking to by their name and their birthdate. We understand the hesitancy with information. In the society we live in today, information theft, identity theft is a very real threat and it is a very real threat to our pandemic response. We’re trying to put measures, even as simple as our caller ID, into place so that people know that it’s a legitimate phone call. Lindsey Hendrix: Just to give context to our listeners, because we just started diving in and saying Texas A&M is going to be calling people and doing these case investigations. This is part of an inter-agency agreement that was put into place between Texas A&M University and the local Brazos County health district to conduct contact tracing on campus for the campus community and to also provide surge support for the county at large. The center that we’re referencing is called the COVID Investigations Operations Center, and it was really a brainchild of the provost and Texas A&M leadership, both at the university and the system level. Angela Clendenin: That does go back to your question about, how are we going to keep people safe when they come back face-to-face? The credit, again, goes to the Texas A&M administration. They recognized the impact that bringing students, thousands of students back into Bryan College Station could have on our county health district and how important it is, if we want to continue to have face-to-face class opportunities this fall and try to return to some sense of normalcy, that we had to be quick, and flexible, and responsive when we start to see cases appearing and increasing in our communities. Angela Clendenin: In order to do that, we’ve put a system into place where we can be quickly responsive, isolating those people, like we talked about before, that are cases and contacts, supporting our local health district with surge capacity to be able to deal with the increase in cases that we’ve brought into our community by holding class. The credit really goes to them for recognizing this in advance and empowering us to be able to build a system that seems to be working and it’s working well enough that we’re extending it to the other system member entities as well. Lindsey Hendrix: Oh, that’s great. This model then is set up to be replicated in other areas of the state as well? Angela Clendenin: So, [crosstalk 00:30:16] … Oh, go ahead. Rebecca Fischer: Well, I was going to say, not so much that the model is replicated. I think it’s a very unique model because it was really the brainchild of Texas A&M reaching out to the county, so a very unique situation. A large university with resources and the capacity to do that, and so not every place can do that. But certainly, we would encourage partnerships with local universities. We know that in Austin, Texas there’s a similar model with the University of Texas, Dell Medical School, and we are happy and we do talk to other institutions about possibilities, and lessons learned, and what we’re doing that they might be able to replicate. But the model for Texas A&M really is centered in Bryan College Station so that we have a dedicated team to be contacting individuals, say, in Dallas, in Corpus and West Texas and that sort of thing. Lindsey Hendrix: Right. Let’s pretend for a minute that we’ve got a captive audience of students. And hopefully, we do have some students who are tuning in to this. What do you want to tell them so badly? What is their role and responsibility in slowing the spread of COVID-19 and protecting their community? Rebecca Fischer: I want to say, students, we hear you. We don’t speak the same language. We’re trying desperately. We are moms and a little ahead of you in terms of our life years. We hear you. We want to protect you. We’re trying to give you tools … We’re trying to find those tools, and that language, and those resources. We really can use your help. Talking to your peers, helping us understand how to reach you, things we want you to avoid. In our perfect world is social gatherings, parties, and not just avoid going to bars where wearing a mask is quite difficult and you’re in a confined close space, but also casual social situations where you might feel relaxed. Maybe you have a small birthday party and it’s only 10 people you invite, but throughout the course of the evening those masks might come off. We get more relaxed. And we really want to try to avoid those situations. Rebecca Fischer: Young individuals, including in the college age group, seem to suffer less severe disease. That’s pretty well documented. However, there are some that still suffer severe disease. There are still some that suffer fatal outcomes. What we don’t want to see, and Texas A&M campus is across the state of Texas, is for our college students to end up in the hospital. And we certainly don’t want any of our student members to suffer a fatality. We’re really working toward that end. Please know that it’s a real possibility that we’re trying to avoid and every misstep in our behaviors or carelessness that we do, we could be facilitating that virus to spread to a person who, whether they know it or not, is vulnerable to severe disease or may have an underlying health condition that their friends and their peers don’t know about. We really want to appeal to an emotional side of our students. We want to appeal to a sense of service, and responsibility, and unity. Rebecca Fischer: But at the same time, we want to be hopeful and optimistic. There are great activities that are safe for us to do. Going for a walk, interacting with others socially that does not involve close proximity. There are a lot of things that we can do and the school’s trying to be safe, but we want everybody to be hopeful and know that we’re going to get through this on the other side. Lindsey Hendrix: Nice. Angela Clendenin: Texas A&M has a long history of Aggies helping Aggies. That’s what we really want to reach and to kind of pull on those heart strings as well, that, like Dr. Fischer said, we hear you. We don’t want to be cliché, but we are all in this together and the sooner that we can all do our part and engage in these behaviors, once we’re all together here in the fall, the sooner we will be able to get on the other side of this. And so, how this progresses in our community and the types of things that we’re going to be able to do or not do, it really falls back down on each and every single one of us caring enough about the people around us to do the right thing and wear the mask, even though it’s hot in Texas. Maintaining that physical distance. And I know that we have had since March, people telling us the 50 million things that we cannot do. But, psychologically, let’s focus on the things that we can. Angela Clendenin: And even those activities that you think you can’t do, sometimes you can adapt them a little bit and still be able to abide by the physical distancing or the mask wearing and engage in them. It’s a time to be creative and maybe invent some new activities, or fix some old activities so that we can continue to engage those things that nourish our physical and mental self, while we try to get to the other side of this thing. It’s not impossible. It just takes that selfless service and that commitment to being the 12th man. The Aggies helping Aggies. That means, Aggies young, and Aggies old, and future Aggies, and old Aggies, all of us doing our part to keep each other safe. We set the example. Across the state, if we can follow this, then others will follow too and Aggies will lead the way, like they always have. Lindsey Hendrix: Awesome. I think that’s so true. We’re so lucky to be a part of a community that really stands on those core values. I mean, we really, really do embody those core values of respect, excellence, selfless service, leadership and all of those. Students, we’re counting on you, we’re counting on you. Rebecca Fischer: That is so true. Lindsey Hendrix: Now, I want to go through a speed round. I’ve got a list of claims here that I’ve heard surrounding COVID-19. These are mostly misconceptions. There might be some half-truths here. But, what I want to do is read a claim and then I want you to set the record straight on that claim and respond with the truth. And so, give concise of answers as we can in just a couple of sentences or so. And we can go back and forth. You can each answer the question. All right, you ready? Angela Clendenin: Okay. Lindsey Hendrix: Okay. The first one we kind of touched on earlier. It’s about face masks. Wearing a cloth face mask can protect the wearer from COVID-19, the person wearing the mask? Rebecca Fischer: That is true. Most of the information out there suggests that it’s the person who is infected wearing the mask is preventing droplets from being exhaled to somebody else, to reach somebody else. That is true. And you think about that person wearing a face covering that then protects many individuals. The wearer of the face mask, this face covering, it’s not unidirectional. If there are droplets containing virus out there in the air, this mask will trap those as well. It’s just protecting the one person, versus protecting the multiple individuals. Angela Clendenin: And the bigger issue on that is making sure they’re worn correctly. Covering the nose, covering the mouth, making sure that it fits snugly. It’s uncomfortable, but they’ve even shown with some of the fitted types of masks for health care workers, you’re still getting a good oxygen supply through those, it’s just a little more moist than you’re used to getting. But you’re getting air, it just needs to fit comfortably. Rebecca Fischer: Yeah, and the wearer who’s being protected, remember that if you are being protected and that mask is working for you, then the outside front of your mask is a dirty zone, so you don’t want to touch the outside front of your mask when you’re taking it on and off. Pull your little ear loops or your around the head piece. Lindsey Hendrix: And so, how often should you change out your mask or wash your mask? Rebecca Fischer: If you’re wearing your mask a lot, then you can wash it on a daily basis. If you’re wearing it just when you go inside the grocery store and you pull it off and you want to wear it again, you can put it into a paper sack or an enclosed area so that it doesn’t … Again, if it’s dirty, doesn’t get anything on other surfaces. But if you’re wearing it a lot, then you want to wash it frequently. Then of course, if you are somebody who’s sick who is masked, you should be doing that more frequently or discarding it and replacing it with a new mask. Lindsey Hendrix: Okay. Here’s the next claim I’ve heard. And this is a followup to this question. Only people who are sick should wear a face covering when out in public. Angela Clendenin: That would be incorrect. Absolutely, as Dr. Fischer said, these are not unidirectional, so if a sick person is wearing a mask, it’s keeping them from spreading droplets, but it’s also keeping whatever’s on the outside from getting in. And so, it is not just for the protection of the sick. It’s for the protection of those who are not sick as well. Rebecca Fischer: Then remember that we have a lot of folks out there who are infected and don’t know it, because they don’t have sick symptoms. They may not be coughing, but they could be spreading those viruses. And everybody who gets infected with SARS-CoV-2 starts out without any symptoms, so every single person who is infected starts out symptom-free and may develop symptoms or may not. Remember, your mask is protecting you when you don’t know you’re sick. Lindsey Hendrix: Got it. Okay. Fever, cough and shortness of breath are the only symptoms of COVID-19, true or false? Rebecca Fischer: False. False. Really, anything you can think of that you might see with the flu. This is not the flu, but mirroring some of those symptoms. We see stomach pain, vomiting, diarrhea. A very common one is losing the sense of smell or taste. Also, I hear, a very strange sensation to have. Most people have a headache, so many headaches are reported, especially early on. Fever may develop. Again, roughly in 50% to 80% of individuals will develop a fever at some point during the course of their illness, but not usually the first thing. What else, Angela? Fatigue, weakness. Really, the thing that just echoes in my head is folks saying, “I felt like I just had allergies,” so congestion, runny nose, sore throat or scratchy dry throat, rash. Angela Clendenin: One of the things that we’ve heard a lot too is that this whole loss of taste and smell, people have had that before when they’ve had sinus infections, but this is above and beyond that in terms of sensation. The headaches are above and beyond just your average stress headache. People that don’t have migraines are saying that this feels like what I would imagine a migraine to feel like. It really is important that you recognize that this symptom list started with three and now it’s 12 symptoms. If you’re experiencing one of the symptoms that is at an unusual level for you, that’s probably an indicator that you need to get checked out. Angela Clendenin: And certainly with some of the more severe ones, like shortness of breath. If you’re experiencing shortness of breath, then maybe your lips are turning blue or something to that effect, you need to go to a doctor right away, to an emergency room. That’s a really serious symptom that especially if it gets worse, before you make that call. Pay attention to what your body’s telling you. Know what your normal is and things that are above and beyond normal are a good indicator that there might be something else going on as well. Lindsey Hendrix: Okay. Next claim. Kids under 10 years old cannot spread COVID-19. Rebecca Fischer: Not true. Again, kids seem to be less likely to suffer severe disease. We know that they’re often being infected. They might show milder disease syndrome slightly different. We hear a lot of rash of hands and feet, loss of appetite, fussiness. But, kids under 10 can pick up that virus. Even if they don’t act sick, they could be passing it to family members. Also, they could pick it up from a family member. Their teenage brothers and sisters might be culprits when they’re out interacting with folks and bringing it back to their families. Don’t be afraid to get your kids tested. If you take your kid to the testing site and they say, “Oh, your kid is probably fine. They’re probably not going to be that sick.” You can insist on testing and it’s smart if your child has been in contact with other kids and we need to reach out and notify them that they may also be infected. Because remember, kids have contact with parents, and have contact with grandparents, and with teachers. And so, there’s a chain here of transmission that we want to make sure doesn’t happen. Angela Clendenin: Yes, children can be transmitter and carriers of the disease. They can have the disease. If a child has an underlying comorbidity, they can also have severe complications. It presents a little differently in some cases, but it’s important to realize that just because they’re under 10, they’re not immune and they play a very important role in transmission. Lindsey Hendrix: Okay. Next claim. Once you have had COVID-19, you can’t get it again. Rebecca Fischer: This is unknown. Not just do Angela and I not have an absolute question for this, but we can’t lose, because the answer really scientifically is not understood yet. What we do see from the literature is that most people develop some kind of immunity. What we don’t know is … Let’s say someone with antibodies. Antibodies is what we use to protect ourselves from reinfection or from disease. We can say that most people develop antibodies. We don’t know if those antibodies keep us from getting infected again and we also don’t know how long those antibodies last. For some diseases, like measles where we get a vaccine or get measles and then those antibodies last forever and keep us safe and immune, we don’t know that for SARS-CoV-2 antibodies. But, we do think that there’s at least short-term, if not longer, immunity. Rebecca Fischer: It looks like we are pretty confident in at least a three month for most people. But this is the kind of thing that we can’t rush knowing. We can’t speed up learning this piece of information. We literally have to follow people over time to see what happens to them a year from their infection. Although it seems we’ve been in this situation for a very long, an uncomfortable period of time, we still need to wait and see. Angela Clendenin: That’s been the big challenge of COVID-19 is because it is a novel disease that we have not experienced in our society before, the experts that people would normally turn to to be able to give them those kinds of answers, don’t know the answers. And we’re all learning about this together. From an epidemiological perspective, that’s kind of, I guess, one of the frustrations of being an epidemiologist is that everything that we need to know, we won’t know until we get on the other side, and we can look back retrospectively, and follow things over time, and be able to look at what we knew when, and how, and moving forward. There’s a lot of answers to come, it’s just going to take some time. Lindsey Hendrix: Right, right. Okay. Now, I got a couple of doozies. Angela Clendenin: Oh, boy. Lindsey Hendrix: COVID-19 was created by scientists to test the world’s public health response. It’s a conspiracy. Rebecca Fischer: I can say that virologists have debunked this. This is not a virus that could have been created in a laboratory. I will tell you that the virology statement is that we don’t know enough to have done this. This is too scientifically complex. Admittedly, we want to know everything about viruses, but the scientific knowledge is not there to have created that sort of thing. Angela Clendenin: People need to realize that coronaviruses are a family of viruses. There are a lot of them out there. There are probably coronaviruses out there that we haven’t seen yet. Viruses mutate over time, and so we’ve known for a very long time that at some point a virus is going to mutate and enter into our society and cause a global problem. We just didn’t know which one and we don’t know how to pick which one. And so, it’s one of these things that it’s a family of viruses that are out there. And so, it would not be uncommon for one of them to have mutated and get into our society without having to have been lab-created. Lindsey Hendrix: Right. Rebecca Fischer: Let’s be clear, this kind of event happens all the time. Viruses are out there doing their thing that viruses do. A lot of viruses move from animal’s feces to … Can get into another species. And usually, it just hits a dead end. Sometimes viruses jump from animals to humans. We know this for a lot of diseases that we know a lot about. But, it’s sort of a rare chain of events that it would be so successful in that it could create an epidemic, let alone a global pandemic. Lindsey Hendrix: Right, right. Okay, another one. The media, politicians and officials are hyping up COVID-19. It’s not as bad as they claim it is. More people die from the flu every year then are dying from COVID-19. Rebecca Fischer: Well, I can say in Texas that more people die from COVID-19 this year then have died of the flu in the past. When I pulled up the numbers this past weekend looking at the mortality rate of influenza and pneumonia in the state of Texas, for the latest data available public, which is for 2018, already this year for COVID-19 in Texas we have surpassed that number. I would suggest that the media is not hyping it up. I would say that if anything, they are trying to alleviate some fear and anxiety, as their role in media. This certainly deserves a lot of attention. It doesn’t deserve a lot of fear, and stigma, and anxiety, but a really thoughtful response to a very dangerous virus and a very important public health threat is warranted. Angela Clendenin: It goes back again to trying to provide that information to people so that they’re empowered to take care of their own health. We’re starting to see some of the longterm health effects in some people, not everybody, but in some people from having COVID-19. It is a very serious illness and we need to respect it. The more that we can put out in the media that provides that education, it’s not hyping it, it really is trying to make it something that people see, and respect, and they know that it’s in our communities, and they know that we’re going to have to live with it for a while. Lindsey Hendrix: Yeah, absolutely. This is a real thing. The numbers speak to the magnitude of this pandemic, so let’s take it seriously everybody. Now, the final thing is more of a question than a claim, but I know a lot of people are concerned about how rapidly the world is trying to come up with a vaccine for COVID-19, for SARS-CoV-2. I think some people are skeptical about getting vaccinated once that becomes wildly available. Should people be skeptical of it or should they go ahead and get vaccinated? Rebecca Fischer: I would say that not just for a vaccine against SARS-CoV-2 infection, but for any vaccine, scientists work tirelessly for this. In my previous role, I worked alongside vaccinologists at the Sabin Vaccine Institute at Baylor College of Medicine, so I saw them working on vaccines constantly and these processes take years sometimes. A little bit hesitant about the language, “Warp speed,” vaccine production in terms of what that really makes people think is possible. The process is a long process. There are set trials and tests that are performed that we can’t shortcut. Because again, some of these take time and they’re watch and observe what happens, including observe what happens in a real-life setting. I think it is tough to say that we could really speed that up. Rebecca Fischer: That being said, we do know a lot about coronaviruses. We know a lot about vaccines. We know a lot about how to construct vaccines so that they can be effective. We can borrow knowledge from those vaccines and then production pipelines can be set up in advance to push those out. My hope is that no vaccine would make it to market or to public use that hadn’t been fully vetted and gone through the scientific rigor that is necessary and required for any vaccine. If that’s the case, which I think should be the case. I mean, I have no reason to believe otherwise. There shouldn’t be a vaccine released into the public that was unsafe. I think the real question would be, how effective is that going to be? Especially given what we know and we don’t know, as we just covered about immunity and how long that lasts. We don’t know if this is a vaccine that we would get every season, like with influenza vaccine, or if it’s something that would be available to a few individuals, such as just frontline workers and health care providers. There are a lot of unanswered questions about the vaccines. Angela Clendenin: We’ve experienced coronaviruses before. We’ve had SARS with its outbreak. There’s MERS, which is Middle East Respiratory Syndrome. We’ve had scientists working with answers to coronaviruses, the siblings of COVID-19 as it were, for years. And so, their knowledge of how these things work is good. It’s still growing and it’s advancing, so it feels like almost we have a little bit of a head start. There are policies in place. I hate, again, to politicize response, but we have a policy called Project Bioshield, which works with vaccine and therapeutic manufacturers to expedite the process of getting something from concept to deployment. Angela Clendenin: It doesn’t mean that they shortcut any of the safety concerns and the safety testing, but it may reduce the amount of time that you follow a cohort. But it’s one of those things where you have to kind of sometimes weigh the greater good. They’re not going to take shortcuts that are going to put people at risk, but they are going to find ways that they can move it from bench to bedside so that we can try to have an answer for COVID-19 sooner, rather than three years down the road or four years down the road. But, like Dr. Fischer said, what we don’t know about the immune response and the potential immunity to COVID-19 that our bodies generate, what that vaccine is going to look like. Is it only going to be 50% effective? Is it going to be 75% effective? Are we going to have to have it every year? Is it something like a measles vaccine that provides lifelong immunity? Those are questions that we don’t have the answers to right at this time. Lindsey Hendrix: In the meantime, until there’s a vaccine, which could be awhile down the road, let’s all protect each other and take the measures that we talked about earlier in the show. Anything y’all would like to end this on? Any advice or calls to action that you want to present to our listeners? Rebecca Fischer: I would just appeal, again, to sort of this sense of responsibility and collective action. Taking care of each other, while we’re taking care of ourselves. Be cognizant of those that are around us, our loved ones and others. Be conscientious. Be thoughtful. We’re thinking about things that we never thought about before, how many times I touch my face. Did I clean my hands before I touched the shopping cart? All of these things. Our commercial partners have put guides on the floors of stores for us. I think this is really funny, but so helpful. If you’re standing a foot in front of that line and you’re a little close to the customer in front of you, just back up a little bit, because that person’s health should be protected as well as yours. Angela Clendenin: On top of that, again, it goes back to, this is a new disease that’s invited itself into our world, and it’s going to be with us for some time, and it doesn’t pick and choose who has it and who doesn’t and how those people’s bodies react to the disease, so we need to be respectful not only of one another by engaging in appropriate behaviors, but respecting the disease itself and understanding that the one way we can kind of chorale it is to behave appropriately and engage in good, well thought out, tried and true methods to break the cycle of transmission. Rebecca Fischer: And be creative. We both, we talk about this fairly often. We want people to find creative ways to enrich their emotional, and social, and physical wellbeing, while remaining safe from the virus that causes COVID-19. Lindsey Hendrix: Awesome. Well, I think we can just end this show on saying there is a light at the end of the tunnel. I think we will get through this, eventually. It might not end with the year when we pop off fireworks on January 1st, but it will be over sometime soon. Just as long as everybody does their part, right? Angela Clendenin: Absolutely. Lindsey Hendrix: Awesome. Well, thank you guys so much for being here, taking time to be on our show. We really appreciate it. I know this won’t be the last time we talk. Hopefully, we’ll have you back on. Y’all, take care. Rebecca Fischer: Thanks. You too. Bye-bye. Lindsey Hendrix: Thanks. Bye. And thank you listeners for tuning in. I hope you really enjoyed this episode and got something from it. Remember, in this case, just this once, don’t pass it back. Wear a mask. Keep your distance. Be creative. All right, guys. Until next time, stay healthy. Tim Schnettler: Thank you for joining us on Texas A&M Health Talk, a production of the Texas A&M University Health Science Center. Visit us on the web at vitalrecord.tamhsc.edu, where you’ll find answers to all of your health questions. Until next time, stay healthy.
45 minutes | Jul 23, 2020
Self-care and mental health during the pandemic
Lindsey Hendrix: We bring you advice and compelling insight on the latest in health, medicine and scientific discovery. From tips for getting better sleep, to discussions about major issues like health disparities in America, we’ll talk about it. You’re listening to Texas A&M Health Talk, part of the Texas A&M Podcast Network. Lindsey Hendrix: Hello, and welcome to Texas A&M Health Talk. I’m your host, Lindsey Hendrix. If you’re an avid Health Talk listener—which I’m sure about two of you tuning in right now are avid Health Talk listeners—you’ll notice this is different for us, and you’re right, because we used to have about five different shows under the Health Talk umbrella. Now we’ve decided to consolidate all of that excellent content into a single show, this awesome podcast called Health Talk, hosted by yours truly. So, this is episode one. Thank you so much for tuning in. This episode is going to be a little bit different than what you’ll experience down the road, because we are still very much in the midst of the COVID-19 pandemic. I’m recording from my home office and my guests are joining us today via Zoom. But I felt like we really needed to dig into this topic because what we’re going to talk about today is incredibly pertinent for a lot of people, and that is mental health. We’re in unprecedented times right now. I know you’re sick of hearing that term by now, unprecedented times, but it’s true. This is something that we’ve never navigated, at least not in this generation, and definitely not in the way that we’re navigating it right now. Mental health is something that I think a lot of people are thinking about right now. Many people are having a difficult time, and that’s to be expected. Our lives have changed so drastically, so rapidly. Our world doesn’t look like it did just weeks ago. I have with us today the lovely and brilliant Dr. Carly McCord. Carly is the director of the Texas A&M Health Telebehavioral Care Program, and she’s also a clinical assistant professor in the Texas A&M College of Medicine. And along with Carly, we’ve got Bradley Bogdan. Brad is a licensed clinical social worker, and he works with the psychiatry and behavioral health program here at Texas A&M Health. Thank you both so much for being here. Bradley Bogdan: Thank you for having us. Carly McCord: Thanks for having us. Lindsey Hendrix: Oh, absolutely. Absolutely. Thank you for coming. Let’s just go ahead and dive right on into this topic. Like I said in the introduction, life has changed so drastically so rapidly. I feel like a lot of people are struggling right now. A lot of us are still working from home. Kids haven’t been in school for a while, and we’re not entirely sure when they’ll go back, and we just don’t seem like we’re quite as socially connected as we were just weeks ago. In general, in your professional opinion, how are Americans doing right now? How are we doing? Are you seeing an increase in stress and anxiety and depression and things like that right now? Carly McCord: Yeah, I think we are. Having routine and consistency for both adults and kids are some of the things that give us just the constancy in life to know what to predict. When we know what we can predict, then we feel like we can cope. So, having new things thrown our way and being separated socially from many people that we care about definitely is taking a toll on people from what I can experience personally and what we’re seeing in our clinics, and just what we’re hearing from folks around the state and the nation, and the world. Lindsey Hendrix: Yeah, that’s so true. I think we tend to think about this as Americans, because this is our experience, but this is a worldwide issue and stress, anxiety, and depression, and mental health issues aren’t just unique to Americans or citizens of the United States. If you’re tuning in overseas or from somewhere else around the world, just know that we’re talking to you too. So, have y’all seen an increase in people seeking services? Have you noticed more people coming into the clinics lately? Bradley Bogdan: Here in our outpatient clinic, we’ve seen about a 50 percent bump in people seeking services. That is probably not entirely due to the pandemic, but I’m sure a giant portion of it is, being it happened at the same time over the last few months. I know, in the first month or two of lockdown, the National Suicide Hotline also saw a giant spike in terms of calls, and fortunately, their assessment of that increase was fortunately not necessarily that amount of people looking to get help for suicidal thoughts, but it was very much reaching out to have some contact to talk to a professional and not really knowing where to start. Fortunately, they do a great job with making sure they’re out there and available as a resource, and they were able to help with that surge of folks looking for help and get them directed to the right places. So, it is definitely real. Lindsey Hendrix: Yeah, and it’s good that people are reaching out, right? Because I think if you look back just a few years ago, a lot of people either weren’t aware of the signs that maybe you should seek some professional help, but there was also so much stigma surrounding mental illness and mental health issues. So, in your experience, how is that trending these days? Are we seeing more people open to talking about mental health issues? Carly McCord: I would say yes, because it’s such a shared experience, and it’s really hard for anyone to be going through this pandemic and just the racial and cultural tensions that we’re experiencing here in the U.S., and even that is a global issue as well. It’s hard to not bring attention to mental health issues. Talking about those figures earlier, I think that there is some relation then to an increase in seeking services, and hopefully, that correlates too, to a reduction in stigma or fear of reaching out. I know that across the globe, there’s been a huge increase in telehealth use and breaking down of barriers that clinicians and proponents of telehealth had been fighting for, for years in terms of reimbursement and regulations that may have prevented accessing those services. Many of those kind of broke down overnight, and so it’s made it easier to access care from the comfort of your home. That, I think, all of that helps break down stigma when more people are using it, experiencing it, then it becomes less of this scary unknown, and now you know somebody who’s tried it, and was like, “Oh, telehealth is great.” Lindsey Hendrix: Yeah. I would definitely want to try it out if I heard from a friend that I trusted that it’s good. From a professional standpoint, though, are there differences between telehealth and in-person services? Are you going to find differences in the quality or the outcomes between the two? Bradley Bogdan: I was going to say, Carly’s group has done some fantastic research, the fact that people seem to get the same benefit from in-person therapy as they do via telehealth. Carly McCord: Yeah, having done telehealth for over a decade, I definitely like it a lot, or I wouldn’t keep doing it. All of our data has shown that outcomes are similar, at least from the behavioral health side of being able to see someone from a distance like this, it’s still … you’re still able to make a connection. The treatments we use, the evidence-based therapies and things, they transfer. It’s talk therapy. I think, in some cases, we even see, in a lot of our trauma clients, we see, being able to do this from the comfort of their home actually provides an additional layer of safety and security. Some people even like it better. I think on the primary care side and other specialty disciplines, it can be harder to get vital signs and things. There’s so much that can be done in preventative care just by asking questions and checking on symptoms and connecting with people, that all of that can be done from a distance. Lindsey Hendrix: Yeah. I can say, even from just a professional standpoint, I think a lot of us are working from home right now, and it’s kind of nice, because as we’re all getting more savvy with this teleconferencing systems and stuff, like what we’re doing right now, recording this podcast. It’s nice to get to see people in their houses. I see you in your house, I see you in your office, and I feel like seeing people in their own environment kind of adds a level of personability or something. Like, I can get to know you a little better, just seeing you in your own environment. So, do you think that applies to counseling as well? Bradley Bogdan: Absolutely. In a couple previous jobs I had, I was doing primarily in-home services. Even when somebody says, “Oh, things are going great,” if you notice that all the dishes are stacked up, or if you notice that the laundry hasn’t been done in a couple of weeks, or some of those other signs that you wouldn’t necessarily hear if they were coming into the office, and not necessarily feeling comfortable to talk as openly as you might hope they would. You can totally see when you get a window into where they’re living and where they’re spending all of their time. It can be a big benefit to be able to see into somebody’s home. Like Carly mentioned, it really helps kind of deepen the relationship in a way too, because the relationship is different with somebody that you invite into your home to do something, even digitally, than it is when you go out to a third-party location to just meet and do something. Yeah, it can push that therapeutic relationship another step farther. Lindsey Hendrix: That brings up another point, which is, what are some of the warning signs that maybe you don’t have it all together mentally or emotionally, and maybe you should seek some professional help. You mentioned dishes stacked in the sink, or laundry not being done. There could be a variety of ways that it could manifest. Can you list some of those warning signs that you might see? Bradley Bogdan: Sure. The things that tell me most is not necessarily specifically somebody getting behind on laundry, getting behind on the dishes, because obviously that happens to all of us, but big changes in routine. If somebody is typically really on top of those things, and then isn’t, that should be a sign that something is off and you need to ask. Big changes in sleep. If somebody is used to getting a full night of sleep and they’re not able to get to bed, or they’re not able to stay asleep once they’re asleep can be a really important indicator of something being off or some kind of stress or anxiety or depression building up. Then, differences in how they’re interacting with other people. If somebody is typically really bright and cheery, or typically maybe not very talkative, and you see their behavior change or the way they interact with other people change, that also can be a really important sign that, hey, you should ask and see if something’s going on, or if they’re connected with people they need to be connected with and feel supported. Lindsey Hendrix: Right. Yeah. How would you advise broaching that subject with somebody? You’re noticing a family member or a friend who seems to be having a hard time, how do you open up that conversation and get them to talk about it? Carly McCord: That’s a good question. I would say there’s probably no one right way to do that. Often, I think, when we are just caring and concerning selves, that we often know our friends and our family pretty well, that you can trust your gut in trying to think about a way to broach that subject. I think just the most important part is that you do broach the subject, if you’re worried about somebody. Being able to ask them, “Hey, I’m really worried about you, all of this,” affirm, “all of this is really hard and there’s a lot of challenges, and I’ve noticed, it seems like you’re not sleeping very well. Do you want to talk about that, or have you thought about talking to somebody else about that?” I think that’s really important. It makes me think of the suicide question, that there’s a myth out there that if you ask someone, “Are you thinking about taking your life or killing yourself?” that you’re going to put that idea in someone’s head. I guess, I want to take this opportunity to dispel that myth specifically, that it’s okay to ask, “How’s your sleep, are you eating? Hey, you have seemed really down. You just seem really blue. Have you thought about hurting yourself or taking your life?” You don’t have to be a mental health professional to know what to do next. If someone says yes, your next thing is, “Can I get you some help? Can I help you get connected?” That can be your role, is just to help make phone calls, google providers, talk to insurance companies, whatever kind of those barriers, whatever’s getting in that person’s way. Are there barriers that you can kind of help break down for that person? Lindsey Hendrix: Yeah. So, when you are ready to make that next step, what do you google? What do you look for? Who do you call? What kinds of professionals are qualified to provide that kind of care and help for mental health? Bradley Bogdan: I was going to say, wherever folks are listening to this from, there is, at least in the U.S., there is a couple of different national helplines for mental health and suicide. Also, every locality in the U.S., as part of the funding they get through Medicaid, has a more local helpline for mental health emergencies. We have one here in the Brazos Valley that’s run out of our local public mental health provider. If there is an emergency and you call that number, there will be somebody there within a half an hour, and usually a lot sooner, to be able to respond to that crisis. If somebody is not in an emergency, there are a lot of different places that you can go to seek services. Through your insurer, if somebody has health insurance, they will always provide you a list of local individuals who can provide those mental health services under your insurance plan. Every county in the U.S., again, through that same national funding, has a public mental health provider. Sometimes they’re an overburdened resource, but they exist every place. Carly does a great job of reaching out to a lot of underserved communities through telehealth. Are there more clinics like our own, Carly, that reach out to those underserved areas to treat people? Carly McCord: Yeah. Often, training clinics, whether that be for social workers or master’s level licensed professional counselors, marriage and family therapists, psychology doctoral programs, often we’ll have training clinics associated with them, or trainees that operate on sliding fee scales or provide free services. One of our former graduates and postdoctoral fellows created a website called Low Cost Help. It is a resource where they’ve compiled, across all of the states, different low-cost mental health resources. Yeah, I think different licensures and credentials have some built-in security and established standards for training and previous experiences that give you some kind of stamp or guarantee on some of this shared set of experiences and trainings that they’ve had, that you can rest assured, often in those licenses and credentials. We certainly don’t necessarily have a corner market on change though, with a credential, that there are, culturally, there can be healers in different cultures that may seem more appropriate. At the end of the day, I would rather someone reach out for help than not get any help at all. I would lean towards recommending someone that is licensed and credentialed in your state. Lindsey Hendrix: Say you’re not quite ready to seek professional help yet. You feel like you’re struggling a little bit, but maybe there are some things that you can just change yourself to help build that resiliency during this health crisis and other crises that you may encounter in your life down the road. What are some things that you can do yourself? Carly McCord: I just had a flood of things come to my mind. Number one, I just think that, in my opinion, hurt and pain thrive in the darkness and in secrecy. Anytime you can reach out and tell someone what you’re struggling with that, that is a major win, in and of itself, aside from setting lofty goals for, maybe things that we know are really helpful, like journaling, gratitude journals. Trying to focus on the positive things that are going on in your life, and the basics of, that you cannot underestimate the positive impact of getting seven to nine hours of sleep a night, and putting healthy foods into your body, and getting up and moving in between your Zoom meetings, or at some point, in the day where you put your body in motion. All of those, even just setting small goals, it’s got to be attainable to let it come true. You don’t have to set this, “I’m going to work out an hour every day for the next month.” “I’m going to walk in between one Zoom meeting a day,” and try and do something that you can do is going to improve your mental health. Lindsey Hendrix: Yeah, that reminds me of something I heard the other day. Somebody who had just recovered from alcoholism was saying, you don’t have to not drink alcohol every day for the rest of your life. You just have to not drink that day. I found that so helpful, because it really breaks it down into what you can do that day. You just do what you can do that day, and don’t worry about working out every day for the rest of your life or something like that. Do you think some advice like that would be helpful? Bradley Bogdan: Absolutely. I know, just like Carly was mentioning, the things that I’ve been working with my own therapy clients on have been those small things that they do on a daily basis. So, have you picked up the phone to call somebody that you care about today and have that connection that you might otherwise be missing out on? Have you gone outside today? Did you take a shower and throw on a new set of clothes? They sound silly and basic, but when you have some sort of established routine of those good things, even when they’re little, that provides so much benefit, in terms of resilience, that it’s tough to overstate. Lindsey Hendrix: Yeah. Routine reminds me so much of how routine helps young children. Like I’ve said before, I’m a parent of two littles. So, how can we help our kids during this time? How can we help, from small children who are used to going to daycare every day, to teenagers who aren’t seeing their friends, they’re not going out and going to parties and things like that? How can we help support their mental and emotional well-being during this time? Bradley Bogdan: I found that the first thing that seems to have helped the families that I’m working with is being able to share your own feelings and thoughts with your kids in age appropriate language. One of my favorite folks that works with kids is not somebody who’s licensed, but it was Mr. Rogers. He, very famously, developed an entire way of speaking through the scripts in his shows that was very concrete and directed at the age group he was looking to work with. Because until we’re reasonably old, kids don’t have a great handle on language that isn’t concrete and very firm in what it means. So, being able to say, “Hey Cindy or Bobby, I’m sad too, because I haven’t been able to go out and see my friends today,” is a great way of sharing some of the fact that you’re struggling with this too, and then figuring out a way to do some of those restorative things that’ll help both of you, parent and child, get through it together. Carly McCord: Yeah. I think scheduling is hard to come by, is a bit of a luxury, sometimes, these days. When you can schedule and creating a routine, a bedtime routine and sticking to those, where if you got off kilter, what’s something that you can, again, break it down into smaller pieces. It doesn’t have to be every night, it’s going to be this particular time with these seven different bedtime steps. What’s one thing that you can reinstate a routine into some of the chaos? Lindsey Hendrix: Yeah, and I think it’s funny. We think we’re all locked down inside our houses, I think a lot of times, but we can still go outside. Right? You can still do physical activity. You can still get out there and ride your bike and do things like that. I would imagine that would help kids, at least get the wiggles out or get their energy out if they’re little, and then older children as well. I’ve got a next door neighbor who’s got three teenage boys. You can imagine what their house is like right now. They have kind of a home gym in their garage, and all three of those boys are in and out of that gym all day long, and then sprinting down the street. I don’t know how they’re doing it in this Texas heat, but I know she’s a therapist, so I’m sure she’s kind of recommending or prescribing that for them right now, if you will. Carly McCord: Yeah. We do have … sorry. Internet lag. We have the heat in Texas, but we also have the space. I think, yeah, in most places you can probably go outside, unless maybe you live in inner city, New York. I don’t know. I don’t know if it’s safe to go outside everywhere, but that doesn’t mean you can’t move your body or you can’t do something active, or you can’t do something playful, taking a break from work or from the distress and finding something to laugh about and to just play. I think you can probably find that just about anywhere. Lindsey Hendrix: We just dove right into the topic and started talking about some of these mental health issues that some people may be facing, but what are some of the differences in signs? There’s anxiety, there’s stress, there’s depression, and there are some more severe illnesses. What is the difference between stress and anxiety, first of all? Bradley Bogdan: The best way I’ve heard it explained is that stress is just the human response to change, be it good or bad change, something really exciting can be happening, and it’s still kind of stressful. You think about every wedding you’ve ever been to, people are really stressed, even though they’re all happy to be there and happy that it’s happening. Anxiety is when that stress or just natural response turns into something that is not helpful, it isn’t well suited to the situation. You can get to anxiety through a lot of negative stress, or just too much stress at a given point, but anxiety can also build from some very organic places, and that’s part of the reason why, when medication management can help with that and other coping mechanisms can help with that, it’s not strictly a behavioral way to address it. Lindsey Hendrix: Then, how about depression? What are some of the signs of depression? Carly McCord: Depression is more low mood, feeling blue, feeling sad, sometimes the sadness feels a lot more, or is expressed more as anger, but kind of that low mood, problems sleeping, problems eating, thoughts, maybe, that you’d be better off dead, or hurting yourself in some way. I think the thread that flows through all of the, when is it time to seek help, and when does it meet criteria for a diagnosis. And our diagnostic and statistical manual, they all have this criteria of functioning. Is there a significant impairment in functioning in more than one area of your life? That yeah, either it’s this worry and concern and fear or anxiety, or perhaps kind of sadness and overwhelm, that once it reaches a certain level, may then more a diagnosis. That doesn’t mean you have to wait until that level to seek help. Help can be available before you reach that kind of criteria though. Lindsey Hendrix: That’s helpful. That’s really helpful, because I think we are all sad at points, and we all experience stress, but that’s normal to an extent, until it interferes with your everyday life. Right? Bradley Bogdan: Exactly. Exactly. Carly McCord: Yeah. Emotions are normal. They’re good. They’re data, they give you information about what you need, and if you’re not listening to them and not allowing them and just pushing them away, then you’re never going to know what it is that you need, and then it’ll build up over time until your body and your mind tell you and demand attention for whatever it is that you’re going through. Lindsey Hendrix: Yeah. I think, especially as parents, I’m a parent of two littles, I tend to put myself on the back burner and concentrate more on the well-being of my kids and my spouse. We’re thinking a lot about our older adult parents at this time. What’s some advice that you would give for kind of stopping and checking your pulse, so to speak, or checking back in with yourself to kind of see how you’re doing? Carly McCord: I think that has to be an intentional slowing down. Again, unless you’re going to wait for those alarm bells, which could be suicidal thoughts or just frequent breakdowns. If you will give yourself two minutes, even five minutes would be great, of just time away and just checking in. What do I notice in my body? Is there a particular part of my body that I’m feeling a lot of tension? If you just give that some attention, oh, there may be some … maybe there’s feelings or worries or thoughts underneath that, that if you just will provide some quiet and some stillness, there’s a lot to be discovered. I think that also can happen in the context of relationships. If you’re isolating yourself and you’re not talking to anyone, then it’s hard for those things to come up spontaneously. But if you’re allowing yourself connection, even if it’s at a distance, and then allowing yourself to be vulnerable with people that care about you, then that might also be a place where kind of recognize what you’re feeling and needing. Bradley Bogdan: Carly, you hinted at sometimes those feelings can be physical too, the tightness in the shoulders, or the fact that you’ve got that cramp in your neck or your hip or something that is not usually there, and you didn’t put there through yoga or something else can clue you in that maybe something is building up, and yeah, you need to take some time to address it. Lindsey Hendrix: Yeah. It’s really interesting how much tension and emotions we can store inside our bodies. But I want to kind of switch gears a little bit and ask you guys about something that’s trending right now, and that’s text-based counseling, or counseling done over text messaging. What is your professional opinion on that? Do you think that is a good option for seeking counseling services, or is it more of like an entry point to counseling? Carly McCord: I think we know a lot less about text-based therapy, from an evidence standpoint and a research standpoint. It’s kind of the same as the conversation about credentials in my mind, that someone with credentials has gone to an accredited program and has a license, and has just gone through a number of similar steps to say that, what I’m going to give you is quality. Again, I think who’s the person on the other side of the text can make a big difference. There’s certainly a lot of data missing and tone and pacing. Yeah, that it’s certainly different. Again, I don’t want to say that there’s one right way to do therapy. So, if it’s something that you’ve tried and found helpful, then great. I certainly think, again, some of the evidence-based ideas, cognitive behavioral therapy, which is about identifying your thoughts and whether they’re rational, being able to replace those with rational thoughts. I think those are things that you could do asynchronously with these breaks. So, it might also depend on the presenting concern. Bradley Bogdan: I know that, at least the major platforms that I’m familiar with, I’m at least uncomfortable with the idea of interacting with somebody without being able to interact with them on a live basis, either over the phone or over televideo or in-person. Just because, exactly like you said, Carly, there are certain things that work in therapy with some space to breathe and try out and practice or whatnot in between kind of check-ins, but there are also a lot of safety assessments and ability to respond in the moment and keep somebody’s attention and get them to set aside some time to take care of themselves and take some time out to address whatever is going on, that is really valuable, that I would be really concerned would be lost if you’re trying to break up most of your clinical work into 160 characters or whatnot, at a time. Lindsey Hendrix: Yeah. So, how do you go about finding a counselor for yourself? Is it like online dating where you pick somebody online, you kind of read about them, you go and visit with them for a little bit, and then you try somebody else, or how does that work? Bradley Bogdan: I think dating is actually a pretty good analogy for it. No good clinician will be offended if, after a session or two you come back and tell them, “Hey, I appreciate what you’ve done, but I don’t think we’re the best fit for each other for this. You’re not really able to provide what I’m looking for.” Anybody with some of that standardized training and a license behind them is definitely professional enough to realize that they are not the right person for everybody. A lot of people come to, at least our clinic, through word of mouth referrals, even if it’s for other services. People are generally much more comfortable to go to somebody that they know recommends. So, asking some folks that have been to counseling before, “Hey, who did you use, or can you make a recommendation?” Your primary care doctor also likely has some folks that they work with all the time, that they’re comfortable referring people to. Like I said, it’s a little more of a shot in the dark, but if you do have insurance, your insurance provider keeps a list of local professionals as well. That is a little more like looking up somebody in the phone book, or Googling, but it is definitely possible to find somebody good through there too. Carly McCord: Yeah. I always say therapists are just people. You’re not going to like everyone you meet, and if you don’t … As a therapist, I really appreciate when people tell me, “Give me some feedback of, hey, this isn’t working,” and then I can say, “Oh, I can adapt in that way. Or can we get one more session?” or, “I can’t, you’re right. That’s actually not the way that I do therapy. Maybe I can help you find a referral.” I don’t think there’s anything wrong with that. There are some good … Psychology Today is one of the big listing organizations, it’s not just for psychologists, but where you can read about what are people’s approach to therapy. There’s lots of different theories that drive the work that we do, or looking at the presenting concerns that they’ve worked with, if you have a specific concern. Have they worked with that before? But yeah, I think the word of mouth is a great route to go. Lindsey Hendrix: Yeah. I know word of mouth is how I choose where I’m going to eat dinner, if I’m going out to a restaurant. I think taking some advice from friends that I trust would be my compass for picking a counselor, especially when you’re talking about somebody who’s going to be working on your mind. Say you’ve chosen somebody, you’ve booked your first session, and you’ve never been to therapy before, what can you usually expect from that first session with your therapist? Bradley Bogdan: I know, when folks come to see me for the first time, I break it down into three parts for them, because that is a super common question. Folks know that they want to get help and they don’t know what’s going to come, and they’re super apprehensive when they sit down in a chair and have all sorts of preconceived notions based on what they’ve seen in TV shows or movies, or they’re wondering where are the Chaise Lounges. I tell them, I’m going to ask them questions about, what is going on now, what’s brought them in, because obviously if you’re coming to see somebody, you have some level of concern, right? Then I tell them I’m going to ask a little bit about the way it was before. What did you notice has changed to make it like it is now? Usually, that involves some history about how it was before and how it got to be where it is now, as best as they know. Then, the third part of the conversation is what they want going forward. Is the goal to make whatever feelings that are coming up go away, is the goal to be able to go out and do something that they aren’t able to go out and do anymore? What is the goal? What are we working for? If you’ve got at least the faintest idea of those things, it’ll be a conversation from there to figure out where we’re going to go and how we’re going to get there. Carly McCord: Yeah. I think the only thing I would piggyback is what’s usually different from an intake, from that very first session, than maybe subsequent sessions is often, the intake is very therapist guided, where they’re going to have more questions. They’re going to have set of questions when you walk in, perhaps, and forms that you have to fill out. Brad kind of gave you this broad overview of, that he’s going to ask you questions along the way to get this past, present and future, and each therapist is going to do that a little bit differently. Then perhaps, in some modes of therapy, subsequent sessions may be more, where you do more talking, and there’s less direction. But I think that’s something that varies therapist to therapist, is how directive they are, how much talking they do and guiding they do, versus wanting you to turn inward and discover and come up with material. Bradley Bogdan: Yeah, and going back to that idea that there are a million different people under the sun, and there are just as many different people that are therapists under the sun to match them to. It is okay to come in with some suggestions on how you feel most comfortable talking, or how directive you want somebody to be. There are folks that come in to tell me that they really just want a place to talk and almost word vomit everything out. They’re not really looking for a lot of direction or forward movement or shooting for a specific goal. They just want some space, and that’s fine. We can do that. Then there are people that want the exact opposite. They want to present a problem. They want concrete steps. They want physical things to practice in between sessions. They want a lot of input and guidance on what they should be doing to change this or approach that differently. That’s great too. Then there’s shades of everything in between. So, if somebody has a comfort level with one end or the other, or someplace in the middle, it’s totally okay to tell your therapist before you show up on day one, or on day one, “Hey, this is how I feel the most comfortable. Can you work with this?” And odds are they can. Lindsey Hendrix: Yeah. I know this is going to vary from person to person, but I got to ask the question, how long can you expect to go to therapy before you notice improvement? Bradley Bogdan: You’ve got data on this, Carly. Carly McCord: Sorry. I muted myself. I thought I was already muted. Our research would show that by four sessions, most people achieve some clinically significant change. We use a measure called the PHQ. Majority of people come in with some kind of depressive symptoms, and so going from a severe category to a moderately severe, that change usually happens in four sessions. What that looks like functionally, from severe to moderately severe, didn’t mean that the depression went away. It meant that maybe your sleep’s a little bit better, or that, perhaps … One of the ones that we usually see change the fastest, honestly, for a lot of people is the alarm bell, is the, “Oh my gosh, I’m having thoughts that I’d be better off dead. I can’t handle what’s going on right now. I don’t think I even want to be here anymore.” That, once you’ve reached out and connected, instilling hope can often happen pretty quickly, and so that can show some significant gains early on. Therapy’s not a linear process though. Sometimes you go to one session. A lot of people will come for one session, and whether they didn’t like therapy or they really got something from it that they didn’t have before, I think both of those things happen. Then I think sometimes weeks of therapy get really hard. If you’re doing good work, sometimes you feel crummy, crummier than you did when you walked in the door, but I would really encourage you, that’s the time to stick with it. Do not drop out if you get to one of those spots where it gets really hard. That means it’s about to get really good. Yeah, it’s not linear. Bradley Bogdan: I very much look at it like, and tell people to approach it like they would working with a personal trainer and going to the gym, whereas people don’t go to the gym and get what they need in a week or two. Every once in a while, I suppose you can end up with a wild card and they figure it out. But for the most part, you have to come back to it and you need to work on it on a regular basis. Then, measuring it over time, you can see the progress. Again, just like physical training or going to a gym, there might be weeks where it’s really tough or it’s really hard, or you feel crummier than you did to begin with. But just like Carly was saying, those are often the times, where if you stick with it, you’ll see a really big gain on the other side and get a lot closer to where you want to go. Lindsey Hendrix: Any parting thoughts or words of wisdom you’d like to share with our listeners today as they’re navigating this uncertain time? Bradley Bogdan: That, this is not an original thought to me, but I had a client say it to me from her pastor a few weeks ago, and it stuck with me ever since and I’ve shared it a bunch. Quite often, during times of really big change or national or international issues, we think about how we’re not responding to it well. We need to be better, we need to change this, we need to be able to do that, even with some added stress or concern or routine change. Quite often, those are times when we wouldn’t expect the same out of somebody else. If our neighbor was that way or our mom was that way, or our kid was that way, or some other relative, or aunt, or uncle, or the person down the street, we wouldn’t expect them to handle it without a bead of sweat or any effort involved. Be good to yourself, and extend that same kind of grace to yourself in a time like this. Don’t have expectations that you would be able to handle this when you wouldn’t expect anybody else would be able to handle it without any stress or worry. Carly McCord: Yeah, definitely. I think, acknowledging the reality of the challenge that we’re all living in, that if you haven’t infected someone today, you’ve done a great job. You’ve achieved a lot. Being kind and compassionate to yourself during this time, to pace the fun, to survive, and stick to the basics of trying to eat, sleep and connect are a good place to start, and just encourage you to … If I could challenge every listener to do one thing, it would be to give themselves the two minutes today to stop, to turn off all inputs and check in, and just see if you hear something from yourself that you could respond to and be kind enough to act on that for yourself. Lindsey Hendrix: Awesome. Well, thank you, Carly. Thank you, Brad, for being on the show today. Y’all are amazing guests. Y’all have such great wisdom in this area, and I’m sure this won’t be the last time we’ll have you on. So, until next time. Bradley Bogdan: Absolutely. Thanks for having us. Carly McCord: Thank you. Lindsey Hendrix: Bye, y’all. Carly McCord: Bye. Lindsey Hendrix: Thank you, guys, our listeners, for tuning in. We really appreciate it. We do this for you, so we hope you like what you hear. If you do, please subscribe, follow us, like us, share us with your friends, pass it back, y’all. All right, until next time, stay healthy. Timothy Schnettler: Thank you for joining us on Texas A&M Health Talk, a production of the Texas A&M University Health Science Center. Visit us on the web at vitalrecord.tamhsc.edu, where you’ll find answers to all of your health questions. Until next time, stay healthy.
28 minutes | May 20, 2020
The COVID-19 vaccine trial Texas A&M Health is leading
Mentioned links Sign up for the BCG vaccine trial for COVID-19. Read the article about the trial that Kevin references. Show transcript Lindsey Hendrix: We sit down with experts who are tackling some of the most pressing health issues. From the opioid crisis to hospital closures, food desserts to human trafficking, these are the problems that impact us all. Find out how Texas A&M is contributing solutions. You’re listening to The Vantage Point on Texas A&M Health Talk. Howdy, friends. Lindsey Hendrix here, recording from my home office. Here at Texas A&M, we are practicing safe social distancing, working from home as much as we can, so I’m not in the studio. I apologize that the audio is not quite what you’re used to, but we’re all doing the best that we can. I truly hope that you guys are staying safe. I’ve missed you, and I’m really happy to be back on the air for this special episode of The Vantage Point. Today, we’re featuring a special show from our friends at CHI St. Joseph Health. The following conversation about a potential vaccine to protect against COVID-19 was recorded for their Inside Health Podcast. So, if you’re interested in getting more content from them, go subscribe to the Inside Health Podcast wherever you get your podcasts. In this episode, they talk with our own Dr. Gabe Neal about a late-stage, phase four clinical trial Texas A&M Health is leading to find out if an existing tuberculosis vaccine can be effective in mitigating severe illness from COVID-19. If they’re successful, this vaccine could provide a level of protection for health care workers, essential personnel and perhaps even the general public until a COVID-19 vaccine is widely available. Just a quick note about this vaccine trial before we get into the episode, the researchers are actively recruiting health care workers to volunteer. So if you’re interested in stepping up to the plate, please visit health.tamu.edu/bcgtrial. Again, that’s health.tamu.edu/bcgtrial. I’ll be sure to provide a link to that website in the show notes. Now, without further ado, the show. Enjoy. Kevin Keys: Welcome back to the Inside Health Podcast. I am your host, Kevin Keys. COVID-19 has forced us to make more consistent changes in our daily health habits and that’s probably a good thing. We’re washing our hands more frequently. We’re covering our coughs and sneezes, and doing our part to try to slow the spread of this virus. But there’s one thing that our society will really need to knock out COVID-19, and that of course is an effective and safe vaccine. I’m a big supporter of vaccines, so when I heard that there’s research being done on one for COVID-19 in my backyard at Texas A&M University, and it’s in a late-stage, phase four clinical trials, I was very excited to talk to someone about it. Today, we are blessed with not only one, but two, very special guests talking about the research that is happening at Texas A&M on this vaccine. That, of course, is Dr. Kia Parsi and Dr. Gabriel Neal. Dr. Parsi earned his doctor of medicine degree at Baylor College of Medicine in Houston, and is a member of the American Board of Family Practice, American Geriatric Society, and the Texas Medical Association. Dr. Parsi was a member of the CHI St. Joseph Health Medical Group for 18 years, serving as medical director for the Caldwell Family Medicine Center, chairman of the board of directors for both CHI St. Joseph Health’s clinically integrated network and accountable care organization, and medical director for the Senior Service Line. Currently, Dr. Kia Parsi is the chief medical officer and family medicine physician for CHI St. Joseph Health. Dr. Neal is board certified in family medicine and received his medical degree from the University of Oklahoma. He became a clinical associate professor at Texas A&M in the Department of Primary Care and Population Health, and is also a faculty member in the Texas A&M Family Medicine Residency. Over the past decade, he has taught numerous preclinical and clinical courses for the College of Medicine. He is the family medicine clerkship director for the A&M Integrated Medicine Program at the Bryan-College Station College of Medicine campus. He was awarded Clinical Faculty Preceptor of the Year in 2011, and often writes lectures and interviews for lay audiences regarding popular medical topics. Dr. Neal is also currently the director of Texas A&M Family Care, formerly Texas A&M Physicians Clinic. Dr. Parsi, welcome to the podcast. Dr. Kia Parsi: Thank you for having me. I’m excited to have this discussion. Kevin Keys: Yeah, it should be good. Dr. Neal, welcome. Dr. Gabriel Neal: Thank you very much. It’s great to be here. Kevin Keys: Yes. Thank you both for being here. This is very exciting. I’m excited for this topic. So, one of my favorite things to do though to start off the podcast is a little icebreaker question, something a little bit fun and also topical. Have you guys seen the news about murder hornets and making their way to the United States? Dr. Kia Parsi: Well, it’s funny. I think I got a text message about hornets invading or attacking a squirrel, but I did not open it. So I am not fully knowledgeable about that. I might need to learn more. Kevin Keys: Dr. Neal? Dr. Gabriel Neal: Yeah. I saw a newsfeed on it. Apparently they’re in Washington state now. My wife asked me about it because it came up on one of her newsfeeds too. It sounds horrible, whatever it is. Dr. Kia Parsi: Yeah, yeah. Wasps in general I try to stay away from. But killer wasps? Kevin Keys: Do you think that murder hornet honey is better than regular honey? Dr. Gabriel Neal: Maybe it has some spice to it, little sting. Kevin Keys: Spicy honey? Okay. So we’ll go ahead and get started. The one thing that I keep hearing when talking with physicians is that mass vaccinations is needed to beat COVID-19. So why is that? Why is a vaccine important for our community and our health care workers? Dr. Kia Parsi: I can just respond to that and I’m sure Dr. Neal can add as well. Vaccinations have been one of the greatest scientific and medical advances that we have seen over the last few hundred years. Vaccines can almost completely eradicate a certain illness or disease. And when we see the challenges that we are facing with COVID-19 with this new coronavirus, having a vaccine that can create immunity without any risk of illness, that is golden. So over the last 50 years, we’ve seen eradication of polio for the most part. Smallpox, other very common illnesses. By creating a vaccine, we have decreased the death and illness rate of these diseases. We would like to do the same with COVID-19. Kevin Keys: Yeah, that’s great. And could you go into a little bit more detail on why it might be important? Obviously it’s important for our community, as you described how vaccines have been life-saving in general. But can you go into how they’re important for our health care workers as well? Dr. Gabriel Neal: Well, health care workers are among the highest risk individuals for catching this disease, COVID-19, because of the exposure. We have health care workers right now in our hospital that are treating COVID-19 positive patients daily, and we want them to work in an environment where they feel it’s safe to work and not have that undue burden of catching the disease or passing it on to their family members. Kevin Keys: Yes. One of the things that I get to do in this awesome position that I have here is, I get to sit down and talk with a lot of medical professionals. And one of them that I spoke to was the chief medical officer at St. Luke’s, Dr. Raza. And he was talking a little bit about comparing this to SARS. And he said that in 2003, SARS fizzled out before a vaccine could be developed. What’s different here, besides the obvious that COVID-19 has hasn’t fizzled out yet? Dr. Kia Parsi: It’s great that you have Dr. Neal on the line because he actually dealt with, I don’t know if it was SARS, but didn’t you deal with MERS, Dr. Neal? Dr. Gabriel Neal: That’s true. I was living in the United Arab Emirates during the 2013, 2014, 2015 years, where MERS was present. And I was unfortunate enough to live really in the epicenter, the town of Al Ain, where most of the cases were occurring in the Emirate of Abu Dhabi. So the World Health Organization would generally report the cases from Abu Dhabi, but they were truly in our town. And, one of the real keys to surviving that coronavirus infection was wearing masks, which we’ve emphasized during this pandemic here with the SARS-CoV-2 pandemic, and wearing gloves. And what we found there was that if doctors and nurses were wearing appropriate masks and gloves, then they didn’t die. And then if they didn’t, then they did. And so, it was an interesting time to be in the Middle East and to experience that. This virus though seems different. I was hoping that it would be as quick to go away as MERS was, thankfully not as deadly as MERS was. But, this one seems to be lingering and I’m happy to talk further about it, but it has some characteristics to it that make it different from SARS and MERS in particular. Kevin Keys: Yeah. Curious myself, what are some of the different characteristics there? Dr. Kia Parsi: Well, Gabe, you can probably add as well. There’s a couple of characteristics, they’re all coronaviruses, but with this virus, it seems to be more infectious, so people catch it easier. So there’s an infectivity rate. So if you’re infected, what is the likelihood of you infecting those around you? It seems to be higher with this one. Another characteristic is, there seems to be a asymptomatic phase, where you could have the disease, be contagious, and not know it. So you’re more likely to spread it to other people because you don’t have any symptoms. And you’re still in the workplace. You’re still among your family and friends. And that seems to be one of the bigger challenges with this virus. Dr. Gabriel Neal: Yeah. I’ll add to that. The amount of time that this COVID-19 virus spends hiding but being transmitted before you were aware of it, is longer than with the MERS and the SARS. And then people are experiencing the illness longer than with the MERS and the SARS. I remember the MERS virus, people would get it, and they would die within days. There was not a period of weeks where they were ill in the hospital, then maybe got better. And then they got really bad and then died. This one seems to really take a long time to do what it’s going to do to somebody. And that makes it really hard to slow down. Kevin Keys: So, okay. In general, what is the progress in vaccine development for this virus? How many other trials are maybe going on in the world right now? Dr. Kia Parsi: I don’t know the exact number, but I know that there’s a lot of work, and it’s global. Not just in the United States, but around the world. I know England has a trials at Oxford that they’re working on. One of the challenges we’re facing now is, usually to get a vaccine through development and be ready to be utilized takes years. Dr. Gabriel Neal: Right. I’ll add to that. I’ve seen certain organizations who are counting how many trials there are for therapy and for vaccinations, and there’s over a hundred different vaccine trials, and an almost 200 or more than 200 therapeutic trials currently. So there’s hundreds of vaccine and therapeutic trials that are currently in progress right now. But there is consensus that for a COVID-19 or a SARS-CoV-2 vaccine that’s specific to that, we are years away. The idea that we’re one year away from a vaccine is really not entirely accepted. Those of us who are taking a longer view of it, I think it’s two to three or more years away. Kevin Keys: Right. Dr. Kia Parsi: We’re trying to accelerate it as quickly as we can. So typically it would definitely be years. We’re not just talking one or two or three years, usually it takes multiple years to get a vaccine. I think Dr. Neal is correct that most likely it would take two or more years, although I have heard, 18 months. That might be very optimistic. It might be a hope more than a goal. But definitely the worldwide medical community is working as quickly as they can to find a safe, effective vaccine. Kevin Keys: Right. And that brings me to my next question. Can you give a general timeline for what is required of a vaccine to go from early development to worldwide use? And I guess maybe a follow up to that is, why does it take so long? Dr. Kia Parsi: Number one, the animal models that they generally start with, don’t always translate into benefiting humans. And so even if they come across something that seems to the effective in mammals, like mice, that often doesn’t translate into benefit in humans. And so, there’s many, many, many studies that usually occur that that are inconclusive in whether there’s benefit or not. And it takes a while to get a study that can truly indicate that there is a benefit, and that just takes time. I think that’s the easy answer for why it takes a while. It takes time to get robust data. Well, I will say in general, first you have to have testing in the lab, and that may not even be with live animals. So there’ll be in vitro testing just in the lab setting. So that’s one stage. Then you go on to animal testing. And after that you would go to humans. And one of the challenges with therapies or vaccines is you don’t want to do harm, and so you have to have some robust data before you will ever bring it to a human being. There is always a potential that without safe standards, you can cause significant harm to the individuals in a trial. Kevin Keys: Yeah. As I mentioned in the intro, Texas A&M is working on repurposing a vaccine that’s already in use for other treatments and has been seen to be safe for that. Can you give us some background on this vaccine? Dr. Gabriel Neal: The BCG vaccine is used worldwide to prevent tuberculosis, and it’s been around for decades. There’s a number of different strains and different makers of this vaccine, and it’s a wonderful work that is being done worldwide with that vaccine. It’s also a therapy for bladder cancer, which was remarkable. They actually injected into tumors in bladders. So it has two very wonderful current good uses at least. And, its safety profile is very well established. Billions of doses of a BCG vaccine have been given over the past several decades. And while there are some mild side effects to the vaccine, such as developing a small scar on your arm, its benefit way outweighs a scar that you might get on your arm. And so, repurposing of vaccine that we know is very safe in humans to fight a COVID-19 helps us move much farther down the track to being able to offer health care workers, or even the general public perhaps, something that they can take to help prevent and reduce the burden of illness from COVID-19 in the future. Kevin Keys: That’s excellent. So, why this vaccine? What made it stand out to researchers as a possible solution? Dr. Gabriel Neal: Well over the past several decades, the vaccine has been studied in many different contexts and what they have found is that, it actually causes our body’s immune system to be more effective against a number of different viruses. And so, with this idea that it can cause not just an anti-tuberculosis immunity, but if it can improve our immunity to other diseases as well, then it could, or will likely, give us a boosted immunity towards COVID-19. So that’s the theory. We don’t know the answer to that, but since it seems to work on other viruses, it could work for COVID-19. Kevin Keys: That’s good to hear. That’s great. Dr. Kia Parsi: Dr. Neal covered it. Going back to your previous question, how long does it take? Well, this is a vaccine that’s already been tested and safe. So it can go to human trials right away and not go through those other phases. Dr. Gabriel Neal: Starting tomorrow. Dr. Kia Parsi: That quick. Kevin Keys: That’s great. We do a podcast that starts tomorrow. So, in preparing for this and talking with both of you, I read an article from Texas A&M Today, that talks about how this vaccine—you mentioned it’s called BCG—is widely used, and I’ll make sure to link that article that I was reading in the episode description so the listeners can read it too. Is this vaccine something that we use here in the U.S., and if so, do we all receive it or is it just for a specific population? Dr. Gabriel Neal: Well, the United States does not employ the tuberculosis vaccine on all children or adults because the incidence of tuberculosis in the United States is so low. So it is used worldwide, but not in the U.S. So if you were born and raised the United States, it’s very unlikely that you would have had this vaccine already. But if you were born in the United Arab Emirates, like my fourth child was, then they just had the BCG vaccine because they give that to every child at a certain age. So it really depends on where you grow up, whether you’ve had it or not. Dr. Kia Parsi: My wife, she was born in Korea, South Korea. She has the scar from the vaccine. One of the reasons why, as Dr. Neal said, we don’t utilize it in the U.S. Is because of the low incidence of tuberculosis. And the way we screen for exposure to tuberculosis is a skin test. If you have the vaccine, your skin test is positive. So it affects our ability to monitor and evaluate if you’ve been exposed to tuberculosis. Kevin Keys: Right. Right. Okay. That same article talks about how currently Texas A&M is seeking 1,800 health care workers to start testing on this vaccine, and you mentioned it might even start as early as tomorrow. So what does the landscape look like for the completion of this trial for the vaccine? And what else is needed to complete, I guess, this research? Dr. Gabriel Neal: Well, we just need health care worker volunteers. We are partnering with a number of other institutions like Harvard and UCLA, and we need hundreds and hundreds of health care volunteers to get enough data to show that it’s effective in reducing the burden of illness from COVID-19. So right now we’re in that recruiting phase and we’re beginning to give the injections. Like I said, tomorrow’s going to be the first day of therapy with the injections, which we’re very excited about. But, it’s not nearly the 1,000, 1,800 that we need. So, we’re trying to expand our clinical sites right now to bigger cities to try and get more health workers involved. But we’re very grateful for those that have already volunteered and that have tried to sign up and are involved in the current clinical trial out here in Bryan-College Station. Kevin Keys: One of the things I noticed that that article talked about too, and I think it might be important to mention, is that this vaccine isn’t necessarily designed to eradicate the virus, but more or less to slow things down, or to maybe reduce some of the complications that people were getting from it. And then give us a window for that continued development. Is that how this is going to work? Dr. Gabriel Neal: Right. Something you alluded to earlier was, wanting to protect health care workers during a pandemic. I’m very happy that we have not seen the infections and death among health care workers that worst-case scenarios might’ve brought us with this pandemic. But there’s no doubt that our health care workforce has been impacted by it. But, when you look at the literature for pandemics, you have to plan for about a 40 percent attrition rate among your health care workers in a pandemic, which is a huge number. So just when your need for doctors and nurses and respiratory therapists and physical therapists and all the things that people need when they’re very ill, when you’re at your biggest need is when your health care workers will be at their most sick. And that’s a double whammy that we’d like to avoid. And so, this therapy can be a stop-gap between now and when the vaccine is developed, and it could also be a used in addition to a future vaccine to help protect health care workers. So it could serve two purposes in the future. Dr. Kia Parsi: Yeah. And Dr. Neal could clarify, but because this is not a specific vaccine for the COVID-19 virus, we’re hopeful that it can create some immunity, but probably the likelihood of having a very vigorous immunity is less likely. So, as you mentioned, this might be a good stop-gap, but we might be wrong. It might create significant immunity that would be adequate to not have to investigate for further vaccines. Kevin Keys: Right. Either way it’s good. It’s good stuff if it all goes over well. Okay, so how long will this trial take to see if the vaccine is effective, and I guess more importantly, safe? Assuming we get all the health care worker and volunteers pretty quickly, how long do you think that that testing process takes? Dr. Gabriel Neal: We are tracking each participant for six months with regard to their immune status and days missed of work related to illness, particularly COVID illness. There are some aspects of the study that may continue longer, but that’s the bulk of the work that will occur within six months. So, when we enough volunteers and enough participants, really within six to 12 months, we should be able to have the data that says this is something that’s worthwhile or not. Kevin Keys: Is there anything that people can do to help with the research? Maybe sign up once the health care community has been thoroughly tested? I’m ready to sign up now, where do I sign up? Dr. Gabriel Neal: Yeah, there’s been a ton of non-health care worker interest in the study and it’s been hard to exclude non-health care workers from participating in the study. But we want the study to be rigorous, and so we have to be very judicious about our selection process. So I really appreciate how there’s a ton of excitement from people who aren’t involved in the health care world for getting this, because everyone could potentially benefit from it. But at the moment, you could ask your own doctor, “Hey, have you signed up for the vaccine trial?” That could be useful. Kevin Keys: I’ll do that. Okay, I’ll give him a call right now. All right, I like to finish the episode the way that we started with a little bit of fun. So this time we’re going to play a little bit of Jeopardy. So you have to write down your answers and wager the fake money to see who’s the winner. So are you guys ready for that? Dr. Kia Parsi: Let me get a pen here real quick. I already forfeit to Dr. Neal. Okay. I’m ready. Kevin Keys: Okay. I like hockey, ice hockey. So the category is ice hockey. We’re going to test your ice hockey knowledge all the way down here in South Texas. Dr. Gabriel Neal: Oh geez. Dr. Kia Parsi: My wagering is very little on this. Kevin Keys: So, the answer is, “The last team to win the Stanley Cup in two consecutive seasons.” Dr. Gabriel Neal: Oh gosh. Kevin Keys: Give you a little bit of time. I’m not going to do the theme song. Dr. Gabriel Neal: Okay. I have an answer, but I have … Dr. Kia Parsi: Trying to remember the … Dr. Gabriel Neal: … Okay. Dr. Kia Parsi: … I know the city. I’m just … Kevin Keys: If you know the city, I’ll give you half of whatever your wager was. Dr. Gabriel Neal: I don’t know the city. I’m completely guessing. Dr. Kia Parsi: Oh, I remember. I remember. I remember. It just came to me. Kevin Keys: Okay. All right. Dr. Kia Parsi: All right. All right. Okay. All right. Kevin Keys: Okay. All right. All right. And one, two, three, all right. Dr. Neal says, “Who is the Detroit Red Wings for $5?” Dr. Parsi? Dr. Kia Parsi: I said for $3, who are the Edmonton Oilers? Kevin Keys: Well, both of those teams did win Stanley Cups. The Oilers did it twice in the ’80s, and the Red Wings did it in ’97 and ’98. But the last team to win, it was actually the Pittsburgh Penguins in 2016 and 2017. So you both had winning teams, but not the most recent. Dr. Gabriel Neal: Gosh. Kevin Keys: So no, I like to have a little bit of fun. And, I appreciate you guys coming down here to do this so much. Dr. Parsi, Dr. Neal, thank you for taking the time to do this today. The work that you guys are putting into this vaccine is really good news, especially during a difficult time for many of us. We all appreciate the work that you guys are doing, and we appreciate all of the health care workers brave enough to be on the front lines right now and to sign up for this vaccine research. Is there anything else that either of you guys would like to say about any of this? Dr. Kia Parsi: Well, I just want to say I’m so excited that Dr. Neal and Texas a A&M University Health Science Center’s in this study. We need all hands on deck and CHI St. Joseph Health really wants to support this, and are looking forward to the results that they come up with. Dr. Gabriel Neal: Right on. I want to say thanks to CHI St. Joseph for the support they’ve shown us, particularly Dr. Kia for helping us recruit. And I’m grateful to the doctors and nurses from CHI St. Joe’s who have volunteered, and will be coming tomorrow to get their shots. So, very excited. Kevin Keys: Well, thank you guys again, and thank you listeners for tuning in. We will have more episodes coming your way, so stay tuned. And if you like the show, don’t forget to hit subscribe and leave us a review, we’d love to hear from you guys. So thanks again, and we’ll see you guys next time. Bye. Timothy Schnettler: Thank you for joining us on Texas A&M Health Talk, a production of the Texas A&M University Health Science Center. Visit us on the web at vitalrecord.tamhsc.edu, where you’ll find answers to all of your health questions. Until next time, stay healthy.
36 minutes | Jan 14, 2020
Safety climate and culture
An expert in industrial organizational psychology at Texas A&M dives into safety climate, how it differs from safety culture, and how to assess the safety climate of an organization.
30 minutes | Jan 7, 2020
Myths and facts about keeping your new year’s resolution
Mark Faries: Welcome to Health Hullabaloo. I’m Mark Faries here with Tim Schnettler. Good afternoon, Tim. Tim Schnettler: Good afternoon, Dr. Faries. Mark Faries: So I asked you before, do you have a New Year’s resolution? Has that changed? Tim Schnettler: It hasn’t changed in the last five minutes. I told you I’m not big on making them. I mean, when I do, it’s usually the same ones over and over and I never accomplish ’em. I’ll be honest I don’t usually accomplish ’em. Mark Faries: When was the last time you tried one? Tim Schnettler: Oh, I tried one this past year. Mark Faries: Oh last year? Okay. Tim Schnettler: This past year and I got through maybe the first month or two and then I kinda started to tail off. And you know, you get busy. With me, it’s always one of those I’m gonna eat healthier. I’m gonna do this, I’m gonna do that. And then you get caught up in the day to day and you end up breaking it somehow. Mark Faries: It’s interesting. Do you think these resolutions are different than like just people wanting to change throughout the year? It’s something special it seems like about a New Year’s resolution. It gives everybody at least one opportunity a year to take on a bigger resolution. And I think that’s the myth we’re gonna try to expose today potentially as we try to provide some clarity in all the confusion as we do on Health Hullabaloo Podcast. And so the idea that these resolutions, New Year’s resolutions have to be big, grandiose. I was thinking on the drive over here do you know anyone who sets small resolutions? Like I’m gonna eat one apple on January 2nd. That’s my resolution. I’m gonna ride the bike for 30 minutes on the 2nd and the 3rd and then feel good about it. I met my New Year’s resolution. I completed it. I was successful. We can’t think of one. Most people normally set these big ones. Tim Schnettler: Yeah, it’s usually I’m gonna do the bike 30 minutes a day every day- Mark Faries: Forever. Tim Schnettler: Forever. I’m gonna go through the whole year, 365 days, but then it’s always well, I can’t start on this day because it’s a Wednesday. So I’m gonna start on Monday. But yeah, as far as smaller goals, don’t see that very often. Mark Faries: Many years ago, I had this idea I was gonna learn Latin. And so for New Year’s, I like bought. It’s long ago. I had audio tapes. That’s how long ago it was. And so I bought audio tapes and I was gonna learn Latin but I never made it past that. I might have popped the first tape in and I had a book to go along with it and it was like too hard or something. It’s weird. Like I made those first kind of steps of commitment. Tim Schnettler: Right. Mark Faries: That were doable, but then this larger vision of resolution of learning a whole entire language was just too big. It could be problematic. You know, if you look at resolutions, the idea behind a New Year’s resolution by definition is a firm decision to do something. It doesn’t necessarily say it should be big or small. Now, it might also be a resolution not to do something. I’m gonna quit doing A, B, and C as opposed to start doing. I looked at some history of the New Year’s resolution and there is evidence of New Year’s resolutions so to speak 4,000 years ago with the Babylonians. And then into Romans. And then the early Christians. But those were all around religious resolutions. I’m going to repent. I’m gonna fix something this coming year, the error, so to speak, that I have made in the past year. I’m gonna do better in the future. And so these resolutions have been around for a long time. So then I started digging into the research on what kind of resolutions do people pick and are they big? And what we find is that most people do pick very large grandiose New Year’s resolutions. This one study I’m looking at here was from 1972. And the way it talked about big resolutions was general resolutions. And one thing that it noted in the results was that overly general resolutions are more difficult to assess compared to those which are specific, discrete, like small targets of change. So the example, it says it’s easier to report success in keeping a general resolution such as becoming an all around better person because of the lack of that specified criteria. Did you meet your resolution? Oh yeah, I’m a better person. But as soon as you start getting more specific or smaller, it becomes, one, it’s harder in like they say in the research to assess it, but even in life. How do we classify that we were successful in these small changes? What’s interesting is I worked it down. It said almost two thirds of the people in this study who had broken their resolution reported that the cause was themselves. Like it was the deliberate choice. I just quit as we talked at the beginning. Tim Schnettler: Right, right. Mark Faries: There was perhaps a lack of willpower or I kept forgetting, life got in the way. Only 36% of the failures were attributed to environmental forces. I guess other people maybe or the barometric pressure. We’ll do whatever we have to. You know, it wasn’t my fault. That’s the eternal optimist. So the statement here has really struck me and I’ll see what you think about this. It said that the decrease obtained in self concept ratings of these participants. In other words, they measured self concept or this view of self, positive, negative. Sort of like self esteem. It’s just your general, let’s say, view of self. So they saw that there was a decrease in the view of self in those people who broke their resolutions and it might reflect the process of attributing failure to self. So in other words, I set a resolution and I don’t get it. Thus, I changed my view of self because I didn’t get it. And self esteem can be impacted. I’m a bad person. We can start labeling. Tim Schnettler: I’m a failure. Mark Faries: I’m a failure. This labeling of self. And in the behavioral medicine research even with self monitoring from physical activity trackers to weight tracking, to any of these things that are commonly done with New Year’s resolutions, they’re not benign, in other words. We even see it with diabetes self monitoring and we might have talked about this before. I prick my finger to check my blood sugar but every time I do that, it reminds me of my diabetes. It reminds me of how I’m not eating as well as I should be but I’m trying. In other words, they’re not benign. They’re not valueless types of information. And so I started thinking about this. There’s a couple terms that popped up to me from the psychological literature. One is called self liberation. It’s used a lot with smoking cessation and changing those behaviors which are also common New Year’s resolutions. But self liberation is this idea that I believe I can change, one, and number two, I’m committed to changing. New Year’s resolutions are always seemingly used as an example, a prime example, of self liberation. We might akin it to willpower, this belief that I can and I’m gonna commit to change. What the research finds is that the more choices people have to meet a goal, the more commitment they’ll have. So for example, if a goal is to quit smoking for the New Year’s resolution, let’s say my only choice is cold turkey. That’s it. My commitment’s gonna be lower theoretically compared to if I had three options or two options. Let’s say the three were cold turkey, or I could do a nicotine fading like slowly go down with it, or the third option is just to do nicotine replacements going from cigarettes to nicotine patches, et cetera. Now, I have three options or choices. It increases the potential for commitment. And so we hear self liberation and New Year’s resolutions be an example but the problem is. The good thing about commitment is that we want to stay consistent with those commitments. And there’s a great book by Robert Cialdini called Influence. If you haven’t read it, it’s well worth it. He has a whole chapter there on commitment, and consistency, and how crazy we are as humans to stay consistent even with the smallest commitments. That’s why we get people to sign contracts. It’s the foot in door technique. Salesmen use it all the time, advertising, business. It’s used all the time. If I can get you to commit just to this little thing and then swoop back around a little bit later and say well, you’re already committed to this. Right? And making it public is even stronger now. So we make these big resolutions and maybe we make those public, maybe we don’t. So that was the first thing that came to mind was this idea of self liberation that we have to go big or go home. I gotta commit to something and I gotta think of something that’s big enough for me to believe in myself ’cause back to these small, why people probably don’t choose small resolutions is the meaning’s not there, don’t you think? Tim Schnettler: Yeah. And to me, if I set one and I set a bigger one, I feel more accomplished. Mark Faries: Yes. Tim Schnettler: When I hit that if I hit that. I’m not always gonna hit it. But rather than well, there was one little step and I accomplished that. I think that’s just a part of the self satisfaction thing. You know? You want that big, big self satisfaction. Mark Faries: Yes, and that’s right. And so these successes or failures as we just read, we can then interpret those and they influence the way we view ourselves. So in the weight loss research we did years ago
28 minutes | Dec 17, 2019
Bloating reasons and relief
A family nurse practitioner breaks down the most common reasons people feel bloated and what you can do to find relief.
37 minutes | Dec 10, 2019
Why is my period late?
A missed period can signal much more than pregnancy. An OB-GYN discusses six of the most common reasons your period may be late.
37 minutes | Dec 3, 2019
What is safety leadership in the workplace? How are leadership and management different? Find out these answers and more as three experts discuss these topics and try to fill awkward silences in this episode of Work Factors.
32 minutes | Nov 26, 2019
Fad diets: Intermittent fasting, KETO and more
A family medicine physician at the Texas A&M College of Medicine discusses fad diets and the health benefits--and risks--for each.
24 minutes | Nov 19, 2019
Sex and intimacy in older age
An expert from Texas A&M Center for Population Health and Aging discusses health concerns and stigmas associated with sex and intimacy for older adults.
31 minutes | Nov 12, 2019
Diagnosis: TB or not TB?
We sit down with Jeffrey D. Cirillo, PhD, a Regents' professor in the Department of Microbial and Molecular Pathogenesis at the Texas A&M College of Medicine, to discuss his work on diagnosing diseases like tuberculosis quickly stopping the spread of the infection.
26 minutes | Nov 5, 2019
Are ADD and ADHD the same thing?
Andrew Harper, MD, child and adolescent psychiatrist and clinical professor at the Texas A&M College of Medicine, explains attention deficit hyperactivity disorder (ADHD), common symptoms, medications and why it's no longer referred to as ADD.
26 minutes | Oct 29, 2019
Raising awareness about bullying
October in National Bullying Prevention Month, so it's a great time to talk about bullying and what parents, teachers, health care providers and community members can do to prevent and stop these behaviors.
39 minutes | Oct 22, 2019
Exploring breast cancer research
For breast cancer awareness month this October, listen to a breast cancer researcher explain her work on why some women get breast cancer, while others don't, and why they can have very different outcomes.
39 minutes | Oct 15, 2019
What do procedures have to do with ergonomics?
Work procedures: what are they? Learn what's important about writing and following work procedures and effects on worker health and safety in this episode of Work Factors.
Terms of Service
Do Not Sell My Personal Information
© Stitcher 2021