2021 Caucus Overview - Printable PDF 2021 Abstract/Poster Submission 2019 Caucus Program Guide Movement is Life
Catalyst for Change
Proceedings Report Movement is Life
Articles of Interest » Continuing Education Modules Collaborative Partners Shared Decision Making Tool for Knee Pain Start Moving Start Living
Brought to you by:
Podcast Episode: COVID-19 Pandemic: What we can do to stay healthy, safe and strong.
The COVID-19 podcast everyone needs to hear. Four experienced doctors working on the frontlines of healthcare share their words of wisdom. Together they discuss the important subjects: the basics such as handwashing, strengthening your immune system, the need to take social distancing seriously, coping with the mental health challenges, and tapping into faith and spirituality. The conversation addresses issues particularly important to minority communities, and in a lighter moment the panel discusses the need to “channel your inner Michael Jackson”, but this podcast is seriously packed with the kind of essential information that can help you adjust to the “new normal”, be you a care provider or a potential care receiver. Let’s flatten the curve together. For links to information sources featured in the podcast, text the word “podcast” to 47-47-47. Hosted by Dr. Mary O’Connor, and featuring Dr. Carla Harwell, Dr. Lauren Powell, and Dr. Yashika Watkins.
COVID-19 Pandemic: What we can do to stay healthy, safe and strong.
Featuring Dr. Mary O’Connor, Dr. Carla Harwell, Dr. Lauren Powell, and Dr. Yashika Watkins
[Recorded April 2020]
Dr. O’Connor: Welcome to the Health Disparities Podcast sponsored by Movement Is Life. My name is Dr. Mary O’Connor, chair of Movement Is Life and Director of the Center for Musculoskeletal Care at Yale School of Medicine and Yale New Haven Health. I am excited to moderate this podcast that will focus on how we can stay healthy, physically and mentally, during this terrible COVID-19 pandemic. By the way, we are creating and updating a guide to the best information links on the internet during this Pandemic. It’s called, “The Safe and Strong Guide”, and it’s a list of helpful links from trusted sources, some of which we will be talking about during today’s podcast. It’s very easy to get this guide. Just send a text to the number 474747 with the word “podcast” in the message. You will get an automatic reply back with a link to our, “Safe and Strong Guide”. I’d like now to introduce you to our three panel members for today’s podcast. Dr. Carla Harwell is the Medical Director of the Otis Moss, Jr. Community & Health Center, which is in Cleveland, Ohio. She also finds time to be an Associate Professor of Medicine at Case Western Reserve University School of Medicine. She’s also previously hosted this podcast and she’s been an active contributor to Movement Is Life talking about the importance of staying physically active. Welcome back, Dr. Harwell.
Dr. Harwell: Hello, and thank you, Dr. O’Connor.
Dr. O’Connor: You’re most welcome, Dr. Harwell. Our Next panel member is Dr. Lauren Powell who is a Board Certified Family Medicine physician in the Atlanta area. She’s also known as the culinary doctor because of her passion for culinary medicine. You might have seen her on CBS, FOX, NBC and ABC demonstrating her recipes, and we love her Facebook page where she frequently posts helpful videos. Welcome, Dr. Powell.
Dr. Powell: Thanks so much for having me.
Dr. O’Connor: Finally, Dr. Yashika Watkins is our Public Health expert. She’s an Associate Professor of Public Health at Chicago State University and she’s someone who is a specialist in how we can help people make healthy changes. She’s been with Movement Is Life since we’ve started and has helped create many of our programs.
Dr. Watkins: Thank you, Dr. O’Connor. Hello, everyone.
Dr. O’Connor: So, panelists. This is such an important topic. Staying healthy through this COVID-19 pandemic. I want to get right into questions with our panel. So, first, let’s talk about the ways that we can stay healthy and, of course, the most obvious way to stay healthy is to avoid catching the virus. We should all know the basics, but this is such an important topic that I’m asking Dr. Harwell, to refresh on these basics and give us any new advice on how we can avoid becoming sick. So, we’ve all been watching TV. We’re hearing these terms social distancing, let’s wash our hands, isolation, and so what we have to remember here is that the way to get ahead of this virus spread is to first and foremost, distance ourselves, socially, from one another unless it is absolutely, necessary that you be in close contact, and we really need to take this very seriously, and even a little more seriously. We’re all watching the news. We see Dr. Fauci on TV, who is leading us in how we think that this virus is going to be hitting its peak coming up, and so, the way to slow this down, as you may keep hearing is to quote/unquote, “get ahead and flatten the curve”. So, basically, what that’s saying is that we need to try to do what we can do to continue to slow the spread of the virus. And so, it really, really is important that we practice what’s now been termed this social distancing, which, basically, it’s staying, at least, six feet from other individuals. If you have to out and go to the grocery store and go to the pharmacy, you want to make sure, as you’re standing in line, that you keep that social distance from the person in front of you. So, that’s key. Also, handwashing. There was a mad rush to all these stores. Everyone was buying up all the hand sanitizer, buying all the bleach, buying all the bleach wipes and just such a panic to go out and get these things. Now, while it’s important to have those things, if you do, but the real thing here, and the real way to slow the spread and to make sure that you aren’t carrying around any contaminant on your skin is handwashing. I cannot emphasize enough how important that is, and you also need to make sure that you wash for, at least, a minimum of 20 seconds. Don’t just go in there and put a little soap on and rub around, put it up under the water and boom, I’m done. You really, need to take some time and do some really, active, engaged washing of your hands. So, that alone, will be a major contributor to making sure that you are decreasing your chances of spreading the virus, at least by that mechanism. Again, social distancing and handwashing are two very, very important things, right now.
Dr. O’Connor: Dr. Harwell, I want to do a follow-up question with you. This is really, focused on sometimes the challenges of washing your hands so often, and getting dry skin and your skin starting to get cracked and whether handwashing with cooler water or lukewarm water, which might be easier on your skin is as effective, as if you’re washing with warmer or hotter water. Does the temperature of the water that you’re washing your hands with matter in terms of effectiveness for killing the virus?
Dr. Harwell: Oh, no. I don’t know of any evidence that shows that the temperature of the water makes a difference. What makes a difference is how long you’re actually washing your hands and making sure that you’re covering all your areas and then rinse it off. Once again, I want to reiterate that it’s not enough to just get your hands soapy and one, two seconds, three seconds later, you’re rinsing it off. The key is to really lather your hands up, keep the soap on for a minimum of 20 seconds, that’s bare minimum before you go to rinse off. So, in terms of the temperature of the water, that isn’t as important as the fact that you are washing your hands long enough.
Dr. O’Connor: What advice would you have for people in terms of social distancing, if they have to take public transportation and maybe they’re in a situation where they’re trying to social distance, but those around them are not permitting them to. Is there an indication for individuals to wear masks in that situation?
Dr. Harwell: Currently, there’s a little bit of controversy about who should be wearing masks and who shouldn’t. Keep in mind, the nation, we are under a shortage of what’s been called, PPE, which is personal protective equipment, and that includes face masks, gowns, protective shoe covering, face shields, all those things, that people who are first responders and healthcare professionals that are on the frontline, we really, need to make sure, that we have enough of those items for those individuals. Now, yes, the general public, does have access to some of these facial masks, and there’s some controversy over whether or not that helps. If you do have them and you do choose to wear that out in public, again, you have to be mindful of the fact that you’re putting it on correctly. I’ve seen people in the grocery stores with the mask dangling down from one ear or it’s not even over their nose. The nose is exposed and it’s just over their mouth. So, if you have access to a face mask, and you do to choose to wear it out in public, then, at least, make sure that you’re putting it on, properly. If you find yourself in a situation where you can’t socially distance yourself that recommended six feed, then other things that you can do, once again, should you feel the need to cough, again, make sure that you’re coughing inside the crease of your elbow or down into your clothing. You don’t just want to cough and let just any type of air droplets just go out into the air. Try not to touch handrails and things, as much as possible. People are wearing gloves. You will see people, out in public, with gloves. Again, another caution about that is if you don’t know how to take the gloves off properly, it’s fine while you have them on, but, then, when you go to take them off, you’re exposing your hands to whatever external germs you may have picked up on the gloves, on the outside of the gloves. So, even after taking something like gloves off, you still want to, immediately, if you can, go and wash your hands, again. Lastly, I cannot reiterate, enough, for everyone to, please, take seriously this need to social distance. I had a patient who told me that he was invited to a card party. That he was going over one of his friend’s house and they were going to have a card party. With all this social isolation and all of this social distancing that five or six guys wanted to get together in the basement and have a card party. So, he said to me, I know these people. I know these guys. We’re all clean. We’re all safe. We’re just going to be hanging out and that’s what we’re going to do. I said, “Well, first of all, I think it might be very hard to be six-feet apart from each other and play cards. I don’t know of a card table long enough for six guys to sit around and do that.” I said, “So, there’s the first problem.” I said, “Second of all, what I think people aren’t thinking about. This isn’t a matter of you being, quote/unquote “clean or not clean,” or you knowing this person and you thinking, ‘Oh, they don’t have the virus.’” You have to also think about where these individuals are then leaving and going back to. Are they going back to a home where let’s say their elder parents live in the house? While you may think that what you did was okay for you, you’re, now, potentially, exposing other vulnerable individuals because of your actions, and that’s what I don’t think people understand. This is bigger than just you. This is bigger than each individual. This has to be a concerted effort from all of us to try to keep everyone as virus-free as possible, and the only way to do that is to not just think about what your actions could potentially do to you, but what they can also do to other vulnerable individuals that’s in your household.
Dr. O’Connor: Well, Dr. Harwell that’s very well said and so important. I want to turn, now, to how we can make ourselves more resistant to the infection. Obviously, social distancing, handwashing, are probably the two most important things that we can do prevent ourselves from being exposed to the virus or to kill the virus before it infects us. What about how we can potentially make ourselves healthier, so to speak, so that if we are exposed to the virus, we won’t get sick, and I would like to ask Dr. Powell to comment on this because I think a lot of our listeners would be very interested in your thoughts on the role of nutrition and exercise and sleep, for example, and how we can stay more resistant to the virus.
Dr. Powell: Yes, that’s super important and I think it’s important that we empower people to know that there is something that we can do. With any of ours, you always want to support the immune system and help it to be as strong as possible. One of the ways of doing that is to be mindful of the food that we’re eating. So, eating whole food, plant-based foods in your diet. It’s hard, at this time, because many of us are home. It’s easier to do the snacking, the pizzas and the processed stuff. If you have access to it, this is the time that you want to put fruits and vegetables in your body, foods that are full of antioxidants and a wide variety of nutrition profiles. Eat the broccoli. When you make your soup, make your soup at home and put fresh vegetables in it and freeze small portions of it, but we want to make sure that we’re putting good stuff in our body. Sleep is also a super important one. We want to make sure that we’re getting at least seven to eight hours of sleep. You guys all know that when we don’t sleep our cortisone levels are all crazy and it’s kind of compromising our immune system. So, sleep is going to be critical. Getting off our devices 90 minutes before we go to sleep, so that we’re able to fall sleep easily. A lot of our children are not going to school and maybe we’re working from home, and we may not have a schedule, but still making sure we have adequate sleep. Still setting a bedtime, still getting up and not sleeping the day away. Those things are going to be important, as well. Movement is super important. I talk to my patients about this every day. We’ve been transitioning to telemedicine in my office, and so, still making an effort to go for a walk outside, maintaining social distance but taking 20 minutes, getting your physical activity and not sitting around all day is important. So, many apps and computer programs are doing home workouts for free. You can do stuff on YouTube for free. So, just making sure that we get some kind of movement in every single day. The last thing I would mention would be stress. Stress is definitely not good for the immune system and so, with stress, we have to be mindful about how we start our day and how we end our day. And so, for me, I know, when I first wakeup, the first thing I want to do is go to the CDC website and check the latest numbers, but that’s probably not the best way to start your day. You should probably start your day with meditation or gratitude or prayer or whatever you choose, and the day should end that way, as well. I think those things are important for stress. All of these are going to be supportive to the immune system. For those who do have chronic medical conditions, there’s been research about those with chronical medical conditions, practicing extra care with those individuals. We want to make sure those diseases are well-controlled. This is not the time to skip out on your medications or to not be monitoring your diabetes or your blood pressure or things like that. You still want to make sure that you’re generally taking care of yourself.
Dr. O’Connor: Dr. Powell, let’s talk a little more about vitamins. Are there some specific vitamins that would be more helpful to people in order to promote their immune system or specifically, make them more resistant to a viral infection?
Dr. Powell: In general, I always proceed with caution with this. I think most individuals should be taking a general multivitamin. A lot of times I see people that are just taking maybe a B complex or just a vitamin C, but I think what’s important, all the vitamins and the minerals are important. So, I think it’s important to be taking a general multivitamin. Our bodies actually absorb vitamins and nutrients better from food. So, when we talk about vitamin C, I’d rather my patients get into the habit of eating an orange or a tangerine or eating their vitamins and minerals rather than being focused on taking a tablet or supplement. I think we just have to be careful with our supplements because there are supplement or natural, I think people are more inclined to get things off the internet and we just have to be careful because those things can still interact with our other medications, potentially. So, I always advocate for a multivitamin. People in my office know I’m going to check their vitamin D, and what their level is and determine how much replacement, for those who are having viral like symptoms, I generally recommend an EZC pack, which can be bought on Amazon or at your local pharmacy over-the-counter, and that’s just a high dose immune support of echinacea, zinc and vitamin C, and you take that over a five-day period. So, that I usually recommend when people feel like they’re coming down with something or for my mommies who have kids and the kids are kind of sick, and you know it’s coming to you, those are usually the main supplements that I’ll recommend.
Dr. O’Connor: Great, I would think, in general, but would just appreciate your comment, that combination would be pretty safe for everyone. Very few other medications would interfere with those.
Dr. Powell: Correct.
Dr. O’Connor: Dr. Powell, thank you so much. I think that, in particular, that advice on those nutritional supplements will be very helpful to our listeners. I just want to remind our listeners, please don’t forget, you can receive a link to our “Safe and Strong Guide” by simply sending a text to 474747 with the word podcast in the message.
I want to turn, now, to the topic of stress. I know we’re all experiencing mental, emotional stress related to this pandemic. Our daily routines are shattered. Of course, we’re concerned about our loved ones. Some of us, probably most of us, feel some degree of some financial stress. I, honestly, don’t know one person who doesn’t have some level of stress at this time, even my husband, who, normally, has no stress. The opposite of me. I want to ask Dr. Watkins how she feels we can best address the mental stress that I sense so many of us are feeling, right now.
Dr. Watkins: Thank you, Dr. O’Connor, for such a great question. The coronavirus can significantly impact mental health for everyone, but, especially, it’s important for those who are suffering from mental illness. Ways that it can impact mental health is through anxiety, obsessions and loneliness. So, people may have anxiety about contracting the disease, as well as, social distancing, being isolated and feeling lonely, as a result of social distancing. There was a poll that was taken March 11, through the 15th. So, just released two weeks ago, by Kaiser Family Foundation, and they really asked people, “What were your key worries related to coronavirus?” And so, some of the key worries that caused people anxiety were them getting sick or someone else getting sick. Things like investments. How will this impact their retirement savings, college savings for parents, loss of income due to being laid off or reduced hours. Also, just not being to afford, if they did get sick, not being able to afford testing or treatment. There were some of the main worries that people have that cause them anxiety as related to the coronavirus.
I mentioned obsession. So, Dr. Harwell talked about handwashing and the importance of handwashing. People that suffer from chronic, obsessive disorders may do a lot of cleaning, sterilizing and washing in obsessive patterns. They may do that in higher volumes during this pandemic than what they used to prior to the pandemic. I also mentioned loneliness. So, what can you do as a result of feeling anxiety? For example, loneliness if you’re suffering from obsessive obsessions. So, one of the big things is practicing acceptance. We have to accept that we are in a pandemic and we must trust our medical community that they are doing the best to address the situation. Also, there have been stories about how people have had panic attacks from watching the news and Dr. Powell mentioned first thing, getting up in the morning, checking the numbers of the virus across the country. So, we want to limit our sources where we get information and limit the consumption. People have, as I mentioned, panic attacks just from watching the news and realizing, oh, this is so close to home. It’s in my backyard. I know, personally, living in the New York City area, I definitely have a heightened awareness as compared to someone who is not living in the New York City area, due to this area being the epicenter but obviously I’m going to have to taper my own emotions and realize that at the end of the day, we’re in this together, and we just have to address this the best way we can.
A big thing, too, that I want to mention is coming up with this idea of coming up with a health disruption plan. So, if you know you suffer from mental health, talk to your healthcare providers and it can be through telehealth. Talk to them about specific things related to your health needs, to your mental health illness, and they can help you create a health disruption plan. Also, take care of you yourself. When I say take care of yourself, engage in things that are distractions for you. Yale University has an online course called the Science of Wellbeing. Check that out. Learn about how you can take care of yourself. Watch movies. My husband has been watching repeats of the NFL that he saved on the DVR and NBA games. My kids the same. They’ve been watching different cartoons that we saved for them because that brings them enjoyment. Lastly, I would say, and the local media has done a great job of trying to push this principle but the Helpful Principle. So, we get benefit from doing things for others. So, if you know there’s an elderly person that’s isolated and can’t get out and go to the grocery store an hour ahead of the time that the grocery store opens, a lot of stores have been opening an hour earlier for seniors to come shop, if you know this person has limited mobility and can’t get out and run those errands like go to the grocery store, do those errands for them. That’ll actually bring you some benefit and help you, as you try to deal with your own anxiety and other mental health issues during this pandemic.
Dr. O’Connor: Well, Dr. Watkins that’s so helpful. Do you have any specific advice for parents? Many of us have children back at home with us that weren’t with us previously or, we’re altogether, now, whereas the parents had been out working at their place of employment, but, now, they’re working from home. And so, while the family time I think is actually a really, incredible opportunity for us to reconnect in so many ways, I’m sure that it is also stressful in other ways. Do you have any specific advice for parents with younger children and then, perhaps, parents with adolescents, and then parents with young adults, who may be back home because they’re college has closed?
Dr. Watkins: So, I am a parent myself. I have young children and of my two kids, my oldest is out of school and I have, now, become his teacher. The school has sent us resources from SAMSA. This is a federal agency. It’s called the Substance Abuse and Mental Services Administration and they sent us guides on how you can talk to kids about coronavirus, particularly, young kids since my school aged child is a young child and the school provided us with that. One of the take-home points that I implemented from the guide was being honest and talking at the level of the child. So, we told my son, my son is able to articulate, even at three years old. He says, “I know I’m not going to school because of the virus,” and he’ll ask me, quite frequently, “When am I going to see my teachers and my friends, again?” Then, I’ll say, well, you know when you’re going to see them. And he says, “Well, when the virus goes away, and everyone gets better.” So, even at the young tender age of three, they understand what’s going on. So, just be honest, talk at their level. If you have older kids, I was watching on NBC Nightly News. Again, with older kids, being honest is really, the best route to go. Talk to them. Tell them what the updates are. Don’t give them the gory details, of course, the frightening details, but you want to be honest and let them know, we are in a pandemic. These are the things you need to do to protect yourself. College students, I have a friend, she has a 19-year-old who is home from college. She came home and she asked her husband, where is so-and-so and her husband said, “Oh, he just left with his friend.” She said she immediately got on the phone with her son and told her son, “No. You come back immediately and don’t bring any of your friends with you.” When he got back home, she explained really, the importance of social distancing and people don’t understand that social distancing means you isolate yourself from people who do not live in your home, who you don’t interact with every day. So, going out with your friends, hanging out with your friends, as a college student is not social distancing.
Dr. O’Connor: One more question related to children and this is from my own personal experience. I am, as you know, an orthopedic surgeon, and I still go into the hospital to take care of patients. I think, at least, in my household, for my children, especially, my youngest, how is a college student, there’s a underlying fear that I’m going to get sick, and I reassure them that, of course, I’m not going to get sick. I’ll be fine. My children are smart, and they know that I can say that, but I cannot guarantee them that I’m not going to get sick because of my inherent exposure because of my work. So, any other advice for the many of us in healthcare that continue and first responders to continue to be out there on the frontlines with addressing the anxiety that our families may have?
Dr. Watkins: So, what I’ve noticed a lot from things I’ve been experiencing and stories I’ve been hearing is that you have to drive home the message of this idea of social responsibility. So, staying healthy. It is your social responsibility and personal responsibility to stay healthy. So, if you do get the virus, you have a high chance of survival. We’ve seen, already, many stories of people surviving the coronavirus. Tom Hanks and his wife. Andy Cohen is back on TV, now, saying, “I’m a survivor of this.” It was an attorney in Westchester County in New York and some people say he started the virus in Westchester County in New York and the New Rochelle area. He’s out of the hospital, now, but the key message here is social responsibility of being healthy, protecting yourself and if you’re healthy, even though you may get it, you will have a high chance of survival getting out of it. In terms of first responders and the healthcare workers, people have talked about this next group, and not as if they’re not getting enough attention as they should, it’s the grocery store workers. The workers at Target. The people that are restocking our shelves. They are really on the frontline, as well. So, know that for your children and for anyone else who are in families of people who are on the frontline, again, understanding that being healthy, they themselves need to be healthy, the children need to remain healthy. They need to be socially responsible. Stay away from people who don’t live in their homes because they can bring it home to you. You, as a frontline person as well, have to remember, you have to remain healthy, mentally and physically, so that you can fight it if you get it. So, again, there’s this idea that we all must be socially responsible so that if we are close to it, we get the mild and minimal symptoms as possible, so that we have the highest rate of survival.
Dr. O’Connor: Panel, I am so enjoying the podcast. I want to turn our attention, now to spiritual health and I want to discuss with the panel how you each feel about the importance of spirituality in this pandemic. I think we know that we can’t pray away the virus, but, yet, spirituality is an important component of many people’s lives. So, Dr. Harwell, I’d like to start with you and ask you to share your comments on what you feel may be the importance of spiritual health offer individuals in this very difficult time?
Dr. Harwell: Religion and the church have always been staples in the black community. As a whole, we’ve always looked to the church for spiritual counseling and guidance and also, to get us through very trying times such as segregation and lots of other historical things that people of color have had to face in this nation. Once, again, we find ourselves in a situation where we will look to the church for support and spiritual guidance. I think that that’s very important for our wellbeing, as we try and maneuver our way through this pandemic. It’s unfortunate that many states have stay-at-home orders in the sense that although we can’t come together as a group and worship, it doesn’t mean that we cannot worship individually, and collectively, in the larger sense. So, I’m sure you all out there are aware that many churches have gone to livestreaming their services either via Facebook or some other mechanism. I know that many churches have setup a conference call number that people can call into and worship together, all at once, at the same time. Bible study has been replaced, again, with either livestreaming or a conference call that everyone can then be on the call, all at the same time, and still get that sense of collectiveness as we come together and look to each other for spiritual support. So, I think, at least, for sure, in the African American community, I think that we are continuing to look to our church leaders for guidance and support and spiritual wellbeing as we try to maneuver our way through this pandemic.
Dr. O’Connor: Dr. Harwell, thank you so much. Dr. Powell, your thoughts on this topic.
Dr. Powell: It’s definitely strong in the African American community that we rely on our faith and many of us are looking to our religious leaders, which I think is great. African Americans, in general, have heavily relied on our religious leaders for guidance and so, I know at the church I attend like I’m thankful to see them kind of following the guidelines recommended by the CDC and sticking with those recommendations about social distancing, and then, also recognizing a role that faith plays. Like this is not the time to fear. This is not the time to be unselfish. This is the time for us to give and to help one another when we can while still following the guidelines of those health organizations. I actually loved seeing all of the things that our community and our church leaders have done. In my office, I’m recommending to those who are without food, that’s a concern because their kids are getting two of their meals at school. Many of our local churches are making food and things like that available for individuals. I know many churches are offering virtual tutoring to help the students. I’m actually very proud of how the church has responded.
Dr. O’Connor: Dr. Powell that’s just a fantastic response. Dr. Watkins, you touched on this earlier, but I just want to see if you have some other thoughts about the importance of spirituality for all of us in this pandemic.
Dr. Watkins: Sure, I thought about this, two ways, one from a committee perspective, and then, one from a healthcare professional perspective. So, I’ll start with the community perspective. I did see one of my family members actually posted, I’ve been 90% socially distancing myself. Please don’t punish me for the 10%. That one picture just drew me in, and I said, I have to read what this message is about. As I started reading it, I understood it to be about how in the community people have these notions that the coronavirus is God judging us for the way we’ve lived our lives. It was so awe inspiring because I never even thought of this as a judgment, as God saying you’re not living in the right way, and so, because you’re not living in the right way, I’ve now passed this pandemic on society. I just thought it was interesting and it brought me back to this idea that even though there’s not a lot of empirical evidence around religion and spirituality necessarily improving health outcomes, we do know that we have to view a patient as a biopsychosocial spiritual whole. So, when I say that what I mean is we have to talk to them about religious and spiritual factors and how they can impact decisions that patients make, compliance decisions. For example, are people going to continue to engage in social distancing? One of the things that I do like that the church has been saying is, “No, we’re aren’t fearful as for example as Christians, but we must live by the rules of our local, state and federal government and so, if they’re saying, we need to social distance that’s what we need to do. We did see an example today of a pastor in Florida who got arrested for holding services despite the orders to shelter in place. We do need to feed our spiritual souls, but we still need to remember that God is not judging us. This is not something we can pray away. This is something that we have to be collaboration with God. I mentioned previously about Kenneth Pargament has three styles of religious coping styles of religious coping, collaborative, self-directive and deferring. So, we can defer to God, we can self-direct ourselves or we can be a collaborator with God, and out of those three we need to be a collaborator with God. We can pray and ask God for healing but, at the same time, we have a personal responsibility for doing the things we need to do to slow and blunt that curve, as much as we can.
Dr. O’Connor: Amen, sister. I think those comments are so important for our audience to hear. My personal comment is I’m a very spiritual person and I personally think that all healing comes from God. I know that there are individuals that see this pandemic as a way of God expressing displeasure with us. I don’t actually know if that’s, I don’t think any of us know if that’s true or not, but I think it does, really, at least to me, bring home the message that God is the lealer and praying to God for support and guidance is more important, now, than ever before. I think it’s wonderful for us to have this kind of conversation about spirituality. In my own practice, I simply will tell them that if they want to pray before we go back to the operating room, because I am a surgeon, I would be happy to pray with them. It is amazing how many people say they would love to do that. They never expect me to say that. I just try to put it out there as an offering. They can say, no thank you, and then, they might be a little surprised, but it is amazing to me how many people welcome that. I think the more that we acknowledge that connection and that need for divine healing and divine support, the better off we’ll be and the faster we’re going to get through this pandemic. I want to turn and ask everyone on the panel to comment on what they might think our communities of color, both African American and Hispanic communities, could be doing to help protect themselves from this pandemic. We know that these communities of color are even more vulnerable to the virus for many reasons. There’s lower baseline health. Higher levels of illnesses from diseases like diabetes and hypertension, higher baseline levels of obesity. We know that diabetes is associated with higher risk or, at least, we have early evidence that suggests that if you’re diabetic your risk of getting sick with COVID-19 is increased. We know that communities of color often live in denser housing, which makes self-isolation all the more difficult. So, I’m just going to ask everyone to comment on whether you have some specific advice for our communities of color. Dr. Powell, I’m going to ask you first.
Dr. Powell: You know, it’s really tough. I would say the hardest thing is that oftentimes, minorities don’t have access to care, already, and so, that makes it difficult. I know in my office, we’re still doing telemedicine, and it doesn’t matter if you’re a new patient or an existing patient. So, I think reaching out to your local health providers who are still willing to have conversations with you. I know we can’t do a whole lot over the phone, but so much of a patient’s care is history and just having those conversations, talking about your health, talking about maybe what medications they used to take, talking about these things that we’re talking about on the phone that many people have access to this regular information. So, I think this whole pandemic has changed. I think we will forever think about food differently. I think we will forever think about our health differently. You know, I guess the biggest thing is just reaching out to whatever resources you have. I know that they are different for different communities, but like I said, I love seeing the camaraderie and the things that different community organizations and churches are doing to try to reach people. I’ve had people reach out to me on social media and asking me specific questions and I’m like, “Yeah, this is not kind of what this is for, but do you have a doctor?” They say, “Yeah.” I’m like, “Well, you know, you can ask them these questions.” Sometimes people, they don’t even know they can ask certain questions. I say, “That’s what we’re here for. We’re here to answer your questions. If you have concerns about you and your risk or your family members or things that you can be doing,” like that’s what we’re here for. So, I think the biggest message that I want all the minority patients to know is that we’re here for them and reach out, whatever it is, whatever resources you have access to, and we’ll try to help you through this. We’re all kind of thinking and learning and figuring things out as we go, but the biggest thing is knowing that they are supportive.
Dr. O’Connor: Thank you. Dr. Harwell, your thoughts.
Dr. Harwell: We all need to reach out to the resources that we have, just amongst ourselves. I was telling my daughter who is away in Washington, DC at college. Of course, it’s virtual learning, now. She lives alone in her apartment and she’s gone from a state of going to classes every day and being around other people to basically, isolated in her apartment with this virtual learning. And so, I said, you know, you’ve got so many social media outlets, maybe have a Facetime party one night or you can do a group Facetime and you’ve got four or five or six of your friends and you’re all video chatting together. You can see them and somebody’s playing some music. Get up and dance in front like a virtual party. I think we have to come up with some creative ways, first of all, just to keep our sanity. This is some real trying times, mentally, and I think that the biggest thing that we can do is to just try to find ways, creative ways to have some sort of social outlet. We are, at least, at this point, unless this changes, allowed to leave the house to go to grocery stores, to go to pharmacies, essential places, but, also, to just take a walk. Take a walk around your neighborhood. Of course, if it’s more than two individuals, more than yourself, still, social distance, but just to get out and get some fresh air. I think that we just need to find something that gives us some sort of pleasure, but I know it’s hard, especially, when you live alone, or you’re just so used to being able to go. My elderly parents have been quarantined for probably a month, now, just by virtue of the fact that they already didn’t go that many places, but, now, they really have hunkered down and have stayed in. And so, these are two individuals that went from, they didn’t watch a whole lot of television, but they found a TV station that shows some old Westerns, and now, every time I called, you know, I say, “What are you doing?” “Oh, I just got through watching this old Gunsmoke episode.” So, you’ve just got to find some passion. Maybe there’s more time to read books. Maybe you were an avid reader but just never had the time to do that. Just reach and find something that gives you joy. I think our mental health is what I’m most concerned about with this social distancing and this sort of mandated isolation. Let’s keep our minds strong, as well as our bodies, because I think that’s going to play a real, key factor in just how people are able to continue to cope with this.
Dr. O’Connor: Dr. Harwell, that is such excellent advice for all of us. Dr. Watkins, I’ll ask you for the final comment on how you see our communities of color protecting themselves because they are clearly at higher risk here in this pandemic.
Dr. Watkins: Our communities of color experience the weathering effect, which is when every day racism causes a stress response, and this response, essentially, presents itself through, for example, high levels of diabetes and hypertension for example. Our communities also experience differences in gene expression through epigenetics. So, for example, how structural racism and chronic stress can alter the way our genes are expressed. So, our communities of color are vulnerable and when you add the layer of the coronavirus pandemic on it, that’s an additional form of structural racism. It makes us sicker and more vulnerable to have higher morbidity and mortality rates from coronavirus. But all is not lost. We’ve seen Elmhurst Hospital in Queens, which the population around Elmhurst Hospital is a diverse population by race and ethnicity and has a lot of different health disparities. It has now become the face, in terms of a hospital, where a lot of resources are lacking and because we’ve seen, for example, the refrigerator trucks outside of the hospital where bodies are being placed because the morgue is filled to capacity, those images have created, at the congressional level, additional resources going to that neighborhood hospital. So, we just have to get the word out about how in our communities, we suffer from health disparities and how we need more resources as a result of the suffering.
Dr. O’Connor: Dr. Watkins, thank you. Dr. Powell, I want to ask you a question about masks. So, I know our listeners hear a lot about masks, and they hear about N95 masks and regular masks, surgical masks. Can you start by helping our listeners understand what are the differences in these masks?
Dr. Powell: So, the surgical masks are kind of like the flimsy ones that are made of paper. They don’t fit very tightly. The top of the mask has a kind of metal underneath, so that it can kind of form to your face. Those are the masks that you see at the nail salons. Those are the ones that you see people using when they’re cleaning, and so, those are the common surgical masks. The N95 is fitted. So, it has to be fitted to the person wearing it and it forms a tight seal around the face and nose. And so, at this point, currently, and I know the guidelines are, literally, changing by the day, but, at this point, the recommendation is for people who have symptoms should be wearing them. So, not necessarily, every single person in the general public but for those who are diagnosed, you should definitely be wearing a mask in order to prevent the spread of your respiratory droplets. But, again, these recommendations change daily, and it might be different by the time that this airs. In my office, as a medical provider, I’m wearing an N95 mask, now, with just every patient. I used to only wear them in those who are presenting with respiratory symptoms, but, at this point, since people are presenting asymptomatic, I’ll have patients coming in for one thing, and then, I’ll ask them a couple of questions and it turns out, yeah, they’ve been having fever and some GI symptoms. So, as a medical community, I think, universally, all of us are attempting to wear N95 masks, if we have them. Again, there is a global shortage, and so, in my office, we get one mask per provider and so, I’ve been using the same mask for the past two weeks, which is not ideal because in an ideal situation, after you’ve interacted with the patient and their respiratory droplets are potentially on the outside, you want to be able to toss that. So, my recommendation for the general public is to continue to follow whatever the guidelines are from the CDC, and those will change. Please don’t horde masks. That’s how we’re running into situations where there is a shortage. I see patients who come in who have better masks than we do and I’m just like, “Where did you get that from?” They’ve spent $30 on some website buying something. So, at this point, it’s our medical providers that we just really, need to make sure have protective wear because we’re the ones that are having to take care of people. So, we have to make sure we’re protected. At this point, my recommendation is medical providers should be wearing masks, obviously. Patients who have a diagnosis or who have any symptoms of respiratory illness such as cough, shortness of breath, anything like that they need to be wearing a mask. Then, again, if the CDC changes that we should all be wearing masks, then, we’ll follow those guidelines.
Dr. O’Connor: Dr. Powell, thank you so much. Panelists, there’s been a lot of questions about how long the virus lasts on surfaces. I’ve done some research because my husband and I will have these conversations, very frequently. How are we going to handle the mail? What about when we bring the groceries in? There could be virus on that orange juice container. You could just kind of go nuts going down to one level after another about potential protection of bringing the virus on a surface into your household. The latest research that I found today is that, basically, we don’t know how long the virus that causes COVID-19 survives on surfaces. It could be hours. It could be even up to several days. I’m just going to ask each of you to provide what you think is the best kind of common sense advice you can give our listeners on how we address cleaning our surfaces at home or cleaning our home environment given the fact that we simply lack good information on what science would guide us to do. Dr. Harwell?
Dr. Harwell: Yes, so, I cannot reiterate enough about handwashing. Like you said, we literally will drive ourselves crazy if we go, “Oh my God, can I touch the mail?” “Okay, I’ve got the groceries out of the bag and now, do I need to wipe down all of the cans because I don’t know who touched this can of corn before I did?” You literally, I think will almost drive yourself crazy, but, at the end of the day, I cannot reiterate enough that handwashing is still going to be the key here. Again, you need to make sure that you are washing your hands correctly and for the correct amount of time. So, you wet your hands with some clean running water. It can be either warm or cold. It doesn’t matter. Then, you turn off the tap, and then, you apply your soap. You need to be lathering your hands. You need to warm them together with the soap. You need to lather the back of your hands, between your fingers, under your nails and, again, you’re scrubbing your hands like I said for at least 20 seconds before you rinse. So, handwashing, handwashing, handwashing. Even if the virus is living on these surfaces, I think I read somewhere it can live on cardboard for a day or so. I mean, again, I think you would just literally drive yourself crazy, but you can never wash your hands too much. So, after handling the mail and I’m a little nervous or concerned about that, then, go wash your hands. After you take those groceries out the bag, go wash your hands. If you get a package delivered to you in a cardboard box that’s left on your porch, now, pick it up, take it in the house, take the contents out, discard the box and go wash your hands. So, again, I think handwashing is still going to be the one thing that we all can do. Everyone doesn’t have gloves at home. I know a lot of people are wearing gloves when they’re handling different things. Everyone doesn’t have gloves, but everyone has access to soap and water. So, for me, I think the key to this is good, good handwashing.
Dr. O’Connor: Dr. Powell, how can we best make our homes as virus-free as possible?
Dr. Powell: Yes, just echoing the same things. I did see that article by the New England Journal of Medicine that looked at various surfaces and how long the virus lasts on them. So, it is something that can be scary if you think about your food and how many people have touched your apple at the grocery store and how many hands have handled it. So, again, I would say be mindful of washing your surfaces. You know soap and water and disinfecting, as well. I make a regular habit of like washing my phone. Just things that you don’t really think about that you’re constantly touching, and you may wash your hands but, then, you may touch something that you don’t really wash. And so, I guess just being mindful of the surfaces, being mindful of those things that you’ve always touched. I know we’ve said before about touching your face or being mindful of things that you may touch, and then, going and touching with your T Zone, to your mouth and your eyes and nose. I make it a habit of, as a physician who sees people, I come home and as soon as I come in the door, my shoes are off in the garage. My clothes are off and they’re in a dirty clothes basket right by the door. Then, I’m in the shower, and then, changing my clothes. So, it’s hard to know. You can go crazy thinking about all the extra things that you need to be doing but, I think, in general, washing your hands, being cognizant of the things that you touch and making sure to wipe our surfaces.
Dr. O’Connor: Dr. Watkins, any advice for our listeners?
Dr. Watkins: So, the CDC has recommended that you should wipe down your surfaces. Dr. O’Connor recommendation is spraying your surfaces, instead of wiping them down. She says sprays, for example, Lysol is really the best. So, spray your surface. Don’t wipe it off once you’ve sprayed it. Let it air dry because air drying is the best. It leaves the residue from the spray and it cleans the surface rather than you wiping it off. If you don’t have any sprays, it says you can use, for example, Clorox wipes. I’m constantly spraying my door handles here at home and knobs, as well, and letting them air dry. They even recommend if you receive packages, you shouldn’t touch them for 24 hours. They say, if you can, leave them out in the sun. I know this part may be hard to do in some urban areas, to leave the package outdoors in the sun, but if you have to bring them inside, do not open them for 24 hours, and, when you do, wipe down the contents of the bag that the items that you purchased is in. The same thing with food. If you have bought food from the restaurant they say, do not use any of the plastic utensils you’ve gotten from the restaurant. Don’t use the foam or the aluminum that your food came in. Put it in your own plate or bowl. These are things we didn’t think about before, but things we need to be, obviously, more cognizant of during this pandemic. Some of this stuff is just common sense and probably with things we should have been practicing before. Now, since we are in the pandemic, we have more heightened fears and, obviously, more awareness of things we should have been doing before.
Someone posted about how we used to make fun of and talk about Michael Jackson when he wore his mask and gloves, but, what we need to be doing, now, is channeling our inner Michael Jackson and wearing our mask and gloves when we go out to stop the spread.
Dr. O’Connor: That’s a great sound bite. I want all of our listeners to appreciate and I know everyone does, that we’re all in this together. Well we see certain communities being more impacted, no one can self-isolate completely from this virus. I really see this as the call of our generation to recognize that we need to help everyone because until no one is sick, we’re all at risk of becoming sick. I think that that’s probably a good comment to close our podcast on. I want to thank our panelists and thank all of our listeners. Please listeners don’t forget you can receive a link to our “Safe and Strong Guide”, by texting 474747 with the word “podcast” as the message and we’d be happy to send you the link to the guide. Next week, I will be interviewing a panel of frontline surgeons, people out there dealing with this pandemic in real-life and I hope you can join us for that interesting conversation. Until next time, everyone stay safe and strong. Thank you very much.
(End of recording)download pdf transcription of this episode