Hello everyone and good evening. Thank you so much for taking time out of your data to visit us tonight. Enjoyed, excuse me, our webinar on winter and the pandemic. Certainly Gill's wintry outside and we certainly know what pandemic I think we're all going to be talking about. It is what is happening and what comes next for public health COBIT response on this comes from the University of Delaware. My name is Noel Duckworth and I'm with the University of Delaware Community Engagement Initiative with the Partnership for healthy communities. On my website is there if you'd like to learn more about what we do as a partnership, are directly, is read-only and craft, former Cabinet Secretary of Health and Social Services here in Delaware for eight years of Lamarck **** administration. Our Associate Director, Dr. Aaron Knight, who is here with our Biden School of Public Policy and and teach it in our Public Health MPH program and an undergraduate on public health offerings as well. And then we had staff that support our strategic initiatives. I'm Paula has cast then is our administrative specialist, Christine's Alinsky, operator Mental Health Program, and Cape coupon Phillips operates our healthy communities, Delaware and issue them. Just to tell you a little bit about the partnership real quick for those of you who are new and we have some of our steering committee members way. We are on the call with us and I want to thank them for their continued leadership. I'm to make this partnership possible. In 2013, the Carnegie Foundation for the Advancement of Teaching doesn't AT viewed as a community engaged university. And at the request of our progress duty planned, developed and launched the community engagement initiative to continue to strengthen our capacity to cultivate active citizens there a real partnership that impacts civic mean. In 27 scheme you, these Civic Action Plan was released and that included the creation of several knowledge base partnerships, such as the Partnership for Public education, partnership for arts and culture, and knew our partnership to Wilmington partnership, partners for healthy communities. Pet is now one of these partnerships that it's guided by the Steering Committee I mentioned with leadership a membership for both the community, external partners and the University, including all seven of our colleges. And our mission and vision to really again, to align and strengthen our efforts between University and I'm campus partnership. And to really focus on in terms of the partners, probably communities preventing health equity is, is a key strategy and that's why have goals around research, around education, and around service. And we really think that these balls are all important and synergistic when it comes to advanced thinking and scholarship for ****. So for research, we worked to enhance research capacity and translation in areas of things like community health promotion, social determinants of health health inequities in health policy. Education work to expand public health related opportunities for both undergrad and grad students through new and expanded programs, annexed hands-on experiential learning. And we're really excited to have the new MPH and doctoral program in epidemiology. And the MPH program with a focus on how policy here at UT that's that's lives. The doctor ***** and her team will be talking about here tonight as well and highlighting. And the importance of that degree program and and how relevant that work is as we speak here in Delaware and beyond. So we're so excited to have been a part of the initial thought leaders around making those degree programs happen. I'm in Terms of Service, we're really working too. Just like the MPH program being a practice space program, really working to enhance the University's capacity to partner with and support community-based organizations and theta agencies that address health and well-being of residents living in the highest need communities and Delaware and beyond. We're also excited to has thetas and amp Gates program who work in some of those very agencies. And they're going to share their insight around what it's like to do this work and to do it while pursuing these different degree programs. But we all learn more about the impact of 19 and what the next few weeks hold. In terms of some housekeeping, We have just some technical details. With this webinar audience lines are muted and they'll remain muted on we are going to have lots of opportunities for question and answer. We know there's a lot of questions that they're going on around the state of of kevin 19 and and and how to help protect ourselves and others over the coming weeks. And we'll have a question and answer session throughout throughout the webinar, and you can start to impose those questions in that Q and a box. If you look at your resume toolbox, there will be a little Q and a folder and you could go in there and post questions you want to our presenters and our speakers in that box. Certainly through chat, you can share resources and say hello. And we'll try and keep an eye on that, but primarily will be looking at that Q and a box. Crime as well. And I'm saved, Webinar is being recorded. We have to make it available for viewing after the presentation. And we will be in talks with you about an evaluation. I'm following the event. So without any further ado, I'd like to just thank and and and introduce our special guest here, who is a doctor? Jennifer horn, H0, the professor and founding director of the epidemiology program. And she's quirk faculty at the Disaster Research Center at the University of Delaware. Her research focuses on the health impacts of disasters. And she's currently a member of national advisory boards for the Centers for Disease Control and Prevention, the national academies, and the American Public Health Association. Dr. ***** was part of the public health response to Hurricane Isabel, Charlie, Katrina, William will must give me Irene and Harvey, where she conducted rapid assessments of disaster impacts on Community Health. And she has also provided technical assistance to public health agencies globally around disasters, emerging infectious disease outbreaks, and pandemic and floor planning and response. Most recently, the New York Times just did an article with her about the impact of woven in Delaware. And we're just so lucky to have her here in our state and leaving this important work. So thank you, Dr. warning. We look forward to hearing from you tonight and welcome to the webinar. Thank you know, allow though, I did want to ask you about the few terminology that we can all be on the same page that I find helpful when I'm looking at the news and seeing the updates that are coming out around percent positive, rate the numbers of cases. And so I'll talk a little bit on the next slide about how everything that we've known about cool that we've learned in the lab 11 months. Basically. I've been trying to find an upgraded slide for this presentation, but I haven't because I think they got sort of ran out of theme and updating it. There, there are hundreds and hundreds of papers coming out every day on different aspects of the pandemic. Be it the effectiveness of control measures, the development of vaccine, the inequitable impact in minority communities really run the gamut of everything that we could be presented. In the next part of the show, one of the bread and butter cold of the epidemiologists. And that is the epidemic curve. And the epidemic curve from December first from WHO and what you feel. Because at WHO, when you see the cases, the cumulative number of cases globally a divided out into the WHO region. So you can see that the Americas cut sheets that largest share in the last month or so in the yellow. And then on the right we see the total number of death. And so I remember we put the epidemic curve in like the first week of February to teach my outbreak investigation class in spring 2020. And we looked at it and talked about it. None of us ever imagined that we would be here. Now, turn the neck might look a little bit at some of the data from the last seven days. And I think it's really important to remember that this beta may not yet. I include a third, that it potentially coming from some of the Thanksgiving travel and exposures that people have. They both are updated on December third. And these these maps that are available on the website and they're updated daily. And I think one of the things that's really important to know from an epidemiology perspective is the difference between the count of cases and the rate that they particularly here when we think about Delaware, we're probably never going to show up in dark blue on that map of the count of cases because he simply have a much smaller population than states like California, Texas, Florida. With the important way that we can compare states that have different populations that look at the rate of cases. Hundreds out. Though, from an epidemiologic perspective, it was a little bit more informative to look at the rate of cases. And there we theta's really high rate that you've probably been hearing about in the upper mid bath that had been happening recently. North and South Dakota in particular. And you can see a high rate of cases over there and tiny Rhode Island on the side as well, neck five. I think another epidemiologic concept that's really important to understand is this idea of the reproductive rate, which, which we've talked about a lot at the beginning of coded, and the measure of dispersion, which we designate as a small italic k. And so the reproductive rate of the disease is basically how many people, one infected person will in fact, and so, but it seems to be right around maybe two. You can see that measles is the really scary reproductive rate disease with each kth spreading to 12 to 18 edition. And the target has been, in terms of the reproductive rate. We've been fairly lucky on that. And the image on the right really showed this idea of measure of dispersion. And so that's been really important in the last few months through the pandemic. Because what we've seen are the clusters of cases that have been driven by primarily attendant that event. They'll probably all of you have seen something about a wedding where a lot of people were subsequently infected or another type of gathering for either the so-called super spreader event, where we have one person that tend to be able to spread the few, a large number of people. So on the next slide we'll talk about one of the biggest issues related to COBIT and it would not be very important in the, in the disaster and how their research that I do. And that is that the doctors in pandemic have very inequitable impact on different groups in the data from CDC. And you can see both the number of cases there gives me the rate of cases, the rate of hospitalization and the rate of death is much higher among American Indian, Alaskan, Native, Asian, black and African-American and Hispanic. The US. Weekly that hospitalization. By time higher and in black and African-American and Hispanic or Latino person. And about the rate of death to develop twice as high in Black and African American population. And something that we're understanding more about, but we clearly need more public health action on next slide. Part of, I think, you know, important, but although in important food that you ate, that we have had many similar to that over the last, not the teen years from H1N1 in 2009, avian flu in 2005, the Ebola. We have emergent, re-emergence of needles and areas and then declared eradicated. So that Kobe 19 has all of our attention right now. We really face a number of public health threat from emerging and re-emerging diseases. And that's why it's critical that we rebuild our public health system to be able to respond to the feature event. So I will stop there and turn it over to hear about the perspective of someone really on the front lines of this. Thanks, Dr. Ernie. So my name is Emily Marshall. I am an MPH student where I was in the first cohort. So now in the middle of the end of my third semester, it's been really good experience and I'm doing it simultaneously while working at the Division of Public Health. So I was hoping just give a little bit of background on how I got into public health and then the whole whirlwind that took over all of our lives, but also my professional life last year as covariate began. So think back to UD, actually graduated from UT for undergrad and interned at the Division of Public Health. And then I was hired for a contractual job that eventually led to a full time job as an epidemiologist. My area of focus that I've hired to work on is foodborne diseases. So Salmonella, E. Coli, parasites. Those are the reportable diseases that I'm responsible for per the CDC in Delaware. So that's what the grant that pays me is all focused on doing foodborne diseases snack to meet certain goals. For all of those. I've been in that role for a little bit over a year now, but really only got about four months of solid experience under my belt until of course we started to hear about Cove it. And all of our higher up epidemiologists wanted us to participate in COBIT calls. So really I was on calls with the CDC all the way back as far as January of last year before we had the first case in the United States. And it's just mind blowing to see how far we've come with understanding and our knowledge base. But it doesn't really feel like that long ago. So just just last January, we were starting to prepare for that. And then, of course, by February, March, we were seeing cases here in the United States. And I actually participated with my supervisor on the very first interview of a coded positive person in Delaware. I remember being so excited, like it was a very thrilling experience. I was talking to you on the phone. The very first person who is COBIT positive and performing contact tracing with that individual and collecting other clinical information, making recommendations. And it was so exciting. And only then two months later do hundreds and hundreds and hundreds of those interviews. So it's, it's an interesting evolution. But essentially, once we started EI, first few cases here in Delaware as everyone experience schools, businesses, the University of Delaware, when virtual and while everyone else was saying at home, I suddenly was working seven days a week with other epidemiologists. So we were activated into what's called the Emergency Response. And most state health departments have some sort of function of this or in a smaller state, a bigger stake, excuse me, that counties would be responsible for activating that. But because we're so tiny in Delaware, the governor declares a state of emergency and then my job title basically shifts overnight. So I immediately had to drop all the foodborne diseases and start referring to a different office, to a different chain of command. And but completely different objectives, which was just to use any epi skill that will then be asked to me that day to perform whatever task was. So at the beginning, as you can imagine. It was answering a lot of questions. We stood up a call center very quickly to try to train other public health professionals to answer questions from the community. So there's a bit of education and that I'll try to go through some of the roles that they all turned over so quickly. So we did a lot of trying to educate the community and then very quickly how to do a ton of interviewing as the keys increased in Delaware. So before a lot of other health professionals were trained in these sorts of interview styles. The CDC came out with an interview template and we accommodate it to Delaware and specifically the needs of our community. And before we could disseminate it really and let a lot of people help with the interviews. The burden was on a team of about ten epidemiologists. So I was doing interviews all day, every day. And it definitely got really, really intense to hang up the phone with individuals and hear about their hardship and the health of them and their loved ones and their concern. The extremely challenging when at the time we didn't have a lot of answers. So people are asking for clinical advice or some sort of advice about what they can expect for their recovery or their likelihood of getting it again. And I can only provide answers to them that are provided to me from the CDC. And what's interesting is people thought that I, I, and public health sectors probably had a real inside now. And, and we did a lot of the time we get the information just as quickly as the general public, perhaps a slight bit ahead, but really were just trained to interpret the information better. So that was probably the largest challenge of the spring months, was handling the volume of cases that continued to climb and climb and having a lot of uncertainty to not know if this was an acute situation for right now. Or am I going to have to tell these people which ended up happening that this is going to go on for months and months and months. Obviously, none of us were really prepared to handle that and hear that. But we got a little bit of reprieve in the summer months as the incidence rate dropped slightly and the CDC was able to disseminate other resources to state health departments. So our small team grew and grew and grew week by week with other epidemiologists who were able to come on board. And all of them have really been fantastic as just an environment of learning really quickly. But some of these people are CDC fellows who kinda get assigned to a different state and their plopped in Delaware. They know nothing about though, they don't know our population where anything is geographically, you have to get a little bit of a niche for your environment. So that was interesting over the summer, but it was a slower pace. That was the first experience of trying to accommodate to different vested interests. As I think a lot of people saw in the summer months. A lot of individuals tried to go back to normal life and especially we saw kind of in the area of the droughts are state down south at the beaches where tourism is important. And that's where a large part of the economy is stimulated. In the summer months, we saw outbreaks and beach towns and among specific restaurants and groups of individuals down there. And that was the first introduction to cluster management. So managing clusters in the summer. By the time August came around, our main focus is managing and providing recommendations and performing contact tracing for clusters that are largely related to schools. So I, strangely enough with actually the lead at the to do surveillance for the University of Delaware cluster. Though I'm a student. And but it's not a cluster per se. It meets definitions of clusters, but there was not a single event that everyone attended and got sick from. So it is community spread up here in New York as it is all over the country right now. But I'd hire line list going and been working with the student health member is Dr. Dowling, Dr. Frank, they're fantastic to try to keep the students under control and watching the rates of the student population and making sure that students can get tests when they need it. So we, Dr. Daly and I on a regular basis, would exchange emails and talk about the rates each week of students that we were finding or positive and think, Do you guys need another testing event? Do you need other resources? So to try to accommodate? And though it's reactive, it is very quick, so, so decisions are made very quickly about all clusters at this time, but especially when they're related to school. So the University of Delaware is, of course, the largest cluster that I was responsible for. But now our staff is working around the clock to manor school. So think of anytime that any child, teacher, even parents, anyone associated to a school is coded positive or comes in contact with someone who is go at positive. There's a little bit of panic and scary. So they call epidemiology for assistance and guidance. And we get to 300 calls a day. And we do have the big staff epidemiologists now, but it is just really, really intense and fast response to provide some sort of camphor and recommendation to these individuals. So that would be things like mandating quarantines for impacted persons, which we do all the time, though we don't feel great about keeping a whole classroom school kid at home or assessing risks of sports players. Actually, Delaware high school athletics has been a really big obstacle for us. This fall has been extremely challenging and were seen as reflected in the rates of covered 19 as people tried to move on with everyday life and and there unfortunately was no safe way to do it. We struggle and get frustrated. Myself and school nurses alike, those are our main counterparts to, to do things to try to keep parents and students happy and healthy and thriving, but keep them safe at the same time. And really at the end of the day, unfortunately, all we can do is follow the recommendations from the CDC and it's still usually not perfect. There's a small amount of risk in practically anything you do going outside your house at this point. And if you call public health and ask, is there any risk every OK. My answer is probably going to be there's a little bit of risk and we have to assess that and make recommendation accordingly. So a lot of the skills of how to develop this fall along with matter at these is the escalating situations. Gathering the correct information really quickly and making decisions with complete decisiveness and confidence. A dime and holding true to that. And for just beginning in my career, I I didn't anticipate that I'd have to be so responsive and so so much of kind of a leadership position that other people in the community look up to. I think epidemiology has always been really fascinating, but more than ever, people are respecting his profession. They're valuing it, and they're seeing the skill set that's really necessary. I'm love infectious diseases all the time, so I think about them, but now everyone is thinking about infectious diseases all the time. So it's a really neat place to be and epidemiologists and I'm learning, shows are so much more than I think I ever could've learned outside of pandemic times like the career and the learning skills just been escalated. But it is extremely intense. And the skill set I think that epidemiologists need really is the ability to be fast thinkers who make decisions quickly to collaborate with other partners. And we do a lot of groupthink with RFPs back and forth to talk about different case scenarios, different clusters, and when we discuss them actually status small delaware will often discover links between our clusters. So a church cluster, someone went to the birthday party. That sort of thing happens all the time. But it's really fascinating. It's almost the kind of thing you would read about in books. If you're, again, an infectious disease, narrow, but it's actually happening. It's of course getting, kinda hiring though. So at this point, we're just hoping that people can continue to wear masks properly. Really, really do their best to stay home socially distance when they do need to leave the home. And, and again, remember that it's a pandemic. Unfortunately, life hasn't gone back to normal as much as we all wanted to. And there is a bright future coming with the vaccine. But right now we still kind of have to hunker down and really be diligent and be mindful that this, this virus has a lot more left in it than, than I know all of us are ready to just be done. It's not done yet, so There's a lot still to do and lots of room for improvement, of course, in the next pandemic response. But I think we're all pretty tired right now, but it's been a really, really exciting time to be unprofessional and epi and what I'm learning alongside it and my MPH classes is usually really complimentary to what I'm doing at work. It's actually really cool to see that semblance in that connection there often with kind of outbreak management that we've learned and Dr. warranties class and things of that nature. So it says really coming full circle, but everyone wearing masks and stay safe. That's all I gotta say. Thank you so much Emily, it like this. This is definitely my hope in coming here and learning and Epidemiology Program was that it would be extremely applied and people would get a lot of skills that they need to be able to get the grout yet on the ground running to work in public health. But this is sort of exceeded our expectations in every way, shape, and form that we didn't want to take the opportunity to. Give a brief overview of the MPH, though, again, as Noel mentioned earlier, we have two concentration than MPH in epidemiology and call it the ninth and an MPH and health policy and management that's in the Biden Cool. And both concentration share and interdisciplinary care, practicum and a capstone learning experience that are all part of a 40 to credit the Great Neck flight. And as I mentioned in response to Emily comment, we really do focus on preparing students for public health career than either applied or research setting. In epidemiology, we have faculty that focus on cancer, cardiovascular disease, epi, field that the Anthony mentioned, environmental epi and social epi. Next, what application they're open to. Both concentration where the priority deadline of May 31st. And you can contact one of program directors for information about DRE waiver than application fee waiver which might be available for Udi undergrad another applicant. And you're welcome to email me directly or check out our website. And I think that we have now time to turn it over for questions. Absolutely, we do. And I wanna thank Dr. ***** and Emily for, for sharing information with us. We definitely designed this Webinar purposely to be generous with the Q and a time. As Cove it obviously is is front of mind for all of us and we all have a lot of questions all the time. And could we wanted to make sure we honor that and created a faith for you all to ask questions of both Emily and Dr. *****. Though? I if you have not submitted questions for the Q and a, feel free to do it now. We'll start working through some of these questions and be sure to, to try to get as many of them as we can. And could we do have a quick question about the MPH program? Any focus on occupational epidemiology? We did have one person who focuses on environmental epidemiology, which is occupational, sort of a section of that program. And though not exactly occupational, but as a subset of environmental, Yeah. We have a someone who has been an adjunct in the program who worked in Occupational Epi. Though I can I can definitely hook joke with them. Contact if you'd like to. Then the emo. And then another question we have is fitting over kick COBIT. Are we expecting another bike after December? Well, I guess that all depends on how we behave for the next few weeks, though. One of the important concepts, I think epidemiologically with coded is lag time. By that we've seen consistently over the course of the pandemic that there's this period of time of 23, maybe even four weeks between when people are exposed, uninfected, when they may need to go to the hospital or when they may unfortunately died from complications of being infected with COBIT. And though we don't back where I mentioned earlier, we, we haven't really seen that. The hot little third we have now is the people who were infected three weeks ago, but we haven't seen a hospital third or the surgeon that related to gathering didn't travel over Thanksgiving. So I think many anticipate will be at 5 thousand, that's the day by Christmas. I think that's a very realistic expectation, unfortunately. And so I'm I am concern, I'm optimistic about the fact that we have a couple of vaccines that are before the FDA for approval. But I'm also concerned that people will not take seriously the type, the social distancing and math wearing and think that they need to continue to do throughout the holiday season. Because they sort of anticipating a little too early that we're going to have the faculty and available, gonna take a very long time to get an update to vaccinate enough people. Though. Leading off from that, as we move into winter and knowing behavior. Thus far, what are you most concerned about? So I think one of the most concerning thing then there was a really interesting article that I just read the other day talking about. Eighth is in Washington State that have been identified in people who've traveled to Idaho where restriction they're much, much less stringent in terms of requiring masking. And so without any kind of federal policy toward the kinds of control measures, with regard to Coded. People can go to a place with a less strict control measure and then return to wherever their home is. So if you have had to do any traveling from covalent and you know that there are a lot of inconsistencies with regard to mapping and businesses with regard to other type of behavior and other kinds of public health emergency order. So we thin relatively. I'm protected here in Delaware with the leadership from the governor with regards to the public health emergency measures, were very smart fate in and there are a lot of patients every day. I, I can't remember which one with 6 thousand knew which one was 10 thousand. Pennsylvania and New Jersey are having, you know, close to having fixed in 10 thousand cases of the day. Which again, if you remember that rate, that, that what it would be if we had a population that looked more like Pennsylvania, New Jersey, but 750, that's our version of 10 thousand because of our population. So they get really important and as people were all fatigue Oliver, including the epidemiologist, to understand the reasons behind why we're being advised to do the thing, though. I think we have to continue to follow the guidance that we can and look forward to a time where hopefully we have the more stable federal guidance. Because that infectious disease doesn't care about whether or not you cross the border and the Pennsylvania, New Jersey, and our kth or in the case of the article I mentioned from Washington State, Dido you're still going to need a hospital bed. You need to, you know, to be admitted. And so I think that's really important. So we have a question about someone hadn't written that. They've heard that people with developmental disabilities are at higher risk for Coven. So the first part of the question is, is that the K. And then if though would mean that the group might be considered for vaccine priority. Emily, do you know anything about that? I mean, I I've heard that that group is a high risk group and that probably related to other co-morbidities that they may have. Related to cardiovascular breathing problem? Yeah, I'm I can't speak it a ton about vaccine priority or dissemination at this point. But I can say from experience we've had, especially again, from congregate settings like schools, behavioral centers, programs for people with special needs, especially children with special needs. We've done a lot of contact tracing and consultation with those sorts of organizations who serve individuals with developmental disabilities. Because often behaviorally, they're not capable of practicing social distancing, practicing mask adherents. And that risk that I mentioned is ever so present in those groups. So that, that call happens very frequently on a daily basis for us in public health where there's a child who's in special needs classroom and unfortunately the whole classroom has to be quarantined. And it happens over and over again. So I would say, you know, just by the pure exposure rates of a group of people being introduced to potential exposure again and again and probably not being able to have perfect Matthews, they're at an increased risk by each person's immune system. Their respiratory health is of course all, all depending. But I know anecdotally we're we're giving those individuals special considerations and always trying to be thinking with their health and their needs in mind. But it's a balance there because often those nurses and families be speak to say now, these children really need the services of being in school more than the average child and, and they need their their services. But our job is to keep them safe and make those recommendations. So often, it's really just the behavioral things of mass squaring and social distancing that can't be perfect at NRI's with them often and increased breast cancer, the question yeah, I'm not sure if he dies. Someone on the panel pin there. It looks like it study which was published in mid-November About the infection rate among people with developmental disability that could be shared with the I think I only chatted it to the panel that could be shared with the rest that occurs. And we have a question. I know we touched on this a little bit both in your remark than income a responsive. But I think I began if it's something that we're all kind of feeling and experiencing, what is your advice or respond to the poor. Syrian thing, pandemic fatigue and not might be justifying relaxing their behavior. We're engaging in a little bit more high-risk behavior by and with the ever-changing information reported in the news, media and literature. Yeah, I mean, I think that we struggled a lot with the messaging around the communication that would then lead people to take action. And so, and I feed different types of messaging being tried, though recently with a table published that basically says one out of every, however many people in each state and major city had died of Provence in New York City at 340. Last time I checked into over 12, around 1250 men, even when I'm talking to my kid, to say like, do you think, you know, a thousand people? You know, if you do, then one of them has died from coated. Now, you know that they work on a percentage of the population that doesn't believe that goes, it is a real thing. But maybe there's a different argument that, that work for those people. That I think that it's true that I've read a file in part out of necessity because we have kids at home and are working full time. We've figured out ways to expand our bubble a little bit. But then, and I think that both are true that we know when we're doing something that's risky. And so that this only worked when we are able to apply multiple layers of intervention. So that going back to my comment about the vaccine, the vaccine it yet one layer that we're going to add to the map, handwashing that social distancing our thumb on the pharmaceutical interventions that have been developed that are helping people have better outcomes when they are hospital, right? And we have a vaccine, we're just going to continue adding the thing that we're not going to throw out, the social distancing and the map query. And once we have a vaccine. And I don't think really that there had been a tremendous amount of change in the bay flying message. I think there's a lot of noise. And so it's hard to find them trusted sources then follow the instead of kind of the thinking might be on social media or other places. So given that the pandemic had obviously kind of shine a light on our public health infrastructure. At all level. What improvement to be. Do you think that we need to make either on a state level or what were the kind of common across the various level to our public health infrastructure. But I think it's really important to remember and I don't have that number that hand, but I'll try and post them in the chat and the minute. But after the financial crisis of 2008, about 65% of health departments either have had stagnant or reduce funding for those 12 years. And they'd laugh thousands and thousands of staff, either three retirement or layoff because of budget cuts that we went into Pandemic Response at the public health system, federal, state and local, 250 thousand workers short of where we needed to be or where we were in 2007 before the financial crisis. So I think that everywhere including Delaware, need to expand capacity in public health to be able to be more proactive instead of responsive, we need more public health data. We need more public health funding. Because like I mentioned, this is not really the, the implication of this pandemic have been unique considering all the ones that we faced in the last 15 years. But it's not unique to have had a pandemic straightening. We've had to influenza pandemic in the last 15 years. We fell have ongoing outbreak, the Murthy other coronavirus. Yet bars and heat Alban three though. The republic, how puts them that's not ready to respond to the type of event that really short-sighted at that point. Emily, do you have anything to add? Add a period and a current PrEP? Hanson are working at Public Health away in the experience of working in the time that very quickly we all went into action on the emergency response, I think in Delaware. And I don't think I'm alone in this thought really kind of exposed some and some fragmented communication and work relationships in the interdisciplinary sort of ways. And that our different groups in public health for quite some time operated really independently and didn't have enough coordination and communication to have plans that we're going to have continuity for this type of event. So there is an office in Delaware all about planning and preparedness, and they have no plans written for a pandemic response. And it didn't satisfy the need clearly. So we really didn't anticipate the burden of this and then were found and pretty much a cycle of being very responsive. And unfortunately, that I think is something that's happened to many state and local health departments. And it's happened to the CDC to, as new findings are discovered clinically and epidemiologically about coded. And what is the next crisis that you have to face and, and how do we mitigate it very short-term. So again, I think it's that reactive aspect of public health when we need to think a little bit more long-term and have longevity to any preventative measures have enhanced interdisciplinary communication. So for us in Delaware, our public health lab, our preparedness folks, in our hospitalists. So we work with infection preventionists on a daily basis and have really strengthen those bonds now by, I think the weaknesses at the beginning of the pandemic were really difficult to work through. And and I'm sure that that also has to do with as doctor where I mentioned the bare bones of staff. So work rowing. And I can say that personally for Delaware that we've had so many new. Staff come in with increased funding from the CDC. Now, there's more funding than ever to try to accommodate. But it would've been nice in January, February, March to to have that at the get go, but we are stronger now it's, it's just, we'll know better for feature genomics. Though ad we, we are transitioning leadership at the federal level. And some of the transition conversation bar literally happening right up the road from us. Do you anticipate or have you heard anything about any potential federal level restrict them or or coordination of activities related? Coben? Not particularly, no. It's it's kinda have always been in the ballgame of, of state health departments and is just because of the diversity of different state and local health departments and how their population sizes function, and what their needs are, and what resources they have. So I have not been given any insult to kind of lend in that direction. But I can say that even vers data smallest, Delaware, we aren't really good working relationships with our bordering states like Maryland, Pennsylvania, and New Jersey to to shake ideas off each other to actually use some similar contact tracing systems. And I think that that's probably true for other regions of the country too. So there is a bit more continuity maybe then than we realize states are acting independently. But let me look at the state over, it's particularly not that different and the way we're really operating. But then things like, you know, guidelines, your mask adherents guidelines for now, the new quarantine guidelines can shift ever so slightly. That kinda makes everyone up that I think that we can intervene that by inherit they've indicated that they're going to app for no, I don't know. I don't I don't know if the mandate for everyone to wear map for the first 100 days. But I think we have to be the, you know, the leaders that get put in and played the lead, PDP and DHA cat than others. But it's important that we have over 3 thousand local health departments in the United States. And there's a saying that goes, if you've seen one local health department, anything one local health departments though, there are, there are definitely continuity across a crop jurisdictions and states, but then they're off, they're different structures, different funding mechanisms, different organizations across different departments. We have a few questions about the vaccine, which is probability of no surprise. And so a question about the effectiveness, effectiveness of the vaccine. And I think this is probably a little bit more if you, you know, kind of the distribution and coordinating all that given things we're hearing about that come out that have to be kept at very low temperature or things like that. And, and will the vaccine be enough to combat the fact that we're off the thing that concrete, that's pretty sharp ride and that curve. And how did that factor in and are decreasing and decreasing the spread. Yeah, I mean, I would say that I'm not an amine and the biologist or an expert in that theme. But from a public health perspective, there are a couple big challenges. One is that a vaccine doesn't save anyone Only a vaccination that and we have a public health and health care workforce that extremely burned out an overshot and add. The implementation of a back being Campaign onto that I think is going to be a heavy lift. And even though we have simultaneously develop the vaccine and manufactured it, if we're going to take a long time before there are enough dose to meet the demand in the US, not to even mention globally. Though there are a couple of, I don't I don't have concerns about the fact that the process has been relatively rapid. Mrna has been researched for more than a decade. You know, it's not unheard of to do the thing that one time, but the third leg of the three-legged stool is actually disseminate the vaccine to people. And we have a lot of vaccine hesitancy. We have a group of people that bill don't even believe Kobe didn't really want that when we add all the people up, who is left that will get the vaccine and how do we get it to them? And how quickly can we get to a point that makes it safer for us to return to some of our normal activity. And, and before we pivot from back the end Gift. Also adding the question because I know that you touched on that a big, a big piece of all of this. And in public health it's really looking at the inequities related issues and to, when we turn to back themes, what are your thoughts on that this is happening in the context that our country is having a reckoning with structural and institutionalized racism. And really looking at our history and our paths related to that, including than understanding community, the color, myth, myth, trust in government institution, the experiences that they've had in the past. And how do we hold space for that? And how do we validate that as we're about to unroll exactly what that campaign about. Really encouraging folks to participate in the back donation process and really trust in this process. Yeah, I think you have to be incredibly careful and there are no expert committees. I actually watched one of their meeting online the other day. You can watch those and comment on them. Who are establishing guidelines for priority group them. We fire the disparities in those hospitals. They well infection, hospitalizations and death among African American and Hispanic population. Then there should be a discussion about how to prioritize vaccinating or members of minority groups. But that had to be balanced with an understanding that there is a lack of truck about both the health care in general and the path experimentation on populations. And so I think that the huge question there are, are high risk areas like home health or a nursing assistants that are definitely, yeah, fry a majority of people who are relatively poor and entity minority, yet they're going to be at the top of the list. Likely can receive a vaccine and so dour thing out that prioritization, but a lack of truck, they tend to be really important and is going to acquire a lot of thought and discussion about ethical decision making and other thing. So get the shift gears for a minute to our experience here at UB. And talking a bit about the aspect of our response and community spread. There was a question about if if there had been any Kobe K2. We know a mountain UD employee in particular that had been tied back to work related exposure. Though I do deal with the employee cases, IED, but we don't and Emily might be able to speak on that a little bit more. You know, we're very cautious about I think in general are very cautious about that thing. Individual, he may have tested positive or had contact. But in particular with curl, it I think it's really difficult because It's very hard to know where that exposure that led to the infection and actually occurred. So we can definitely document potential exposures in contact, but short of sequencing the viral DNA, I don't think that we can do that kind of tracking. Again, I think that we have then both that UV and the state of Delaware in general. Now, i the i live in Wilmington and New Castle County. But in general, I think compliance with mapping has been relatively high. If you go into stores, you see most people wearing math being compliant. That's been very high on campus and classroom than in research setting, than we really have not seen bread of coded on campus and co-occuring either research setting because I think of all the multilayered precautions that are in place. And so I think that we're seeing, like Emily mentioned before, community-driven thread gets very difficult, very difficult piggy contact tracing on, it's very difficult to pinpoint where was that people were infected are or what the contract was that led to the infection? Yeah, I absolutely agree that Dr. Varney, as I'm trying to lead surveillance for the ED clusters since about August. I can say we haven't necessarily pinpointed exposures that are exclusively in the university setting like an in-person class I told, or meeting, or research lab or anything of that nature because we feel really confident and the precautions that are key again, and for the most part, people just don't live in the bubble. So when they leave the university activity that perhaps they were exposed, that there were also perhaps exposed at home with the friend at the grocery store. So it's multifaceted and we take extra care not to ever impose blame when we do contact tracing. And there'll people really want an answer frequently about who got them sick. You could be exposed as someone who has go up and that still might not be the person who gave you covert. It could've been someone next to you at the grocery store, as I mentioned. So it it's it's difficult and it's kind of a language element that we're learning to, to use as we do interviews and perform contact tracing, especially in clusters to not put blame on it because it is a circulating in the community. But the surveillance for the UT cluster gone is primarily with students who are tested at University of Delaware Student Health Services at New York urgent care or specific testing event. Whereas a lot of faculty are actually residents of other states. So it's been a little bit more complex and they don't always get tested at UT Student Health Services. They often use the nurse managed primary care center or other medical facilities nearby. So I don't have exact information on exposure of an employee, but I can say that we're really pleased at the Division of Public Health with how the University of Delaware has responded and taken precaution, taking it seriously since last spring semester. So Emily, you you just talked about how you all really you try to fend for empathy and in your approach to the contact tracing. But I'm going to turn on a little bit and say, what are you, what are you and your colleague doing to support each other and to engage in self-care. And, and really the process kinda emulated view that this is not an easy interact and you are having the number that you're working with. Are there are people behind those numbers? So what what things are you all doing to take care of yourself? Well, thank you for asking who is thinking about that? Because for while I didn't feel as if anyone was thinking about that. It was just really, really intense for multiple months at the beginning, but we were working off adrenaline and to interview, as I mentioned in the very first Kobe, positive person in state was just so thrilling and, and I love differ a few months. But as you get off the phone with people who are really upset, who've lost loved ones, who can participate in school and work. The humanity of it, absolutely, jake, That's toll. And as we bring in more epidemiologists, a lot of them are in my age group honestly between 2030. And it's been very difficult to learn how to compartmentalize and Address people and meet their needs, but also take a minute to put down the phone. And we've all talked about what works for us. So some of us in the office like to go on walks after we've had particularly difficult phone calls around the building, we just take a minute and we take a lap. A lot of us do work lunches together on Friday were already close to each other in the office setting. So we do try to put down the phone and have that social interaction. And it's felt extremely like a positive camaraderie there. But not dissimilar to when you're working on something honestly that's traumatic and that's really difficult that you have to lean on each other. So I think there's going to be actually a lot of interesting studies about mental health and burnout of people working in public health through this pandemic that we're not going to really see the effects of until afterwards. But our leadership is definitely seen how hard public health members are working and has made it a priority to put our mental health and our physical well-being first? They have and a Counselor at the Emergency Response Center. And anyone who's been affected has been granted the ability to take time off, work from home, whatever the scenario is, especially as loved ones are impacted by Coase 19. So it's really difficult because the demand is there. But if we don't take care of ourselves and we're not healthy First, we can't help anyone else, which is really what we've realized through this. Yeah, I think like them on as we think about Barrymore And as we think about that are relatively easy to measure, like the number of Kobe cases. There's so many things in the future that are more difficult to understand, like a mental health impact, the educational impact, all the things that we're going to take a long time to really understand the indirect impact of the pandemic on an individual and community. So I think that that's important to keep in mind that even when, again, when the truth quote unquote over, there's still going to be a lot left to deal with. Well, and I think that is a good place for us to to wrap this up and to end. But before we do, I just want to thank both Dr. ***** and especially Emily for taking time to share her on-the-ground experience with us this evening. I want to thank the participants for the great question. I know I, I always author learned stuff right along with everyone else. And so, and I want to thank the Partnership for healthy communities for partnering with the MPH program on this and encourage you all to reach out if, if a spark your interests in public health or epidemiology. We are here to help you get connected to the program though. Please reach out or apply if you are interrupted. And with that, we will end clinic webinar, and I hope everyone has a good evening. Thank you. And you are in space, dave, everyone. Thank you, Emily. Thanks for having me.

Winter and the Pandemic

From Lauren Camphausen December 08, 2020

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This webinar features Dr. Jennifer Horney, Professor and Director of UD's Epidemiology Program, discussing tools of public health and epidemiology used in the current COVID-19 response. The webinar also features a current UD graduate student in the MPH in Epidemiology program sharing insights into studying and practicing public health during a global pandemic.

Department Name: Epidemiology
Date Established: December 08, 2020
Appears In: Epidemiology Program

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