COVID-19 and Vulnerable Populations

The Midstory Team sits down Jamie Luster, MPH, a public health professional and former student of Dr. Amy Acton, to talk about the U.S. health care system, COVID-19's effect on vulnerable populations and the need for more investment in preventative care.

“The true measure of any society can be found in how it treats its most vulnerable members.” – Gandhi

Browse by topic or read the transcript of our interview below.

Topics covered:
[0:36] What is epidemiology?
[3:17] Dr. Amy Acton
[4:09] Vulnerable populations
[5:34, 10:26] Individuals with substance abuse issues
[7:50] How individuals can help during this crisis
[9:01] How access to internet and technology affects vulnerable populations
[11:32] Overwhelmed health care systems and systemic issues
[13:35] The hidden role of public health: today’s result is a product of yesterday’s actions
[16:24] Takeaways: Investing in public health & preventative measures, not celebrating too soon

Samuel Chang: It is my pleasure to introduce our next guest. She is a West Toledo native and she formerly worked, for the last few years, at the University of Michigan in their Department of Internal Medicine as a Research Area Specialist. She recently transitioned into her new job at Ohio State where she’s working remotely in the Toledo area on the HEALing Communities Study looking at the opioid crisis here. Well, thank you so much for joining me today, Jamie. 

Jamie Luster: Yeah, of course! Thank you for having me. 

SC: So I’m sure I’m not the first person to ask you this question, but what exactly is epidemiology? 

JL: Okay, so epidemiology—a lot of people think it has to do with your skin, like epidermis. That’s not actually the case. So epidemiology is the study of the origin of diseases and kind of the distribution of them, but it’s a pretty broad science, so it can be anything from study design to, you know, disease outbreak tracking. It pretty much encompasses all of that. 

SC: So what got you first involved with looking more extensively into COVID-19? I mean, of course, that’s kind of your background, but when did you start thinking, “Oh, this is something very interesting for me to look at, and as an epidemiologist I definitely should keep tabs on the situation”? 

JL: Yeah, so at first I think I thought of it like a lot of people did, it was just this isolated virus somewhere like across the world. You know, I’m not even thinking about it. And we started to see the spread become more generalized. You know, in different regions of China, it was spreading pretty rapidly and then other countries in Asia as well, and we started to see pockets of it in the U.S., and you know like random places not necessarily the big cities. I think everyone started to take more note of it and that’s kind of when I was like, “Okay, you know this is kind of a big deal.”

SC: If you can talk more about what we’re seeing in the United States right now in terms of the raw numbers, the raw data, the projections and how that nationally compares with what we’re seeing in Ohio. 

JL: So in the U.S. as a whole, I think cases have still been increasing, but I think I just read something today about how in New York City it seems that cases aren’t necessarily increasing so much, but deaths are increasing. So you know, it’s just people have had the illness for longer and people have it more seriously. And in Ohio specifically, I think it’s projected that the peak will be around mid-May, at least that’s the last I heard; and that’s you know if we continue to use the control measures that we have been doing: you know the social-distancing measures, you know the self-isolation, things like that. I think it’s really hard to say, in terms of projections, because this is like a novel virus so we don’t know exactly how it’s going to behave you know in terms of immunity, in terms of mortality, anything like that. But as Dr. Acton says in her press conferences, it’s kind of all based on modeling, so we just don’t really know for sure yet. 

SC: And you were a former student of Dr. Acton?

JL: Yeah, so Amy Acton, she’s the Director of the Ohio Department of Health, and I had her when I was an undergraduate at Ohio State. So I did my undergrad and Master’s there in Public Health. And she taught the Introduction to Global Public Health course that all of the majors, all of the minors, everyone went through her class. And after everybody took the class, everyone just wanted to go into a career in public health. She’s definitely very charismatic and influential and also just so kind and compassionate and always has time for the personal interaction with students, not just at the teaching level. 

SC: So she’s a very inspirational figure? 

JL: Yeah. Everyone at Ohio State loves her. I remember when Governor DeWine appointed her, we were all just thrilled because you couldn’t have picked someone better, honestly.

SC: Well I’m gonna shift gears a little bit and start. I’m going to talk a little bit about maybe a pretty sensitive topic, which is looking into vulnerable populations during this crisis that we’re in right now. I think they’re being affected in many different ways; we have a home, we have shelter, we have food, we have resources, we have family and friends, we have social networks, we have internet. I think a lot of individuals out in our community as well as the global community don’t have those resources. So when you say “stay-at-home” or “shelter-in-place,” some of them don’t even have a home to stay at. So what does it mean for those vulnerable populations during this time? 

JL: Yeah, I think definitely. You know, when laws like this come down from a higher level, it’s easy, like you said, to just tell people to stay home, but what do you do if you don’t have a home? Or what if your home is not a safe place? Or what if you don’t have internet access? You can’t do school or work from home like everybody’s been doing. I think that’s something that we have yet to navigate and I think luckily, at least in our local community, it seems like there’s been a lot of people pulling together resources to try to help out people in need. And I’m just [hoping] that’s the case for the rest of the country and the rest of the world, as well. 

SC: And in terms of those individuals that are kind of within that sector, I think specifically when you’re looking at access to care (and I think maybe this is also up your alley), when you’re talking about individuals that suffer from substance abuse. That in this moment of kind of a health care crisis that we’re in, that access to care is also extremely limited. And because of that, they’re not able to get the resources that they may need to stay off, you know, certain substances. Maybe you can share more about from your own [experience] what you’re seeing in your own research and communities, dealing with maybe even Toledo, how this is really affecting those kind of individuals? 

JL: Yes, I think everyone is kind of facing a shortage of access to care right now, especially, you know, primary care. Just general physician appointments or elective surgery are all cancelled because the healthcare system is basically preparing for an influx of people with coronavirus. So everything else is on hold right now, and I think that’s really challenging for a lot of people. You know, what if you just need to go to the doctor for a checkup or something? It’s not necessarily possible right now. I think it’s just kind of to-be-determined, I guess, what the impact is going to be. I don’t think it’ll be a positive thing. You know people still need their care. But I would say in terms of specific populations like populations who have substance abuse disorders and things like that, at least through my work right now we’ve been working really closely with the Toledo Lucas County Health Department and specifically people who have opioid use disorders. You know Narcan (Naloxone) is a life-saving drug for people who have overdosed. So I know they’ve been working around the clock to ensure that people still have access to Narcan. It’s difficult with everybody working from home and everybody kind of having to work on their own time to figure things out. So I think the community response is positive. We’re getting there, but it’s just a matter of logistically figuring things out when they’re not how they typically are.

SC: Hearing a lot about prisons and the issues within prisons, looking at the homeless population, looking at people struggling with substance abuse. I think all those questions and concerns and challenges that we faced as a community, you know as a global community, are suddenly coming to the forefront and it’s being displayed to us. And I think those challenges, really when we’re looking at the news, we have to feel—and how can we help and how can we really be a part of that solution? What can we do in this current situation to help those within those populations or struggling with that specifically? 

JL: I know there’s a lot of donation sites that have been set up. You know, like monetary donations or even dropping off food at food pantries. I think those services are still happening, somewhat limited or maybe in a little bit of a different scope, but it is really difficult to say when, you know, we just keep being told to stay home—I mean that’s definitely true—but it’s difficult logistically. How do we continue like these other social services?

SC: I think that specifically social services, as you’re saying, is something that almost requires the kind of interpersonal conversation and relationship. And without that, a lot of people are unable to be served, and I think maybe that’s a sign of how we need to move forward in terms of our technology, in terms of allowing and making sure that everybody has that equal access to technology when crises like these hit. So you know there’s a huge portion of our zip code that doesn’t even have basic Wi-Fi access. And I think that’s something definitely worth considering. 

JL: Yeah, and you know, that’s another point. I think a lot of primary care physicians and mental health providers have been providing a lot of tele-health services, which is really awesome. You know, you don’t even have to go into the doctor’s office to get your service. If you’re sick, you don’t infect other people. You don’t become infected. But again, like you said, it’s a matter of access. So I have a friend who’s a speech therapist and she typically visits preschoolers to do speech therapy, and they’re offering tele-health for them now, but it’s kind of like, okay, so do they have internet access? Do they have a webcam? Do they have a person around who’s willing to help [to] facilitate that? So I think there’s a lot of unanswered questions there.

SC: Yeah, the question of access is certainly something that, you know—it’s I think now coming to the forefront. And I mean, if you look into the numbers about—you know, looking into the homeless population, looking into individuals struggling with substance abuse, you know the numbers came out. I think there’s a study done by the University of Pennsylvania that essentially they are two to three times more likely to be hospitalized and they’re also two to three times more likely to actually die from COVID-19 and those are terrible numbers. I mean, that it’s so sad to see that. Can you maybe explain why are they so vulnerable to this specific disease? I mean, why are we seeing the high mortality rates right now? 

JL: You know, I don’t think it’s even necessarily the specific disease, it’s just a matter of access, like you are saying. You know, if you don’t have access to basic health care or basic shelter you know, like food and clean water, I think that’s definitely an issue when it comes to any type of disease: chronic, infectious, anything like that. So that’s probably where that’s coming from.

SC: You know, I’ve done a little bit of digging, as well, looking into the number of hospital beds. We’re looking at around 700,000 to 900,000 total hospital beds that are in the United States. Through my digging, I saw that there was this kind of policy called the certificate of need, which is essentially a policy in place where hospitals and the government could control the hospital beds and the equipment and the new projects that healthcare systems were doing within the state as a way to kind of manage and control that system. Now I think, because of that, what it means is that whenever a healthcare system wants to increase the number of beds or equipment, they would have to go through state approval. How does that all fit into the picture?

JL: Yeah, so I think a lot of it has to do with how the healthcare system is designed. And, you know, it’s really fragmented and decentralized, just like—you know how the government functions here. For health care systems specifically, the way it’s designed, we don’t have universal healthcare, so it’s kind of like health care is a business. And so in terms of hospital beds, like you were saying, I was just reading about this today. Basically the way it’s set up is that you have X number of hospital beds in a hospital and those are generally gonna get filled all the time because they’re available. So the system’s not set up for a pandemic, you know. We don’t have a bunch of extra hospital beds laying around because just the way it works is they typically admit people and they get filled. And I’m not, you know, like a clinician or anything like this, so I’m definitely not an expert when it comes to this, but I think that is one issue. I don’t know if there’s any healthcare system that’s built for an emergency response to something like this, something of this caliber, you know. In theory it would be wonderful, but I don’t think anybody is really ready for this.

SC: Right now, it seems like the projections in Ohio are looking good—and I don’t want to jump to any conclusions. I don’t think anybody wants to jump to any conclusions here. And again, I think it’s dangerous when we just look at Ohio because our neighbors up north are not doing so well. And we are literally in Toledo, OH, 15 minutes from the border. So I think that’s particularly dangerous, but I think people are getting antsy, they want to get back to their normal life.

JL: Yeah, I think I would say that it’s okay to celebrate this in our homes. I think the crux of public health is that it’s working when you can’t tell that it’s there. So, you know, we see these projections going down and our cases are reducing and things are looking good, but that’s because we have these measures in place. And if we have businesses reopened and we go out like we were doing before prematurely, we’re just gonna see a spike in cases again. And that’ll probably happen as things start to open up gradually when it is time, but you know I think I saw some statistic that like 25 percent of people—up to that number—who are infected might not even show symptoms. And the virus presents differently in different people, so I think that’s—you know, a big caution right there is we don’t actually know who really has it and that’s a really scary part. And you know, if we go out and start doing things before it’s really controlled, I think we’ll just see a spike in cases again.

SC: Yeah, I think that when it comes to preventive policies, when it’s a situation that people don’t see is right in front of their face, specifically in disaster prevention, something like this, that’s where the money dries up and we don’t really want to invest as much into it. But maybe that’s a lesson we need to learn and that preventative side of our policies in terms of our healthcare systems, the way our government is organized in this way. Maybe that’s a lesson that we can all learn together during this time.

JL: Yeah, there’s kind of a joke in public health that we don’t have a healthcare system, we have a sick care system, which is really true, you know. We focus a lot not so much on preventative care, but [on] secondary and tertiary care, treating the sickness instead of preventing it before anything even happens or, you know, treating the whole person. It’s definitely a cultural thing.

SC: So Jamie what is our takeaway from all of this? What can we learn or what should we learn from all of this?

JL: I think one thing we can learn is, from a policymaking standpoint, definitely investing in public health, investing in preventive measures, disaster preparedness. I think that’s definitely a big part of this. I would say, additionally, I guess just taking seriously threats like this and trying to do things to reduce the impact, reduce the negative impact as much as possible before it’s really bad.

SC: My takeaway from this conversation is, of course, we have to be aware that this is affecting populations differently and I think part of that is being empathetic to the different populations that this may affect—the vulnerable populations—and making sure that we’re aware of that—you know, if we’re watching this from home in our beds or on our phones and we have data and Wi-Fi access—that we’re among the privileged that have that kind of access to these kinds of resources. And hopefully, we can all abide by what Dr. Acton, kind of our hometown hero in Ohio, we should definitely abide by whatever she is saying and making sure that we do not let up. That even though the projections are looking good in Ohio, there is certainly much more to go for us as a community.

JL: And the projections are looking good because we are doing what we’re supposed to be doing. And I also want to say, on a positive note, though this is obviously a horrible situation, it has really been obvious how communities can come together during this and that’s been really awesome: seeing businesses, like tailors around Toledo, making masks for people—everybody is working on making masks. People working more quickly to develop strategies, like everything from some of the restaurants downtown creating grocery stores. I think everybody is really trying to do their part to lessen the impact and I guess that’s been something positive that’s come from this. 

SC: Yeah, we’re absolutely in this together and actually you mentioned the grocery store—that [is] certainly innovation in a moment of crisis. I definitely know a few restaurants like Fowl and Fodder that are innovating in this time and I think we all could innovate ourselves as we think about how we work, how we recreate, how we do a lot of things that potentially have changed. And also how our attitudes towards human life and our own communities can change and grow, and, for me, just having this conversation was a great opportunity for me to grow and learn from our communities. So thank you so much for coming in and sharing your own experiences with us, Jamie.

JL: Yeah, of course. Thanks so much for having me.

SC: If you enjoyed our conversation with Jamie today, consider giving us a like, a share,or comment below. We appreciate you joining us today and hope that you’ll keep tabs with us on the current situation as we involve more guests onto our show. If you guys have any new guests that you want us to feature, feel free to reach out to us via email at [email protected]. Thanks for joining us and, again, stay safe, stay at home and stay human. I’ll see you soon.

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