All right, thank you for that very enthusiastic announcement. Good morning, everybody. Thanks for coming to our session today on communications for evidence-based impact. I think we're going to have a fun conversation today. This is one of my favorite topics. We're going to be talking about risk communication, communication I've worked in the media for the last 10 years. So something I've done a lot of and enjoyed and lectured on. And we have a great panel today. Before I introduce them, I just want to set some ground rules for today's session. We're hoping to make it a little bit interactive. Most of us up here don't like to do things traditionally. So you can ask questions at any time, please. If you want to ask one right now, come up. Just jump up, go to the microphone, and we'll be happy to engage. I was saying to the panel when I was a resident at Hopkins and we were doing our MPH, the professors, I think, every single class would always get up and say, oh, now we're here at Hopkins. We probably have a room full of people who are more expert in me than this topic. And so I know everyone out here has a lot of expertise in this area. So I want to hear from you and get you engaged. So with that, let me introduce the panel. I'll start at the end. We've got Dr. Chris Purnell. If you don't know Chris by now, I'm not sure what conference you're at. Chris started off her education on the wrong foot, I'd say, attending Princeton University. Finally got things on track by going to Duke for med school. I went there for undergrad. And then came to Hopkins for her PrevMed residency. She's right now the Chief Strategic Integration and Health Equity Officer at University Hospital of Newark. And she chose that title very specifically, which you can talk to her about another time. She's frequently been featured on CNN and other news media outlets over the course of the COVID pandemic. I was telling Chris the other day, I was sitting in an airport lounge the other day. And sorry, I said that. Should I not say I was in a lounge? And Chris was on the screen, and I was so excited. And it said, you know, preventive medicine physician. And I was like, oh, you never see that on TV. So that was awesome. So that's her. Next to Chris is Dr. Celeste Phillips. Celeste and I last sat or stood together on a stage in 2019 in Pittsburgh. We were co-chairs of the conference. And so good to be united again with Celeste. Celeste is boarded in both family medicine and preventive medicine. When she was in the hospital, she was in the hospital for a couple of weeks, and then she was discharged. Both family medicine and preventive medicine. When I met her last time, she was just ending her tenure as Surgeon General of the state of Florida, where she spent 10 years ascending through the ranks there. She went on to go head up the public health at Sonoma County. I was very jealous of that, and is currently at CDC, where she is the deputy director for non-infectious diseases. Hasn't been getting a lot of attention recently. But immediately to my right is our only non-preventative medicine speaker today, but I think you'll like him anyway. He is a professor of global health at UC San Diego in the Department of Anthropology, which seems like a cool place to be. But he's also director of global health policy and data institute. He is the editor-in-chief of a journal called JMIR, which I had to write down. It's the Journal of Medical Internet Research. He is here to really lay some foundation for us for this discussion, because he's basically studying communication all of the time. Not just as the editor of that journal, but his papers are well-published in all kinds of excellent journals. So we'll get started. It's going to be a conversation. And yeah. Again, feel free to join us at any time. But we'll, again, start off with some questions from Tim. Tim taught me a lot of new words in preparing for this panel. So obviously, we've been talking a lot about the COVID pandemic, but the WHO has said that we're also in the midst of an infodemic, right? And everyone here is an expert in epidemiology and data. But Tim, you're going to give us some information about how do we actually measure this infodemic, right? Let's give us some data. Set the stage for us. How do we know we're in an infodemic? Yeah, exactly. So thanks very much for the invitation here. It's great to talk to such an interdisciplinary audience, physicians, public health professionals, people from government. So this is a great place to talk about a very interdisciplinary topic, which is the infodemic. And so the infodemic is characterized by too much information and a lot of it misinformation or false information, mostly during a disease outbreak and in an electronic or online medium. So that's how the WHO defines it. A lot of us before COVID-19 were very steeped in global health. And now everyone knows about global health because this pandemic has affected so many people. And a lot of people understand what an infodemic is, which is false and misleading information about health online. And one of the ways we try to measure that is through these different electronic mediums, whether they be social media, the internet, blogs, whatever way that people communicate during the pandemic. And another thing, of course, during the pandemic is that a lot of us rely more on health information online because there's these information voids that have to be filled. So a lot of our work at the beginning of the infodemic was looking at how people were perceiving what was happening in Wuhan, China, for example, looking at Chinese social media. And this was a time when we didn't even have a name for the virus. We didn't have the etiology of the virus set up. We didn't understand the zoonosis component to it. And so all these information voids have to be filled in some way. They can be filled in with reliable sources like things from the CDC, from other healthcare professionals, from preventive medicine docs as well, people in the field, but they can also be filled from other people who are not experienced, who have no experience at all. They're just opining online, but they have influence. So a lot of what we've done now is try to quantify what that infodemic looks like. And it's just like outbreak investigation. You know, here's a piece of infodemic. Here's a piece of misinformation that gets out. How much does it spread? What's its attack rate? How many people are susceptible to it? And how does that change what we call offline behavior? So does it actually lead to someone being less interested in the vaccine, vaccine hesitancy? Does it lead to something such as someone foregoing preventative treatment, for example? And those are the types of things we're working through. Most of the quantification is done through looking at online data, but we're doing more and more work to quantify how that online data impacts people's health behaviors offline. So I believe that helps a little bit. Yeah, Tim, can you say a little more like how do you translate sort of looking at clicks and articles or posts into the real world of how people behave? Absolutely. So you can think of a lot of the work that we do in infodemiology, which we'll talk about a little bit later, the broader field of looking at determinants of health from electronic mediums. And there's lots of different ways. So my background, I'm a policy guy, but because of academia and funding, I had to move to become data science because that's where the funding is. So a lot of our work we do is in machine learning, big data, natural language processing. And so you're collecting large volumes of data of people self-reporting, their behaviors, their attitudes, their perceptions, how they change, how they interact with information. And you could think of it like a huge online focus group, but it's not structured at all. And when you take that data, you're using all these complicated methodologies to assess what are the categories of what people are talking about. And one of the advantages of what we do in infodemiology is we're generating that data closer to real-time, faster than you would through a survey instrument or another structured way of collecting data. So again, there are many different ways. There's people that use just Google Trends. They'll look at how many people search for certain words online, for example. And if there's more people searching for Tamiflu or for COVID vaccine, maybe that shows interest. Or looking exactly at what people are saying on a social media platform like Twitter, Instagram, you know, any of these platforms. And the one other thing that's important is all these platforms are different. They have different demographics. They have different ways to interact with people. So understanding how people are talking in the whole totality of not necessarily the metaverse, but all these different online forums, gives you a better indication of how behavior is changing over time. Cool. Let me ask you one more question. Yeah. Do you have a second? Oh, yes, please. Go. No, Celeste, you ask your question. So this is our mixing it up. Because I was a little nervous about my co-panelists asking me questions, so sorry. Now I'm doing it. But, you know, this really resonates with so much of the experience, I would say, for public health in the field and also at CDC, where it was almost like you had to start monitoring Twitter to hear what people were being exposed to in terms of, I'd say, especially around masking and vaccinations. I'll use those two examples. And I remember at one point, I talked with a friend of mine, childhood friend, about whether he, and he has five kids, and I'm like, oh, are you guys getting ready to get vaccinated? And he started sharing with me that his oldest daughter, she found all of these concerning side effects from the vaccine that she had been talking about with her friends, with him, that included, and we now have heard all of these over and over, but this was early on, and so there were concerns around fertility, and we'll talk about the microchip, but, you know, more plausible potential effects. And it just struck me that, you know, there's so much of this going on, and, you know, how do we get a handle on it? So I didn't know about infodemiology until now, or until preparing for this panel discussion. So I'm just curious if there is a correlate to say, you know, as you're monitoring the different themes in the various platforms, is there a way to actually identify, like, where did this first come from? And if you, I don't know if there's something you could share from COVID to something interesting where you found out the origin of a particular misinformation piece. Yeah, so we've done a lot of misinformation work. I'm happy to talk after the plenary if anyone wants to get citations to some of our work. We're just part of a broad community that's doing this work. One of the things that's fascinating in this space is we've never had so many computer scientists interested in public health, and I don't know if they're sticking around, but, you know, everyone was writing around COVID-19. So it's amazing that we have people from policy, sociology, anthropology, computer science all involved in this, and we can leverage these new methodologies to tackle this issue of infodemics. So one of the things that you can do to try to track down, you know, the origin of that misinformation is you can do a social network analysis and try to determine where the centrality in the network is. Like, where is all that traffic coming from? Who's the most influential node in that network? And the best misinformation we found, best is in, you know, most interesting, is the ones where they don't tell you about the misinformation. You have to dig deeper yourself. So they give you a little hint about something like, did you know that this person died from, you know, this particular vaccine? You know, we're just telling you that someone's dying. You dig down into that link a little bit. You start seeing what other people are saying. Oh, it's related to this. We actually have a paper out that talked about the death of Hank Aaron. And, you know, basically anti-vax people use that as an opportunity to say, hey, this famous African-American died from getting vaccinated just recently. He passed right after he got vaccinated. No relationship to being vaccinated. He was actually a champion of trying to get the African community vaccinated. But these anti-vaxxers came in and tried to use that as a wedge point to convince people that now the vaccine has killed someone famous, and you shouldn't do it. And, Mike, just to weigh in with a real-world example. And so some of you may listen to hip-hop, and some of you may know Dame Dash of Rockefeller fame, the past partner of Jay-Z. I happen to know him. And he monitors his social media stats. So he knows who's commenting on which posts. He knows the demographics around those persons. So he would reach out to me from time to time and say, hey, we need to jump on a live. Because Dame Dash is well-known in hip-hop, but also has a chronic condition. He has type 1 diabetes. So he's frequently talking about health topics to a community that may not be accessing health in a traditional format. So we would use that information that he was privy to to say, let's talk about this. Let's talk about this to this audience. And they need to hear it from a black woman. They need to hear someone who has similar traits and characteristics from the culture, someone who they see as having bona fides, who is credible. And that would drive our conversations. What were the latest misinformation or disinformation even that was populating his social media feed? He has like a million followers, right? Was populating his social media feed, in particular, his Instagram feed. And I saw that happen across other influencers in society, whether it was related to music or whether it was related to a neighborhood level, pastors or whatsoforth. It's like, hey, people from our church, they're sharing this type of information. So people don't know about an infodemic formally. But I think the more that we can help the public understand how information is shared and how that impacts behavior, in particular, health-related or health-seeking behaviors, people begin to get savvy. Because I would have people send me things. They would send me things on Facebook. And they said, how do I respond to this? This is being circulated in this focus forum or group. Or they would send me something on Instagram Live and say, this is what people are talking about in this particular age group. What's a perspective that I can put forth? Or would you even jump into this conversation to help bring some knowledge and some truth, but do it in a way that they're like, OK, perhaps I can listen to this person? So fascinating. I was living it in real time without knowing what it is formally. Cool. All right, so I was going to jump to my third question. But now you've brought me back to my actually second question. Oh, that's perfect. So when we think about risk communication, and when I teach people risk communication, there's a bunch of principles. I think CDC has some. Everyone has different books on the principles of risk communication. But there are things like being transparent and honest, being clear and concise, having a trusted messenger, either coming out first or at least coming out early and often, being consistent in your message, not using jargon, being empathetic. Let's see. Anything else I missed from the list of principles of risk communication? Tailor your message to your audience, right? But now, in the new world we're in, right, in this post-COVID world, or pre-current COVID world, right, where we've had I don't know actually which question this is on my list. What's different about risk communication today? What do we have to do differently now? Are those principles still apply, or things changed, or are there some new principles we need to recognize? I think those principles definitely apply. I think what probably is different or there's more nuance to is the speed with which we communicate. In my previous role in organizational development and things, we used to say communicate early and communicate often. Because there is so much information and being shared at such rapid rates, the information or misinformation or disinformation at times would get ahead of the truth. So in risk communication, for me, I would say it was just timely communication. And it's something that I would say over and over again, only say with certainty what you know with certainty. I think too often and early in the pandemic, and I remember when I even was asked in my hospital, we had doctors in the emergency department who wanted to wear masks. And at that point, we weren't recommending universal masking. I was asked to go down to explain to them why they didn't have to wear a mask. And when I look back on that, it was to our detriment of not being able to decipher information as quickly as it was happening. Because there was data and there were lived experiences coming out of the West Coast that was suggestive. No, we should be masking. Everyone should be masking. We had not yet had an outbreak in the New York, New Jersey area. But that's those two pearls. I learned quickly. I learned through failures and through lessons. But to communicate often and only say with certainty what you know with certainty. Because that begins to inculcate trust. That begins to say, look, we're in a rapid-paced environment. Things are going to change. As things are going to change, we're going to decipher that information, decipher that data, and give you the best available knowledge at that moment. And I remember I would have people in communities say to me, I think I'm finally getting it, doc. Basically, you're saying, only go off of what you know right now. Yes, only go off of what I know right now. And when I come back to you in two or three or four weeks, that might change. But it's not changing because we lied. Because sometimes people would say, especially on social media, oh, you all were lying. You said this before. It's because our knowledge has changed. That's the nature of science. And so I think it's helpful in risk communication, especially with this pandemic, to emphasize that's how science happens. That's how science changes. Yeah. I think that's a good point. And I think, do you want to add something to that? Well, just to pick up off a couple of points that Chris made, for me, it was really quite humbling to realize that not all communities or all people want to hear directly or only from government. I'd say the previous response, emergency activities I had been involved in prior to COVID, it usually was a governmental team providing the information. And that seemed relatively sufficient. I now think, actually, we go back and look and see if we were reaching different communities in different ways. But I think we were slow to recognize how important. And it's one of my later slides. Oh, you want a slide? If you could go to the slide pairing the government. That government spokespeople are, it's really important for us to think about, early on, being paired with the right community leaders, the right voices, as Chris was saying. And I think it took us, we got there. But there was a lot of time lost. And I'm speaking somewhat from the CDC perspective in that comment. Because I would say in a lot of communities, I spent a lot of time in local public health. That was something that you develop over time, those relationships, those community partners that you knew needed to be at the table and then being the main messengers in their communities, in their spheres of influence. So I think it's a balance. So certainly in the beginning, it's likely to be the health department. Or with COVID, it was also fascinating to see how many mayors and governors at the federal level, in the beginning, the president was doing a lot of the press briefings. So something of this magnitude, it really does, you have to kind of prepare for who are the different people who are going to be talking and making sure that the political leaders, where they will have their platforms. But really importantly, in communities, we need to have the right trusted leaders and share information with them as quickly as possible so that they can then be more effective with many community members that, quite frankly, as government, we probably will be dismissed. Just to, if I can, if I may, just to piggyback on that really briefly. So we saw that happening in Newark, New Jersey. People were seeking out and they wanted another credible voice to be able to speak to them about the truth of what was happening in the pandemic and why they saw so many of their family, loved ones, friends dying and dying rapidly. Because we were thrust into the epicenter of the outbreak. So we at the University Hospital, we started a Facebook Live. We started a Facebook Live. At one point, we were doing a Facebook Live every week. And it became known. Tune into the Facebook Live at 630. The CEO of the hospital is going to have on people from community, people you know, whether we're pastors. At times, it was the mayor. We did joint Facebook Lives with the mayor, myself, and the CEO. And the mayor's Facebook Lives became one of the most credible sources of information for the Newark community. And we in the hospital would oftentimes want to know who was putting out information, what was their bandwidth, who had credibility with specific populations within community, and how could we partner and collaborate with those people. Because that's where we began to see a bit of a shift and a sea change around. I don't call it hesitancy. I call it either confidence or a lack of confidence, right, or willingness or a lack of willingness. In particular, around vaccination. That's where we started to see sea shift changes when we were able to communicate in pair with people that other people in the community said, I know that person. I know Ms. Williams. I trust Ms. Williams. I listen to what she says. Just to add one more thing to that, exactly what Chris said. We looked at liberate movement, which was this movement. Oh, sorry And what we found in that social network analysis study, which is looking at what the origins were, is that science is really hard to communicate. And that information can change but with misinformation, it's easy. You just tell someone Oh back This may not be the right demographic to talk to because you guys really, you know, look at very high qualitative. And I think that's one of the things we all have to address, is what is this new medium environment we're working in? And how do we communicate science more effectively directly, just as Celeste and Chris mentioned? Yeah, and I think along those lines and what, you get to keep that one, I think, something Chris said about one of the principles of risk communication of basically being right and talking about what you know. I think we have to change that one a little bit, actually. And maybe people will be mad at me for this. But I mean, I think we have to do that faster. We have to be right faster, right? And because now you can get your information instantly, and everyone can be an expert, and everybody wants an answer, right? And so there is a void in information. And if we wait to fill that void, then misinformation takes off, right? And so I think, in my opinion, in COVID, there was a lot of things that we should have known, or it just was basic biology. But we said, we have to have the evidence. But we have the evidence. That's just the way viruses work. And we waited. And then the void was filled by other information. And I think when you looked not, I mean, it was different. And it was different across the country, right? So like Santa Clara County, California, was probably the most progressive public health department, right? And they were out. They were also the first place dealing with COVID, right? But they were out always with the message before anyone else. But then, I don't know, when that message takes a long time to spread, and other people take a long time to adopt those things, then, again, more information fills the void. I agree. And I think that's why I continue to say in public, only say with certainty, and to help people understand that there is an amount of uncertainty in science. And there is a way that data grows or accumulates. And what I would often try to do in community is to talk or think through out loud for people the considerations that we in public health were making around, when should we give a different recommendation? Or when should we give different guidance? Or when should our behaviors change? Sometimes I was aligned with federal agencies. Sometimes I was not. I have to be very honest. Because I was looking at how the data was being revealed for that particular group. And I was also considerate of how information is received or perceived by those groups. And oftentimes, I would say, look, these are the risks for you locally here. These are the risks for you as an African-American man of this age. These are the risks for you as a person who works on the front line of industry or on the front line of community. And this is what you need to do to keep you in your household safe. And this is what we know is the best information at this time. And I would say sometimes that resonated with people, teaching them a way to understand and process information and helping them to understand that information will change. Because I was so concerned about trust. I was concerned about repairing trust because there was broken trust. I usually don't use the term distrust because it falls too much on the onus of the individual. And you use things like broken trust because it talks about the lack of accountability of institutions, the lack of accountability of systems of power in generating that broken trust. So helping people in their own language, their own understanding, their own way of interacting to know, OK, this is when we should move. This is when we should think about this differently. And that, I would say, is the difference in the nuance and the risk communication. Remember, any time anybody wants to jump up and join in, please do. All right, Tim, you want to talk a little more about infodemiology? Sure, yeah, absolutely. So just to, oh, I'm sorry. Oh, yeah, you got that. Hopefully this works OK. So as I mentioned before. Oh yeah, this slide up there doesn't match what's down there. And then it includes, you know, what may be in the future, things like blockchain, or even the metaverse, how people are going to be impacted by those very interactive and very multi-modal environments that they're going to be using for a lot of different health-related behaviors. So, again, one of the most important things about this field is that it has to be interdisciplinary. We have to have people from multiple disciplines come in, and we have to have people sharing methodologies. And so that's what's exciting about it, is that there's very little retention. So I want to challenge everyone here to help us identify how we can insert prevention in here, because if we can get some of this data to get it to feedback loop into prevention practices, that would be really, I think, a game changer. So I just want to put that out there. It's a really fascinating thing to look at. Cool. Oh, thank you. Okay, so I see that I made a mistake when I asked people to ask questions, because now there's a huge line, but also the lights are there, and I can't see you, but I see a mass of people. So go ahead. All right, which program are you? UCI. UCI. All right. Does anyone want to start? I mean, I can tell you what we did. We did a mix of, and I did a mix of this myself, so I would mix information coming from like a CDC or World Health Organization versus information coming out of some of these advocacy and interest groups. We had a lot of black and African American or Hispanic or Latino physicians speaking up, having conversations where they would help to break down information, and we wanted to get that in the hands of other providers. We wanted to get that in the hand of other healthcare professionals so that they would have go-to material that was being created, oftentimes with a certain sensitivity to ensure that it had social and cultural fluency with the communities where we wanted that information to penetrate. That was elevating certain podcasts, elevating certain cartoons, elevating standard public health guidance and information, elevating certain interviews. We did that on a very rapid basis. We would work personally at the hospital. We saw about probably from May, June to July a rapid drop-off in people coming even into the emergency room for conditions like heart attacks, strokes, and things of that nature. We had concurrent data from our EMS runs that more people were dying at home or were dying en route. We were like, look, we got to get information out to people that it's safe to come to the hospital. Right? We had to think about ways that we could communicate that, attaching ourselves with, again, influencers. We had a local rapper. We had, some of you may know, Redman. We had Do It All, Dupre Kelly, who just won and is a councilman now in New York. They would give messages. They would do these PSAs. I said, look, let's do a bunch of PSAs. Let's do one in Spanish if we can. Let's do one in Creole. I would say it's important that we have that diversity of information and that healthcare professionals and providers get used to disseminating information that is not just coming from a doctor. Yes, it has to be valid. Yes, it has to be evidence-based, but having the directive to search and to collect. There had been a couple of efforts to collect in various different, I belong to some COVID-19 prevention networks. They would search information that had been created and was out and available in the web. They were like, push this out in your community, if you will. It was unorganized at one point, early, and I would say more customized by different groups. As we progressed throughout the pandemic, like that COVID-19 prevention network and others, like the black and Latino physicians groups, that started to populate with information that we could then use in real time, and I would say in a meaningful way in communities that otherwise were not getting the message. I think there was a question, or part of the question about training for residents. Sorry, it is bright to see. That's all right, yep. I, you know, when I went through my residency, that was something I was offered. I think it was maybe like a couple of half days, and it's a traditional, you have a mock question, scenario with an interviewer, and actually one of the concurrent sessions on, I believe, day one, or no, I think it was yesterday, all the days are running together already, from the Department of Health in Texas, from that program, there, I think there are a lot of opportunities to standardize that kind of experience as part of the curriculum for residents, and I'd say not just preventive medicine, but I think particularly because we have that unique voice, and to be able to pull together lots of different aspects for emergency responses, but I'd say just more broadly, our ability to talk about social determinants of health, and community health in different ways, that training, and I remember at the time, I, you know, you think it's kind of goofy, and you're like, I mean, I have it on a VHS, like that's how long ago it was, I'm like, I don't even think I could play it to watch it now if I wanted to, but that exercise is invaluable, and that was something I did early on, and then looking for opportunities, and I know there are a number of companies, actually I'm making a mental note, CDC used to offer training on risk communication and media training in general, I think maybe because of the pandemic, and lots of challenges, I don't know that's been offered as recently, but I'm gonna ask about that. But CDC, I mean, just to add, like CDC is a good place to go, like there's still a lot of good resources on the principles, and a lot of training materials there. Certainly online trainings, but I don't think that takes the place of the actual, like that mock experience, where you are on the spot, and you know, learning to say it's okay to say I don't know, and you know, feeling okay with that, and not making up an answer because you feel like you're supposed to know everything, which I think is a trap that many of us have probably found ourselves in, but I, so I would encourage, you know, we are here to talk about training opportunities, I think that would be a really excellent, consistent skill set to provide to residents as we're thinking about the role for preventive medicine. Yeah, and I think something that college is also exploring, how to create some content around that for training, plug for Angela. And if you, I love going to California, so if you want me to come talk to your residents, I'm happy to come visit. I think Rick, is that you? Yeah, it's a good question. It's sort of like my next question that I was going to ask Celeste. So maybe we could combine the two. I don't know, Celeste's giving me funny look. Well, I was like, actually, I was going to ask Tim. Do you know where the ivermectin rumor started? Well, I mean, but as Rick said, I mean, I think there was a lot of things. And I know my former boss jumped on to hydroxychloroquine. I didn't want him to, but he did. I mean, there was lots of doctors who did those things and maybe spoke too exuberantly about them. And then they became very political. But it all started with some data. Yeah, and I think I spent seven years of my life debunking things, and I think it's so much harder to debunk something than to spread misinformation. That's easy, but to then formulate the argument against it is very, very difficult. Well, I know we, I see, is that a mirror? I mean, let me just ask Celeste a question, and we'll come back to your question. So I mean, kind of along Rick's question and Tim's comment, like, should public health be political? I think people have different feelings about that, and how should preventive medicine physicians navigate that space? Yeah, you know, I've heard this question in debate quite a bit, and my perspective will be from a governmental seat, because public health means lots of, you know, we're all practicing public health regardless of where we are and what types of organizations, but from a governmental perspective, you know, it is political. No matter what level you are in, there is a governance structure that is tied to elected officials. You know, I made the comment earlier about the predominance of spokespersons for COVID who were elected officials, which I think is unlike any other kind of response we've seen before, although, of course, we've been saying this is unprecedented. But I think that highlights how closely entwined public health is with politics, and maybe we just haven't thought about it enough intentionally to think about, you know, how do we try to better address some of the messiness and challenges associated with that? But then I would say on the flip side, you know, what are some of the opportunities that we haven't yet developed strategies around? So for example, I think in certain states, you saw that, and this is all about relationships. You know, when I say strategy, it's not necessarily some complicated technical thing we have to do, but just emphasizing how important it is when you are in these roles to develop those relationships with obviously your governance team, whatever that looks like, but then also with all of the right community partners, and that includes these trusted voices we keep talking about. And I think having that network really helps strengthen the science and the message associated with the science, because you might be in a situation where, and, you know, I should back up a second and say that the science and data have to be considered with the policy decisions, and we can't, especially when you think about what happens in communities, we can't separate what happens once we make a decision from all of the other maybe non-health related but really important consequences that happen. I think that's some of the struggle that we saw with COVID when it came to the shutdowns and saying, well, everyone should stay home except for if you're an essential worker, or critical infrastructure, that has to be maintained. Well, you know, who were many of those individuals, right? And that created then this dynamic of perpetuating some of the inequities that we've been working so hard in public health, and I don't think we were prepared to speak to that. And so thinking about in communities where there was likely a stronger relationship between the health department and other parts of government, I think there was more support for the voice of public health, and that I think helped to minimize some of the politics. Because when it is the elected official giving the message, I think there is always that question of what is really driving this. So I think it's not an easy answer, but going back to the earlier conversation about training opportunities, I do think this is another space for our residency programs, and not that all of us end up in governmental public health, but certainly as part of the training period, if there's a way to make sure that your experiences expose you to some of these elements so that it's, and these are skill sets that I would say serve you well regardless of what kinds of organizations you end up working with. But in the end, being able, like if I could turn to Chris and say, you know, I can't necessarily be the person saying this, but you have those entrees, that should be a part of the skills that we are taught to think about and hone as we are moving through life. So I would say it is political, but there are opportunities for us to take advantage of the potential for what that could mean. If I could just add something to that, because this became a bit of a quagmire for me. So of course health is political because of asymmetries of power and systems of oppression. Health is political, and what happened in this pandemic is you had political bad actors who were funneling misinformation and disinformation, and at times that was disproportionately impacting historically marginalized groups, especially around the Hank Aaron death where I felt the need to, I spoke up very loudly about that. I spoke up on MSNBC around that, and I spoke about how white supremacist power structures utilizes information gaps and how utilizing information gaps, because we would have people come to Newark, New Jersey, who looked nothing like the Newark community, to tell Newarkers not to take the vaccine, and I took umbrage with that, like even people protesting outside of our hospital, and I remember there was I am also a public health physician. I'm going out there because we cannot stand by idly while people attack, and that's what it felt like. People attack. Someone who can connect and. We were running a Moderna COVID vaccine. Dr. Chris, you're becoming too vocal, but I had a decision. hospital, I won't speak for the hospital, but I will speak as a public health and preventive medicine physician. And I will speak as a member of community. And I had to do that. I was faced with that choice. I had to separate because the truth still needed to get out there. And that's what I would say to this body. There are times where we have to be savvy around the political calculus and how that political So, along those lines, and- I'm having trouble with these slides. No, they're there. But, you know, along the lines of having to stand up and, you know, be the face of this, I just wanted to highlight, and, you know, many of you, some of you in the room might be a part of this number, where, you know, going back to this issue of politics, the impacts on individual health departments, well, the health officials, their families, you know, some of it was- and I was able to talk with a few folks. being asked to say things that they were not comfortable with. They were being threatened. People showing up at their houses. People showing up at their kids' sports events. So it is not easy, and, you know, that I think also is something that we, you know, hopefully we will not see something like COVID again, but I think it is important that we are able to talk about the trauma we have experienced as a profession and think about, you know, these really important roles and, you know, for those of us that have been in these roles, like you feel like it is your dream job until it is not and until something like this happens and, you know, the reality of having that, you know, it is a beautiful opportunity, but the responsibilities and those authorities can come with some really put before this group to think about as well. If you go to the next slide. And related to this, the impact on, and this is not just now the heads of health departments, if you will, but a survey that was conducted across health department staff at state, tribal, local, territorial levels that was quite stunning. There's been a lot of talk about the, and I think rightfully so, the prominence of the impacts on healthcare workers, which some people will say, well, that includes public health, but we were really talking about people in hospitals or in more traditional clinical settings. So this survey, which was specific for health department staff, I mean, it really told the story of how much of an impact this is having, having these responsibilities across all of the various roles within health departments. And, you know, talking with a few colleagues who still are in local health departments, you know, some of it was the sheer. There's just nobody else, especially in the beginning. But as things progressed, some of this came from a place of saying, we're doing all of this really hard, important work to get people vaccinated, to convince people about the right protective measures for themselves. And there came a point where we kind of flattened out our curves. I'd say the support for public health, as we saw in surveys. And the impact of that is, I don't think any of us, or I certainly wasn't thinking about these elements early on until we started seeing them. So again, going back to this idea of the politics, I think there are opportunities going forward to think about. I like the broken trust phrasing. Because in many ways, that was a part of where some of those barriers lay. But some of it was also political. And so thinking through how we can work with leaders with diverse backgrounds and perspectives to understand how can we best serve everybody in our community. And I know there was some criticism in certain parts of the country that we weren't thinking about rural communities as much, white evangelical communities. And we have to hear that feedback and think about, again, going back to the politics, what drove some of that perceived or real lack of investment or ability to work more directly with those communities. And oftentimes, it may have to do with some of the elected officials. But in public health, our role is to try to work towards being able to work with them. Thank you, Angela gave me a note that to let the audience know there are two microphones on either side of this room. I think she was really giving me the note because I'm only looking in this direction, so I don't know who is next. And we actually work with several of these platforms. And so I think this is such an important topic, and one of the things that I really would love your perspective on is we've gotten a real pull both from our patients that we see day-to-day where they're trying to do their own research. And as you're mentioning, people who are spreading misinformation have gotten really savvy at mimicking the things that look like they are legit and they're not. But even the platforms themselves are really struggling with how do we figure out what are those trusted voices? What's really evidence-based? How do we help people to know so that, yes, the CDC, yes, the WHO, but when you have some of these influencers or you have some of these community voices, how do we help people to know that that actually would be somebody that they would want to be listening to and know that they can trust that versus somebody who might look very similar but is not actually evidence-based or not spreading information that would be helpful? And it makes me think back to I had the great opportunity through Preventive Medicine actually to do the residency rotation with the Office of Disease Prevention and Health Promotion. And even back then, they were doing a lot of interagency work about healthfinder.gov and other ways like could we actually have some sort of signal so when people are doing their own research, we're not always going to be in the room with them. We're not always going to be in that conversation with them. How do we help them to also know what to trust, what not to trust, and to have some of those conversations themselves? And so I'd really love to hear your perspective on what we might be able to think about in that space. I can tell you what we're thinking about on a local perspective. So my office also oversees our community and population health department. And I've been hitting the drumbeat around asset mapping, community and neighborhood level asset mapping. And assets are people. Assets are not only brick and mortar structures. But it is important for healthcare institutions, and in particular, those who are living out an anchor model, that you know what the assets are in community. And that's going to take some investment in building relationships. And that's also going to take an investment in sharing power, which institutions do not do well. We don't share power well. And so it's taken us quite some time, but we were able to get this young, smart kid who was able to really help us map out, you know, using the technology of who is where. Whether it's a particular community center, or like I'm telling you, down to a person, and helping people to understand, we know that this person is important in your community. And then when we can marry that person or that resource with factual and evidence-based knowledge, that power is multiplicative, right? So it has to be that level of investment by the institution to learn community and to share power with community. And we often don't do that. We say that community doesn't have an expertise. We say that there is not an expertise in the lived experience. But through community health workers, we have community healthcare chaplains. So we're using chaplains who can go into communities where they have influence, where they have value, and we're adapting and helping them to grow skills so they can become messengers around health-related information. And so that's just one model at the local level. We must think through a more asset-rich lens, and in order to think through that asset-rich lens, we have to have the understanding that there's someone else out there other than us that knows something, and that has value in community, and begin to build those human interactions and connections with those people so that we can begin to not just get information out related to COVID-19, but we're thinking about this through, we're calling them prevention pods. How do we get information out just around all of clinical preventive services? Because we know how unfortunately that has been lacking during this pandemic. People have missed screenings. People are not showing up for appointments and things of that nature. So it's a worthwhile investment for health care and for public health. I could just, my mic's still on, are you okay? Yeah. Just wanted to briefly mention a pilot that is being conducted in six cities across the U.S. that's being funded from COVID supplemental dollars to, I think, get at some of these issues that Chris was just mentioning. It's called Project Refocus. It's being led in conjunction with Howard University, GoHU, I don't know if there are any other Bison in here. Okay, yes. And UCLA. I know I saw a lot of folks from UCLA here. But it's looking at how media, social media, just data that is being talked about in different settings might be targeting, you know, thinking about groups of people coming from out of town to say, you know, to gaslight. How is that influence impacting communities and in their, I learned this term, racializing the experience and bringing additional stigma as people are trying to decipher what information and what people should they trust. So this is early on. They're looking at, I think they're actually trying to identify what are the right kinds of metrics to see which communities are being targeted by this kind of effort to better understand how to, number one, call it out, and then empower community members to kind of take control of the messaging and sharing power through, I'd say, federal agencies. We have problems with that, too. You know, there really is a shift to saying, you know, thinking about your comment about resilient communities, you know, what are those tools and how do we create platforms for more community engagement to have ownership of your narrative and be able to make decisions for your community that inform what government does. And I think what to play off both of those comments and to try to answer your question, I think that, you know, the world has changed and institutions are not the only source of information anymore, and that's a good thing and sometimes not a good thing in the case of misinformation, right? And so while anyone is now empowered to be an expert if they want to be, because technology allows that. So if, as a preventive medicine doc or as an organization or as a community member, you want to be that more credible voice, you have got to put in the work, as Chris might say, right? You've got to build that. You've got to, between now and the next event, you've got to be putting in the time and building your audience and your reputation so that when that does happen, when people step in to fill that void because there's no one's talking, you have to be there. I would say, so we partnered with the state to have these mobile units that would go into the areas that were disproportionately impacted throughout New Jersey. So they were county-specific and sometimes zip code-specific. And so the bus would be there on a certain day of the week or certain days of the week. But in addition to that, those persons or that unit was married with community health workers. Oftentimes, community health workers who were from the communities where the door knocking would happen. And so my team, we were the team that was overseeing this partnership with the state. And that did loads of good work, like in Trenton, New Jersey. That really led to the conversion of people who otherwise were not going to get vaccinated. They were able to say, hey, so-and-so came and knocked on my door, had a conversation with me and said, on such and such date, we're going to have a unit right open up in the parking lot. You can come there and you can get vaccinated. So there was this army, if you will, that went forth preliminarily to have the conversation. Then there was the mobile unit that was there on the specific days. And then there were text messages sent out, right? To remind people, hey, within a certain geographic radius, we are here right now. If you want to come, you want to get vaccinated, you want to ask questions. And that's where institutions and agencies, that's where we have to invest. Because that's an asset-informed approach, right? Who are those assets and how could we deploy assets in community? How can we use technology-backed solutions to help influence a behavior? And I saw us do that with a level of success. But my concern is that evaporating, right? That there is no longer this frenzy, if you will, or focus around all of these sectors coming together to ensure, because states wanted to achieve a certain amount of people vaccinated, right? We had that percentage before us. And we're like, we want to get here, we want to get here. But what about when we get there and we still have these inequities that are driving the disparities that we see among all the other chronic health conditions? And so I would say this is a continuum. This is a process that we must continue to agitate around. And I'm using that word deliberately to ensure that we can truly deliver on health and well-being for communities. because I'm also ordained. I come from a family of pastors and bishops, right? So it's my life. And sometimes people didn't know that about me, so it was like my secret weapon, and other people discover that about me. So I've spoken to groups in Atlanta, I've spoken to the little, small, predominantly white conservative church in Southern New Jersey that only had nine people on the Zoom that morning, but I could speak their parlance, I could speak their language as a believer, as a woman of faith. And sometimes we have to understand the intersectionalities of identity to say, where can you curry favor? Because the person doesn't really believe in the science behind this, and I was able to, in faith-based communities, I had conversations about the microchip. I had very direct and explicit conversations about it, right, and to be able to have that in a very nuanced way, and this is back to that asset-informed approach. You have to know what assets are in your community, know what assets are in your institutions, know what assets are in your networks, and to be able to deploy and leverage those assets. And so at face value, I think oftentimes people would say, oh, Dr. Chris, she can speak to a black or African American or Latino community, but I actually did a lot behind the scenes speaking to faith-based communities, and literally very small groups or larger groups. It would say, hey, let's hit the nail on the head. Let's talk about exactly what people are speculating over, and I found that to be a rewarding experience, and everyone won't have that particular intersectionality, but to know where those assets lie and how to leverage and how to collaborate through those assets, because anti-science is a phenomenon that is hyperbolic. It has become very muscular, and I've even seen it in some peers, which was very concerning. I've had off-record conversations with some physicians who were just not comfortable. We were finding locally that there were certain primary care docs who were not counseling their patients to get vaccinated. They wouldn't do it. And so in learning that, it was like, what are the conversations that we can have when anti-science pops up in unexpected places, and how do we have it, and sometimes not as inflammatory as a setting, as a forum, but to have that, and then to be able to hopefully sway, convert, change certain folks who were pretty staunch about, no, I'm just not gonna give that advice to my patient. Yeah, but I also, I think we have to be a little careful about labeling people, right? And I think people aren't necessarily against science or anti-science. I think we've gotta listen to people. They have different points of view, and to change their minds, we have to meet them where they are, right, and get on their level and understand where they're coming from, right? I didn't mean to, I don't know. Right, but anti-science is different from wait and see. Anti-science is different from I don't really understand. Anti-science, the way I see it, is almost a learned response, that I don't trust this science, this science doesn't have value, so then I won't communicate anything meaningful or helpful through this science. And that's the phenomenon that I think is quite dangerous. And oftentimes, so my father, whom I lost during this pandemic, I also have publicly spoken about, my father had HIV AIDS, and for years, my father lived with the stigma of that and would not tell anyone, would not even tell family. But he would say to me, look, when I'm dead, we never imagined he was gonna die of COVID, but when I'm dead, make sure you use my story and this information to help bring change and things of that nature. So when I would be in certain groups where people were talking about, oh, I don't trust this, or I don't believe in this, and I think it's one of the best ways to meet someone where they are is through stories. And stories that may resonate with them. And stories that may help them unpack. So oftentimes, I would use my father's story of how it was science that gave him the longevity that he did, and how he was so willing, even when he was not directly sharing with us his condition. I remember he would go to all these homeopathic stores, he would go to all these different pharmacies, and I was in medical school at this point, so my antennas were up and I said, something's going on here. But to begin to use that, that science saved his life. And it saved his life in a way that had it not been available, his life would have been cut short. It would have been cut short by decades, by decades. So that's, hearing where a person is coming from, yes, is very important, because then using stories through data to help influence and have, if you can have someone question what they believe so rigidly, I think you've done a great service, especially of what they believe so rigidly is not rooted in the science. And I've had to do that in my community, because specifically, there were people sent to spread disinformation in black and brown communities, and to manipulate very, very raw histories, so that people would not follow through on evidence-based actions. And so there were those of us, I would speak with people at the White House, I would speak with people across the nation, like what are you all doing on the front lines where you are, because we realized that this is happening, and that was a part of that anti-science phenomenon that I'm describing. Yeah, no, that makes sense. And I think the other thing is that we have to be humble. Like science isn't perfect. Science has limitations, right? And I think when we decide like someone's, this is the science, we'll be transparent. We should be in risk communication, and I think that helps. So okay, back to the- Can we pull that video real quick? Oh, you want the video? We're jumping around. All right. We're covering everything on the agenda here. Speaking of being humble, so I work for CDC, I'm trained in all these different areas. I did a number of COVID talks, and I think the one where I was most effective is because it was my friend's father, who's a pastor, asked me to speak to his church, and he was able to say, I've known her since 2000, or actually it was 1998, and she's like a daughter, and you can trust her, and it was amazing. Like that interaction with his church congregation was unlike any other talk I did, because I got all of these questions, and some of them were very surprising, like some of the things people were hearing, and being able to understand what mattered to people, I think that sometimes also, you have to take time to have those conversations to understand what is most important for people, and is that part of the reason why they're not, why they have concerns about listening to government, or getting a vaccine, and I mentioned my friend earlier, who had the daughter who was hearing all of these different concerns about the vaccine, like infertility, his comment to me, which I then started hearing over and over, was until the vaccine is off of its emergency use authorization, I'm not getting my family vaccinated, and we then started hearing this in a lot of faith-based settings, and we're able to then kind of keep that in mind, and be able to say to the FDA, like this is a really important next step, and once that happens, there's a new message that I think will resonate with a lot of these communities, so just speaking of communities, and trying to find the right messages, I wanted to show this video, although I'm not sure, okay, so this, I said we were a little bit slow to understand the importance of having the right spokespersons and voices, but this is an example, I think, of when it happens, it can be very effective, and I wanted to share this with you all. This is Wes Studi, who is an award-winning actor, but also a tribal elder. I believe he belongs to, oh, it says Navajo, I thought he was Cherokee, but we just wanted to show this video as one example of when it's the right messenger, how much of a difference it can make. Council, COVID-19 vaccine. So this was something that was funded, I think, a combination of CDC, COVID funding, and CDC Foundation. So I think, you know, without it being overstated, you know, he speaks to some of the values for tribal nations in a way that, you know, there's probably very few people that would have that kind of impact and voice. So just, you know, something for us to think about moving forward. And thank you for the nod to non-infectious diseases, because I think we can take some of these models and replicate them as we're thinking about, you know, some of the data we heard earlier in the conference about all of the delayed care, the delayed screenings. You know, can we mobilize ourselves to use some of these networks of community health workers or community leaders to talk about health more broadly and help move forward in that space as well. Yeah, we spent a fair amount of time in senior buildings and senior residences just sharing information and this goes to using networks or using systems that are not just specific to COVID. And so we had all already as a part of our community arm, we want it to be inside of senior buildings, bringing care to where people were, right. So that was something that the hospital has it had as its goal. And what we found is that we did have to have those multimodal ways of communicating that information because our seniors weren't turning, tuning into our Facebook live. Sometimes they were, because sometimes we would ask community groups to do watch parties. And so we had set up in a couple of community centers, because now we have like a wellness Wednesday Wednesdays with the seniors and we go in and we do like Zumba and all these different types of things. We set up a zoom so they can come into their, their community area. And so we have to not, not imagine that we can use technology backed solutions for that population. We need to be more creative in how we do it. Right. So that's just one thing I would say. And then we have to emphasize multimodal ways of communicating and leveraging solutions. And so that's why we were oftentimes in person as soon as the senior buildings would let us back in, because for a while we couldn't get in, right. There are certain senior buildings, for instance, in Newark that are control under the Newark housing authority. And then there were senior buildings that were independently owned and there was not the comfort level, given the level of risk to let healthcare providers in the building. So that was one of the times that we felt the most locked out, if you will. And we're thinking about like, how do we shuttle information in? So we used phone where possible. We use social workers who are already in the building. Some of these buildings had social workers or community coordinators already in the building and we would share information with them. And when there was a comfort level of letting us in and properly socially distance, we started to do in-person things, or like I said, having community groups who had technology based solutions sponsor watch parties and sponsor it right there at the senior center. So they could ask questions, they could be a part of our Facebook lives, but we have to be more intentional of thinking through where there are gaps and how we can marry solutions from another group that may also work in this group as well. As well as, for instance, I did something with 1199 SEIU once and they were like, look, we have phone meetings. We've been doing this in our union for years. Come on to a phone meeting and talk. They're like, Chuck Schumer is going to be on at a certain time and then you just come on and talk. So just using the phone where I saw no one's face, but being able to share information and to share knowledge and that union has middle-aged to older Americans that are represented in 1199 SEIU. So that level of creativity I think is necessary. In the beginning, there was a very intentional focus on what was happening in facilities. So skilled nursing facilities, which became a correlate to some extent for older adults. There was such intense focus because of the congregate setting and making sure we had infection control protocols in place and prioritized for testing and vaccination. And I would say overall, that could be seen as pretty successful. But there are lots of older adults that live in communities, that live with families, that might live alone, that might have difficulty leaving their home. And I think we got to a point where a lot of health departments started engaging with the various agencies that focus on older adults. Some places, it was immediate. Others, it took some time to get there. But we then saw this wide array of very creative approaches to delivering services to people at home, which is resource intensive. But again, this could be a model that has many benefits going forward and speaks to this growing trend of all of us getting older, the silver tsunami. My parents are at a point where they're looking to sell the house they've been in for 40 years and move into a retirement community. So personally, I'm also thinking through, how are we thinking about health more broadly for older adults? And what have we learned from the pandemic? And I think we have some really great examples of being creative and being able to provide those services. But like probably several things we've said, it would be a shame if it goes away if we're not able to sustain those models and those efforts. Because I think many of them have been very successful. So I'd say there are pockets where we should be very proud. But we collectively need to be intentional about thinking about older adults moving forward. Vaccination rates among older adults are very good. They're fantastic. Yeah, I mean, I think that's a combination of, like I said, including people in congregate settings and that you're able to vaccinate a lot of people at one time. That's always a good thing. And then I think also, we did see some people that, regardless of age, said, no, thank you. But most older adults, they did understand, I'm at higher risk. I have these other health conditions. I think physicians were much more likely to recommend to older adults because of the deaths we were seeing early on. And then as we kind of got to younger groups, that interestingly, we didn't see it happening as often. So that is also a success story, yeah. Just one other fact to put on that that I just thought about. And so even through our ambulatory practices, we had a very robust outreach arm where we would call older adults and say, hey, you are eligible for this. Your next appointment is such and such date, but you can come in sooner to get vaccinated. And if we knew that there were seniors that were homebound, we'd try to connect them with city agencies or city groups that were vaccinating homebound seniors. So that's a part of that also multi-sectoral approach. But you have to, when a population has barriers to care, you have to think about how you as an institution or you as a particular setting can be more proactive in trying to reach out and engage them and pull them into care. Thank you so much. I really have appreciated the speakers, not just in this, but in previous lectures that have remained sensitive to the idea that the vaccine confidence is not straight down party lines, that gun control is you've got Republicans who would like to see more control and liberals who own guns. And so I really have appreciated the speakers speaking to that. And I was really pleased to also hear you specifically comment on getting into those rural communities because I think sometimes we focus so much on minorities that we forget to think about them as a population we can reach and perhaps influence as well. And so I'd like to focus on a different minority population. It'll be a little bit of a strange thought in a way, but I'd like to talk a minute about the 1% because there's a little anecdote here and then the question. So I know I can speak to Chase Bank, so I have no affiliation, no promotion here, but I just happen to have friends and family who work there, and therefore I'm aware that they are a fairly progressive leadership organization with very pro-minority politics within the organization. And I know and have been privy to some analysis that Jamie Dimon did in his looking at the pandemic. And I looked at his analysis in a kind of an interesting way. It was sort of divided into two parts. I think the first thing that we need to be very aware of is that financiers are always looking at the cutting edge, the next trend, and they are always looking for being on the front edge of the science that's going to make their people a lot of money. And so it is very predictable that before you get a chance to get a message out about hydrochloroquine, they've already been in touch with all of the people making the drugs and doing the science, and they are actually probably ahead of us trying to get that science and hoard it and analyze it and put it out. The second piece, though, is that I think because they are a very progressive organization, he also just really seems to have a lot of interest in getting information to his people as quickly as possible. So while we know that just so that they can make decisions and feel like they've got a CEO who's paying attention to their health and what they can be looking for. So I think what happens is we know that trickle-down economics did not work, but I think trickle-down misinformation is still very effective. So I think in doing that analysis and getting information out, I know that he actually was really looking at hydrochloroquine and azithromycin and some science that was coming in around maybe that being one of the earlier better treatments. And because of the connection with the political community, because so much of our wealth is focused in our politicians and these community leaders you talk about, it seems to me that that connection with the financial industry is a great opportunity to, if we can connect earlier with them and talk to them about the science before they get the science from other sources, I think even well-meaning CEOs and financiers who want to see better things for the community and are doing the best analysis they can could maybe benefit from some of the communication strategies and being part of that leadership. But instead of being the mouthpiece communicating with the community, maybe their influence on the financial analysis could get to those community leaders who are investing with them and working with them. So I feel like we may have a preventive opportunity in that realm, and I just wanted to hear your comments on whether you have considered going to the bankers and the people in the community that sort of pull the strings and sort of follow the money. So I'd just love to hear from you on that. Yeah, I have. I did a session with JPMorgan and Chase, and I did a session with Bank of America. And so the JPMorgan and Chase session involved myself, Donna Shalala, and a peer, Dr. Carlos, out of Emory. And it was focused on their workers to ensure, because you can imagine it's a global organization, they have people all across the world experiencing the pandemic at different phases of the pandemic. So it was about getting out correct information. It wasn't so much on the angle that I think I hear you talking about, the power of that type of organization to disseminate accurate information, but I can tell you that they were seeking voices and they were seeking diverse voices. So I was oftentimes, sometimes in the clothing industry. People would reach out and say, hey, would you come in and speak to this fashion house about this information? Because they have influence, they have value. And we, I'm going to go back to the Pittsburgh ACPM. I'm a fan of preventive medicine. Just going to warn all of you, like I toot the horn all the time. So I'm going to go back to when Soledad O'Brien said to us, right, we need to do a better job of communicating around public health and preventive medicine. And we need to be as savvy and communicate to audiences that we may not think about at first brushstroke. So that sat with me, that really resonated and was germinating in my spirit for quite some time. And so when this pandemic happened, when those types of industries that I may not otherwise have partnered or collaborated with, I said, this is a ripe opportunity. This is a ripe opportunity for public health to think about how to get access to power, right? And how to share critical information. And I definitely appreciate your point. How can we think about that more intuitively? Because oftentimes they have reach or they have resources that we may not have. And so I can, as a person who has participated, I would say it was helpful and beneficial. So I'll just comment briefly. Many of you may be aware that the Defense Production Act was utilized several times throughout the pandemic for various supply chain issues to re-divert or redirect resources or facilities. And this question just made me start thinking like, is there an opportunity and we are a free market, but are some of those conversations opportunities to think about businesses, maybe having a bigger health portfolio or investing in communities in a different way from a health perspective. So I think it is an excellent point because we talk about all the time, the importance of having private sector partners and what does that really mean? And can we get to some of these ground level planning opportunities with them? I'll just share also very briefly, when I was in Florida and we were dealing with Zika, which seemed like nothing now compared to what we're dealing with COVID, but it really was all consuming and very terrifying because of a lot of the unknowns in the beginning about what happens to women who want to be pregnant or people who are planning or in the middle of a pregnancy and now you're told you can't leave your house. So during that, some of the initial phases of thinking about the right partners, we did have a CEO round table that we would meet with regularly in addition to all the other more traditional partners for them to think about their workforce, but then they also ended up donating funds to certain kinds of activities or supplies. Some of it was like the repellent, they would donate to certain communities because of that engagement. And that's a very small example, but I do think it is an opportunity for us to all think about in our respective roles, how to pull in some of these large companies or private sector more for health in general. to be in front of every leader in every industry, whether it's finance or the media, and our voices need to be heard, right? So prevent MS and docs need to make more of an effort to be there, because they're always going to turn to whoever they know, and they have to know us, because we have good answers. Okay, oh yes, sorry, you've been waiting a long time. I feel like I'm getting, I'm getting stupider as I watch these short videos, you know what I mean? And yet, I still watch them, and they get into my head. I tried to crack that algorithm with no success, but I have learned what platforms I have had more success than with others and have promoted messages through there. I started this whole under my personal banner as a public health and preventive medicine physician life clinic. I would do these Facebook live sessions and then promote them. Some of them became pseudo-viral and people were sharing them. I would try similarly to do things on Instagram, either alone or partnered with a Dame Dash or partnered with an urban league or partnered with another group. When I thought I understood it, I was like, no, that one, it didn't get through, it fell flat. I think it's worth, like Tim, I can't get to TikTok, I just can't do it, I leave that to my nieces. They share stuff with me, I'm like, I'm not taking on another platform, but I do think it's worthwhile for us to begin to agitate and advocate with big tech, ways to make that algorithm more friendly to healthful conversations. Hi, my name is Meredith Millian. I'm a family physician from Dartmouth and a preventive medicine resident. As part of our training, we participate in the Positive Power and Influence course. One of the strategies they put in our toolbox is disclosure. I wonder about your thoughts on the use of disclosure when talking about COVID-19 with patients, both on the personal side in terms of what it might have been like to walk past protesters going into the hospital where you know you're going to see a lot of folks die from preventable complications of COVID-19, as well as disclosure about the imperfections of the public health response, specifically when you're in that clinic room with a patient who's saying, I don't trust the information I'm getting because I'm getting mixed messages. How much do you think it's reasonable to say, you know, our response wasn't ideal? There were a lot of mistakes that were made. I'm partnering with you in that frustration, and how can we move forward together to make sure that you get the best outcome you can possibly get? I think you're spot on. And that's what I've done. And so my mom, I always tell people, neither of my parents went to college, but they gifted me with such beautiful assets and tools, and my mother had a PhD in love, and my mother taught me the power of speaking, the power of telling stories in her kitchen. I didn't learn how to cook in her kitchen, but I learned how to tell stories and how to talk to people. And so I have used disclosure to disarm, to befriend, to show empathy, and to make human connection. And so many people knew that I lost my dad on April 13, 2020 to coronavirus while I was working at one hospital. He died at another hospital four miles away. I talked about that publicly. I talked about what that felt like. On the day that the U.S. Army showed up at my hospital, I still went in because I wanted to make sure my teams were okay. They were giving out assignments, and I said, my teams need assignments. And then that's the same day I rushed out to see my father before he died because I finally got permission, but he died by the time I got to the parking deck. And so I tell that story, and I've told that story publicly. I've told that story on the news. I've told that story to two people, three people, four people, and it has carried power. There is power in truthful telling of things that are otherwise uncomfortable. And with permission, I've spoken about my sister who has had long COVID and the challenges that she's had of being a frontline worker, working during the pandemic, getting exposed. My sister had just returned to work. She was a breast cancer survivor, had just returned to work, didn't have adequate access to PPE, got exposed, got COVID, and developed long COVID. So I think it really was able to give me entree to certain people who otherwise didn't want to listen, and when I don't see a response that I think is as effective as it can be, I've said that. When I don't think we know with certainty a particular thing, I've said that, and I think the more that we can do that, the more we can generate trust. Yeah, I mean, I think being open and honest in yourself is the most important thing. I know of no other way of being, but I think that resonates with people, and I think even like, I don't know, maybe it's a dumb example, but when you think of someone like Martha Stewart, who I love Martha Stewart, but when you read her social media posts, and she's doing some crazy thing, like diving for scallops in Maine, cook five minutes later, no one ever posts, writes something nasty back to her, there are always good comments, because that's actually who she is. She's like a crazy person who does these crazy things, and I think that makes, that's why people like her. I think being genuine is really important. You know, I would share that, you know, I talked about several people in my personal life that, you know, I think in the end helped influence changes at a federal level, because, you know, what we're doing is meant to help people, right, and if we take ourselves out of, you know, if we forget why we're here, then we've lost, and so I think, you know, for me personally, you know, people know where I work, and so I would get calls all the time from friends who have no healthcare background, or, you know, friends from med school or residency or, you know, along the way, and, you know, it's hard to try to be able to explain some of the challenges, and, you know, I'll go back to our earlier conversation about the politics of it, and, you know, it took me a while, even though I was involved with the CDC response, you know, I went to D.C. in June of 2020, and that's when I saw, like, there is this huge apparatus, I mean, there were these huge rooms full of people from FEMA and DOD, in addition to HHS staff, and, you know, all of a sudden I was like, oh, this is, like, this is way bigger than public health, and I think, you know, it wasn't until I saw that I was able to articulate, you know, in conversations to say, you know, I know oftentimes it looks like CDC is making decisions in a vacuum, but we're not, and, you know, that, again, goes back to the politics, and, you know, it's difficult to be able to explain, I think it's equally difficult to hear, because I think people, you know, want to feel confident in all of our decisions, you know, I think going forward, this idea that we've all been talking about of being very clear that this is what we know for now, but we're dealing with something novel, we will have to, you know, these changes might be weekly, you know, that's something that we've, I think, learned so much from from this experience, but being able to talk about that in a way, because I think people would understand that, like, it's new, like, if you did know everything, then maybe it really did come from a lab that was, you know, intentional versus having to learn as we go, because we really don't know what we're dealing with. So I would encourage all of us to be honest about some of the missteps, some of the areas where we should have communicated differently, and, you know, I would say, you know, I'm saying we as in all of public health, but I think it's fair to call out certain agencies where appropriate, but it really was a very large U.S. government response that we've never seen before. And, you know, we never really talked about that publicly. And I think that, you know, again, something for me personally, was really eye opening. And I hope me sharing this with you will give you, you know, maybe pause for you having some some deeper insight into some of the whys for certain things. All right, well, you know, we were thought we were going to end early, and now we're time. We have no way. So I want to thank everybody. Are we actually over? We actually went over?

panel discussion

risk communication

COVID-19 pandemic

transparency

misinformation

infodemic

infodemiology

trust

healthcare professionals

residents

challenges

engaging communities

technology

social media platforms

collaboration