health

Ana Santos Rutschman, Saint Louis University____Editor’s note: The Equal Employment Opportunity Commission, the federal agency in charge of enforcing laws prohibiting discrimination in the workplace, on Dec. 16 said that employers can require employees to get vaccinated before entering the workplace. Now that two COVID-19 vaccines have received emergency use authorization in the U.S., some people are concerned they could be fired if they don’t want to take the vaccine. We asked legal scholar Ana Santos Rutschman, who teaches a course on vaccine law at Saint Louis University, to explain the decision and the rights employees and employers...

If you’re interested in sharing your opinion on any cultural, political or personal topic, create an account here and check out our how-to post to learn more.____Certainly, the events of 2020 are unlike anything we’ve ever experienced. In the midst of a pandemic, a series of unjust and unimaginable deaths of African Americans were recorded and revealed to the world via videos on eyewitnesses’ cell phones. The prevalence of systemic racism in our country pervades more now than ever. The veil has been lifted. For the first time, some people are realizing a reality they didn’t know or want to acknowledge existed — that African Americans in this country are treated as second-class citizens, even in the “Land of the Free.”While I have found myself occasionally bogged down by fear, frustration and hopelessness, I have also used this time to reflect on ways I can create, channel and spur real change. As an African-American genetic counselor and scientist, I mourn the incessant attacks against people who look like me year after year. As I turn inward to counter outward pressures, I am empowered to create and sustain a legacy that fosters equity and inclusion of visible and invisible diversity, both for those working in the field as well as the patients and communities we assist...

If you’re interested in sharing your opinion on any cultural, political or personal topic, create an account here and check out our how-to post to learn more.____Living a life of normalcy and enjoying the oddness of the mundane are great ventures that weren’t afforded to me. Adulthood seemed like incomprehensible anguish, a rollercoaster of fickle despair with a drop of elation.“Wake up to smell the roses,” they said, if only I could manage to get out of bed and brush my teeth first, or shower and wash my face.You see, at 19 years old, I was diagnosed with depression and anxiety. I was living every day in waking misery, fatigue and body ache, and the wretchedness of trying to make it through college. As an young adult, the trepidation of looming deadlines from essays, projects and later nagging bosses would leave me paralyzed, unable to complete even the most basic tasks, while constant changes to my antidepressants and antianxiety medications led to a 50-pound weight gain and deeper depression. While I was maxed out on Prozac, my soul felt numb and the rapid thoughts and heart palpitations never seemed to stop.By the time I was 28, a new team of doctors finally accurately diagnosed me with bipolar II and a borderline personality disorder. I was placed on a new medication regime with the proper antipsychotics. A cocktail of Lamotrigine, Abilify, Lexapro, Trazodone and Klonopin made my soul glow, and my mood swings finally ceased.From there, I was able to gain some control over my feelings of hopelessness. With proper medication and regular psychotherapy that helped me reprogram my thoughts, I learned that nothing is black and white, and recognized that there are gray areas. With that, I found a happy medium in life.Despite it all, I had become an accomplished young adult with friends and family by my side. I landed a graphic design job with my dream starting salary. I work with an awesome team with room for me to grow in the company. I live in a cute garden home with my pups, sister and nephews. All this filled me with energy and a zest for life. I knew that anything was possible, and I wanted to take on the world.One night, as I was sitting on the edge of the bed, I searched for something special to treat myself because I finally felt like I had it all and wanted to celebrate that. But I could not find anything that culturally represented me other than a graphic tee. I wanted to celebrate my wholeness, and all the craziness that came with it. As an accomplished 28-year-old with a mental illness, I could now recognize all my wins and lessons learned. So, at that moment, I decided to take matters into my own hands and birthed my business, Curly Contessa, a culturally centric home goods and giftware line.I found solace in illustrating and celebrating my tribe. Each product highlights the beauty and strength of Black women. I find joy in sending friends and loved ones gifts for holding me down through a bad spell. It is important for those gifts to represent them, to represent our diverse hair textures and varying skin tones. So, because I get to help other people feel seen, life has become one big celebration.I am now able to celebrate the little things because of the times when even the thought of getting out of bed was difficult. I am more engaged in life. Now at the end of the day, I get to pour a toast to myself in my own “Black girl magic pint glass” or sit in serenity on the sofa with my “All the feels” mug. Holiday gifts I give will be wrapped in paper with the faces of a diverse group of Black women who look like me.Battling a mental illness is tough because you must retrain yourself to get through each day of the week. The holidays can be a challenging time and emotionally exhausting. Whether it’s seasonal changes, meeting end-of-year deadlines or dealing with dysfunctional family members, the holidays can seem not so merry for some. I am happy to be in a place where I can share my feelings and bring hope to others. By being my own Santa, finding soothing activities and creating a relaxing environment with serene music and a cozy blanket, I put myself in a jolly spirit. Focusing on what makes me happy, being encompassed by friends and family, and keeping things simple helps me create merry little moments.For me, there is no gratification in being average. My comprehension of life has heightened, and I have far surpassed being standard. Now, I aspire to be great in everything I do. I have learned to enjoy all the complexities of life. The delicate nuances of daily living and experiencing a vast array of feelings when I once felt numb make me whole. I cannot wait to ring in the New Year knowing how far I’ve come; I have plans to extend my home goods line. The pride that comes from watching my dreams grow has been the best gift...

If you’re interested in sharing your opinion on any cultural, political or personal topic, create an account here and check out our how-to post to learn more.____“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”— Dr. Martin Luther King, Jr.There is a crisis of trust in healthcare in the Black community. From the brutal days of slavery, when Black people were constantly exploited, to the U.S. Public Health Service Syphilis Study at Tuskegee, where Black men were left to suffer and die untreated, and Henrietta Lacks, whose cell line gave birth to countless advances in the treatment of disease without her knowledge, consent or any compensation to her or her descendants, the medical establishment has betrayed Black people. Today, we see that maternal mortality for Black women is three times higher than that of white women, Black newborns are more likely to die if not treated by Black doctors and COVID-19 is more likely to kill Black, Hispanic and Native American people.These are the hard realities of the Black patient experience in healthcare.When Black patients don’t feel safe, respected, valued or heard, they are less likely to seek medical treatment and more likely to suffer from treatable diseases. Moreover, more than 90% of patients that participate in clinical trials are of European ancestry, but in order for medicines to work for everyone, we need more diverse representation. Our team at Genentech — a biotech company focused on tackling some of the world's most serious diseases — wanted a better understanding of why patients of color were not participating in clinical trials and discontinuing healthcare services, so we went directly to the patient.We developed a study that elevates the patient voice by asking them how they experience health inequity in their daily lives, and how that inequity impacts their relationship with the healthcare system. We probed into the healthcare engagement and experiences of 1,200 medically disenfranchised patients, as well as 1,000 patients that represent the U.S. general population for comparison. Medically disenfranchised patients belong to historically marginalized communities that lack access to quality healthcare, and report having experienced unfair treatment based on factors including race, ethnicity, gender, sexual orientation, income and socioeconomic status. Of the 1,200 disenfranchised patients, 300 were Black, 300 were Latinx, 300 were LGBTQ+ and 300 were of low socioeconomic status.Our study highlights what millions of Black people, and other medically disenfranchised groups, live every day. But what we learned is this isn't just an issue of access, it's a crisis of trust. Medically disenfranchised patients believe the system is rigged against them, and understandably so. In fact, less than half of medically disenfranchised patients have confidence that the healthcare sought will be considerate and empathetic, and fit their specific needs. I understand this dynamic first-hand. While I may be a biotech executive, I am first and foremost a Black woman. A Black patient. A Black mother. In fact, my family members and I will often go out of our way to be seen by a physician of color. I know that by doing so we will be cared for and understood.Patients do not believe they all are treated fairly and equally, and medically disenfranchised patients are delaying and discontinuing routine care because they do not believe they are understood. Based on our study, 49% of the U.S. general population feels all patients are treated fairly and equally — medically disenfranchised patients don’t agree. Only 27% of Black patients surveyed believe that all patients are treated fairly. This contributes to a vicious cycle of underdiagnosis and undertreatment.To combat this problem, Genentech is working to build trust by leading the industry forward in delivering scientific innovations that drive better outcomes for patients and communities, our employees and the healthcare system by advancing and boldly championing diversity, equity and inclusion. We are acting with urgency to make the healthcare system work for patients who need it most. We are committed to advancing inclusive research, partnering with communities to make quality healthcare more accessible and investing in a diverse STEM talent pipeline to ensure the next generation of doctors, scientists and researchers are diverse and representative of what the world looks like. But there is still so much more work to be done.Clinical trial participation may not be something you or a loved one are eager to do, and understandably so. But in order for us to deepen our understanding of disease and develop more personalized treatments for people of all backgrounds, we must have more complete information and study a broader population, including Black patients. A great example of how we’re working to advance this at Genentech is our recent EMPACTA study of patients with COVID-19 pneumonia. We focused on enrolling minority patients often underrepresented in clinical trials, and by coming up with new ways to engage patients from diverse backgrounds, we were successful: about 85% of patients came from racial and ethnic groups underrepresented in clinical studies. We were encouraged by our ability to enroll so many diverse patients for this trial — which makes me optimistic for a future with more diverse clinical trials.It is critical that our industry engage diverse representation in clinical trials — especially when it comes to illnesses that are more likely to impact minorities. That’s why it’s important that as we advance personalized healthcare for all patients, we create systems that are inclusive and equitable. As we continue to use artificial intelligence (AI) to rely on data for personalized healthcare and the use of technology continues to grow, the need for more representative data increases. AI will become increasingly important to diagnose patients, yet the current data that feeds into the models is not representative of diverse patient populations. We need to build trust and engage underrepresented populations in our healthcare system to inform and improve AI algorithms that will be making many of our future healthcare treatment decisions.Another way to achieve health equity and hold the healthcare community accountable is to empower patients with the tools to advocate for themselves while under care of a medical professional. Taking steps like insisting on multiple professional opinions and getting written documentation of diagnosis, or even documentation of treatment refusal are important in the fight for equitable treatment, and holding healthcare professionals accountable.As we work to advance better health outcomes for everyone, we must also foster belonging and support the wellbeing of the people we work with every day, and lead with empathy for those around us who are most affected by medical racism and health disparities.The findings in our study and the reality of health disparity are not surprising. But it is important that we have the data to back it up. To address health care disparities, we must address issues of trust in the healthcare system. We need to build bridges to medically disenfranchised patients. We must give them reasons to believe in the healthcare system.We must speak up, stand up and step up to end all forms of racial injustice. By doing so, we can work to advance health equity for everyone, including the Black community.____Quita Highsmith is Vice President and Chief Diversity Officer at...

Written by Sterling M. McPherson, Washington State University; Erica Weintraub Austin, Washington State University, and Porismita Borah, Washington State University____Recent polls indicate that more than a third of the country has concerns about a vaccine that in all likelihood will be the only reliable way to end to the COVID-19 pandemic.These results reflect a similar public sentiment in the U.S. in the 1950s when a polio vaccine was introduced. There are likely multiple reasons for this suspicion, including safety concerns, lack of transparency from the scientific community, lack of trust in the government and the desire to wait until a longer track record of safety can be established.We are experts in media literacy, health and political communication and biostatistics and biomedical research for future health care providers, from Washington State University’s Edward R. Murrow Center for Media & Health Promotion Research and the Elson S. Floyd College of Medicine. We also live in the communities we hope to serve with our science.Based on our research, we believe that officials need to use this testing period to build trust, not to create reasons for diminishing it. Respect and forthrightness can turn the tone from adversarial to collaborative, and from a provider-directed practice to a shared decision-making process. Scientists and public health officials must anticipate and address people’s concerns and not brush aside concerns, a process that has become commonplace across other areas of the provider-patient relationship, but vaccine decisions remain a notable exception.Vaccines and complicationsVaccines are among the safest, most transformative drugs on Earth, with adverse events so low that very nearly universal vaccination is a reasonable expectation. With such a safety record, and with so much at risk with diseases like COVID-19, measles and influenza, vaccine advocates have good reason to stress the overwhelmingly positive safety record.History has included some vaccines of questionable quality as well as vaccination tactics of even more concern. Certain minority groups have been targeted with egregious coercion. This included cases of forced vaccination for smallpox of African Americans at gunpoint in the southern United States in the early 1900s. At a tenement house in Manhattan’s Little Italy, over 200 men in 1901 in essence performed a smallpox vaccination raid in the middle of the night, trying to vaccinate as many people as they could.When the miracle vaccine for polio was widely distributed in 1955, speed took precedent over safety, and many doses were distributed that contained live polio virus. As a result, 70,000 children developed muscle weakness, 164 were paralyzed permanently and 10 children died. This led to direct government intervention that has led to thousands of required tests in order to ensure safety and effectiveness.Instances like these undoubtedly fuel people’s concerns. Such occurrences should give us all pause, scientist or not, to do better next time and strive to never repeat such notable grievances.Why can’t vaccines bounce back from mistakes?As medical and public health researchers, we have found it interesting that corporations that have been lax and dishonest have bounced back without lasting damage to their reputations. For example, Volkswagen was caught in 2014 for outright lying to the public about their emissions. By 2019, the company topped its prescandal sales record of 2014.We accept these occasionally fatal flaws and ethical missteps because cars are essential to our lives. The documented safety record of vaccines is staggering, not unlike the impressive safety record boasted by most automobiles on the road today.Why do vaccines get special scrutiny? Have scientists and health care providers engaged in scientific snobbery by assuming people should do what we advise, without question or any decision-making process? Can scientists and health care providers communicate the good and positive (and bad) background of vaccines better? Has social media sown doubt in an authority that can be perceived to be overconfident? Personal health care decisions have a lasting impact on our kids and our families, so let’s rise to the occasion and utilize this unique opportunity to reframe the conversation about vaccines.Embrace shared decision-makingThe existence of a little-known but critical government office both acknowledges past problems with some vaccines and also provides a method of recourse for those injured by vaccines. The National Vaccine Injury Compensation Program, launched in the 1980s, is a powerful tool for transparency and accountability that should help shape this important, shared decision-making process. For example, between 2006 and 2018 over 3.7 billion doses of covered vaccines were distributed in the U.S. During this same period, 5,233 filed petitions to this office were compensated out of a total of 7,482 petitions. This means that for every 1 million vaccine doses distributed, one individual received compensation.Rather than brushing off concerns among parents and others who are concerned about safety, experts should listen. When they do talk, they should explain safety issues and should use metaphors such as the safety of vehicles and other medical breakthroughs (e.g., insulin, heart valve surgery) so often relied upon in an effort to work toward the same goal together as a country, and as health care provider and patient.Experts should acknowledge that the practice of medicine and public health research is a relatively new field of science to drive public health, medical practice advancement and policies when compared to other, far more established scientific disciplines such as physics or chemistry. Building public support requires more than citing solid evidence in the peer-reviewed scientific literature. Owning up to setbacks in vaccine development that the current administration may be on the brink of repeating – and then making the necessary repairs to move forward again, as the auto manufacturers do – also builds confidence. AstraZeneca’s public announcement about a serious adverse event in one of their trials, which led to a pause of participant enrollment, was a great first step.Let’s begin by acknowledging that all parties want to achieve the same end goal of a healthy, safe return to daily life. Despite the explosion of misinformation about COVID-19, a clear, consistent and respectful approach can reset the vaccine conversation.[Deep knowledge, daily. Sign up for The Conversation’s newsletter.]Next, let’s acknowledge that vaccines are not now and have not been 100% perfect (nor is any medicine or car). We should also note that the same science that produces vaccines also produces myriad breakthroughs in specialties such as cardiology and oncology, along with over-the-counter medications such as ibuprofen that mitigate minor ailments but also have limitations and warning labels.Finally, invite skeptics to a conversation and acknowledge up front that, like any other scientific advancement of things that now work, there was a time when they didn’t work as well, or at all.____Sterling M. McPherson, Associate Professor, Director and Assistant Dean for Research, Washington State University; Erica Weintraub Austin, Professor and Director, Edward R. Murrow Center for Media & Health Promotion Research, Washington State University, and Porismita Borah, Associate Professor, health communication, Washington State UniversityThis article is republished from The Conversation under a Creative Commons license. Read the original...

If you’re interested in sharing your opinion on any cultural, political or personal topic, create an account here and check out our how-to post to learn more.____COVID-19 is a diverse illness. Some have no symptoms (asymptomatic), while others have flu-like symptoms. In the worst-case scenario, mechanical ventilation or death is a grim reality. A number of factors are theorized regarding why COVID-19 impacts people differently. Many people like myself are not sick enough to need mechanical ventilation or be hospitalized long-term, yet have been sick at home for months.I remember back in March collapsing on the bathroom floor, suffering from severe shortness of breath and chest pain, begging God not to let me die. Most importantly, I pleaded that my two little girls still needed me.My life was thankfully spared that night, but the next day I updated my last will and testament to ensure my daughters would be taken care of in the event of my death. My video diary chronicles my experience to warn others about how awful COVID-19 can be to a young healthy person.  Nearly five months later from experiencing my first COVID-19 symptoms, and I’m still under the care of a neurologist, cardiologist, pulmonologist, urologist, infectious disease specialist and a gastroenterologist. I belong to a hidden group of people who suffer from post-viral syndrome. I have experienced doctors who didn't take my struggles with COVID-19 seriously. It took a lot of work to assemble a good medical team. My next obstacle is economics, because being sick for so long means the possibility of being forced into short-term disability and taking a pay cut. The most upsetting aspect about my situation is that doctors cannot tell me how long I should expect to be...

If you’re interested in sharing your opinion on any cultural, political or personal topic, create an account here and check out our how-to post to learn more.____Co-written by Tahj Blow and Lala Tanmoy Das____We are in an unprecedented time.In response to anti-Black police brutality, variations on these words have reverberated in media reports, protests and across kitchen tables over the past weeks. Police brutality is not the only symptom of systemic racism, however. Focusing on law enforcement is a reductive solution to a complex set of problems. The cessation of American Apartheid requires that all social institutions eliminate their contributions to institutional racism.Medicine and science are not exempt from this responsibility, despite swift condemnations of racist policing by medical institutions. Medicine has played an essential role in perpetuating systemic racism through the codification of race itself. From scientific polygenism to eugenics, the justifications for slavery and discrimination relied heavily on pseudoscientific claims about the inferiority of Black people and other non-whites. Racism cannot thrive without race.Today, overt hierarchization of the races has evolved into a new medical racism, its logic rendered more subtle and insidious by the seeming support of statistics. The ripple effect of medical racism’s assertions pervades not only medicine and science, but is also used to justify white supremacy in social and criminal justice policy.Within medicine, racism can corrupt the patient-doctor relationship; it also affects the treatment of trainees. After a weekend galvanized by New York protests, L., a Black medical student, was joined at her workstation by her attending physician and medical team. L. took her turn sharing weekend updates.“I bet you went to the protests,” the attending pointed at her and said.L. nodded.“I hope you didn’t bring a gun to the hospital to take out your anger.”Everyone laughed and L. joined nervously.L. is far from alone. Medical trainees of underrepresented backgrounds tolerate both microaggressions and explicit discrimination, and bear witness to this mistreatment of patients who look like them. Although medical centers have established channels for anonymous reporting of mistreatment, fear of career repercussions is often a deterrent. Despite efforts like 24-hour hotlines and direct reporting to academic deans, the protections afforded to offenders by titles, finances and institutional prestige often thwart positive change.To correct these failures, many medical institutions have implemented anti-bias training initiatives, touting them as a panacea to institutional racism. However, research has often shown that implicit bias training not only fails to alter behavior or change workplace culture, but may actually normalize stereotyping. Instead of promoting anti-racist behavior, our current methods disincentivize the application of comprehensive, structural, radical interventions necessary to address workplace bias.So, where do we go from here?First, we must recalibrate medical education to teach racism, not race.In 2018, Serena Williams sparked a national conversation on racial disparities in maternal mortality. In a lunch conversation one of us had at that time, a non-Black medical student expressed her surprise, presuming that larger hip width makes childbirth easier for Black women. When informed of Black women’s unequal treatment, she waved off the fact, citing the genetics of Blackness as the probable cause of disparate outcomes.Medical education, and the licensing exams that shape it, must acknowledge the sociopolitical, structural factors that contribute to racial and ethnic health disparities, rather than perpetuate narratives emphasizing physiological differences among races.From diabetes to heart disease, students are routinely taught that Blackness itself leads to disease. Teaching race as an epidemiological risk factor, without discussion of the structural insults leading to these statistics, confers biological truth to the social construct. It upholds racial essentialism, suggesting innate differences in the Black body and allowing racial bias to persist.Alternatively, medical curricula must emphasize the effect of redlining on increasing pollution in Black neighborhoods, escalating the prevalence of asthma in Black children. Students must be taught about the physical toll of the unrelenting stress of racial discrimination contributing to hypertension. The field must address the misuse of race corrections in debunked medical algorithms. It must address practitioners’ failure to prescribe adequate pain medication to Black cancer and postsurgical patients, as compared to their white counterparts. This is critical to ending dangerous stereotypes otherwise persisting in the minds of medical trainees.Second, we must invest in genomic research and studies of the epigenetics of risk genes in order to provide truly personalized medicine to patients of non-European ancestry. Currently, genetic analysis lacks the granularity necessary to accurately determine risk or prognosis, and guide treatment, for patients with African ancestry. Diagnostic shortcuts often use phenotypic Blackness as a proxy for genetic ancestry, even though the presence of high-risk alleles may vary by country origin and within ethnic groups. Efforts to determine genetic risk scores in Black patients are further stymied by science’s inequitable focus on European genetics.In genetic studies, individuals with genes associated with European origin are overrepresented at a rate nearly five times their percentage of the global population. Comparatively, individuals with genes of African ancestry are understudied at a rate only one-sixth of their global representation. As a result, patients of European genetic ancestry benefit from more nuanced clinical care, based on their individual genetics — whereas Black patients are often treated as a monolith. Treatment recommendations, like first-line treatment for hypertension, are determined by their skin color. In this paradigm, disparities in treatment and health outcomes are inevitable.Third, we must effectively teach allyship — the concerted practice of social justice and inclusion by a majority group to advance the interests of a marginalized group. Following racist encounters, Black, Indigenous and People of color (BIPOC) often must seek safe spaces with their peers to have their experiences validated and discussed, an experience that contributes to a sense of isolation in the professional arena. Teaching allyship requires that non-BIPOC participants be involved in a way that encourages them to learn from leaders among their peers, propose their own solutions to biased encounters and be held accountable by marginalized groups. This was demonstrated with the successful “Advocates to Allies” program, pioneered by North Dakota State University in 2008 to combat inequity for women. Such a framework could be replicated in medical institutions, where BIPOC patients, students, staff and faculty experience a biased environment. These changes are particularly important, as our society becomes more diverse and efforts to promote BIPOC recruitment and retention can outpace strategies to improve racism in medical culture.Finally, national accreditation and ranking organizations must impose anti-racism grading metrics to hold medical institutions accountable. Medical schools and academic health centers currently lack standardized measures for the implementation of anti-racist medical education and healthcare practices. Although White Coats for Black Lives’ Racial Justice Report Card provides a viable tool for appraising institutions, participation in the assessment is voluntary. As a result, institutions only change as much as they see fit, enabling variable treatment of patients, trainees and professionals of color.Standardized evaluation of anti-racism policies and practices must be nationally mandated by professional medical organizations (i.e. the Association of American Medical Colleges, The Joint Commission, etc.). The Healthcare Equality Index, a national measure for equity in LGBTQ patient care, establishes a model for creating systemic, objective measures of diversity and inclusion. Subsequent rating of anti-racism policies should be reported by both the U.S. News Rankings and the Medical Student Admissions Requirement (MSAR) database.While abolishing systemic racism will take time, these are some immediate measures medicine can undertake in the near term. Eliminating racial essentialism, and instead making critical race theory an integral part of medical education and training, can help foster an anti-racist medical system.____Reine-Marcelle Ibala is an MD student at Weill Cornell Medical College in New York City.Tahj Blow is an MD student at Weill Cornell Medical College in New York City.Lala Tanmoy Das is an MD-PhD student in the Weill Cornell/Rockefeller University/Memorial Sloan Kettering Tri-Institutional Program in New York...

If you’re interested in sharing your opinion on any cultural, political or personal topic, create an account here and check out our how-to post to learn more.____For many of us, our stress levels are at an all-time high and it seems like we can’t catch a break living among COVID-19. As soon as things seem to be tapering down and businesses reopening, a rise in the number of cases surface, leaving many of us wondering when all of this will end or if this is going to be our new normal. It can all feel overwhelming, and while it’s likely impacting our mental health, it’s also taking a toll on our bodies. To the nervous system, there is no difference between emotional and physical stress, and the only thing our body puts above balance is survival. We are literally in a fluctuating state of fight or flight, and these high intense stressors cause our bodies to experience multiple microtraumas as we attempt to cope with it all.Signs You Are NOT OKYou may not consciously realize when you are in the danger zone because the pressure builds like a slow pressure cooker. But there are warning signs to look out for. If you answer yes to any of these questions, it's a good indication you are not coping as well as you might think.Does the thought of interacting with others feel taxing or overwhelming? If you feel a sense of wanting to be alone or like it’s too much work to connect with others, pay attention. You may say to yourself, “I don’t want to have this conversation because I just don’t feel like it.” When we find ourselves beginning to revert from the thought of interacting with people or it becomes a burden or a drudgery, there may be an imbalance. If you begin to isolate it’s easy to slip into depression.Do you feel as if social distancing, mask wearing and lockdowns must end now because you can’t it take anymore? (i)If you’ve said to yourself, “enough is enough, this is too much,” and anything other than the restrictions ending right now is unacceptable, then it’s time to check in. Ask yourself why it has to stop. What is it that you have to do that supersedes the relevancy of what’s happening right now? You are likely responding out of stress.Are you making decisions that you know are not in your best interest? If you find yourself making decisions you wouldn’t typically make under normal circumstances, that’s a sign. The body will always find a way to ease the stress in an attempt to find balance again, and this can lead people to turn to food, shopping, drugs or alcohol. The desire to relieve your stress can push you towards unhealthy coping mechanisms to find some sense of feeling good. For example, American Addiction Centers is seeing a rise in the number of people turning to substances during the COVID-19 pandemic. The treatment provider has also noticed a 10% increase in the number of people reaching out for help during this time and a spike in admissions at some of its treatment facilities.If you find you’re exhibiting signs that you are not coping well or a self-assessment survey reveals some concerns about your stress level, you should take action. Here are some tips for managing stress with...

If you’re interested in sharing your opinion on any cultural, political or personal topic, create an account here and check out our how-to post to learn more.____Co-written by Linda Goler Blount and Nicole Austin-Hillery____The summer of 2020 will (as in recent years) be hotter than average and with more periods of extremely hot weather. Like the pandemic, extreme heat exposure disproportionately harms Black women and communities of color, who are already hit the hardest by a number of health inequities.Pregnancy reduces the body’s ability to regulate temperature and also makes pregnant people more vulnerable to heat exhaustion, and potentially fatal heat stroke. The connection between exposure to elevated temperatures during pregnancy and adverse birth outcomes, like preterm birth and low birth weight, is increasingly supported by studies. According to one study, “the hotter the temperature or the longer the heat wave, the greater the risk.” Two California studies have found a higher risk of preterm birth linked to heat exposure for Black mothers than white mothers.Pregnant women receive little attention as an at-risk group. In emergency plans or government extreme heat warnings for Washington D.C., New York City, Philadelphia, Chicago, Austin, Nashville, Boston, Phoenix and Baltimore, only Phoenix mentions pregnancy — while older people, for example, are mentioned by all nine cities. The Centers for Disease Control and Prevention and the American Red Cross issue more temperature safeguards for pets than for pregnant women.Urban neighborhoods are often hotter with fewer trees and more concrete. Marginalized areas, often home to communities of color, are where there are more multi-story, densely populated buildings less likely to have air conditioning (costly to run) and access to clean water to keep hydrated.  A recent study examined the long-term impact in 108 U.S. cities of “redlining” — a racially discriminatory practice in the 1930s by which companies refused or limited loans, mortgages and other investments within specific geographic areas, especially Black inner-city neighborhoods. The study found temperatures in formerly redlined areas, still usually home to communities of color, are often as much as 13°F warmer than in non-redlined areas.Imagine the pregnant woman who must stand on the hot pavement this summer waiting for public transportation to take her home where she must walk up three stories to no air conditioning hoping to cool off in front of a box fan?What’s more, hotter temperatures exacerbate already existing maternal health disparities. Black women are three to four times more likely to die from pregnancy-related causes than white women for a number of reasons, including giving birth in poorly resourced hospitals and not receiving adequate care during an obstetric emergency. Similarly, preterm birth rates are much worse for Black women and they are two times more likely to deliver low birth weight babies as their white counterparts, even when socioeconomic class is considered. Several studies have found a singular cause: racism.Because of the intersecting impact of increasing heat, barriers due to racism and maternal health disparities, our climate crisis is a Reproductive Justice issue. The climate crisis undermines a woman’s ability to have a healthy pregnancy and deliver a healthy baby.The COVID-19 pandemic promises to make the heat of this summer season even more difficult for vulnerable communities. AC may be an impossible cost for low income families, especially after job cuts and wage loss. Social distancing makes going to a relative’s house, mall or library to cool off harder or impossible.We will not address any of our crises — the pandemic or the climate crisis’ health impacts — without centering and addressing these health inequities and their cause: racism. Local governments need to wake up to the dangers of pregnancy and heat, and work with pregnant people and Reproductive Justice organizations to address this assault on the health of Black mothers and babies.____Marcela Howell is the president and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda.Linda Goler Blount is the president and CEO of Black Women’s Health Imperative.Nicole Austin-Hillery is the U.S. Program executive director at Human Rights...

Bruce Y. Lee, City University of New York____The U.S. is pinning its hopes on a COVID-19 coronavirus vaccine, but will a vaccine alone be enough to stop the pandemic and allow life to return to normal?The answer depends on a how “good” the vaccine ends up being.In a study published July 15 in the American Journal of Preventive Medicine, my colleagues and I used a computer simulation of every person in the country to show how effective a vaccine would have to be and how many people would have to get vaccinated to end the pandemic. We found that a coronavirus vaccine’s effectiveness may have to be higher than 70% or even 80% before Americans can safely stop relying social distancing. By comparison, the measles vaccine has an efficacy of 95%-98%, and the flu vaccine is 20%-60%.That doesn’t mean a vaccine that offers less protection would be useless, but it would mean social distancing in some form may still be necessary.What is vaccine ‘effectiveness’ anyway?Some political leaders have suggested that society will return to normal soon, especially if a vaccine becomes available by the end of the year or early in 2021. Some vaccines are currently in early-stage trials, but that timeline would still be very optimistic.However, it is important to remember that a vaccine is like many other products: What matters is not just that the product is available but also how effective it is. Take clothing for example. If you are going to a formal dinner, underwear alone may partially cover you but probably not well enough for the occasion. This doesn’t mean underwear is useless.Similarly, different vaccines may offer different levels of protection. Scientists talk about this as the vaccine’s efficacy or effectiveness. If 100 people who haven’t been exposed to the virus are given a vaccine that has an efficacy of 80%, that means that on average 80 of them would not get infected.[Get our best science, health and technology stories. Sign up for The Conversation’s science newsletter.]The difference between efficacy and effectiveness is that the former applies when vaccination is given under controlled circumstances, like a clinical trial, and the latter is under “real-world” conditions. Typically, a vaccine’s effectiveness tends to be lower than its efficacy.Computer simulations show what could happenSince COVID-19 coronavirus vaccines are still under development, now is the time to set vaccine efficacy levels to aim for, as well as to manage expectations. Running computer simulations is really the only way to ethically do this.For the study, our PHICOR team at the City University of New York Graduate School of Public Health and Health Policy, working with scientists from the National School of Tropical Medicine at the Baylor College of Medicine, developed a computer simulation model of the entire United States and its population interacting with each other. Using that model, we were able to introduce the COVID-19 virus into this virtual population in different ways and have it spread from person to person in various pandemic scenarios. Each simulated person who gets infected has probabilities of being hospitalized, placed on a ventilator or dying based on the severity of the problems just as in the real world.Experiments using this simulated population can represent the different vaccines and what is likely to happen if different proportions of the population are vaccinated at different times during the pandemic. The results show how vaccines with different levels of efficacy would affect the pandemic and can be used to estimate the impact on things such as number of people who get infected, health outcomes and costs. In this case, we assumed that only one vaccination would be required.What will it take to stop the pandemic?Typically, in an epidemic or pandemic, as more people are exposed to the virus, the number of new infections per day steadily increases until it reaches a peak and begins to drop. Of course, how long this takes depends upon how the virus and the response to it may evolve over time.To stop the pandemic, the number of new infections per day needs to drop to zero, or at least to a very low number, as quickly as possible.If the COVID-19 pandemic was just beginning and the population infected was close to 0%, the simulations show that vaccine efficacy would have to be at least 60% to stop the coronavirus if the entire population was vaccinated. Given the number of susceptible people who couldn’t be vaccinated because of age or health problems and the number who would refuse to be vaccinated, that’s probably impossible.If only 75% of the population gets vaccinated, the vaccine efficacy would have to be around 70%. If only 60% of people get vaccinated, the threshold goes even higher, to around 80%. It’s all about making sure the virus can’t find more people to infect.Those numbers assume that a person infected with the virus infects 2.5 other people on average. If the virus is more contagious, the vaccine has to be more efficient.Now, the further along the pandemic is, the less the height of the peak can be reduced. It’s like climbing a mountain – you are already at a certain height. Plus, it is harder to shut a pandemic down when there are more infectious people running around.So, when 5% of the population has already been infected with the virus, the best that you can do is reduce the peak by around 85%. The difference between 0% and 5% can add up to millions of infections. So far, about 1% of the U.S. population has been confirmed to have been infected, but officials estimate the actual percentage is much higher.How many people get vaccinated is crucialBased on these findings, a vaccine with an efficacy as low as 60% could still stop the pandemic and allow society to return to normal. However, most if not all of the population would have to be vaccinated.This seems unlikely, given polls showing that only about three-quarters of Americans say they would get a coronavirus vaccine if assured that it was safe.With fewer people protected, a vaccine would have to have an efficacy of at least 80% to be able to stop the pandemic by itself, meaning social distancing could be completely relaxed. This can provide a target to aim for when developing COVID-19 coronavirus vaccines.Again, all of this doesn’t mean that a vaccine with a lower efficacy would not be useful. It would mean that social distancing and mask-wearing likely would have to continue until the pandemic runs its course or a vaccine that is actually “good enough” arrives.____Bruce Y. Lee, Professor of Health Policy and Management, City University of New YorkThis article is republished from The Conversation under a Creative Commons license. Read the original...