Full Blossom Magazine Issue 41 by Full Blossom Magazine

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MODEL: @RHOXYLEZAMA PHOTOGRAPHY: @MOMENTSBYMELLO LOCATION: @PRINCESTREETSTUDIO

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FULL BLOSSOM MAGAZINE MASTHEAD CEO | FOUNDER | EDITOR-IN-CHIEF | PHOTOGRAPHER Evron Andrews (Moments By Mello)

CONTRIBUTING WRITERS Evron Andrews Guirlaine Agnant MD Elton Andrews Vilma Joseph Alexandra Bastien MD Kecia Gaither, MD MPH FACOG Iyabo Muse, MD Tracey Straker MD MS MPH CB

CONTRIBUTING PHOTOGRAPHERS PHOTOGRAPHERS Moments By Mello, Photos By Kai

COVER MODEL Mello

FRONT COVER PHOTOGRAPHER Photos By Kai

BACK COVER PHOTOGRAPHER Moments By Mello

ART DIRECTOR Nicole Nolan

ASSISTANT EDITORS Tasha Andrews

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Table Of Contents

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HOW MANY OF YOU KNOW SOMEONE WHO HAS BEEN AFFECTED BY THE CORONA VIRUS?

This edition of the magazine is dedicated to bringing clarity to

the evolving crisis that is COVID-19. The Westchester/Bronx Society of Black Physicians, a local affiliate of the National Medical Association, is committed to working within the Bronx and Lower Westchester, and to all communities of color, to improve healthcare outcomes in communities at higher risk during this pandemic. COVID-19 is affecting our community, morbidity, and mortality, at a higher rate for many reasons. We know knowledge is power and for that reason, our organization has put together a series of articles to inform our readers. The coronavirus disease (COVID-19) is caused by a virus officially named SARS-CoV-2, a type of common virus that infects humans, leading to an upper respiratory infection. There are seven different types of human coronaviruses that have been identified. Most people will be infected with at least one type of coronavirus in their lifetime. The viruses are spread through the air by coughing and sneezing, close personal contact, touching an object or surface contaminated with the virus , fecal contamination and most recently seen in semen, . The incubation period ranges from 1 to 14 days with an average of five days. The most common symptoms of COVID-19 are flu like symptoms such as feeling tired, fever, dry cough, and rarely, diarrhea. Some infected people are asymptomatic but may be contagious. Roughly, 80% of infected people recover from the disease without specialized intervention. According to the WHO (World Health Organization) ,about one out of six infected individuals will become seriously ill and develop respiratory compromise. Those individuals are generally older, diabetic, hypertensive, and suffer from heart disease and chronic medical illnesses. Please let us educate and arm ourselves so that we can control the spread of the disease and protect our community. Thank you. Guirlaine Agnant MD President of the Westchester/Bronx Society of Black Physicians

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400 Years, 1619...

Model: Mello Photo: @PhotosByKai Location: @PrinceStreetStudio

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Black outrage, civil disobedience, protesting, looting, burning of police cars & precincts……. Do I agree with all of this? No. Do I disagree with all of this ? No. Should we be outraged? Absolutely. I pledge allegiance to the flag of the United States of America, one nation under God, indivisible, with liberty and justice for all . Under God- the mighty Dollar is their God! Indivisible- Bullshit, we are very divided! Liberty and justice for all - BULLSHIT, please define justice … or maybe define All?

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400 years of hunting the Black Man. What do we see next? Our heads mounted on walls with the “other animals“? Should we be outraged? Absolutely! Is Atlanta ( today’s Black Silicon Valley) the new Target because of the Black prosperity? Is Atlanta the next Tulsa Oklahoma which was formerly known as” Black Wall Street “ before it was burned to the ground ironically between May 31st June 1st 1921 because of Black prosperity? Along with many that have said it before me“ I can’t breathe“! We have survived 400 years of being physically and emotionally held down, beaten, choked, shot, hung, incarcerated, tortured and killed! Yet we still thrive against all odds by the grace of God!

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Model: Mello Photo: @PhotosByKai Location: @PrinceStreetStudio

Along with many that have said this before me, I am not OKAY, we are not OKAY. In spite of all, we will survive, thrive and we will remember all of those that came before us and paved the way. We will mourn the long list of those that were unjustly taken from us, and strongly pursue the ever elusive “Justice for all”. Over hunting of animals lead to endangered species the eventually extinction. NEWS FLASH, WE are STRONG, INTELLIGENT, EDUCATED ,RESILIENT and in most cases GOD FEARING. We will Survive against all odds ! Elton Andrews

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AMERICA IS DAMAGED A MERICA IS DAMAGED . I AM DAMAGED . M Y CHILDREN ARE DAMAGED . O UR LEADERS ARE DAMAGED . O UR SYSTEMS ARE DAMAGED . How do we recover from this self-inflicted pain? America has woken up to our reality. This is much more personal than the Pandemic. America is damaged, in the midst of a pandemic. America is beginning to feel a little bit of the pain that we have endured for way, way, way too long. We try to teach our kids to respect authority, how do you respect authority when authority does not respect you? How do you recognize true authority, versus bad leaders? How do you approach people that hate you or fear you without any knowledge of who you are? How do you approach people that are born into hatred? How do you spend a lifetime of pretending to be OK? How do you acknowledge and follow bad leadership? How do we ignore the fact that the leader of this great country has sanctioned shooting people for voicing their opinions? For expressing the pain that he cannot understand. For expressing the anger and the frustration, the things that we cannot communicate, not because we are unable but because no one listens. How does the leader of our country put in writing ”When the looting begins the shooting begins”? Maybe I misunderstood, that sounds to me like very clear directions to kill people for expressing their frustration. To be clear I do not approve of destroying things that our tax dollars were used to build. I do not approve of destroying the places that could be our next source of employment. But I do understand the pain and oppression that has gotten us to this point. The world is watching at some point the world was laughing for what mockery we have made of our “Democracy “ some of the world has now begin to see our realities . The world is now crying and beginning to see some of the realities/ inhumanity that we face and have faced for a long time. Where do we go from here? America is damaged. Post 911 America and the world was humbled for a moment. We came together and proceeded to rebuild, we can only rebuild if we acknowledge that our country and our people are broken. America is damaged. We are damaged. Our children are damaged. We cannot create or begin to repair the damage without first acknowledging the damage, defining the damage, acknowledging the hatred, acknowledging the racism, acknowledging the oppression, acknowledging the killings, our country prepares to fight wars on foreign soil, this battle is larger than that. How do we stop fighting amongst ourselves? America pray to whom or whatever you believe in. America recognize that we are on a path to self-destruction. America is damaged, this is an open outcry to open the eyes of America. Acknowledge the damage that has been done to our children, the damage that is done to our future, this is an open outcry to save this country that we’ve all put our blood sweat and tears into. irreparable damage is on the horizon if we haven’t already gotten there. America wake up The next Civil War is here . God help us all!!! ELTON ANDREWS

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The Woman... The Mother... The Sister... The Daughter...â&#x20AC;¦

THE WARRIOR AND PROTECTOR OF THE BLACK MAN...

MODEL: SHALANDA BOYCE CLOTHING: FLAVORS OF FULLNESS MUA: UNIQUE RAVINE SHOES: ANNE MICHELLE PHOTOGRAPHY: @MOMENTSBYMELLO

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COVID-19 AND HEALTHCARE DISPARITIES Vilma Joseph, MD, MPH,FASA The COVID-19 pandemic is here and everyone wants to know “What I can do to protect myself”. Sure, we can practice social distancing, wash our hands, stay home if sick, and seek out medical care when ill. The elephant in the room is the fact that African Americans, Hispanics, and other minorities are more likely to get sick and die during the COVID-19 pandemic due to healthcare disparities. What are healthcare disparities? Health disparities are differences in health outcomes and their causes among groups of people. For example, African American women are more likely to die due to breast cancer than White women. Scientists are investigating if the presence of different receptors may be the cause and further postulate environmental factors vs. genetic factors may play a role. Another example is the observation that African Americans are more likely to die from prostate cancer than White men. They postulate that it may be due to the fact that African American men don’t like to get annual prostate checks and/or can’t afford to see a physician. The COVID-19 pandemic is really affecting minority communities and healthcare disparities are apparent. In New York City, African Americans comprise 22% of the population but represent 28% of the deaths due to COVID-19. Hispanics constitute 34% of the population, and 29% of the deaths from COVID19. Throughout New York State, the population has 9% African Americans and 11% Hispanics while, respectfully, contributing to 18% and 14% of the COVID-19 deaths. In Michigan, African American residents account for 33% of confirmed COVID-19 cases and 40% of fatalities, despite making up only 14% of the state’s population. In Louisiana, 70% of those who have died from COVID-19 so far are African Americans, compared with 32% of the state’s population. Initial data from Boston shows that among people whose race was reported, more than 40% of people infected with COVID-19 were African Americans, despite making up just 25% of the city’s population. A person’s health is impacted not only by what diseases run in their family (genes) ,but what is happening around them. This latter is referred to as social determinants of health. Social determinants of health encompasses a patient’s economic stability, education level, healthy environmental neighborhood conditions, health literacy, community cohesiveness, and the ability to access healthcare. These social determinants of health are impacted by policies, programs, and institutions from the government and private sectors. The public, healthcare professionals, media and governmental officials are aware that healthcare disparities are rampant in the minority community. Steps are currently being taken to eliminate these disparities. In New York, testing in majority-nonwhite communities has increased. Minorities are known to be essential workers (i.e. nurses, transit workers, hospital support staff, supermarket workers, etc.) so data is being collected to determine if their occupation is putting them at increased risk.

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At the federal level, the Equitable Data Collection and Disclosure on COVID-19 Act was introduced in April 2020 to Congress. The bill would require the Department of Health and Human Services (HHS) to collect and report racial, ethnic, age, socioeconomic status, disability status, county, and other demographic data on COVID-19 testing, treatment, and fatality rates, and provide a summary of the final statistics and a report to Congress within 60 days after the end of the public health emergency. HHS would be required to take all necessary steps to protect privacy and tribal sovereignty in releasing this data.

Finally, this bill authorizes $50 million in emergency supplemental funding to HHS and state and local public health departments to conduct or support data collection on the racial and ethnic implications of COVID-19. Collecting the baseline data is important but the next step requires a multi-prong approach. Community leaders, governmental officials, the healthcare professionals and public/private businesses must work together to improve the social determinants of health: provide more nutritional foods in our neighborhoods, increase preventive care, increase high school graduation rates, decrease crime, increase employment, decrease structural racism and unconscious bias, etc. As an individual you can work with your community leaders and school system to demand better services. Call/email/visit your local and state political officials if you have any questions or problems regarding your community. Always know that you should hold your political officials accountable by voting in political elections. Remember to fill out the U.S. 2020 Census so the federal government can do things like fund your schools, fix your roads and give you more congressional representation. It starts with small steps but we can play a role in decreasing healthcare disparities. Vilma Joseph is a Professor of Anesthesiology at Albert Einstein College of Medicine and an Attending Physician at Montefiore Medical Center in Bronx, New York.

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I CANâ&#x20AC;&#x2122;T BREATHE

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THE FIGHT OF MY LIFE AGAINST THE C ORONAVIRUS - M ELLO Well I have to start by saying thank You God that I am a survivor of Covid -19. I was one of those people that did not believe that this virus was the real at all. I thought that it was a hoax perpetrated by the media and it would all blow over soon. I remember the quarantine in NYC had just started and I thought it wouldn't last long so I should get some much needed sleep. I remember thinking, “Man my body must be tired from working so much because I'm sleeping so many hours every day.” I did have a light headache for a few days but I thought it was nothing. I remember standing outside of yard one day around 5 o'clock talking to a friend and telling him I'm going to take a nap for an hour or two and then as I woke up a short time later it seemed that my bedroom was spinning. I thought I was having a heart attack because I was dripping wet of sweat and I didn't even seem to have enough air in my body to make it across the room. I passed out for a short moment and then I mustered up enough energy to make it to the bathroom just to splash cold water on my face. I truly thought I was having a heart attack. The last thing on my mind was that I was suffering from the Corona virus and I was A- symptomatic all of this time. However with all the memes and videos going around that the whole world was sharing on social media I managed to come across a video talking about ways to beat the Corona virus. I didn't believe I needed it but I still looked at it anyway. It was a video with a woman talking about hanging her head over a pot of boiling hot water, no other ingredients, just plain old hot water with a towel over her head. She described how the hot water would draw the virus out of your system after 10 minutes and how you should repeat this process two to three times a day. Over the next few days I literally contracted all the symptoms of the dreaded Corona Virus, from the fevers to the coughing, deliriousness and shortness of breath... I was scared… Very scared… I literally turned off all social media because every morning before 9:00 a.m. I had already given 10 family's condolences for their loss love ones. This brought on more fear daily. Many nights I went to sleep not expecting to wake up , I know it was selfish of me but I was so scared and didn’t want to alarm any family and friends. The only person I actually called was my daughter. I told her that I loved her and that in this crazy pandemic none of us knew what tomorrow holds so she should always remember that I loved her with all my heart. She questioned me, “What's wrong Daddy? Why are you telling me this Daddy?” She had no idea that I was subtly trying to say good bye to her. The only thing that sustained me was listening repeatedly to a song entitled “Victory” by Kiera Clark Sheard and continuously praying to God. Over the next few days I continually took vitamin C tablets, Tylenol and I repeated the process of hanging my head over the pot. Many days I didn't have the strength to even make it out of bed.

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Little things like simply picking up the phone to look at Instagram or simply turning my head from left to right seemed like such an incredible task. My body just didn't have enough air within it to maintain these simple activities. I think I must’ve passed out at least 60 times in a week. This by far was the worst experience I have ever had in my life. Every day I thought that it would be my last. I don’t know why God was sparing my life but I kept on saying in my mind, “God I know if You are keeping me alive for whatever reason then there must be a part of my mission that I have not completed yet.” I simply want to do good things and impact the world and make change in all good ways... By my 5th day with the virus I mustered the strength to drive to a testing center to get tested and within a few days I got my diagnosis that I was positive for Covid-19. However by the time I got tested I was already feeling stronger and a lot better. Luckily the prayer and home remedies I was taking seem to be working. The doctor did give me a Z-Pack but suggested that I didn't use it since I seem to be feeling better already. Thank God He had taken me through and I had beaten the virus. Even though I still feared for my life and had shortness of breath, everyday seen brighter and brighter. The virus however did take a toll on my mind, body and soul and it truly put so many things in my life in perspective. Many things that were meaningless I totally did away with and many things that were important I drew closer to. Sometimes it takes a near death experience for you to realize that many of the things on social media, unnecessary drama, and failed business deals were nothing more than a waste of time. This was time that could be used for something more productive and more detrimental to your mind, body and soul. I urge everyone who's reading this article to take the time and try to do something every day that uplifts your life or betters humanity. No one is promised tomorrow and in this crazy and unpredictable time in history that the world is experiencing right now we need to realize that you never know when your last breath can be taken so you should take nothing or no one for granted… Use your time wisely… -Mello

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TREATMENTS FOR

COVID-19

Alexandra Bastien MD The information in this article is considered opinions and not the practice of medicine... As the situation surrounding COVID-19 continues to evolve, it is possible that some data may have changed since publication. I also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

after use must be the norm. Soap and water are key! Any product with 70% alcohol will suffice for disinfecting. Exercise, eating right and certainly build up the immune system with Vitamin C and Vitamin D is paramount. When we speak about building immunity, we must understand that there are two parts to the immune system. The “Innate immune system” that you are born with and the “Adaptive immune system” that you develop when you are exposed to an infection. When a virus enters your body the first time the innate system can have a quick response and eliminate the virus so that a disease will not occur, like the flu. the viral infection leads to disease. Disease can occur when immunity is low or impaired, when the virus ability to damage cells in the body is high, or when the number of virus particles in the body is great.

We are in a situation where our actions will have a tremendous impact on our health and possibly our lives. The treatment of any illness therefore starts with prevention. There are three categories of treat- Some recommendations to build immunity ment.  Brazil nuts from amazon rainforest (3/month, Best 3/week) 

Curative – to cure a patient of an illness



Vitamin D



Palliative – to relieve symptoms from an illness



Zinc

Preventative – to avoid the onset of an illness For COVID-19, prevention is key. Most of us live in situations where social distancing might work outside but not in our homes, or apartments with an extended family structure. If an individual within the home catches the virus, then the entire family may become infected with deadly consequences. When speak about prevention in that setting, we must be creative. For instance, the person with symptomatology must be given the enclosed bedroom, if possible, and the rest of the family sleep in areas around the living room. Plastic eating utensils and disposable plates must be used for this person and thrown away carefully. Urinals should be utilized in the bedroom to minimize their bathroom visits. Planned bathroom time with full disinfection of the entire bathroom



Vitamin C: anti-viral: Bell peppers (raw) have more than oranges



Quercetein: flavonoid with effective antiviral properties



Elderberry: Antiviral



Estragolist tea deals with cytokines from viral infection



N-acetyl cysteine - 100 mg 2 capsules daily for bronchitis



Flax seed oil one teaspoon daily



Silver antibiotics

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Silver hydrosol: 1 teaspoon under tongue



Mushrooms potent immune boosting and antiviral



Liposomal glutathione

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Besides these measures, the ultimate preventative treatment would be to have acquired immunity. We do this by getting a vaccine. Unfortunately, the vaccine is approximately 1 year away. Another way to become immune is to build antibodies for this virus after you become infected; this is using the “Adaptive immune system”. Eventually many individuals who become infected may develop antibodies, and eventually this will make a large amount of people immune. This type of immunity takes time, and as a form of prevention, it relies on you becoming infected, and surviving the infection. If enough individuals have this immunity by “herd immunity”, it may protect others that did not get the virus (like a herd protecting their young). Unfortunately, our communities are considered at risk (diabetes, high blood pressure, asthma, obesity, sickle cell, cancer, elderly, HIV, smoking), making us more likely to die from this infection. Prevention is the most important form of treatment for us. So, you started to have symptoms of the “Rona”, what next. The types of treatment you can do at home are palliative treatments. While beginning to start these treatments,you should get access to a health care provider. Since most emergency rooms and clinics must deal with many patients, it is advisable to use telephone and videoconferences to speak to your doctor. This practice is not just for patients with COVID-19, but for all other nonurgent medical issues.

TREATMENT FOR COVID: OUT OF HOSPITAL

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Below are some positions recommended with COVID-19 to improve breathing. Do not delay getting help though if your breathing is compromised and becomes difficult.

So, things have gotten worse; you breathe When it comes to your health and that of your loved ones, donâ&#x20AC;&#x2122;t take any chances but you must engage now. When you seek treatment in the E.R. Do not forget your travel pack. You are your loved one will most likely not be allowed an accompanying adult. This is serious since the death rate amongst our communities is highest, this may be the last time you see each other. We can avoid this loss of contact by making sure you have a phone and charger. You write down who is to help make decisions for you in case you cannot. Bring all your home medications with you. Your reading glasses, and plenty of reading material. Also have a healthy conversation with family prior to this event about your wishes on inserting a breathing tube, and things you need them to do just in case. This is not the end of the road; this is called advance preparation so you can concentrate on fully getting better. Treating your thoughts and worries. A lot of us are scare of going to hospitals at this stage because of fear of losing a loved one or catching COVID if one has a different issue; your concerns are valid but emergencies and worsening symptoms should be addressed in a medical setting; you may not have the tools to care for yourself and can cause further distress to your serious medical issue. The following are some of the reasons to call EMS or visit an ER.

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1. You're experiencing the symptoms of a heart attack. According to the American Heart Association, heart attack symptoms in both men and women include pressure, fullness, squeezing, or pain in the center of the chest; pain or discomfort in one or both arms, the back, jaw, neck, or stomach; shortness of breath; nausea; sweating; or lightheadedness. 2. You're experiencing the symptoms of a stroke. The American Stroke Association (ASA), the acronym FAST can help identify stroke warning signs: face drooping, arm weakness, and slurred speech (the T stands for "time to call 911"). Other common stroke symptoms include numbness or tingling, drooling, confusion, leaning to one side, and nausea and vomiting. 3. You broke a bone—and it looks bad. According to the Mayo Clinic, broken bones that require emergency medical treatment may also include heavy bleeding, a bone that has pierced the skin, or a bluish color on the affected extremity. If the broken bone is in the head, neck, back, or chest, that will warrant an ER visit, as well. 4. You experienced a major trauma or injury. While people are out less than usual lately because of social distancing, accidents can still happen. All doctors agreed that if you have been in a bad car accident, had a major fall, or sustained a gunshot wound, you should always visit the emergency room immediately. 5. You have symptoms of appendicitis. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), appendicitis is inflammation of the appendix, and it's the most common cause of acute abdominal pain requiring surgery in the US. The most common symptom of appendicitis is a specific type of worsening abdominal pain. "Often it is a general pain in the middle abdomen, near the belly button, then it localizes to the right lower abdomen. The abdominal pain often gets worse when you move around, take deep breaths, cough, or sneeze. The NIDDK says abdominal pain comes first, but can also be accompanied by loss of appetite, nausea, vomiting, diarrhea, constipation, a low-grade fever, or abdominal swelling. 6. You're having a severe allergic reaction. While many allergic reactions can be mild or controlled through medication at home, some can be severe and life-threatening. The most severe allergic reaction is known as anaphylaxis or anaphylactic shock, and mainly occurs seconds or minutes after exposure to the allergen. If the allergen has been eaten, however, it can cause a reaction hours after ingestion. Symptoms of a severe allergic reaction include abdominal pain, abnormal or high-pitched breathing sounds, difficulty breathing or swallowing, heart palpitations, severe swelling, and even unconsciousness, among others.

7. You were sexually assaulted. According to a news release from the New York State Department of Health, dated April 7, "treatment of patients for a post-sexual assault medical forensic exam is an essential service in all New York State (NYS) hospital emergency departments." That is because, depending on consent from the victim, medical professionals can gather a forensic history, perform a medical examination, and coordinate treatment, and document findings. Patients can consent to involvement by law enforcement at that time, as well. Hospital staff can also offer sexual assault victims’ information on sexually transmitted infections, pregnancy, suicidal ideation, and alcohol and substance abuse, and provide recommendations for additional treatment and services. While hospitals may have to make changes to their current policies due to COVID-19—like relocation of sexual assault services within the hospital—treatment will not be compromised.

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8. You're experiencing severe COVID-19 symptoms. If you have a bad cough, chest pains, shortness of breath, and are unable to walk much without needing breaks; or if you have comorbidities [COPD, diabetes, heart disease] and have symptoms of COVID 19, I would absolutely recommend coming to the ER. The CDC also underlines the importance of seeking emergency medical care for severe COVID-19 symptoms, urging people to go to the ER if they experience trouble breathing, persistent pain or pressure, new confusion or inability to arouse, or bluish lips or face. Of course, the CDC says that this is not an inclusive list, and that anyone experiencing any severe symptoms that are concerning to them should seek medical careâ&#x20AC;&#x201D;a good rule of thumb for any of the above conditions or symptoms as well.

The ER health care professionals will take a history of your problem and do a physical and draw blood and possibly require that you have some diagnostic images to help them with your care. This is all considered Palliative treatment. Now, there is no cure for corona virus. When a disease cannot be cured, doctors often use treatments to help control it.

The following generalizations are some of the treatmentâ&#x20AC;&#x2122;s doctors may use while you are hospitalized for COVID.

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At the time of writing this article the specific treatments for COVID-19 are all under investigation. If you are going to be admitted to the hospital, chances are you will be asked to participate in studies to help treat you and future patients with this disease. The following information is to help educate you so that you can better participate in the informed consent process. There are two things you should be aware of. Two treatment options (Convalescent Plasma and Rendemsivir) have been in the public to possibly show promise in treating this disease. The information about these treatments and many others have come from patients that were very ill in this disease process. It may be that starting these treatments earlier may provide an added advantage. This is especially important in our communities because of the higher risk we have. It may be necessary to have our ER docs active the studies early by invoking the MAYO clinic at risk of developing worsen outcome reason. Some of our ERs may not be doing this and you may have to advocate for you and your loved ones to receive early treatments. The good news is that researchers are constantly coming up with advances in medicine. So, it is possible that a disease that can be treated but not cured today may be cured in the future.

These are examples of some of these treatments.

TREATMENT FOR COVID-19 IN THE HOSPITAL

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This does not mean you should be passive about the options provided to you. In 45% of cases, your diagnosis or treatment plan could be optimized

This is a time for educated consumers of health care. You are not helpless. The first step is already taken if you have read these articles. The road you take has always been your choice.

Alexandra Bastien MD is an Associate Professor of Anesthesiology at Albert Einstein College of Medicine and an Attending Physician at Montefiore Medical Center in Bronx , New York

References: Elmhurst Hospital: Position Guide

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Living the Sweet Life: Pregnancy, Diabetes, and CoVID-19 Kecia Gaither, MD MPH FACOG An unseen menace has stealthily made its way into our world. It has left in its stead a dissolution of all that we hold dear— taken lives, impacted our liberty, and surely stolen our happiness. The big disease with the tiny name, CoVID-19 is caused by a corona virus, of which four types exist, alpha, beta, delta, and gamma. CoVID-19 is a beta coronavirus, the difference between the four highlighted is noted only by changes in their protein composition. These viruses are globally distributed and impact both humans and animals. While most human infections are relatively mild, two betacorona viruses, SARS-CoVID ( Severe Acute Respiratory Syndrome) and MERS- CoVID ( Middle East Respiratory Syndrome)- both distant relatives of CoVID 19- have been responsible for major outbreaks of virulent pneumonia’s with tremendous mortality rates. Although the overall mortality rate of CoVID-19 is lower in comparison to the other two, the infectivity appears to be higher; additionally patients with co-morbidities are more likely to manifest more severe disease and subsequently higher mortality. For the women who are pregnant in the time of CoVID-19, joy and anticipation has been replaced with worry, anxiety, and trepidation. Questions abound concerning fetal developmental sequelae, if vertical transmission in utero or during delivery occurs, or if the virus is excreted into breast milk potentially infecting the neonate—- questions which no health provider has a DEFINITIVE answer to. For women with high risk conditions such as lupus, hypertension, or diabetes, the dread is palpable. Why? Because it has been noted across all media that individuals with co-morbid conditions have poor outcomes if infected with CoVID-19. To this circumstance, there is abject proof, particularly for diabetics. Diabetes appears to be the bait that attracts this virus to a host, like a moth to a flame. From the paucity of available studies gleaned from China, it has been shown that diabetes mellitus, as a distinctive comorbidity, is associated with more severe disease, acute respiratory distress syndrome, and increased mortality. Pregnancy, in and of itself, confers a circumstance of vulnerability for women. 1. The immunologic status of the pregnant woman is depressed. While any foreign organism initiates the body’s defense system to attack, in pregnancy the fetus IS the foreign organism and the fetoplacental unit produces chemicals , which in effect, depresses the mothers immune system— thus allowing the fetus to maintain its existence in the womb, and to grow and thrive unharmed. 2. The growth of the uterus displaces the lungs upward in the body, thus comprising a change in both their function and capacity. 3. Hormones from the placenta induce a diabetic state (hence the rationale for screening women for diabetes during pregnancy) 4. Pregnancy additionally increases the propensity for abnormal clotting to occur Diabetes effects on the body, particularly if poorly controlled, are many— but the main derangement reflect an increase in inflammation/ oxidative stress, a decrease in immunological competency, and a derangement of clotting factors ,increasing the risk of clot formation in the body. This pathological condition- poorly controlled diabetes- coupled with the normal physiological changes of pregnancy, make this particular cohort of patients one that extreme oversight need be paid if Co-VID19 infection occurs.

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I am a Maternal Fetal Medicine specialist, and serve as the Director of Perinatal Services at NYC Health + Hospitals/Lincoln in the Bronx-located directly in one of the epicenters of Co-VID19 infection in New York. My demographic is primarily underserved women of the African and Latin diaspora— for whom multiple co-morbidities exist, particularly diabetes. In the last few months, I have noted, exclusively with my poorly controlled pregnant diabetics, exceeding poor outcomes. This group has presented with stillbirths, diabetic keto acidosis, cardiovascular dysfunction, respiratory arrest, and death. Why this group? Depressed immunity allowing for easier viral invasion? Potentiation of the inflammatory response already present by the virus? The absolute etiology has yet to be determined One piece of the Co-VID puzzle I am convinced that an inroads can be made with is via change in diet and nutritional supplementation to boost immunologic function. There are a number of studies out of China, Italy, and Korea that have utilized vitamin supplementations- specifically of Vitamins C and D for treating patients afflicted with Co-VID-19. While these therapies are not a cure, their utilization appears to mitigate the severe effects of the infection. These vitamins appear to decrease inflammation/oxidative stress, inherent in Co-VID 19 infection. Vitamin C is a powerful antioxidant, and is involved in promoting the growth and spread of lymphocytes (those cells in the body which help fight infectious agents- like viruses and bacteria). Vitamin D is a fat-soluble vitamin that is produced in the skin in conjunction with sunlight. For people of color, this vitamin is made in lower amounts in the body because of melanin—which inhibits the production. Vitamin D has a multitude of functions within the body inclusive of, maintaining cardiovascular health, stabilizing cognitive function/mood, essential for bone health, and boosting immunity. Deficiency is correlated with the development of Type 2 diabetes, hypertension and preterm labor. For pregnant women afflicted with diabetes, particularly women of color— who due to public health recommendations are remaining indoors, thus devoid of sunlight exposure, it may be prudent to supplement with both vitamins— but particularly Vitamin D. It is helpful to have your health provider obtain your levels— it is done with a simple blood draw- and have your provider recommend appropriate dosage of Vitamin D. I generally treat my patients with 1000-2000 IU’s daily, to obtain a blood level of >30 ng/ ml. I additionally recommend changing dietary practices to include foods rich in both vitamins, and foods known to naturally boost immunological function. Onions, garlic, turmeric, citrus fruits, salmon, sardines, kale, collards, red/yellow/green peppers, eggs, and prenatal vitamins containing Omega-3. The medical community has a long way to go to find a cure for this disease— we are just at the beginning of a journey to even understand the pathophysiology and how it impacts men, women, children — pregnancy and lactation. In the interim, for pregnant diabetics especially, compliance with diet, INSULIN AND/OR ORAL MEDICATION FOR GLYCEMIC CONTROL are of utmost importance , in addition to hand washing, mask wearing, and maintaining social distancing. Natural augmentation of immune function with a healthy diet and vitamin supplementation with Vitamin C, AND PARTICULARLY VITAMIN D, will hopefully prove to be the armor to help protect pregnant diabetic women in the war against CoVID 19, and ultimately allow them to continue living the sweet life. Kecia Gaither is the Director of Perinatal Services/ Maternal Fetal Medicine at NYC Health + Hospitals Lincoln hospital in Bronx, New York

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Health and Wellness in COVID-19: Stay Connected Iyabo Muse, MD

Burnout is defined as a syndrome characterized by high emotional exhaustion, high depersonalization, and low sense of personal accomplishment according to the Maslach Burnout Inventory (MBI). 1 .Factors accelerating burnout includes providing care for an ill family member or yourself, uncertainty and lack of treatments for the virus, lack of childcare and the economic impact due to shuttered workplaces. The COVID-19 pandemic has created a society of isolation and fear because of social distancing, the only public health strategy that data has proven to help “flatten the curve” and decrease the number of cases. Due to the deadly nature of the virus, from its easy transmissibility to the detrimental effects on the human body, it has created an environment in hospitals and nursing facilities where isolation is the standard of care. In hospitals, patients are separated from their families, even on their death bed - they are alone or have medical personnel as the last people they see before they die. This scenario makes it almost impossible for healthcare workers, family, and friends of COVID victims to avoid burnout or long-term trauma that can lead to post traumatic stress disorder. Thus, it is important to have strategies to help mitigate the impact of stress. Some of these strategies include staying connected with family, friends, and co-workers virtually, eating healthy food, taking nutritional supplements, engaging in physical activity, managing one’s expectations, and participating in activities that help relax one’s mind. Stress mitigation strategies should be employed by individuals, and communities that can help everyone prepare, manage, and survive this global pandemic: Preparation Get the facts. Seek health information updates from trusted sites such as the Centers for Disease Control and Prevention (www.cdc.gov) or World Health Organization (www.who.int). Limit your news watching. The constant stream of information can cause anxiety and fear. Know your limit, pace yourself- understand that this will be stressful and “it is okay to not be okay-feeling stressed and anxious are by no means a reflection that you cannot do your job or that you are weak.” 3 Management

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Managing your psychosocial wellbeing is as important as managing your physical health.

Communication is key. Develop a buddy system, it could be with your family, friends, co-workers, or a religious leader.

Survival

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“Self-care” is important. Doing basic daily activities are important: eat healthy, hydrate, sleep, take a walk, and it is okay to have your favorite glass of wine occasionally.

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Remember that you are alive- take a deep breath, literally shake your body out, speak positive words aloud to yourself, find opportunities for gratitude, and if religious say a prayer for yourself and others. 4

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Research resources on state, city, and local websites. Below is a list of some of the free wellness resources for healthcare workers and the public.

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Institutions and organizations should also invest in their worker’s physical and mental wellbeing. Leadership support in creating a healthy environment for workers by providing adequate personal protective equipment, free meals, free transportation, access to child and elderly care, and access to mental health providers, are some of the ideas that foster a collegial environment and long term retainment of employees after the crisis. Look into your organization’s website-there may be an abundance of resources available to you without cost. There are several signs and symptoms of burnout - prolonged sadness, depression, irritability, indifference, inability to focus, poor hygiene, exhaustion, feeling like a failure, insomnia, and suicidal thoughts. If you display one or more of these signs for a prolonged time, do not hesitate to seek help. Resources available to the public can be found on state, city, and local municipality websites. Most of this information can be found on the Department of Health(DOH) website for each city or town. For example, in New York there are several websites created to assist healthcare workers emotionally, i.e NYS COVID Emotional Support Helpline, NYC Well, and NYC COVID CARE.org. Nationally, there is the Disaster Distress Helpline (1-800-985-5990), National Suicide Prevention Lifeline (1-800-273-8255) and National Institute of Mental Health Crisis Text line (text HELLO-741741). Burnout is not a new phenomenon; it is well known to medicine; however, the COVID-19 pandemic has exacerbated the problem. It is important to have a support network that may consist of family, friends, religious leaders, and fellow co-workers who can help you through this difficult time. Self-care should be a priority. If you do not care for yourself, then you cannot expect to care for others. As a community, we must work together to defeat COVID-19, by sharing knowledge about the virus, recharging ourselves, and supporting everyone’s physical health and emotional wellbeing. A favorite quote that resonates with me is

“STOP, BREATHE, then THINK- slowing your breathing slows the stress cycle and re-engages your frontal lobes-then you can think.” Dr. Julie Highfield MD

Dr. Iyabo Muse, is an Assistant Professor in the Department of Anesthesiology at Montefiore Medical Center, The Hospital of Albert Einstein College of Medicine in Bronx, NY References 1. Maslach C, Jackson S.E, Leiter M.P. Maslach Burnout Inventory Manual. 4th Edition. Menlo Park, CA: 1996-2916. Mind Garden, Inc 2. Burnout syndrome among critical care healthcare workers. Embriaco, Nathalie; Papazian, Laurent; Kentish-Barnes, Nancy; Pochard, Frederic; Azoulay, Elie. Current Opinion in Critical Care: October 2007 - Volume 13 - Issue 5 - p 482–488 3. Highfield, Julie. “Self-Care During COVID-19.” Intensive Care Society. April 2020. www.ics.ac.uk 4. Sinclair, Stacie MPP. “We Are in a War”: Mitigating Burnout in COVID-19.” Clinical Care(capc). April 23, 2020. www.capc.org/ blog/we-are-in-a-war-mitigating-burnout-in-covid-19/

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I’M TRYING TO LOVE A BLACK MAN SO GOOD THAT HE FORGETS THE WHOLE WORLD IS AGAINST HIM…

MODEL: @RHOXYLEZAMA PHOTOGRAPHY: @MOMENTSBYMELLO LOCATION: @PRINCESTREETSTUDIO

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MODEL: @RHOXYLEZAMA PHOTOGRAPHY: @MOMENTSBYMELLO LOCATION: @PRINCESTREETSTUDIO

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COVID -19 Community Resources in New York State Tracey Straker MD MS MPH CB

COVID -19 arrived with a vengeance, killing populations and destroying communities. All aspects of our lives have been impacted .People are struggling to find the information and the resources to begin to piece together their daily lives . Below is a compilation of resources that may be useful , as we move forward.

Health - Anyone who is low-income can get free COVID-19 testing, evaluation, and treatment in New York State, regardless of immigration status. https://pronto-core-cdn.prontomarketing.com/537/wp-content/uploads/sites/2/2020/04/ NYIC_COVIDMedicaidOnePagerFV.pdf www.coronavirus.health.ny’gov

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City MD – a free standing medical site will do Antibody testing with or without insurance – no monies are exchanged upfront

Health Insurance Special enrollment for uninsured New Yorkers is now available. Individuals can enroll through New York State of Health or directly through insurers from now until June 15. Call New York State of Health at 855-355-5777. www.nystateofhealth.ny.gov

Food Over 400 NYC school locations will be serving Grab and Go meals for ANYONE, Monday to Friday from 7:30 a.m. through 1:30 p.m. No registration, ID, or documentation is required to pick up these meals. Three meals a day will be available per person, and may be picked up at the same time. None will be turned away! No dining space is available, so meals must be eaten off premises. To find the closest location serving meals here.

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The Food Banks are as follows: *Bedford Stuyvesant Food Bank (732) 771-9663 *Crown Heights Food Bank (917) 341-7675 *Flatbush Food Bank (718) 732-7196 1. You have to call the Food Bank in the Borough and Area that you live. 2. You call and leave your Name, Address, Cross Streets and Phone Number. 3. They will call you back to get your moderate list of essential groceries that you need and let you know when they will be delivering them. (Have your (MODERATE) grocery list prepared ahead of time. *Food Bank For New York City- Main Number CALL: (212) 566-7855 To find a Food Bank in your area.

Housing Eviction proceedings and pending eviction orders will be suspended statewide, until further notice starting March 16 at 5:00 p.m. Essential functions that will continue include proceedings on landlord lockouts, serious housing code violations and repair orders.  Renthttps://nextcity.org/daily/entry/what-to-know-about-housing-and-rent-during-the-covid-19emergency

Well Being  If you are in New York City and feeling anxious, stressed or overwhelmed, connect with trained counselors at NYC Well. You can also text "WELL" to 65173 or chat online at https://nycwell.cityofnewyork.us/ es/.  If you are feeling anxious, stressed or overwhelmed and you are outside New York City, you can call the New York State Department of Health Coronavirus Emotional Support Hotline at 1-844-8639314.otlin 

NYS Domestic ana Sexual Violence Hotline 1-800-942-6906

Education  Families with technological needs should fill out this device request form, which is now offered in 9 languages. Please contact 718-935-5100 option 5 or your school’s principal if you have not received and/ or filled out the technology survey.  Learn at home resources- https://www.schools.nyc.gov/learn-at-home  College AP exams www.apcoronavirusupdates.collegeboard.org  Manage student loans - www.edcapny.org/advocacy/

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Childcare 

The Department of Education has 57 “Regional Enrichment Centers” and childcare sites open across the city for children of healthcare, emergency services, and transit workers, as well as grocery store, pharmacy, and food workers, including restaurant, takeout and delivery workers, REC & feeding staff, residential and commercial building staff, and other front-line workers, regardless of whether they go to public or private school. They will be open from 7:30 a.m. to 6 p.m. for children in 3-K up to 12th grade. Parents should fill out this survey to find out if they qualify for childcare at this time.

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Paid Family Leave- www.paidfamilyleave.ny.gov

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Family and Medical Leave Act www.dol.gov

Finances 

www.governor.ny.gov/programs/paid-sick-leave-covid-19-impacted-new-yorkers

If you are unemployed or furloughed without pay and a U.S. citizen, or a noncitizen with work authorization, you can file a claim for UI through the NYS Dept of Labor website to see if you qualify. Find more information here.  NYC small business owners can receive information on loan/financial support program by completing this survey (English): https://www.surveymonkey.com/r/N336ZYB 

Mortgage relief- https://smartasset.com/mortgage/coronavirus-relief-for-rent-and-mortgage-payments

 Stimulus checks for non tax filers and people with disabilities - https://www.irs.gov/coronavirus/nonfilers-enter-payment-info-here  You must call your credit card companies and utility vendors individually to negotiate payment terms . Credit card and utility companies are not advertising how they will help people. DO NOT stop paying your bills without speaking to the vendors- it will devastate your credit score  Student loans can be placed in forbearance for a minimum of 3 months – call your lender to formalize the process- DO NOT stop paying your student loans without speaking to the company

Pandemic Unemployment Assistance https://pronto-core-4cdn.prontomarketing.com/537/wp-content/uploads/sites/2/2020/04/PandemicUnemployment-Insurance-NYIC-Explainer-4_5_20.pdf

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Recreation 

Spectrum is offering free internet for 60 days to college students and households with K-12 students that currently do not have internet. In addition, people behind on their Spectrum bill can get their internet service restored. Call (833) 267-6094 for more details.  Charter cable will offer free Spectrum broadband and Wi-Fi access for 60 days to households with K12 and/or college students who do not already have a subscription, and installation fees will be waived for new student households (call 1-844-488-8395. 

AT&T is also offering 60 days of free public service.Call and ask about it.

Seniors All programs run by the Department for the Aging are closing and cancelling all congregate meals, recreational, and educational services and activities, effective immediately. Senior centers will operate strictly to deliver food to seniors. Call your local senior center or 212-244-6469 with questions.

Immigrants 

Pandemic Unemployment Insurance

https://pronto-core-cdn.prontomarketing.com/537/wp-content/uploads/sites/2/2020/04/PandemicUnemployment-Insurance-NYIC-Explainer-4_5_20.pdf 

Emergency Medicaid /Free COVID-19 testing/ Treatment/ Antibody testing

https://pronto-core-cdn.prontomarketing.com/537/wp-content/uploads/sites/2/2020/04/ NYIC_COVIDMedicaidOnePagerFV.pdf 

City MD – a free standing medical site will do Antibody testing with or without insurance – no monies are exchanged upfront Tracey Straker is a physician anesthesiologist and Professor of Anesthesiology practicing at Montefiore Medical Center and Albert Einstein College of Medicine in Bronx , New York

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