Infectious Diseases

A Guide to Contagious Disease in a Time of Pandemic

Infectious Diseases

From hepatitis, HIV, and malaria, to discovering new vaccines or a career in public health, this guide will expand your infectious disease knowledge far beyond COVID-19

JUNE 2020 | FUTUREOFPERSONALHEALTH.COM

AT PPD, OUR MISSION TO HELP OUR CUSTOMERS DELIVER LIFE-CHANGING THERAPIES HAS NEVER BEEN MORE CLEAR.

Learn about the Elton John AIDS Foundation’s million-dollar COVID emergency fund Find out about the role of vaccines at the World Vaccine Congress, September 27-29 An Independent Supplement by Mediaplanet to USA Today

IN THIS ISSUE

What COVID-19 Has Taught Us About Infectious Diseases were tasked with developing national plans to meet the World Health Organization’s goal of eliminating viral hepatitis by 2030. While some plans exist, they are often not supported with funding or resources, and only five countries are on target for elimination. Why do we remain apathetic to the many lives lost to hepatitis, when these deaths are entirely preventable?

When I was diagnosed with hepatitis B in college, I was afraid to tell anybody. I went through medical school and residency only letting a few of my closest friends know. Living with an infectious disease is very different from living with a non-infectious disease, as many with COVID-19 are now experiencing. You live with guilt and selfstigma, and a constant worry that you could transmit the disease to loved ones.

The many ways public health professionals can change the world PAGE 16

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Learn about vectorborne illnesses from Dr. Carlos Espinal, Director of the Global Health Consortium

Dr. Su Wang, M.D., MPH, FACP, President, World Hepatitis Alliance

COVID-19 has thrust a spotlight on infectious diseases and the importance of testing, containment and effective treatments — strategies well known to the viral hepatitis community.

COVID-19 has spread across continents and countries. We are seeing unprecedented global attention focused on one disease, leading to drastic actions to limit its spread and reduce its death toll.

Too many lives will still be lost and the effects of the pandemic will be visible for years. What’s remarkable is the singular focus of governments, scientists, and the healthcare sector to combat COVID-19 and overwhelming response. @MEDIAPLANETUSA

Many are already all too familiar with the devastating impact of global infectious diseases. For example, viral hepatitis is the world’s second deadliest infectious disease, affecting more than 325 million people worldwide and claiming 1.4 million lives each year ­— more than HIV and malaria combined. Yet unlike COVID-19, public awareness is shockingly low and the global response is paltry.

The strategies being used for COVID19 are already the same for many other diseases, including viral hepatitis — identification (screening), containment (prevention), and treatment. But it is the urgency of action that makes COVID-19 stand out, due to the nature

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of the many unknowns about its transmission, natural course, and effective treatments or vaccines.

In contrast, we know how viral hepatitis is transmitted, and have the diagnostic tools to identify patients accurately with ease and at low cost.

We also have cures for hepatitis C, effective medications for hepatitis B, and research is ongoing for a hepatitis B cure. Effective, safe, and affordable vaccines for hepatitis B are game-changers and have dramatically reduced rates of transmission.

A global goal With all these tools, viral hepatitis can be eliminated. In 2016, countries

Sharing stories I have since learned that telling my story and the stories of others affected by hepatitis (many of whom feel they have no voice) is critical for increasing awareness, and this is a key lesson for the COVID-19 response. The stories of those impacted by COVID-19 are painfully familiar to the global hepatitis-affected community.

Not having access to testing, feeling alone and isolated, not knowing where to go for help, and not being able to obtain potentially life-saving therapies are all barriers that resonate with us.

We ache when we hear stories of people facing stigma and discrimination, because many of us hide out of that fear as well. As we witness how life-saving these can be, let us ensure these interventions reach the 325 million living with viral hepatitis among us. n

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The Secret to Overcoming Hepatitis C Removing the stigma of hepatitis C and helping patients pay for treatment will save thousands of lives.

Stigma One reason so many people 4

PHOTO: COURTESY OF LEONARD

W

hen Leonard went to his family doctor for a regularly scheduled checkup, the last thing he expected was liver trouble.

“My blood enzymes were very high,” recalled the retired middle school administrator.

“My doctor decided to do the hepatitis screen. No A or B, but definitely C.” Like thousands of other people, Leonard had contracted the hepatitis C virus (HCV) without knowing it and showed almost no symptoms.

The Centers for Disease Control and Prevention estimates about 2.4 million people have the chronic form of the disease, meaning they’ve been infected for more than six months with one of the leading causes of cirrhosis and liver cancer, and the most common reason for liver transplantation. What many don’t know is that with proper medication, hepatitis C is curable.

“I thought it was terminal,” Leonard said. “My doctor dispelled that immediately and indicated a relatively high cure rate with proper meds.”

are unknowingly infected with HCV is the stigma associated with the disease. Many assume that only those who engage in high-risk activities like intravenous drug use can be infected, which isn’t true.

While sharing needles is one of the biggest risks for HCV, other common vectors include needlestick injuries in healthcare workers; sharing common items that may have been exposed to someone else’s blood, such as razors and toothbrushes; sexual intercourse with an infected

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person; or getting a tattoo or body piercing without proper sanitary practices.

Sometimes there’s no obvious vector for infection.

That makes HCV screening as part of a regularly scheduled checkup incredibly important.

“In my case, I never did learn how I was infected,” Leonard said. “I lived none of the high-risk lifestyles.”

After his diagnosis, Leonard discovered something else few people know about HCV: the incredibly high cost of treatment.

“A three-month regimen — one pill per day — would cost about $72,000,” Leonard said.

His doctor’s office worked on his behalf to reduce the cost, getting it down to about $12,000.

“That was great, but still out of reach,” he recalled. “It was foreboding.”

Assistance When diagnosed with HCV and discovering the high cost of the life-saving medications required, many people despair or, worse, try to live with

the disease. But, as Leonard discovered, there are several options that can help make treatment affordable.

One option is to contact the pharmaceutical manufacturer directly — many have in-house assistance programs for people with qualifying finances.

Another is to research organizations that offer copayment assistance programs or patient assistance programs (PAPs).

PAPs are designed to help those who have either private or government insurance pay for their out-of-pocket costs, such as medication copayments and deductibles. In addition, some PAPs offer specific programs to provide assistance to Medicare patients who cannot take advantage of coupon or copayment programs offered by manufacturers.

For those who don’t qualify for these programs, a final option is to identify a patient advocacy organization that can offer assistance.

For Leonard, the lessons of his experience are clear.

“Follow the directions of your healthcare professionals,” he advised. “Put the usual anxiety behind you. Hep C will be cured.” n Jeff Somers MEDIAPLANET

If you have health insurance and are living with Hepatitis C, the HealthWell Foundation may be able to assist you with prescription drug copays for treatment.

The HealthWell Foundation, a nationally recognized nonprofit organization, has provided financial assistance across over 70 disease areas to more than 500,000 underinsured patients with chronic or life-altering medical conditions, including Hepatitis C. Through our Hepatitis C Fund, HealthWell provides up to $30,000 in copayment assistance to eligible patients who have annual household incomes of up to 500 percent of the federal poverty level.

To learn more about HealthWell’s Hepatitis C Fund, visit our Disease Funds page at www.healthwellfoundation.org.

Website www.HealthWellFoundation.org

Facebook Facebook.com/healthwellfoundation

Twitter @HealthWellOrg

Phone (800) 675-8416

Instagram @HealthWellFoundation

Linkedin healthwell-foundation

How a Pandemic Affects Health Insurance As the COVID-19 pandemic continues to disrupt communities around the globe, knowledge about access to care and health insurance has never been more valuable. We talked to Alan S. Klein, chief development officer for the HealthWell Foundation, about how people can use their insurance and other programs to receive the care they need during these times.

Saving Lives

by Raising Awareness and Finding a Cure for Hepatitis B

What should readers know about hepatitis and health insurance?

There are different options for people and households in different situations. Those who are fully insured have all their usual options available to them for treating their hepatitis disease.

Those who are underinsured, with private sector policies, can apply for additional assistance above their insurance coverage through patient assistance programs run by their drug’s manufacturer. Any remaining balance can also be addressed by applying for funds via independent copayment assistance foundations.

Those who are on Medicare or Medicaid can go directly to copayment assistance foundations for financial help with their remaining balance. Those who are uninsured can apply for assistance through the free drug programs run by drug manufacturers.

Hundreds of thousands of Americans go through one of the above scenarios each and every year to treat their hepatitis.

What is one tip you can share for people trying to navigate the healthcare system today?

There are resources available to patients, even during a pandemic. Please investigate coupons, copayments, and free drug safety net programs offered by drug manufacturers. Additionally, look into independent copayment foundations that may be able to offer financial assistance related to their disease, their insurance premiums, or COVID19 in general. Those foundations, such as HealthWell Foundation, CancerCare, NORD, and others, and their offerings can be found by doing a basic internet search.

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Chronic hepatitis B infection causes illness and kills millions of people in the United States and around the world. A cure is critical for saving lives.

The SARS-CoV-2 pandemic has highlighted an important lesson for us: to address a worldwide epidemic and save lives, we need effective strategies for prevention, treatment, and cure, and we need the public health and medical communities to implement these strategies.

In May, which is both Asian Pacific Heritage Month and Viral Hepatitis Awareness Month in the United States, we were reminded that we face these same challenges for an illness that leads to approximately 840,000 deaths worldwide each year. The hepatitis B virus chronically infects almost 300 million people worldwide and 2 million Americans. It disproportionately impacts Asian Americans, Pacific Islanders, and people of African descent. In the United States, only 25 percent of those who have hepatitis B are diagnosed, and of those diagnosed, less than half receive care for their hepatitis B. The hepatitis B virus can cause a chronic, lifelong infection that greatly increases the risk of cirrhosis and liver cancer, striking

people down in the primes of their lives. Those who live with hepatitis B face stigma, discrimination, and a relentless fear of developing liver cancer and having their lives cut short. They also face a lifetime of pills.

Currently, hepatitis B has no cure. There are antiviral medications that can slow down viral replication in the body and, for many people, can prevent liver damage and liver cancer. But these medications don’t work for everyone, they can be expensive, and they need to be taken for many years, usually for as long as a person lives.

On the verge We are in a unique situation to address, and even eliminate, hepatitis B. We can create a world where no one dies of hepatitis B. We have many of the tools necessary, including a safe and effective vaccine that can prevent new infections. What we don’t yet have is a cure.

A cure is a critical tool that would allow us to eliminate hepatitis B worldwide and save millions of lives. With a cure, we could reduce the need for liver transplantation and cancer treatment, saving billions of future dollars. And we could improve the length, productivity, and quality of life for all those currently infected — bringing an end

to a lifetime of painful symptoms, worry, fear, isolation, and stigma.

Researchers around the world are diligently working to find a cure. At the Hepatitis B Foundation and its research arm the Baruch S. Blumberg Institute, we have more than 50 scientists trying to find a cure for hepatitis B. But overall, hepatitis B is an under-prioritized and underfunded disease. Without an influx of resources, we fear we will not reach the goal of eliminating hepatitis B and will continue to see lives lost.

We call on key stakeholders — governments, corporate partners, medical institutions, academics, and public health organizations — to work together to prioritize hepatitis B, help find a cure, and build capacity in the United States and globally to ensure all people who have hepatitis B are diagnosed and able to access medical care.

We urge communities and families impacted by hepatitis B to make their voices heard and to advocate for increased resources.

Working together, we can find a cure and eliminate hepatitis B. n Chari Cohen, DrPH, MPH, Senior Vice President, Hepatitis B Foundation; Associate Professor, Baruch S. Blumberg Institute; and Timothy Block, Ph.D.; President, CEO, and Co-Founder; Hepatitis B Foundation and Baruch S. Blumberg Institute

Why All Adults, Especially Pregnant Women, Should Get Tested for Hepatitis C Hepatitis C patient advocate Rick Nash applauds the Centers for Disease Control and Prevention (CDC) for recommending universal hepatitis C screening.

This spring, the CDC updated guidance to recommend all adults get tested for hepatitis C, including pregnant women. It is a dramatic shift from previous guidance that focused only on screening Baby Boomers and those with risk factors.

The expanded guidance is critical for identifying the disease among a growing cohort of millennials and for reducing vertical transmission to infants.

Hepatitis C affects more than 3 million Americans and there are an estimated 40,000 new hepatitis C cases each year in the United States, many of which go unreported. Nearly half of those living with hepatitis C are unaware of it because they don’t show symptoms, which is why universal screening is critical for identifying those living with the silent disease.

Vertical transmission Particularly concerning to me are the increasing rates of vertical transmission of hepatitis C. Birth certificate data suggests more than 18,000 newborns are exposed to hepatitis C each year. The figures nearly doubled between 2012-2015 alone, in

alignment with increased unsafe injection drug use associated with the opioid crisis.

Screening for hepatitis C during pregnancy increases the likelihood that there will be follow-up care for the baby and mother to provide curative therapy when needed, which is a much-needed change given 55 percent of patients are currently lost to follow up on treatment. If this guidance had been in place when my mom was pregnant, my story might have been different.

I was diagnosed with hepatitis C at 12 years old after a terrifying ER visit for blood in my urine. It was unusual for a young boy to have hepatitis C, so my family was tested and weeks later, my mom was determined to be the source of my infection.

By the time I was 18, I developed liver fibrosis and by 24 I had end-stage liver disease. I spent six years slowly dying, waiting for a liver transplant, and attempted multiple treatments for my hepatitis C. During that time, my bill to insurance total came up to about $6 million. My treatments don’t even account for a million dollars of that, even though they were costly at the time.

Delivering a cure Thankfully, since then, direct acting antivirals were developed and a cure for hepatitis C now has 90 percent efficacy, minimal side effects, and can be com-

pleted in as little as eight weeks depending on the severity of liver damage.

Both my mom and I have now been cleared of hepatitis C and the United States is on the right path to preventing other families from going through what we endured.

Rising rates of viral hepatitis among millennials due to the increase in injection drug use necessitated the new recommendations from the CDC, which are an important move toward eliminating hepatitis C in the United States.

Research has proven that risk-based screening is ineffective, which is why it is necessary that the latest recommendations included an essential recommendation that “Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons may be reluctant to disclose stigmatizing risks.”

The recommendations are the first real, meaningful move we have made nationally in an otherwise slow fight.

Universal hepatitis C screening is critical in the fight to eliminate a silent, deadly viral threat that is driving increases in liver cancer and kills thousands of Americans each year. These new guidelines will put us on the path toward eliminating hepatitis C. n Rick Nash, Hepatitis C Patient Advocate, National Viral Hepatitis Roundtable MEDIAPLANET

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- Provider screening and treatment training in partnership with the Community Liver Alliance Viral Hepatitis Training, Education and Elimination Services

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- Patient treatment via smartphone technology www.telehep.com treatment by a provider with over 15 years of experience treating chronic hepatitis C

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How People With HIV or Hepatitis Should Maintain Care During COVID-19 The COVID-19 pandemic has shuttered stores, businesses, and restaurants, forcing many into unemployment. For immunocompromised people, such as HIV and hepatitis patients who must maintain treatments, the pandemic can cause health and financial hardships.

T

he COVID-19 health crisis currently ravaging the globe has likely changed your daily life in more ways than one.

For example, you may have lost your job, an elderly parent may be living with you, or you may be trying to work from home for the first time, while also overseeing a child’s virtual homeschooling.

The pandemic has brought on much fear and uncertainty about public and personal health, as well as the economy. In terms of these unknowns, those who are immunocompromised, such as people with HIV and hepatitis, have been greatly affected.

“COVID-19 has impacted all of us, and continues to threaten our physical health and economic well-being,” said Clorinda Walley, president of Good Days, a nonprofit organization that provides access to life-saving and life-extending treatments to individuals in need, including those with infections such as HIV and hepatitis.

“Nevertheless, it is people who suffer from chronic conditions that have been hit hardest by this pandemic,” Walley added. “People with underlying conditions, such as HIV and hepatitis, are unfortunately at a greater risk when it comes to getting sick. They need to be extra careful.”

Overcoming financial hardship Amid this pandemic, the United States is facing a historically high unemployment rate. Thus, people with 10

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underlying infections may be struggling to afford their essential treatment.

If you’re one of these people, your insurance company or healthcare provider can guide you on resources that can help you afford the medicines you need. However, know that nonprofits in your area are likely providing help that you can take advantage of as well.

Some nonprofit organizations are launching emergency assistance funds to directly support people at the highest health and economic risk. “We are committed to reducing patients’ financial stress so they can focus on their health and well-being during this difficult time,” Walley said.

Research shows that adhering to treatment of viral infections such as hepatitis is critical for managing health and preventing complications. The same goes for HIV, notes the U.S. Department of Health and Human Services, as it states lifelong treatment is necessary to prevent the virus from multiplying and overcoming the immune system, causing drug-resistant HIV. The National Council on Aging recommends that people who need to obtain prescription medications keep at least a one-month supply of medication on hand, and to take advantage of mail-order prescriptions to avoid going to the pharmacy, or ask a family member or friend to pick up medications. For people with health problems including HIV and hepatitis,

avoiding potential exposure to the novel coronavirus is also critical.

Showing care and compassion for others Indeed, practicing social distancing during the COVID-19 pandemic is important for anyone with an underlying condition. That’s because these people are more likely to face serious and potentially life-threatening complications if they develop the respiratory disease, according to the Centers for Disease Control and Prevention (CDC). People over age 65 also fall into this group.

“We often don’t realize it but there are so many of us walking around with invisible conditions,” Walley said. “Although someone may look completely healthy, they might be more susceptible to a downward health spiral because they contracted a virus.”

While the novel coronavirus is still spreading, the CDC recommends everyone wear a non-medical face mask when they cannot socially distance. This is primarily to protect those who may be more prone to such complications if they are infected.

“Those individuals (with underlying conditions) need to exercise caution but the general public must also remember that this pandemic threatens any given individual’s health in many different ways,” Walley said. “If we continue to care for each other, we will all get through these challenging times together.” n Melinda Carter MEDIAPLANET

The Elton John AIDS Foundation Offers $1 Million in New COVID Fund People living with HIV and AIDS face specific health threats during the COVID-19 pandemic. The Elton John AIDS Foundation (EJAF) is helping alleviate those threats.

EJAF has worked with HIV/AIDS organizations around the world to help deliver quality health services to vulnerable communities since 1992.

The coronavirus pandemic poses new challenges for communities battling HIV, prompting the foundation to launch its COVID-19 Emergency Fund.

“Essentially we’re trying to do two things,” said Anne Aslett, CEO of EJAF. “One is to provide immediate support to enable organizations to continue to

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function,” including accessing protective equipment and medical supplies.

“The second objective is helping organizations think through how they might mitigate the impact of COVID on the work they’re doing for the populations they serve.”

A global impact EJAF works primarily with countries in sub-Saharan Africa, central Asia, eastern Europe, and North America, specifically in communities where access to healthcare is limited.

COVID-19 has placed further stress on already vulnerable communities.

“In countries in the global South, their health systems are often very

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weak anyway,” Aslett said, “so when you bring in an infectious disease like COVID, it can cripple the health system.”

As COVID-19 becomes the health system’s priority, treatment for other infectious diseases can get neglected.

“Attention gets drawn away from some of the big killers like tuberculosis, malaria, and HIV,” Aslett said.

More funding Applications have closed for the first round of EJAF’s COVID-19 Emergency Fund but a second is set to be released soon.

“We wanted to provide money now, so we’ve dispersed just under $1 mil-

lion” Aslett said, “and been extremely fortunate to receive a donation from (Twitter CEO) Jack Dorsey, which doubled the fund. We’ll do another wave around the end of June to see how people’s thinking has evolved.”

Aslett said one of EJAF’s highest priorities is ensuring HIV/AIDS care is available everywhere.

“Nothing we do is unilateral or on our own,” she said. “We always want to make sure we are complementing what other people are doing; that we’re filling gaps that haven’t otherwise been identified.” n To learn more, visit www.ejaf.org.

Ross Elliott

How COVID-19 Is Affecting People With HIV and Those in AtRisk Communities A leading HIV/AIDS expert says interruptions in treatments and services for people living with HIV during COVID-19 could have deadly consequences.

“A six-month interruption in HIV treatment just for sub-Saharan Africa would cost, just in the first year, 500,000 additional deaths,” said Shannon Hader, the deputy executive director of programme of the Joint United Nations Programme on HIV/ AIDS (UNAIDS) and assistant secretary-general of the United Nations. “That doubles the number of deaths in one year from HIV and it actually pulls us back to the 2008 death rates from HIV. We would lose over a decade of progress in just one year.”

That’s according to research modeling work

disease, or obesity, which could put them at greater risk for contracting the novel coronavirus.

UNAIDS did with the World Health Organization, the Bill and Melinda Gates Foundation, and five prominent HIV-modeling research organizations.

The “bad case scenario” research model looked at sub-Saharan Africa, where so many people live with HIV. “We think it’s totally possible to act, so we don’t think that’s going to happen,” said Dr. Hader, who guides UNAIDS’ efforts in promoting an expanded and integrated United Nations system response to HIV around the world. “But people have to realize that autopilot, it’s not going to work. The costs are real for people.”

While people with HIV are not necessarily at greater risk for contracting COVID-19, they often have comorbidities including heart disease, lung

Advocacy Dr. Hader wants people living with HIV and their families to know the bad case scenario doesn’t need to happen. They can drive and demand solutions, and UNAIDS and other organizations want to support them.

Dr. Hader compares COVID-19 to HIV. While they are two different viruses, COVID-19 and HIV both started out as unknown diseases. They have common lessons, especially about empowering communities to take action, fighting against stigma, and never compromising on human rights.

She says it’s essential to set up global solidarity and transparency, and to invest in the technology and tools needed. For example, healthcare workers around the world need personal protective equipment, and people worldwide need affordable access to COVID-19 testing and treatments as they become available.

“I want everybody living with HIV to feel confident that they know the basics about COVID,” said Dr. Hader, encouraging people to be their own health advocates. “I would love for everyone living with HIV to feel empowered to take prevention measures, whether it’s hand washing, wearing masks, or physically distancing." n Kristen Castillo

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Ending the HIV Pandemic: The Light at the End of the Tunnel Since the beginning of the HIV/AIDS pandemic more than 39 years ago, major biomedical research advances have led to highly effective interventions to fight this modern-day plague.

What Parents Need to Know About Newborn Screenings Babies can look healthy at birth and still have a serious health condition, which is why newborn screening tests must be completed before being discharged from the hospital.

Doctors test a few drops of blood, taken from a baby’s heel, for a number of disorders, including a potentially fatal disorder of the immune system known as severe combined immune deficiency (SCID).

The immune system is made up of cells in the body that protect a person from infection. SCID is a disorder where the immune system is so weak that any infection, even a common cold, can be life-threatening. Many people remember David Vetter, who was born with SCID and became affectionately known as the “boy in the bubble.” The good news is SCID can be successfully treated if diagnosed early before serious infections develop.

Dr. John Routes, professor of Pediatrics at the Medical College of Wisconsin, was the senior investigator for the first statewide program to screen all newborns for SCID. By 2018 (a decade later), all 50 states had implemented SCID screenings.

Find our complete interview with Dr. Routes online at FutureofPersonalHealth.com

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R

eaching this goal, however, will require implementation of the tools biomedical research has provided with the discovery of new tools for our armamentarium.

Effective treatment and prevention With the treatments available today, a person with HIV who takes prescribed antiretrovirals daily can expect to live nearly as long as someone without the infection. Rigorous research also has demonstrated that treatment that suppresses HIV below detectable levels in blood can prevent transmission to uninfected sexual partners.

For uninfected people, taking a single pill daily as pre-exposure prophylaxis, or PrEP, can reduce the risk of acquiring HIV by more than 90 percent. Emergency post-exposure prophylaxis, or PEP, can prevent HIV from taking hold if taken within three days of exposure.

Anthony S. Fauci, M.D. Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health

The need for implementation These and other treatment and prevention tools could significantly reshape the epidemic.

However, implementation challenges impede their effectiveness.

By precisely applying these interventions, some communities are dramatically decreasing the incidence of new infections.

San Francisco is leading the nation, working to diagnose all people with HIV and immediately link them to treatment, while making prevention tools available for those at risk of infection. As a result, the city has made

great progress toward its goal of zero new HIV infections by 2020.

This success is mirrored elsewhere, even in certain lowand middle-income countries, including Swaziland, Malawi, Zambia, and Zimbabwe. These countries have been significantly affected by HIV and are now substantially reducing new infections through testing, treatment, and prevention.

Scientific challenges remain New treatment and prevention approaches are under investigation to make an even bigger difference. Long-acting therapies, including antiretrovirals and novel antibody regimens that eliminate the need for daily dosing, are being tested for both treatment and prevention.

Although significant scientific and implementation challenges remain, it is possible to relegate the HIV pandemic to the history books. There is a light at the end of this tunnel. It is just up to us to follow it. n MEDIAPLANET

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Protecting Our Front-Line Healthcare Workers As a pandemic reminds us how vital our healthcare professionals are, the question of how to protect them remains.

As the COVID-19 pandemic continues to disrupt society and claim lives, one segment of the population is paying a tremendous price: front-line healthcare workers. The International Council of Nurses (ICN) estimates that over 90,000 healthcare workers have been infected, and 260 nurses have died as a result of the disease, giving rise to questions about how we can better protect them.

“A huge challenge is inequity across the continuum of care,” says Sylvia Garcia-Houchins, infection prevention and control director at The Joint Commission, a nonprofit healthcare accreditation organization.

A trio of challenges For Garcia-Houchins, the challenges coming in the wake of the COVID-19 pandemic are familiar. “I’ve been in infection prevention (IP) since 1985 — that’s a long time. I’ve seen anthrax, I’ve seen MERS and SARS, H1N1, and Ebola.”

The challenge facing healthcare workers worldwide is threefold. First, it’s simply getting the personal protective equipment (PPE) they need. “If you’re working at a large academic teaching hospital, you are supported by a robust infection control program,” she notes.

Feeding into PPE supply-chain shortages is how many healthcare organizations think about budgeting. GarciaHouchins notes that many administrators rely on ‘just-intime-delivery’ to get PPE supplies when needed, but that this only works for large facilities.

The third challenge in terms of protecting our healthcare workers is information. “It’s happening so fast, there’s no time to peer review everything,” GarciaHouchins observes. “And social media allows for the transmission of both good data and information that helps to make people safe, but also personal opinions that are unsafe.”

Solutions Garcia-Houchins knows exactly what needs to happen: standardization. “I think we need to get everyone on the same page as far as methods of protection,” she says. “What caused a lot of distrust was how COVID-19 guidance changed every day. The Joint Commission heard that loud and clear from healthcare providers. In general, healthcare providers were unaware of a plan for de-escalating PPE and then targeting PPE.” Garcia-Houchins stresses that we have to stop thinking about these issues separately and start thinking about a holistic program. “Just providing PPE is not going to be enough. Only telling healthcare workers to wash their hands is not going to be enough. We have to establish multiple preventative systems that truly work, that truly look at how we stop that first case from entering a facility and exposing a healthcare worker. One prevention method is not enough. We need to follow the hierarchy of controls.”

Jeff Somers

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We Ask the Experts for Public Health Career Advice

Ruthann Haffke Career Counselor and Coach, Former Director of Career Services, University of California, Berkeley School of Public Health

Heather Krasna Assistant Dean of Career Services, Columbia University School of Public Health; Co-Author, “101+ Careers in Public Health”

Katherine Brumfield Senior Career Services Specialist, Colorado School of Public Health

Public health is not about being a doctor, nurse, or other clinical healthcare provider.

national attention, funding, and encouragement for timely, creative problem solving.

When you work in public health, you address health at a community level to improve the lives of hundreds to millions of people at a time. You could be developing or advocating for new policies, collecting and analyzing data, designing or implementing programs, developing treatments and vaccines, creating marketing and communication campaigns, or a variety of other work.

But the core of the field is working to improve health outcomes, which includes addressing the societal and systemic factors that lead to improved health.

Three public health career services experts from the Association of Schools and Programs of Public Health’s member institutions offered their takes on why you should consider public health and how to pursue a career in the field:

Heather Krasna: A commitment to preventing illness and promoting wellness, combined with a passion for changing challenging underlying societal problems to do so, is a prerequisite for a career in public health.

Public health is one of the most meaningful career paths available and allows diverse options for different people.

understand research, statistics, data analytics, survey design, and so forth, is critical to success.

Empathy and strong communication skills are also important.

What advice would you give someone considering a career in public health?

HK: You have to be passionate about public health. Many career pathways won’t make you rich. Commitment to being the unsung hero who keeps people from getting sick, rarely getting the limelight or credit, is important. And public health is science-based. Being able to

Ruthann Haffke: Now more than ever, the need for public health professionals is represented in the news daily. Public health issues are getting

What attributes make someone a good fit for a career in public health?

What makes someone successful in the field?

RH: Being motivated by making a positive difference in the world and enjoying tackling tough problems. Self-motivated, persistent, creative thinkers who can work with a wide variety of people.

Katherine Brumfield: Motivation to improve health for all, driven to solve problems, adaptability to change, and willingness to collaborate and work on interdisciplinary teams.

What additional insight would you share with someone about public health?

RH: Hiring is continuing to happen in the field! The needs are many and great.

KB: Public health careers are very rewarding and not often recognized. When considering a career in public health, remember there are lots of ways you can show up. For example, do you want to dig into research and collect and analyze the data? Or do you want to work with communities to create and implement programs? Or do you want to improve policies? Or do you want to address environmental factors that impact health? We need all of these lenses in public health, but how do you want to show up? n MEDIAPLANET

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How to Re-open a Building Safely After the COVID-19 Pandemic As our country focuses on the next phases of re-opening businesses, buildings from large office complexes to manufacturing plants and small retail stores that were not closed properly, not maintained during the closure, and not effectively cleaned could pose a health hazard to their occupants and staff.

The American Industrial Hygiene Association (AIHA), a professional association of occupational health and safety science professionals, continues to urge employers that their physical buildings and plants need the same attention to ensure they are not “sick.”

AIHA President Kathy Murphy, an occupational health and safety professional, answers a few of the most common questions employers are asking: What industries have been the most affected by COVID-19 and will need to plan for re-entry?

Hotels, resorts, cruise ships, call centers, manufacturing facilities, office buildings, strip malls, gyms, salons, outpatient surgery facilities and other elective-medical office buildings, dental offices, entertainment places (movies, arcades, water parks), and beach-front shops.

What are your biggest concerns about re-entering buildings after they’ve been empty for months?

Waterborne pathogens such as Legionella and Pseudomonas have likely colonized many building water systems that have sat stagnant for weeks and months in the warm conditions. Inhaling the aerosols from sinks, showers, and hose-bibs, as well as cooling tower mist, could cause numerous outbreaks of respiratory disease that will initially mimic COVID-19.

Are there any specific symptoms employees will present if a building has not been properly re-opened?

Yes, employees will have an increase in allergies, eye and respiratory irritation, or even infections from mold growth. Outbreaks of Pontiac fever, caused by Legionella bacteria in water, may cause “flu-like” illness.

Building water systems that aren’t properly flushed may also cause an outbreak of Legionnaires’ disease two to 14 days after exposure. Legionnaires’ disease occurs in people who inhale water droplets (aerosols) with Legionella bacteria. They will have symptoms such as shortness of breath, fever, and confusion.

Many symptoms of Legionnaires’ disease mimic those of COVID-19 and can lead to pneumonia. For anyone who is still recovering from COVID-19, preexisting damage to their respiratory system would likely make a person more susceptible to Legionella infection.

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4 Students Share How They’re Changing the World Through Public Health The pandemic has put a spotlight on public health, however, the field extends far beyond just preparing for and protecting people from diseases. Public health also helps to ensure everyone is able to live their longest, healthiest lives by addressing disparities that lead to inequitable health outcomes.

As public health has many avenues to help others, students have found they are able to positively impact the world by working in this profession.

From health interventions to curbing youth vaping, here are four stories of students who are making a difference in the global community.

Haley Delgado, MPH Community Health, Baylor University Public Health Program The Salud Para Usted y Su Familia intervention I am currently working with has specifically been rewarding because it promotes health in colonias in south Texas, the same area where my mother was raised. Being a first-generation Latina from a really small, rural, agricultural town, I’ve always been aware of social determinants of health even though I never knew what they were prior to my exposure to the public health field. Being able to work on teams and with people who

are working toward solutions for underserved communities gives me hope that someday I can go back and serve the small towns I grew up in.

Laurel Gumpert, MPH & MBA Community Health, Stony Brook University Program in Public Health The single most rewarding experience of my career at Stony Brook’s Program of Public Health was working at the World Trade Center Health Program. This clinic serves the needs of 9/11 first responders and develops cutting-edge research. I grew up on Long Island and was only 5 years old on Sept. 11, 2001, however, I watched the long-lasting impacts 9/11 had on others around me. In a time of tragedy, these first responders ran toward a disaster to save the lives of others. Years later, these first responders are suffering from health problems associated with their selfless work. It is a privilege and an honor to be able to work with this population. I get to spend my days serving heroes, so I consider myself very lucky.

Zaena Tessema, MPH Global Policy, Emory University Rollins School of Public Health Before enrolling in my MPH program, I was working to increase access to chronic disease prevention programs to low-income populations

in DC and Maryland. A major component of my responsibilities included recruiting of beneficiaries into the program, which allowed me to build relationships with those who chose to enroll. Staying in touch and following their successes through the duration of the 12-month program was extremely rewarding. I was able to witness people lose weight, become healthier, reduce their risk of diabetes, and meet their own personal goals. It was very rewarding and I was happy to be a part of their personal journeys.

Lauren Silverwood, MPH Health Behavior, University of Alabama at Birmingham School of Public Health The most rewarding experience of my studies so far has been positively impacting my community through preventative education efforts.

I am completing a summer internship with the Youth Tobacco Prevention Program in Birmingham, Alabama.

As an intern, I am educating groups of adolescents about the harmful effects of using tobacco products, with a focus on e-cigarettes, vapes, JUULs, and other pod-based systems.

There is a lot of misinformation about these products and I find it fulfilling to share accurate information with these adolescents so they can make informed decisions about their health choices. n MEDIAPLANET

The Future is Calling.

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The 3 Keys to Beating COVID-19 be hard on a body even if it wasn’t fighting for oxygen.

Anti-infectives can make diseases like COVID-19 less dangerous.

Tina S. Morris, Ph.D., Executive Director, American Association of Pharmaceutical Scientists (AAPS)

COVID-19 has focused attention on the critical role vaccines and herd immunity play in securing the public’s health. Alongside the case counts and death toll from this virus, the hope for a fast, effective, and easily distributed vaccine continues to climb.

However, the researchers and pharmaceutical scientists responding to this crisis are working on more than vaccines. They know the greatest successes in beating back disease require a three-pronged approach: 1. Diagnostics (testing) We must know who has been infected to determine who we need to isolate in order to stop the spread of the disease — and to learn how the virus works. Reliable, broad-based testing is vital to conquering an infectious disease because it shows us the cycle of the 20

illness. It informs scientists when symptoms occur, if immunity follows (and if so, for how long), and how the illness may branch based on a patient’s pre-existing conditions.

Frontline physicians rely on this information to choose treatments and scientists rely on it to develop those treatments.

2. Anti-infectives Therapies that inactivate disease agents after they’ve started multiplying inside a patient’s body are as important as vaccines. They can reduce the length of time someone is ill and limit the destruction a disease causes inside the body.

COVID-19 can last far longer than 14 days, and may trigger secondary infections and the need for invasive treatments like ventilators.

The foregoing infections and invasive treatments would

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3. Preventive immunization We rarely eradicate infectious diseases — there are still a half-dozen cases of the bubonic plague each year. Fortunately, such cases are now easily treated with antitoxin therapy and other available countermeasures.

The goal of public health efforts is to protect a community while also preventing the spread of an infectious agent. This is where vaccines come in. Vaccines have helped us control deadly diseases including polio, measles, yellow fever, and many more.

Vaccines make it possible to establish herd immunity, which happens when enough people have antibodies to the disease to make it stop spreading, since the virus runs out of susceptible targets.

This is difficult to achieve without a vaccine. Depending on the disease’s life cycle and infectiousness, it can continually find new hosts. Vaccines reduce the number of potential hosts quickly and safely.

The long road In many ways, vaccines are the magic bullet that the infectious diseases pioneer Paul Ehrlich sought in the 19th century. Unfortunately, the attribute that makes vaccines so powerful — being a near-universal shield for a vast, diverse, healthy population — also makes them difficult to develop. Vaccines must be safety-tested in large,

diverse groups of healthy volunteers to determine how well they protect against a disease in people of differing genetic traits.

Scale and access are important factors as well. The ongoing effort to eradicate polio worldwide has required decades of mass vaccination campaigns to deliver more than 20 billion doses of vaccines. This has resulted in the interruption of polio transmission in all but three countries. Polio is a debilitating, yet well-understood, viral disease for which vaccines have been available since the mid-1950s.

To create an effective vaccine that will prevent a new disease, researchers must first understand which components of the disease agent lead to the formation of antibodies, which leads to immunity. In some cases, especially with viruses like the flu, the virus changes over time. Such changes allow the virus to continue moving through people, which is why scientists continually chase the virus with new versions of a vaccine, which is why you get a new flu shot each year.

Changing the game The good news is this: Modern biotechnology has revolutionized how we discover and develop the necessary tools to create vaccines. The toolbox of approaches has been expanded, which accelerates vaccine development.

We can now synthesize vaccines that look like a virus particle but are harmless to the patient. We can use genetic material for vaccination, which will generate

antigens in the patient’s body that lead to an immune response. Modern delivery technologies for vaccines allow safer, easier, and faster administration to patients with a variety of health conditions. New technologies allow vaccine developers to better model and predict how a vaccine will perform in patients.

Vaccines are finally getting their much-deserved time in the spotlight, but their real power comes from their ability to make a disease disappear from the public’s attention, leaving us to go about our lives safely.

If all goes well, we will tell our children about COVID-19, but they won’t really understand because they will not have lost someone to it. n

Martina Kovac, M.D., Vice President, Global Product Development, Vaccines, PPD Inc. “We understand the urgency surrounding the novel coronavirus pandemic and are committed to ensuring the safety of our employees, patients, and customers to help safeguard public health.

We provide innovative solutions to expedite clinical trials to bring us closer to a safe and effective treatment or vaccine. In these challenging times, our mission has never been more clear; helping deliver life-changing therapies to people in need.”

MEDIAPLANET

Why Vaccines Are So Important: A Polio Case Study Vaccination — one of the greatest and most cost-effective global health achievements — saves five lives every minute. It has led to the global elimination of smallpox, reduced global child mortality rates, and prevented countless lifelong disabilities such as paralysis from polio.

So, why are we seeing more and more outbreaks of viral diseases, despite widespread vaccination programs?

Take measles, for example. In the United States, vaccination led to the total eradication of measles by 2000. Yet in 2019, 1,282 cases were confirmed in 31 states; the highest number since 1992. It’s a similar story elsewhere. In the United Kingdom, measles cases are now higher than in the 1990s. Globally in 2019, over 400,000 confirmed cases of measles were reported to the World Health Organization (WHO) in 187 countries.

Part of the answer lies in the erroneous and often dangerous ideas about vaccination that circulate so much faster in our connected, social media world. In addition, there are generations that no longer know what infectious diseases are and what they can cause.

In the early 20th century, polio was one of the most feared diseases in industrialized countries, paralyzing hundreds of thousands of children every year. The tide turned in the 1950s when two polio vaccines were developed, by Jonas Salk (1955) and Albert Sabin (1961).

Polio was brought under control and was practically eliminated as a public health problem in the industrialized world. However, it still remained a major health problem in developing countries, where 350,000 children were contracting polio annually. This led to the WHO launching its Global Polio Eradication Initiative in 1988.

The hugely successful initiative has led to nearly 3 billion children being immunized against polio in the last 30 years. It is estimated that around 18 million people are able to walk today who would otherwise have been paralyzed. An estimated 1.5 million children would otherwise have died as a consequence of catching polio. In four of the WHO regions, polio has been officially declared eliminated: the Americas (1994), Western Pacific (2000), Europe (2002) and most recently South-East Asia (2014).

Affirming the urgency for further vaccination against polio One focus area is polio, an infectious viral disease that targets mostly children under the age of five. One in 200 infections leads to paralysis, which can be of the limbs or, more seriously, of the respiratory muscles, which can result in death.

The knock-out blow to polio However, until the polio virus is totally eradicated, there remains a risk of a major outbreak that could result in as many as 200,000 new cases each year over the whole world.

Unfortunately, stamping out the last strongholds of the polio virus — mainly in Afghanistan and Pakistan

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— is proving extremely challenging.

These last polio-affected regions are often plagued by political instability and conflict, mass population movement, poor healthcare infrastructures, and the inaccessibility of some remote areas. Combined, these make it very difficult for healthcare workers to reach and vaccinate the populations at risk.

To secure a future free of polio, the WHO has launched its Polio Endgame Strategy 2019-2023. It’s a multi-strategy approach that includes the accelerated development of a new, genetically engineered vaccine. Its deploy-

ment could happen as early as June 2020 under the WHO’s emergency protocols.

VAXVOX is fully behind the WHO strategy and we will do all we can to communicate the key scientific messages underlying the use of vaccination to help ensure a world where no child contracts polio ever again. n This article was originally published by Mediaplanet UK. Pierre Van Damme, Professor in Vaccinology, University of Antwerp, Belgium MEDIAPLANET

We VAX becauseÉ Immunization is mankind’s greatest success story of modern medicine.

Routine immunizations prevent 2-3 million deaths per year.* Vaccines have eradicated fatal diseases such as smallpox.

We care about our friends, families and communities.

We want a healthier future for people everywhere. * Centers for Disease Control and Prevention (CDC)

Why We Vax Get the facts at WhyWeVax.org Sponsored by Immunomic Therapeutics. A proud supporter of Why We Vax and healthier people everywhere.

When health insurance is not enough, HealthWell fills the gap.

The HealthWell Foundation is a nationally recognized, independent non-profit organization, that serves as a safety net for underinsured Americans. Since 2003, we have awarded over $1.6 billion in medication copay and premium assistance grants to more than 500,000 patients with chronic or life-altering diseases.

Our vision is to ensure that no patient goes without health care because they cannot afford it. When health insurance is not enough, we fill the gap by assisting with copays, premiums, deductibles and out-of-pocket expenses for essential treatments and medications.

If you have health insurance and need assistance to cover medical treatment costs, we may be able to help. To learn more about our program and current diseases covered, visit our Disease Funds page.

www.HealthWellFoundation.org/disease-funds Website: www.HealthWellFoundation.org Facebook: Facebook.com/healthwellfoundation Instagram: @HealthWellFoundation Twitter: @HealthWellOrg Linkedin: healthwell-foundation

disease funds Acute Myeloid Leukemia Amyotrophic Lateral Sclerosis Cancer-Related Behavioral Health Chronic Lymphocytic Leukemia Congenital Sucrase-Isomaltase Deficiency COVID-19 Ancillary Costs Cushing’s Disease Cystic Fibrosis Treatments Cystic Fibrosis Vitamins and Supplements Cytomegalovirus Disease – Prevention and Treatment Diabetic Foot Ulcers Dupuytren’s Disease Gastric Cancer – Medicare Access Gout – Medicare Access Gout Travel Fund Hepatitis C Homocystinuria Hypercholesterolemia – Medicare Access Lambert-Eaton Myasthenic Syndrome Macular Degeneration (Wet and Dry) Mantle Cell Lymphoma Multiple Myeloma – Medicare Access Nontuberculous Mycobacterium – Medicare Access Pediatric Assistance Peyronie’s Disease Porphyrias Pulmonary Fibrosis Secondary Hyperparathyroidism Small Cell Lung Cancer – Medicare Access Tardive Dyskinesia – Medicare Access Urea Cycle Disorders Wilms’ Tumor