DPHS COVID-19 Impact Report_06_03_21 by UM Department of Public Health Sciences

UNIVERSITY OF MIAMI MILLER SCHOOL OF MEDICINE DEPARTMENT OF PUBLIC HEALTH SCIENCES

COVID-19 IMPACT REPORT 20 21

TABLE OF CONTENTS MESSAGE FROM THE CHAIR.....................................................................................6 LOCAL IMPACT........................................................................................................................8 » Battles Being Waged to Overcome Vaccine Hesitancy.................................................................9 » COVID-19 Remembrance Ceremony Reflects Both Painful Losses and Renewed Hope for the Future.........................................................................................................................................11 » Mobile Clinic Takes Vaccines to Underserved Aeas...................................................................12 » Sylvester Experts to Study COVID-19 Health Outcome Disparities of Breast Cancer Survivors...........................................................................................................................................14 » Miller School Project to Use Health Data to Develop Strategies for Hard-Hit COVID-19 Communities.....................................................................................................................................15 » Miller School Awarded National Grant to Address Health Disparities During Pandemic..........14 » UHealth Pediatric Mobile Teams Surpass 10,000 COVID-19 Tests.............................................16 » COVID-19 Vaccine Trials Exhibit Early Success...........................................................................17 » Course Explores Global Health and Disparities During the Pandemic.......................................20 » Student Garners Reflections on the Importance of Public Health..............................................22 » A Pandemic Strikes, and an Academic Community Responds....................................................23 » U-TRACE Initiative to Address COVID-19 Public Health Crisis...................................................26 » Sylvester Researchers to Collaborate with Miami-Dade County on Coronavirus Testing...........27 » Mindfulness During Uncertain Times..........................................................................................28 » Additional Student And Alumni Local Impact............................................................................29

NATIONAL IMPACT...........................................................................................................34 » Study Shows Pfizer and Moderna are Effective in Preventing COVID-19 Among Health Care and Frontline Workers...............................................................................................................35 » COVID-19 Has Led to the Reformation and Reinvigoration of the Public Health Workforce....36 » Study Finds U.S. First Responders Have Mixed Feelings About COVID-19 Vaccine..................37

» Miller School Leads Groundbreaking Trial Treating Severe COVID-19 With Mesenchymal Stem Cells...........................................................................................................................................38 » COVID-19 Infection is Associated With Economic Disadvantage in a Particular Geographic Area, Study Finds.......................................................................................................................40 » Miller School’s Public Health Graduate Students Play Key Role in Uniting For Action’s New Vaccine Considerations Project........................................................................................................42 » New Study Examines Loneliness, Mental Health, And Substance Use Among U.S. Young Adults During COVID-19.......................................................................................................................44 » New Paper Highlights Challenges and Innovations in Latinx Health Disparities Research Amid COVID-19...................................................................................................................................46 » Miller School Public Health Researchers Study COVID-19 Antibodies in First Responders........47 » Dr. Adam Carrico Receives NIH Grant to Study Risk for COVID-19 Amid Methamphetamine Use And HIV......................................................................................................................................49 » Climate-Driven Atlantic Hurricanes and COVID-19 Transmission: Mitigating Between the Concurrent Threats...........................................................................................................................50 » UM to Launch COVID-19 Vaccine Testing Site for the COVID-19 Prevention Trials Network..........................................................................................................................................52 » Quality of Indoor Air Plummeted in Some Homes During COVID-19 Shutdown.......................53 » Syringe Service Programs Across the U.S. Have Been Impacted by the COVID-19 Pandemic, Study Finds.................................................................................................................................54 » Strategies to Help the Hard of Hearing During COVID-19 Precautions.....................................56 » Methamphetamine Use and HIV Create Perfect Storm for COVID-19 Transmission..................59 » Additional Student and Alumni National Impact........................................................................60

GLOBAL IMPACT..................................................................................................................62 » New Miller School-Led Lancet Study on Redefining the Future of Pandemics...........................63 » Personal Perspectives on the Covid-19 Crisis in India................................................................64 » New Panel to Advocate for a Global Public Health Convention for the 21st Century...............66

TABLE OF CONTENTS » Public Health Leaders Discuss Steps Needed to Empower Women........................................68 » Dr. Felicia Knaul: Access to Pain Relief Medicines in Mexico Should Be a Priority for Policy Makers.....................................................................................................................................70 » Report Confirms Pandemic-Related Spikes in Domestic Violence...........................................71 » Cancer Patients in Mexico Face Dire Scenario in Wake of COVID-19......................................72 » Miller School Professors Develop Model to Correct COVID-19 Sampling Bias........................74 » New Study First to Use Pandemic Stress Index to Document the Effects of COVID-19 on Latinx Sexual Minority Men..........................................................................................................76 » Panel: Pandemic Intensified Need for Palliative Care in Latin America...................................78 » Caribbean Nations Explore New Ideas, Directions to Recover From Pandemic......................80 » Julio Frenk: Empowered Who Needed to Battle Pandemics...................................................81 » COVID-19 Lessons From Peru and Argentina..........................................................................82 » Violence Against Women, Children Escalates During Pandemic..............................................84 » Scientific Evidence And Global Collaboration Can Help End The Pandemic............................85 » COVID-19 is Ravaging Latin America.......................................................................................86 » Orthopaedic Trauma Units Across the Globe Greatly Impacted by COVID-19, Study Finds....87 » Why Brazil Is Now the Epicenter of the Coronavirus Pandemic...............................................89 » Experts Discuss a Potential Global Public Health Convention in University of Miami-Led Advisory Meeting............................................................................................................................90 » COVID-19 Observatory: Bungled Response Compounds Misery in Brazil...............................92 » A New Survey Sheds Light on ‘Vulnerable’ Cannabis Users.....................................................94 » Experts Develop New Tool to Help Contain COVID-19 in Latin America................................96 » Frenk: Latin America, Caribbean Can Learn From Other Covid-19 Responses........................98 » New Grant Targets Global Health Protection Against the Spread of Infectious Diseases.....100 *Please note that this report does not include all of the work led by department faculty, research staff, students, and alumni.

MESSAGE FROM THE CHAIR

The World Health Organization (WHO) declared the SARS-CoV-2 outbreak a global pandemic on March 11, 2020, heralding a period of unprecedented change and challenge across the globe that continues to this day. Since then, there have been truly remarkable advances, including the development, production, and distribution of highly effective vaccines aimed at ending the COVID-19 pandemic. The pandemic has also focused a spotlight on the critical role of public health—the science that works to protect and improve the health of people and their communities. The need for experts in the areas of infectious disease, epidemiology, prevention science, community health, environmental health, biostatistics, and public policy has never been greater. The mission at the University of Miami Miller School of Medicine’s Department of Public Health Sciences—which is to bring about sustainable, positive changes in health—has continued in this pivotal moment in history. Since the WHO pandemic declaration, our faculty, research staff, administration staff, students, and alumni have persevered with resiliency and adaptability—together as a community to provide exceptional solutions to public health challenges. From being on the frontlines, publishing ground-breaking studies, and securing grants for research on COVID-19 to working together as a community, adapting to different learning and working modalities, and thriving with resilience, you name it, they have done it. During this unprecedented year, I am also proud to share news on our graduate programs, new scholarship opportunities, and research rankings. From Fall 2019 to Fall 2020, our Master of Public Health (M.P.H.) and Master of Science in Public Health (M.S.P.H.) graduate programs saw a remarkable 85 percent enrollment increase. In the Spring 2021 semester, we enrolled one of our largest cohorts with 17 graduate students. The future

is bright for these students and for public health. In addition to our research, graduate, and teaching assistantship opportunities for students in all programs, we announced a new full-tuition scholarship for incoming full-time M.P.H. and M.S.P.H. graduate students known as the Resiliency Scholarship, as well as guaranteed partial scholarships to accepted students in the Master of Science in Biostatistics and the Master of Science in Prevention Science and Community Health programs. The department’s five divisions and drug research center, including the Division of Biostatistics, Division of Epidemiology and Population Health Sciences, Division of Environment and Public Health, Division of Prevention Science and Community Health, Division of Health Services Research and Policy, as well as the Comprehensive Drug Research Center, continues to also celebrate milestone research achievements.

part of this incredible group of public health leaders and invite you to peruse through our Department of Public Health Sciences COVID-19 Impact Report, which showcases the incredible aforementioned achievements. Sincerely,

David J. Lee, Ph.D. Chair and Professor Department of Public Health Sciences Chair of Graduate Programs University of Miami Miller School of Medicine 305-243-6980 dlee@med.miami.edu

According to the Blue Ridge Institute for Medical Research in February 2021, the Department of Public Health Sciences ranked as the No. 4 most National Institutes of Health (NIH)-funded department out of 28 in the Miller School of Medicine. Out of 46 research portfolios of public health departments within medical schools nationwide, our department is in the top 20 most funded by the prestigious NIH, ranking at No. 15. Lastly, the University of Miami’s Office of Research Administration announced that our department was No. 6 out of the top 10 highest-funded departments within the University. I cannot say enough about the remarkable resiliency of our faculty, research staff, administration, students, and alumni who have become effective learners in the middle of a pandemic and have partnered seamlessly to deliver and participate in pioneering programs that have improved public health outcomes locally, nationally, and globally. I am grateful to witness and be a

FACULTY, STUDENTS AND ALUMNI:

LOCAL IMPACT

BATTLES BEING WAGED TO OVERCOME VACCINE HESITANCY Written by Robert C. Jones Jr. Published on April 30, 2021 Category: Faculty, Secondary Faculty, Students, Service As more and more vaccines are being administered, the push is on to convince everyone to get protected. Eliminating barriers to health care and ramping up educational efforts are just some of the ways to get more people to get the shot, University of Miami researchers say. It’s not that McKenzi Payne wants to frighten the young men to whom she helps administer health screenings at Miami-area barbershops. But she can’t think of a better way to convince them to get the COVID-19 vaccine than to relate some of the heartbreaking stories she has experienced as an emergency room technician at Jackson North Medical Center. “I’ve seen what the virus can do to the human body, the way it can destroy families,” Payne, a master’s degree

student in public health sciences at the University of Miami Miller School of Medicine, said one recent Saturday at Urgent Cutz barbershop in Liberty City, where she and first-year medical student Melissa Blake conducted free blood pressure screenings as part of the Shop Docs initiative. “I’ve seen people separated from their families in the darkest moments of their lives,” Payne said. “And I’ve seen patients walk into the ER complaining of shortness of breath, and by the time my shift was over, they were intubated.” She can’t say for certain if the strategy works. What’s important, though, is that the effort to persuade more people to get vaccinated, especially the young who don’t fear the virus, needs to be made, she said. OUTREACH EFFORTS With more than 140 million people in the United States 18 or older now

having received at least one dose of a COVID-19 vaccine, or 54.9 percent of the total adult population, everyone from health care workers to community activists are employing a multitude of strategies to combat the last few pockets of vaccine hesitancy, racing against time—and the variants—to dispel the rumors and persuade doubters that the inoculations are safe and effective. Through a National Institutes of Health-funded outreach project, Dr. Olveen Carrasquillo, a Miller School physician and his team, have taken to the radio waves and the internet to spread the message about the safety and efficacy of the vaccines. They are also conducting online focus groups to learn why certain segments of Miami-Dade County’s population are distrustful of the shots. “We listen to their concerns and try to meet them halfway. We still get questions about the long-term safety of the vaccines and if they affect preg-

nant women. But a lot of the conspiracy-fueled questions have been on the decline, and we’re happy about that,” said Carrasquillo, chief of the Division of General Internal Medicine and co-director for community and stakeholder engagement at the Miami Clinical and Translational Science Institute. Partnerships with groups like Health Council South Florida, the Florida Community Health Worker Coalition, and a Little Haiti-based radio station have helped his efforts. So, too, have alliances with houses of worship. “We’ve had bishops, priests, pastors, and other religious leaders on our calls,” Carrasquillo said. “They know how to address a lot of the questions we’ve come across.” Outreach efforts like Carrasquillo’s may be working. A new poll by the Kaiser Family Foundation shows vaccine hesitancy rates dropping among all U.S. residents, with the most positive changes occurring among Black people. About 55 percent of Black adults said they had been vaccinated or plan to get a COVID-19 vaccine soon, an increase of 14 percentage points from February, according to the poll. The rate approaches that of Hispanics (61 percent) and whites (64 percent). BARRIERS TO HEALTH CARE But vaccine hesitancy shouldn’t be confused with barriers to health care that make it difficult for some segments of the population to get vaccinated, cautioned Sannisha Dale, a health psychologist in the University of Miami’s College of Arts and Sciences. Lacking adequate transportation to get to vaccination sites, not having home WiFi to log onto the internet to make a vaccine appointment, and not being able to take time off from work are just some of the challenges marginalized groups face in getting a COVID-19 shot, she said. “People at the margins are used to communicating the challenges they face in their daily hierarchy of needs,” Dale explained. “And when they’re questioned about their interest in get-

ting something, and they’re required to respond with a simple ‘no,’ their answer appears to simply be a lack of interest, but it’s not. In reality, behind that no is a long answer, part of which is having access to those services.” More initiatives to bring vaccines closer to marginalized communities such as mobile pop-up clinics are needed, she said. “Unless we are intentional about how we get vaccines to communities, there’s still not going to be the level of uptake that’s particularly ideal in communities that have experienced the most casualties around the virus,” Dale said.

monitoring to ensure vaccine safety. However, I think the key thing that the moment calls for is ethical journalism and reporting the actual numbers versus catchy headlines that may exacerbate the number of rare cases and fuel skepticism.” There have been about 17 cases of clotting that occurred in about seven million doses of that vaccine, and those cases were among women between the ages of 18 and 50. “These were extremely rare events,” Carrasquillo said. “But media really blew this up. My sense is that the media hype will pass.”

Dr. Erin Marcus, a professor of clinical medicine at the Miller School, echoed those sentiments, saying that more needs to be done to make it easier for some groups to get vaccinated. “In Miami-Dade, we don’t have a super robust public transportation system,” she said. “There is Metrorail, but if you don’t live along those lines and you can’t get access to it equally, the bus system can prove difficult to navigate.”

One statistic that is concerning: the number of first responders who have mixed feelings about the COVID-19 vaccines. In a national survey of more than 3,100 firefighters and emergency medical services workers, Miller School researcher Alberto J. Caban-Martinez found that more than half of the respondents said they were uncertain about (24.2 percent) or had low confidence (27.6 percent) in the vaccines.

Health care workers, she believes, need to be role models in reassuring others that the vaccines are safe. She admits that she is a bit of a proselytizer in that regard. From an Uber driver to a woman she met at a local post office, Marcus always has the same message for anyone with whom she strikes up a conversation: get the vaccine.

The study results were published online Feb. 1 in the Journal of Occupational and Environmental Medicine.

“It’s important that health care workers lead by example,” she said. “So often, if I’m with a patient or just having a conversation with someone, I will point to my ID and I will point to the sticker that says COVID-19 vaccinated, and I’ll say, ‘Look, I got it.’ ” A pause in the Johnson & Johnson vaccine because of concerns over blood clots fueled fears of additional vaccine hesitancy. But if anything, the temporary suspension, which has since been lifted, can “serve as reassurance for some who worry that the vaccine development and distribution process was hurried,” Dale said. “A pause shows that there is constant

Caban-Martinez, associate professor in the Miller School of Medicine’s Department of Public Health Sciences, attributes those numbers to what he calls a “fatalistic culture” among some first responders. “Many felt the nature of their work puts them at high risk of contracting the coronavirus because they’re in the community taking people from their homes and transporting them to hospital and clinical settings. Their feeling was, ‘We’re going to get it anyway. Let someone else receive the vaccine,’ ” he said. Since that survey, the number of firefighters reporting that they intend to get the vaccine has increased, according to Caban-Martinez, who is planning to update his study. REACHING HERD IMMUNITY Good news comes in the fact that 99.6 million of the total U.S. population,

or 30 percent, is now fully vaccinated, according to data from the Centers for Disease Control and Prevention as of April 29. But along with that news, is a softening demand for the shots, as more and more states report a slower pace in their vaccination campaigns. And that is why the push to vaccinate more people is important, as the nation strives to achieve herd immunity, said Dr. Roy E. Weiss, professor and chair of the Miller School’s Department of Medicine and the University’s chief medical officer for COVID-19. “The way in which we’re going to be able to return to normalcy both in our professional lives here at the University and in our private lives is to get to a number of approximately 90 percent of people being vaccinated,” he said. “Why do I say 90 percent?” Weiss continued. “We don’t know exactly what the number is, but we do know that with the variants and other challenges, that if we strive for that number, we’re likely to be able to reach a safe situation where there would be herd immunity and people wouldn’t be getting very ill. It’s just imperative for everyone to take that responsibility to protect themselves and to protect their co-workers and colleagues in society by getting the vaccine.” Dispelling some of the myths surrounding the coronavirus vaccines, Weiss pointed out that vaccines have been used for decades and are the primary weapon employed to fight infectious diseases. “When you think about other things that have cost human lives and high economic tolls, think of polio, think of diphtheria, think of smallpox,” he said. “The devastating effects that these diseases have had have all been essentially eradicated due to the use of vaccines. They’re safe and they’re effective.”

COVID-19 REMEMBRANCE CEREMONY REFLECTS BOTH PAINFUL LOSSES AND RENEWED HOPE FOR THE FUTURE Written by Richard Westlund Published on April 23, 2021 Category: Miller School of Medicine Dean, Faculty, Students For Gabrielle Benesh, a student at the University of Miami Miller School of Medicine, the COVID-19 pandemic brought an intense personal challenge. “My father spent six weeks fighting for his life, while I couldn’t be at his bedside to hold his hand,” she said. “When he came home after 42 days on a ventilator, it was the happiest day of my life.” Medical student Jacqueline Baikovitz also had a difficult experience during the pandemic. “I was in the intensive care unit with the parents of a dying patient in his 40s,” she said. “In their time of grief, I was able to be there to comfort them. It was a reminder that regardless of COVID-19’s tragic numbers, we must always remember the humanity in medicine.” Benesh and Baikovitz were among the members of the UM chapter of the Gold Humanism Honor Society

who took part in a COVID-19 Remembrance Ceremony on Earth Day, April 22. To commemorate the year’s painful losses, as well as symbolize the Miller School’s hope for the future, Henri R. Ford, M.D., M.H.A., dean and chief academic officer, led the planting of a new Royal Poinciana tree in the park near the 15th Street garage on the medical campus. “We pause today to reflect on the ravages of the pandemics of COVID and racism facing our nation,” said Dr. Ford. “In the face of those challenges, we must never waver from our commitment to heal and alleviate human suffering.” Dr. Ford paid tribute to the Miller School and UHealth community for mounting a heroic response to COVID-19. “While our frontline workers were saving lives, our researchers were busy working on tests, treatments and vaccines. This tree will serve as a symbol of renewed hope for our society and a reminder of our unflagging resilience in facing adversity.” Latha Chandran, M.D., M.P.H., exec-

utive dean, founding chair of the Department of Medical Education, and faculty advisor to the Gold Humanism Honor Society, took part in the tree planting with students Ryan Severdija and Priyen Patel. “Today, we pay our respects to Mother Earth,” she said. “Like a tree, we must be strong and resilient, grounded in our roots and helping others with no expectation of returns.” Moderating the virtual event, Jacklyn Perrault noted that there have been 465,000 COVID-19 cases and 6,000 deaths in Miami-Dade County so far. “For every lost life, there are countless loved ones missing them every day,” she said. “Many others have experienced the loss of jobs, income, and even their homes. Today, we acknowledge those losses and focus on healing as we continue our spirit of compassion and community support.” For the remembrance ceremony, Gauri Agarwal, M.D., associate dean for clinical curriculum, read a poem she wrote about how water links all humanity. “In the past year our collective tears have fallen into the great rivers of the Earth,” she said. Melissa Jones noted that medical students have played a role in the great pandemics of the past century, as well as the response to the 9/11 attacks. “Medicine is an unyielding call to action for us,” she said. “Today, as we remember the health care workers who lost their lives helping others, we must encourage family and friends to protect themselves by wearing masks and getting vaccinated.” On the musical side, student Arnaldo Franco played “Until the Last Moment” by Yanni on his piano, and four students from the Frost School of Music presented the first movement of Beethoven’s 14thstring quartet. Reflecting on the past year, Benesh said COVID-19 changed her life, giving her a depth of understanding that will make her a better doctor in the future. “Cherish the moments you have with the people you love,” she said. “And always be hopeful of new beginnings.”

MOBILE CLINIC TAKES VACCINES Written by Janette Neuwahl Tannen Published on March 31, 2021 Category: Alumna, Secondary Faculty, Service

The UHealth Pediatric Mobile Clinic is now offering the COVID-19 inoculations to adult family members of their patients in disadvantaged communities throughout Miami-Dade County. Armed with supplies from the state, the University of Miami Health System’s Pediatric Mobile Clinic is visiting some of Miami-Dade’s neediest communities to deliver COVID-19 vaccines. “We have to be part of the solution to getting this pandemic behind us,” said Dr. Lisa Gwynn, medical director for the Pediatric Mobile Clinic, as well as interim chief of the Division of General Pediatrics at the Miller School of Medicine. “We hope to make this a part of what we do and to offer what we have in these communities longterm.” At least twice a week, and on some Saturdays, the mobile clinic is now offering COVID-19 vaccines to underserved populations in Little Haiti, Hialeah, Florida City, and Homestead at churches, schools, or community

health centers, said Gwynn. For the most part, these are locations the mobile clinic already visits to deliver medical care and annual vaccinations to uninsured children. Now that they have COVID-19 vaccines, however, Gwynn’s staff is working with these partner sites to let families know they will be in the area beforehand. So, adults can make appointments for the inoculations. In just the past three weeks, the mobile clinic has distributed 414 of the Johnson & Johnson vaccines that were supplied by the Florida Division of Emergency Management and Department of Health among four different community sites, according to Gwynn. Although they are given small allotments now, this could change in the future, she noted. Some Hialeah residents who received the vaccine this week said they were relieved to be inoculated. While some felt they had to get vaccinated for work, others wanted it for their own safety. “I’ve stopped traveling for work and

“I know that in the very near future, kids will become eligible for COVID-19 vaccines,” said Gwynn, who is also an associate professor of clinical pediatrics and public health sciences and president of the Florida chapter of the American Academy of Pediatrics. “With this effort, we can refine our processes and get things up and running well before that happens.”

TO UNDERSERVED AREAS vacations because I have been afraid of getting sick, so I wanted to get protected,” said Joaquina Mejía. “I feel like I will have a little more freedom to do things now.” The entire operation began about three weeks ago, when Erin Kobetz, the University’s vice provost of research and scholarship, as well as associate director of population science and cancer disparities at Sylvester Comprehensive Cancer Center, was contacted by Florida’s Division of Emergency Management. State leaders were familiar with Sylvester’s success in using the Game Changer mobile clinic to perform cancer screenings and asked if she could use it to distribute COVID-19 vaccines. Although she was receptive, Kobetz had a better idea. She knew the staff on the Pediatric Mobile Clinic was better trained in delivering vaccines, so she reached out to them to offer the COVID-19 shots. Gwynn agreed right away. The Pediatric Mobile Clinic provides medical care to nearly 3,000 uninsured children in Miami-Dade County annually

Dr. Lisa Gwynn

and distributes more than 10,000 school-required vaccines each year to any child who needs them. A separate operation also coordinated through the mobile clinic is now offering COVID-19 testing for children at public schools. The relationships that Gwynn and her staff have cultivated within the community, as well as their expertise with inoculations, made it an ideal way to reach the underserved. Both Kobetz and Gwynn hope that this new effort will only ramp up with time. “We have long established relationships in these communities and are out there providing health education, care, and prevention already. So, adding the vaccine to our arsenal can only help close the gap for our medically underserved and minority communities who may not have access to the existing vaccination venues,” Kobetz said. Besides the benefits to their network of families, Gwynn believes that this will also help the Pediatric Mobile Clinic prepare for the next year.

To conduct the project, researchers will:

SYLVESTER EXPERTS TO STUDY COVID-19 HEALTH OUTCOME DISPARITIES OF BREAST CANCER SURVIVORS Written by Amanda Torres Published on February 26, 2021 Category: Faculty, Funded Project Cancer survivors may have a higher risk for COVID-19-related morbidity and mortality due to compromised immune, heart, and lung functions. Epidemiology experts with the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine are focusing their research on addressing COVID-19-related issues in breast cancer survivorship and promoting vaccination. Jennifer Hu, Ph.D., professor and director of the Division of Epidemiology and Population Health Sciences in the Miller School of Medicine’s Department of Public Health Sciences, in collaboration with epidemiology experts from the department, will begin a new project to investigate and address the impacts of COVID-19 on health outcome disparities of breast cancer survivors. To support this timely project, Dr. Hu and the group of experts were awarded a grant from the Leslie and Loretta Copeland Foundation. Each year,

the foundation sponsors and supports projects from organizations and institutions that are passionate about making a difference in the community.

» Screen participants for symptoms related to COVID-19 » Investigate how quality of life was impacted by the pandemic using the electronic version of the Functional Assessment of Cancer Therapy-Breast questionnaire » Provide support to address patient needs, concerns, and access to COVID-19 screening, treatment, and vaccination of participants » The outcomes of this project will address critical COVID-19-related morbidity, mortality and health disparities in breast cancer survivors. “To expand COVID-19 vaccination as an important tool to help improve the clinical outcomes of breast cancer survivors and halt the COVID-19 pandemic, we must first provide answers to the most frequently asked questions about COVID-19 infection and vaccination, overcome barriers, address safety concerns, and promote this high-risk population to make informed decisions to receive the COVID-19 vaccination,” said Dr. Hu.

The group of experts that will work alongside Dr. Hu will include Miller School of Medicine’s Taghrid Asfar, Ph.D., research assistant professor, David Lee, Ph.D., professor and interim chair, Wayway Hlaing, Ph.D., professor, Ana Palacio, M.D., M.P.H., professor of clinical medicine, and Paulo Pinheiro, Ph.D., research associate professor—all from the Department of Public Health Sciences. “The anticipated outcomes will facilitate exposure reduction in high-risk breast cancer survivors, rapid detection of infection, reduce stress, and minimize COVID-19 related morbidity and mortality,” said Dr. Hu. Using data from previous studies by Dr. Hu and the research team, 316 breast cancer survivors who are predicted to have worse clinical outcomes if infected with COVID-19 will participate in the project. They are 65 years of age or older, have cardiovascular disease, diabetes, or lung diseases.

Jennifer Hu, Ph.D.

and the team will leverage University of Miami Health System (UHealth) resources and compare data of communities that have been the hardest hit to communities that have been impacted less. The data will include information on the clinical, social, environmental and economic characteristics of communities. The researchers will also select a sample of UHealth patients—who have agreed to be contacted for research purposes—from communities that have been impacted differently in order to collect information on vaccine hesitancy.

MILLER SCHOOL PROJECT TO USE HEALTH DATA TO DEVELOP STRATEGIES FOR HARD-HIT COVID-19 COMMUNITIES Written by Amanda Torres Published on February 26, 2021 Category: Faculty, Funded Project

ports projects from organizations and institutions that are passionate about making a difference in the community.

Racial minorities in South Florida—one of the many areas in the United States that has been severely impacted by the COVID-19 pandemic—have been disproportionately affected by the effects of the pandemic. To help develop population-based strategies that can address these inequities, it is imperative to understand which community characteristics are associated with higher comorbidities, worse COVID-19 outcomes, and vaccine hesitancy.

“It is imperative that we evaluate in more depth the actual drivers of COVID-19 disparities across Miami-Dade neighborhoods,” said Dr. Palacio. “This grant will allow us to use novel geocoding strategies to describe community characteristics associated with high COVID-19 risk and to reach out to members of those communities to understand best approaches to reduce inequities.”

A new project led by public health’s Ana Palacio, M.D., M.P.H., professor of clinical medicine at the University of Miami Miller School of Medicine, in collaboration with a group of experts in the University of Miami and Miller School of Medicine, will collect information from hard-hit COVID-19 communities to provide tailored communications for their populations. To support the timely project, Dr. Palacio and the group of experts were awarded a grant from the Leslie and Loretta Copeland Foundation. Each year, the foundation sponsors and sup-

The group of experts that will work alongside Dr. Palacio include Miller School of Medicine’s Taghrid Asfar, Ph.D., research assistant professor, David Lee, Ph.D., professor and interim chair of the Department of Public Health Sciences, Leonardo Tamariz, M.D., M.P.H., professor of medicine, and Zinzi Bailey, Sc.D., M.S.P.H., a research assistant professor, University of Miami’s Abraham Parrish, librarian and associate professor, and Barbara Millet, director of the University’s User Experience Lab and assistant professor of interactive media at the School of Communication.

Databases from UHealth’s Electronic Health Records and the Florida Department of Health will be utilized to collect the data. UHealth’s Electronic Health Records includes patient addresses that will be used to determine where the individuals live, while the information on the Florida Department of Health will provide information on COVID-19 positive tests. The team will use the geographic information available in these datasets to merge the geocoded social, economic, environmental, census and clinical data. “This will help report the incidence of COVID-19, hospitalizations for COVID-19 and mortality of COVID-19 across different communities and compare the characteristics of communities with high burden and low burden of COVID-19,” said Dr. Palacio.

Ana Palacio, M.D., M.P.H.

To conduct the project, Dr. Palacio

community partners,” Dr. Chandran said. The $10,000 AAMC award supports a collaborative initiative involving the Miller School and the UM School of Law Center for Ethics and Public Service, Grove Rights and Community Equity Inc., and the Coconut Grove Ministerial Alliance to tackle the challenges of population health. The award highlights the Miller School’s efforts to engage underserved communities and address the underlying social determinants of health, added Dr. Chandran.

MILLER SCHOOL AWARDED NATIONAL GRANT TO ADDRESS HEALTH DISPARITIES DURING PANDEMIC Written by Richard Westlund Published on February 9, 2021 Category: Secondary faculty, Funded Project A new grant from the Association of American Medical Colleges (AAMC) will advance the University of Miami Miller School of Medicine’s outreach to Miami’s underserved West Grove community. The AAMC “Nurturing Experiences for Tomorrow’s Community Leaders” (NEXT) Awards provide funding to UM and four other U.S. medical schools to enhance learning opportunities to address health disparities while promoting collaboration among diverse stakeholders.

The UM project, “COVID-19: Evaluating Fault Lines in the Health of Our Communities and Developing Community-Centered Solutions,” builds on collaborative work being conducted by faculty from the Miller School and the University of Miami School of Law. It will engage medical students in addressing the long-term impact of the pandemic on the mental, financial, and physical health of the West Grove community, according to Latha Chandran, M.D., M.P.H., executive dean and founding chair of the Department of Medical Education. “We are pleased that the AAMC recognizes the significance of our work and that we can continue our efforts to enhance access to health care during the pandemic aligned with our

“At the beginning of the COVID-19 pandemic, community leaders expressed their concerns about access to health care and disparities in outcomes,” said Shirin Shafazand, M.D., M.S., professor of medicine and deputy director of the M.D./M.P.H. program. She is the principal investigator of the AAMC grant and co-PI of a joint study being conducted by the School of Law and the Miller School in collaboration with the West Grove community, which has a majority Black population, as well as Community Health of South Florida, the neighborhood’s principal primary care provider. “This multidisciplinary project will provide timely population health information for this underserved community, while providing our M.D./M.P.H. students with a unique opportunity to gain a personal understanding of how the social determinants of health affect individuals and families,” said Dr. Shafazand. “We believe that developing the knowledge and skills to deliver high-quality, equitable health care services is a vital step in training the next generation of medical leaders. This is a unique opportunity for medical, law, and public health students to work together and with the community, practicing valued interprofessional collaborative skills.” In 2020, the Miller School and law school received a University of Miami Laboratory for Integrative Knowledge (U-LINK) grant to launch the West Grove outreach initiative. Referring to the U-LINK grant, Tony

Alfieri, professor of law and director of the Center for Ethics and Public Service, said UM has a “historic leadership opportunity to marshal its resources across the fields of education, research, and policy to assist underserved communities of color in Miami and throughout the region.” “Both Professor Alfieri and Timothy Loftus, M.D., now a senior law school student and fellow of the Center for Ethics and Public Service, have been instrumental to the success of this collaborative effort and are fully committed to training the next generation of leaders through this AAMC grant,” said Dr. Shafazand. “Our students will engage in virtual town hall meetings with community stakeholders, and identify gaps in care using population health data, community surveys and focus groups,” she said. “They will participate in a study to quantify the impact of social determinants of health on medical, psychological, and social well-being, and have an opportunity to present their findings at local and national meetings. It is only through a multidisciplinary, community-centered approach that we can hope to identify and address health care disparities.”

UHEALTH PEDIATRIC MOBILE TEAMS SURPASS 10,000 COVID-19 TESTS Written by Richard Westlund Published on December 22, 2020 Category: Alumna, Secondary Faculty, Service With strong support from community partners, UHealth pediatric professionals have tested more than 10,000 Miami-Dade children for COVID-19, providing a vital service to families without convenient access to care. “While most children are not symptomatic, they can spread the virus to adults, as well as coming down with serious symptoms themselves,” said Lisa Gwynn, D.O., M.B.A., associate professor of clinical pediatrics and public health sciences at the University of Miami Miller School of Medicine, and director of the Pediatric Mobile Clinic and the Dr. John T. Macdonald

Foundation School Health Initiative. “In fact, our findings show that COVID-19 infection rates in children are similar to the overall community rates.” After taking part in Miami-Dade’s initial COVID-19 adult testing program last spring, the mobile clinic team from UHealth – the University of Miami Health System has been focusing on children since July 1, using polymerase chain reaction (PCR) testing kits from the state Department of Health. Financial support for the pediatric testing initiative was provided by Children’s Health Fund, Truist Foundation, Jeffrey and Jenny Binder, Adam Koffler and Lisa Heiden-Koffler on behalf of the Koffler Foundation, and Lisa Heiden on behalf of William B. Heiden.

UHealth has two mobile vans that travel to underserved neighborhoods throughout Miami-Dade County, offering immunizations and other primary care services. However, the COVID-19 testing has been done in outdoor settings to minimize the risk of potential virus transmission. “We travel to neighborhoods, set up our outdoor testing operation, collect important information at check-in, including the reason for their visit,” said Dr. Gwynn. “Once the test results are available, we provide counseling to the parents if a child tests positive.” Testing will be conducted at various school parking lots during the winter recess. Looking ahead, Dr. Gwynn said UHealth has partnered with Miami-Dade County Public Schools to bring its mobile COVID-19 testing teams to school sites throughout the community in January. “We know our local schools are challenged, and our teams will provide important support for the health of their students,” she said. Dr. Gwynn said parents should schedule an appointment for a child’s COVID-19 testing by calling 305-2432059. “We want to be sure we can accommodate the demand for testing, although we do accept walk-ins whenever possible,” she added. “Our goal is to provide convenient and equitable access to testing for families throughout our community.”

COVID-19 VACCINE TRIALS EXHIBIT EARLY SUCCESS Written by Janette Neuwahl Tannen Published on November 23, 2020 Category: Alumna, Service

Physicians at the Miller School of Medicine say that data show vaccines are highly effective against the coronavirus. As they finish inoculating local volunteers for the Moderna COVID-19 vaccine trial and continue recruiting for a new vaccine trial, doctors at the University of Miami Leonard M. Miller School of Medicine are elated by early indications that the Moderna vaccine and another one are extremely effective in preventing the spread of COVID-19. “It’s incredibly exciting,” said Dr. Susanne Doblecki-Lewis, clinical director for the Miller School’s Division of Infectious Diseases and the principal investigator of the Moderna trial. “This shows we can have vaccines for COVID-19 that are highly effective—and hopefully, we’ll have several because they will make an incredible difference in the course of the pandemic.” Last week, Moderna announced that preliminary data shows its two-dose vaccine is 94.5 percent effective in the prevention of symptomatic COVID-19, the infectious disease caused by the novel coronavirus. Just days

earlier, pharmaceutical giant Pfizer announced that its vaccine was more than 90 percent effective. Both companies are now in the process of mass producing the vaccines, although the vaccine trials continue to follow patients for two years after inoculation. If it was not for the willing participants in Greater Miami and elsewhere, Doblecki-Lewis, an associate professor of clinical medicine, said the Moderna vaccine trials would not have generated positive results so quickly. “Our participants should be really proud—without them we would not have this data, and I think we’ll need a lot more volunteers in the future because it’s important that we have multiple vaccine candidates that are tested,” she said. “At this time in the pandemic, volunteering is a really positive thing to do to make sure we have the best possible vaccine and enough of it.” University doctors are now recruiting participants for a one-dose vaccine developed by Janssen, a subsidiary of Johnson & Johnson. They have just a few weeks to wrap up enrollment by the end of the year and hope to get close to 1,500 participants.

nal antibodies, which are present in the Regeneron treatment that is the subject of another clinical trial at the University, she added. “When COVID-19 came about, many thought that the spike protein was the best target, but until now we weren’t sure that was the right focus,” Doblecki-Lewis explained. “It turns out that it was a good bet.” The data released about the effectiveness of the Moderna and Pfizer vaccines was also encouraging because respiratory vaccines are often much less effective, Doblecki-Lewis added. In comparison, the flu shot—which she highly recommends—is only 70 percent effective. Still, University physicians recognize that more than two vaccines will be needed to help immunize the nation and the world against COVID-19. “At the moment, the trial is going very well, and the patients we have had so far have very few side effects,” said Dr. Dushyantha Jayaweera, principal investigator for the Janssen trial and a professor of medicine in the infectious disease research unit at the Miller School. Jayaweera noted that both the Janssen study, as well as the Moderna one, are double-blind, placebo-controlled studies. This means that half of the participants get the vaccine, while the other half will not. But both the doctors and patients are unaware of who is getting the vaccine and who is getting a placebo. So far, the Janssen study has garnered 110 participants in the first two weeks of recruitment, but Jayaweera, and one of his co-investigators, Dr. Olveen Carrasquillo, said they need many more, particularly minority candidates. Right now, he is happy to report that more than 60 percent of candidates are Black or Hispanic, but Jayaweera and Carrasquillo said that just last week they were on a conference call with Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases (NIAID), who

emphasized the need for minority groups to participate in vaccine trials. That way the results will represent all of the people who are suffering from COVID-19. Data from the beginning of the pandemic has shown that Black, Hispanic, and Native American people are much more likely to be affected by COVID-19, and often face more dangerous outcomes. “Everything, so far, suggests positive things. But we need brave people to make sure the vaccine is safe and effective for everyone,” said Carrasquillo, chief of the division of general internal medicine and a national expert on health disparities. Physicians are optimistic about the vaccines being tested in upcoming trials because most share a critical element, Doblecki-Lewis said. All of the vaccines they are testing at the University so far—and most under clinical trials in the U.S.—operate by attacking the disease’s spike protein, which is how COVID-19 enters into the body’s cells and replicates. But until there were some results from these first two trials, no one knew if that was the right approach to provoke an immune response. A similar method is used to create synthetic monoclo-

“We need more than 300 million vaccines for the U.S. alone, so even if the Moderna and Pfizer vaccines are ready, you need more than two,” Jayaweera said. “Even more important is that the public understands how rigorous we are testing these vaccines, so that they will hopefully get immunized after the trials are over. What’s the point of having all these vaccines if people do not use them?” Toward that goal, there will likely be more COVID-19 vaccine trials coming to the University, Doblecki-Lewis said. That’s because the Miller School of Medicine is part of the National Institutes of Health COVID-19 Prevention Trials Network, which is spearheading the nation’s vaccine efforts. Since the Miller School was already a part of the HIV Vaccine Trials network, the existing partnership made it a logical place to test COVID-19 vaccines, according to Doblecki-Lewis. At the same time, the University is also working to: »

Earn government approval for its own rapid COVID-19 test developed by Dr. Sylvia Daunert, in the Department of Biochemistry and Molecular Biology, and an oral

rinse test developed by Dr. Elizabeth Franzmann, in the Department of Otolaryngology. »

Further advance a vaccine platform developed by Dr. Natasa Strbo, in the Department of Microbiology and Immunology.

Test whether convalescent plasma treatments in COVID-19 patients—and in outpatients who may be exposed to COVID-19— are effective to fight off the disease or to prevent it entirely.

Determine whether inhaled nitric oxide can help stabilize COVID-19 patients in need of oxygen support—a clinical trial that is being done by Dr. Roger Argelio Alvarez, an assistant professor of pulmonology.

All of these treatment efforts will help physicians continue to advocate for their patients during what will likely be a challenging winter, said Carrasquillo, who has treated many people suffering from COVID-19. “Over the past several months, we learned a lot more about how to treat these patients. We had a lower mortality in July than we did in April, and every little bit helps,” he said. “But for prevention there was no hope, yet listening to the data from Pfizer and Moderna, I can see a light at the end of tunnel. A vaccine is not going to happen immediately—we are still months away—but I am hopeful that by next summer we will be in a different place than we are now.”

COURSE EXPLORES GLOBAL HEALTH AND DISPARITIES DURING THE PANDEMIC Written by Barbara Gutierrez Published on August 26, 2020 Category: University of Miami President, Faculty Students enrolled in a public health class will examine how countries reacted, or failed to react, to COVID-19 to protect their residents. The global COVID-19 pandemic has revealed crucial fissures in health care systems across the globe as well as the vulnerability of marginalized groups whose fragile societal standing—poor nutrition, substandard housing, and lack of access to health care to name a few—have made them easy victims to the virus. A course at the University of Miami, “Introduction to Global Health: Effective Responses to Hemispheric Challenges,” will explore how the pandemic has affected various areas of the globe, with a focus on the cur-

rent challenges in Latin America and the Caribbean. The class is being taught by President Julio Frenk, a medical doctor and global health expert, who is the former minister of health for Mexico; Felicia Marie Knaul, a health economist whose career includes key positions in government in Mexico and Colombia and who is the director of the University’s Institute for Advanced Study of the Americas and a faculty member at the Miller School of Medicine; and Michael Touchton, associate professor of political science who has studied governance and public health in Latin America throughout his career. “The COVID-19 pandemic has revealed clear divides between the

from the Federal University of Pelotas in Brazil winner of the Gairdner Prize in global health; Dr. Patricia Garcia, former Minister of Health of Peru and graduate of the Harrington Medical Training Program and Sir George Alleyne, Director Emeritus of PAHO and honorary doctoral degree recipient from University of Miami in 2019.

health outcomes and well-being of diverse populations,” said Frenk. “This is a crucial moment for future leaders from diverse disciplines to come together to combat the pandemic and improve global health.” The course will also track the intense changes in demographics, from population growth to rapid urbanization, along with unprecedented shifts in patterns of disease and cross-border risks, said Touchton. “Latin America is the global hot spot for COVID-19. This raging pandemic has devasted health systems and fractured their ability to respond to the health needs of populations. Yet, of this devastation comes the opportunity to seek ways to build-back-better and Latin America offers us a unique opportunity to identify ways in which governments and health institutions can safeguard citizens going forward,” said Knaul, who also oversees the Latin America COVID-19 Observatory. According to Touchton, the class offers an ideal venue to study the pandemic as an example of real-time global health policy making, global health action, and how it has uncov-

ered public health inequities around the world.

University of Miami President Julio Frenk

“We felt it was essential to cover the pandemic in class,” he said. “A focus on global health was already there but now we have real-time examples of what works well and what does not work at all from a global health perspective.” Some topics that will discussed include poor governance by different countries, as well as access to health care to marginalized populations. “For the most part, the Americas have not reacted well to the pandemic and this includes the U.S.,” Touchton said. “There are some exceptions including Canada and some countries in Latin America, like Uruguay and Costa Rica.”

Felicia Knaul, Ph.D.

On the other hand, many Asian countries—like Singapore, South Korea, and Taiwan—reacted well by issuing stay at home orders, followed by testing, contact tracing, and mandatory use of masks, he said. The course has a star list of guest lecturers including: Dr. Cesar Victora,

A month before the World Health Organization declared the novel coronavirus a global pandemic, Schmidt and other members of the student organization had hopes of hosting a panel discussion featuring public health leaders and experts to commemorate the week of awareness.

STUDENT GARNERS REFLECTIONS ON THE IMPORTANCE OF PUBLIC HEALTH Written by Ashley A. Williams Published on April 23, 2020 Category: Alumna, Service Renae Schmidt, in her second year of the Master of Public Health Program, finds an innovative way to express frontline workers’ thoughts on issues facing our community. As the world faces the unparalleled coronavirus crisis, public health professionals are working around the clock to tactically address the needs of different population groups in their own communities. From epidemiologists to biostatisticians to medical lab workers, frontline health care professionals are focused on

fighting the spread of COVID-19.

of public health provided by leaders in the field.

One University of Miami student, with the help of others, took a moment to cast a light on public health industry workers in the University of Miami and Miami-Dade County communities.

The project is intended to emphasize the importance of public health while also bringing awareness to the issues facing the Miami-Dade County community. The following questions were asked to community partners, experts in the field, and the student body.

Renae Schmidt, a second-year Master of Public Health student and secretary of the Public Health Student Association at the University of Miami, recently collaborated with the Miller School of Medicine’s Department of Public Health Sciences to celebrate the 25th anniversary of National Public Health Week by compiling responses on the importance

» »

Why is public health important? What are the most crucial issues facing Miami-Dade from the perspective of your line of work? How can individuals or communities advocate for awareness and action around these issues?

Despite physical events being cancelled, Schmidt was committed to highlighting the voices of the professionals. In less than a month, she took the lead on communicating with each public health professional. She then worked closely with the University’s public health sciences department writer, Amanda Torres, to design a webpage to bring the graduate student group’s vision to life. “We knew that it would have been hard to gather professionals who are currently on the front line for a virtual panel,” added Schmidt, who received her undergraduate degree in biological sciences from North Dakota State University. “Public health has been on the back burner, because people are more interested in treatment— but I think this is a wake-up call.” Schmidt, a Minnesota native, enrolled at the University in August 2018. She decided Miami was the place for her after she had traveled throughout Latin America. “This was the closest I could get to the warm weather and Latin culture while studying what I love,” she said. Since enrolling at the University, Schmidt has proven

herself to be an outstanding scholar. She is a participant in The Learning Collaboratory, a three- to four-semester-long program offered through the Department of Public Health Sciences. The program allows Schmidt, and its other students, the opportunity to apply public health in the classroom and community. Most recently, Schmidt initiated a four-month research project that will study the effects of loneliness, social isolation, and substance use during the COVID-19 pandemic. The investigation is being led by Viviana Horigian, associate professor of public health sciences, and is one of 24 research projects to receive rapid response grants from the Office of the Vice Provost for Research. “The MPH program has allowed me to build a strong public health skill set by facilitating relationships with community members, allowing me to pursue issues I find most crucial, and encouraging engagement and collaboration with faculty leaders,” Schmidt said. “I am excited to join the workforce and to help fortify an adaptive and resilient public health infrastructure.”

A PANDEMIC STRIKES, AND AN ACADEMIC COMMUNITY RESPONDS Written by Robert C. Jones Jr. Published on April 17, 2020 Category: COVID-19 Response The novel coronavirus made its mark at the University of Miami, and members of the institution pulled together as a team to safeguard its students and faculty and staff.

a ballpark where 19- and 20-year-olds wielded bats and gloves to bag four College World Series titles and were poised to make a run at a fifth, the cheers went silent.

From late summer to early winter, the cadence had always been regular and steady. But then, suddenly, the campus’s circadian rhythm was thrown out of kilter. Classrooms in every building sat empty. No students. No instructors. No group discussions. No experiments.

The COVID-19 pandemic that changed the world had turned the University of Miami almost into a ghost town, as school officials, like so many of their counterparts across the nation, made the painful but necessary decision to send students home for the rest of the academic term in an effort to halt the spread of the virus.

Walkways that connect a labyrinth of structures were devoid of foot traffic. Eateries in the massive food court were closed. And in

The University’s commencement exercises, academic rites of passage

for thousands of graduates, were postponed. Students studying abroad were called home. Athletic competitions and other events were either canceled or put on hold. And, employees no longer commuted to the office but worked from home. Still, the lectures, lessons, and learning continued—via Zoom, Skype, and on laptops and smartphones. The changes occurred quickly—seemingly in the blink of an eye. It was the vision of a farsighted university president with a generation’s worth of know-how in responding to pandemics and a task force to support him that made things happen.

In truth, the University’s coronavirus response effort started before the decade even came to an end. When government officials in China reported in late December that health care workers were treating dozens of people in the central city of Wuhan for a mysterious pneumonia-like illness with symptoms that included fever, cough, difficulty breathing, and lung lesions, students were still on winter break, catching their breath after a months-long semester of studying and test taking. Nearly 8,500 miles away in Coral Gables, University officials were keeping an eye on the outbreak, making response plans for the virus’s inevitable arrival in South Florida. By the time the first cases were confirmed in four states, the University was ready, rolling out its first advisory to the University community and launching a coronavirus response website—which grew to include everything from information and FAQs for students, faculty, and staff to prevention and well-being tips and a comprehensive list of resources. The University didn’t go it alone. It partnered with Miami-Dade County and the state of Florida to monitor the crisis as it unfolded, and it followed guidelines from the Centers for Disease Control and Prevention and the World Health Organization when issuing health advisories to its community of students and employees. President Julio Frenk, a former health minister of Mexico, also employed the power of media. In video messages to the University community, he became a

calming and comforting voice in a time of crisis, providing updates on the institution’s latest actions to safeguard students and workers. In one communiqué, he even reminded everyone that it was “a time for preparation, precaution, and prudence—not panic.” In his role as chair of the Miami-Dade Beacon Council’s One Community One Goal Academic Leaders Council, Frenk rallied other academic leaders. He met virtually with the presidents of other colleges and universities in the county to discuss ways to help the Greater Miami area amid the COVID-19 pandemic. With more than 5,000 people participating in three virtual town halls held on March 31 and April 1, University leaders and medical experts answered questions and provided updates for faculty, staff, students, and their families on COVID-19 and its impact on the institution and the University of Miami health system. THE MOVE TO ONLINE LEARNING If there was any measure that demonstrated how swiftly and thoroughly University leadership responded to the crisis, it was their decision and ability to migrate courses to an online environment after students left for spring recess. The University extended the semester break for a week, giving faculty time to prepare for online instruction, a process leadership helped facilitate by launching an academic and business continuity site. What normally would have taken weeks to pull off was done at breakneck speed. All told, faculty,

with support from staff at the Distance Learning Institute, accomplished the transition—which required hours of training, the modification of courses and syllabi, and the translation of their teaching into digital platforms—in a week, a feat Jeffrey L. Duerk, executive vice president and provost, called an “extraordinary testament” to their hard work and dedication. The tools and technology used in the conversion, said Duerk, will serve the University well into the future. “Some might say that this began when we started stepping up efforts to build a robust academic continuity infrastructure following Hurricane Irma,” said Duerk. “Few of us were thinking of a quickly spreading global pandemic; yet, hurricane or pandemic, the ramifications of our efforts will continue to ripple through not only higher education but all areas of our lives in unforeseen ways.” HEALTH CARE RESPONSE From rapid diagnostic tests to potential vaccines, researchers at the University of Miami Miller School of Medicine took up the battle against COVID-19 in their labs, with Natasa Strbo helping to lead the way. The assistant professor of microbiology and immunology enlisted the cancer and infectious disease vaccine she has worked on for more than decade in the fight against the virus. “As soon as I heard that something pretty bad was happening in China, I was excited to investigate the potential of our vaccine, which is a really different approach. It’s based on a

natural protein, gp96, that is present in our cells and activates immune responses,” said Strbo, whose team is working on the COVID-19 vaccine with Heat Biologics, the biopharmaceutical company that now owns the gp96 platform she helped develop. “We already have tremendous knowledge from our previous vaccine studies, so I think the gp96 platform has a lot of potential in inducing a protective immunity against COVID-19.” Meanwhile, Miller School biomedical researchers, in collaboration with Heat Biologics, were involved in efforts to develop a rapid diagnostic test for the virus. The patient-friendly test, developed by Sylvia Daunert, chair of the Department of Biochemistry and Molecular Biology, and her colleagues, requires a simple pharyngeal throat swab to deliver on-the-spot results on a paper strip in less than 30 minutes. “Our lab has tremendous experience developing accurate and easily usable tests for infectious diseases such as HPV and Zika,” said Daunert. Another researcher, assistant professor of medicine Mark Sharkey, also worked to develop a diagnostic test for the coronavirus that would produce results just as quickly, but in a lab. “It’s based on fluorescence,” said Sharkey, “so after the sample is amplified, if it’s positive it will glow green in the reaction tube when a blue light shines on it.” On the frontlines of the COVID-19 pandemic, University of Miami health care workers instituted their

own measures to keep the spread of the virus in check. Teams of masked nurses, patient and visitor services staff, graduate students, and faculty from the School of Nursing and Health Studies, for example, questioned every person entering the 560-bed UHealth Tower, its emergency department, and other health care facilities about their recent travel history and coronavirus symptoms. UM’s health care heroes have also treated those diagnosed with the virus, with one physician using a new therapy that has the potential to delay the need for a ventilator. Roger Alvarez, a pulmonologist with the University of Miami Health System and Miller School, began treating a COVID-19 patient in late March, using a nitric oxide system called INOpulse that had been recently approved by the FDA for treating coronavirus patients. “The cardiopulmonary benefit demonstrated by INOpulse in various indications provides the potential to prevent deterioration in

patients with COVID-19, allowing ventilators to be preserved for the most critically ill,” explained Alvarez, referring to the system developed by Warren, New Jersey-based Bellerophon Therapeutics, Inc.

demics, nutrition, training, career development, and mental and physical health.

WHEN THE CHEERING STOPPED

‘WE WILL GET THROUGH THIS’

Miami’s storied athletic squads saw their seasons end abruptly when the NCAA canceled all winter and spring sports, the announcement forcing two Hurricanes teams—track & field and baseball—to return home even as they were on the road preparing for competition.

The pandemic isn’t the first challenge the University has faced. The first class of 646 full-time students enrolled at the University in the fall of 1926 when the South Florida land boom had already collapsed and just days after a major hurricane devastated the area. And, in August of 1992, Hurricane Andrew hit the city, damaging buildings on the Coral Gables campus and delaying the start of classes.

“It was a surreal scene all around. We felt the anguish that our student-athletes and coaches felt, and particularly empathized with our seniors and those teams who were working so hard to compete for conference and national championships,” Blake James, director of athletics, said in a statement to fans, noting that his department was working tirelessly to provide virtual support to student-athletes for aca-

“The games might be gone for the time being,” he said, “but our devotion remains steadfast.”

In both instances, the institution recovered. So, too, will the University recover from the COVID-19 pandemic, Frenk said.

this, just as we’ve gotten through every pandemic,” he said. “But once we get through it, we would be foolish to assume that this was the last one. There will be another one; and if we let our guard down, we will again incur the same disruption and cost we are suffering now. “We owe it to everyone who is undergoing the sacrifices and to all the people who will have died, not to relinquish our responsibility, and to keep the necessary investments and the capability around the world up to the level of the challenge,” Frenk pointed out. “This is a challenge that we can face. We have the tools. It will be faced successfully. I am very confident, thanks to science.”

But there is a lesson that the nation—indeed, the world—needs to learn from the current crisis, he said. “We will get through

U-TRACE INITIATIVE TO ADDRESS COVID-19 PUBLIC HEALTH CRISIS Written by Richard Westlund Published on April 13, 2020 Category: Faculty, Initiative To help the University of Miami community address the health crisis related to the novel coronavirus, the Miller School of Medicine has launched a multidisciplinary initiative called U-TRACE for UM Tracking, Resources, and Assessment of COVID-19 Epidemiology. “We are mobilizing our resources to respond to this unprecedented public health threat,” said Erin N. Kobetz, Ph.D., M.P.H., professor of medicine and public health sciences, associate director for population science and cancer disparity at Sylvester Comprehensive Cancer Center, and co-vice provost for research at the University of Miami. “Our goal is to identify and manage new cases, protect our clinicians on the front lines, and provide appropriate support and care to our students, faculty, and staff members.” Dr. Kobetz is leading the collaborative U-TRACE program, which was established March 17 to bring together UM’s expertise in epidemiology, occupational health and safety, infectious diseases, nursing, informatics, environmental exposure assessment, and public health education. “Our focus is coordination, tracking and support for individuals with COVID-19 symptoms or positive contacts,” Dr. Kobetz said. “We also provide decision support and real-time information about COVID-19 contacts and cases within the UM/ UHealth workforce to medical school leadership.” With the U-TRACE program, any UM employees, students and trainees with coronavirus symptoms or exposure, should call the UM hotline at 305-243TEST Monday through Friday from 8 a.m. to 5 p.m. Individuals who feel

ill are immediately directed to care. The hotline staff then informs the U-TRACE team, which follows up by identifying recent contacts, answering questions or providing education. Individuals can also email to: utrace@ miami.edu. Another pathway to care is through the UM employee drive-up COVID testing site near the Diabetes Research Institute (DRI) on NW 14th Street. “The National Guard team has been observing our drive-thru COVID-19 testing practices and algorithms,” said Alberto J. Caban-Martinez, D.O., Ph.D., M.P.H., associate professor of public health sciences. “For example, individuals waiting in line must turn off their vehicles or recirculate the internal air to reduce the risk of virus-laden droplets being expelled by the air-conditioning system.” Dr. Caban-Martinez added that the U-TRACE initiative provides a single source for identifying and tracing COVID-19 contacts throughout the university, including the Coral Gables and Rosenstiel School campuses.

ami-Dade’s first responders and other South Florida institutions to help them deal with COVID-19,” Dr. Kobetz said. “We want to help protect our emergency responders, clinicians and other health care professionals in order to maintain our community’s ability to address this growing public health crisis.”

Erin N. Kobetz, Ph.D., M.P.H.

“Now we have a standardized system in place to provide an evidence-based guide to our response,” he said. “It is also providing learning opportunities for our M.D. and M.P.H. students, whose capstone experiences were canceled this semester. They are applying the skills they will need in public health and medicine by participating in the U-TRACE process remotely.” The U-TRACE initiative involves the redirection of the Sylvester Comprehensive Cancer Center’s Firefighter Cancer Initiative, a multidisciplinary team of scientists, clinicians and firefighters focused on cancer control and cancer prevention strategies. “We are refocusing our efforts and sharing our knowledge with Mi-

Alberto J. Caban-Martinez, D.O., Ph.D., M.P.H.

SYLVESTER RESEARCHERS TO COLLABORATE WITH MIAMI-DADE COUNTY ON CORONAVIRUS TESTING Written by Diana Gonzalez Published on April 3, 2020 Category: Faculty, Initiative

The new testing effort, announced Friday by Mayor Carlos A. Gimenez, will use a finger prick to check for antibodies to the virus in a drop of blood to determine past or present infection. When Miami-Dade County leaders set out to quantify the extent of COVID-19 infection in the county, they tapped researchers from Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine to lead this effort. Erin Kobetz and Alberto Caban-Martinez are the director and deputy director, respectively, of Sylvester’s Firefighter Cancer Initiative. They are applying their expertise from earlier research that assesses the burden of cancer among first responders to providing a better picture of how many people in Miami-Dade have been infected with the novel coronavirus. Miami-Dade already has more confirmed cases than any other county in Florida. Experts believe the number of infections is higher than what’s being reported. “We are likely significantly under-

estimating disease prevalence, with potentially eight to 10 people actually infected for every single positive test reported in daily statistics,” said Kobetz. “With limited testing availability, we are largely moving in the dark in terms of understanding what is happening locally, including the proportion of asymptomatic individuals who are positive, and how the curve of infection may change as social distancing and stronger shelter in place initiatives are widely practiced.” She points out that this “community surveillance” for COVID-19 that the county is instituting is the first of its kind nationally and incredibly important for a successful public health response. It’s called SPARK-C, which stands for Surveillance Program Assessing Risk and Knowledge of Coronavirus. The nasal swab test currently used for screening detects the actual virus and is considered the gold standard when making clinical decisions. This new public health surveillance effort will employ a different kind of test using a drop of blood from a fingertip to check for antibodies to the virus, which signal past or present infection.

The company that makes this serologic test has an emergency use application under review by the federal Food and Drug Administration. Miami-Dade County Mayor Carlos A. Gimenez purchased 10,000 kits to test random cross sections of the county’s population. Florida Power & Light is helping with the process of randomly selecting addresses. Those residents will receive a recorded call from Gimenez, asking if they would like to participate. Those who are interested in volunteering will call a number dedicated to the SPARK-C initiative. “The phone line will be staffed by public health and medical students from the University of Miami who speak English, Spanish, and Creole,” said Caban-Martinez. “These students will conduct an initial screening and then will schedule the volunteers who consent to one of 10 testing sites designated solely for this community initiative.” Members of the county’s Emergency Medical Services Ocean Rescue will be administering the finger-prick test. Results will be provided to participants the next day. The Sylvester

research team will be collecting and analyzing the data. “I think we will learn a lot about how COVID-19 is affecting our local community—whether certain geographies and/or population sub-groups have a greater infectivity rate—and most importantly, what to do about it now and in the future,” said Kobetz. “And, I think doing this work in South Florida, given our significant diversity, will offer critical lessons learned for the broader U.S. and Western Hemisphere. Our data can drive local and global solutions.” Some of the test kits will also be used to assess infection among first responders in Miami-Dade County and the homeless population. “The rapid spread of COVID-19 throughout the world and our country has forced us to figure out new ways to collaborate,” said Gimenez. “In our community we are proud to often engage in public-private partnerships, and this testing program is an outstanding example of this. With our combined efforts, we look forward to applying what we can learn from this study and, hopefully, help bring an end to this public health crisis.”

MINDFULNESS DURING UNCERTAIN TIMES Written by Amanda Torres Published on March 30, 2020 Category: Chair, Faculty, Service The outbreak of COVID-19 has led to changes that have been stressful for individuals of all ages. The Centers for Disease Control and Prevention recommend several ways to cope with stress during these challenging times. One of the four suggestions is to take care of your body by taking deep breaths, stretching, or meditating. David J. Lee, Ph.D., interim chair and professor at the University of Miami Miller School of Medicine’s Department of Public Health Sciences, recently recorded two mindfulness practices drawn from a program called

Mindfulness-Based Stress Reduction (MBSR) – an eight-week evidence-based program. This recording has been released to the University of Miami community, as well as to the general public. “We are facing unprecedented challenges as we all confront the uncertainties of the COVID-19 pandemic. It

goes without saying that stress levels are high,” said Dr. Lee during the guided meditation. “I can personally attest to the many benefits of these practices. I will provide you with a few tools that you may find helpful during these challenging times.” Dr. Lee, who is also director of graduate programs at the Department

of Public Health Sciences and chair of graduate programs at the Miller School of Medicine, also said that researchers at the Miller School and elsewhere have demonstrated that stress is not always an adversary.

A A. U. AMANDA NWABA

“In fact, exposure to a mild stressor prior to inoculation with the influenza vaccine has been shown to actually enhance immunological response, potentially conferring greater protection from the flu,” he said. The MBSR program has been studied in thousands of participants suffering from chronic high-stress levels, as well as inpatient groups living with a variety of chronic diseases. Results from these studies indicate that regular mindfulness practice results in reductions in anxiety and depressive symptoms, along with other benefits.

IRENE GOO

Program: M.D./M.P.H. How Nwaba’s work has been related to COVID-19: “The Student National Medical Association (SNMA) chapters at UM and FIU partnered for a project aimed at decreasing the spread of misinformation related to COVID-19 by teaching youth how to critique public health information, communicate effectively on social media, and appreciate civic engagement. Our project is sponsored by the Association of Black Cardiologists and will consist of a series of webinars for mainly Black and Latinx Miami youth to educate and empower them as they continue to navigate their role in their community, and more specifically their online social circles, during the pandemic.

Dr. David Lee

pain with one another as one community, something that far too many have been lacking since March of last year.” – Nwaba

Additionally, the Miller School of Medicine’s executive student government hosted a COVID Diaries event that was aimed at providing a sense of community to Miller students who wanted to discuss how COVID-19 has affected their lives. Students were invited to share how the pandemic has affected their lives, whether directly related to an experience with COVID-19 or relating to the impact of isolation and feelings of uncertainty. The hour-long session was emotional and honest, and more importantly it was a safe space for Miller students to share their frustrations, worries, and

Program: M.D./M.P.H. How Goo’s work has been related to COVID-19: When quarantine and other restrictions prevented students from taking part in their usual community work, Goo connected with the organization ContraCOVID through Instagram. This allowed her to contribute to community efforts and assist community programs in gaining a wider audience through advertisements across platforms. Goo worked with fellow second-year students Danny Castaneda, Erin Dandes, and Nick Lee to develop a series of community resource guides. They compiled information about social assistance programs, COVID-19, health care, and unemployment and distributed these guides to Spanishand Creole-speaking communities in Miami. The guides provided other information about bill deferrals, financial assistance, and food resources — one of the most significant issues people are experiencing during the pandemic. Goo and her team collaborated with community partners, including churches and local organizations, to ensure accessibility and a wider audience for available outreach efforts.

NATASHA KANE

college professors, and anyone who had influence over the physical activity levels of children during COVID-19,” she said.

TARA TARDINO

Based on this data, Kane created a brief animated physical education video intervention to target enhanced physical activity for children during COVID-19 and beyond.

ADRIAN KINKEAD

Program: M.D./M.P.H.

Program: Master of Science in Prevention Science and Community Health

How Tardino’s work has been related to COVID-19:

How Kane’s work has been related to COVID-19: Kane focused her master’s thesis on barriers to promotion of physical activity among children during the COVID-19 pandemic. “Before the pandemic, I was planning to focus my thesis study on schoolbased obesity prevention programs,” Kane said. “During the midst of COVID-19, I kept reading that the pandemic was expected to exacerbate the rising obesity epidemic, especially in children. Since physical activity promotion and obesity prevention are my research interests, I decided to focus my thesis on the barriers to physical activity promotion among children during COVID-19, including in schools with pandemic-related restrictions and in virtual learning environments.” To conduct her thesis study, Kane used an explanatory sequential mixed methods design, which consisted of a quantitative survey of 68 participants followed by 17 qualitative interviews. “I collected data regarding the barriers and challenges to physical activity promotion for children from parents, elementary classroom teachers, physical education teachers,

Program: Master of Public Health How Kinkead’s work has been related to COVID-19: “Prior to being the Epidemic Intelligence Service Opioid Fellow, I was working with the St. Lucie County Department of Health’s COVID-19 response. I helped with contact tracing, working with outbreak data, giving guidance and helping at vaccination points of dispensing (PODs). Currently, I still help at the vaccination PODs.” – Kinkead

Tardino and other members of the Miller School’s Mitchell Wolfson Sr. Department of Community Service (DOCS) Emergency Preparedness Team helped rally more than 175 students this spring to answer calls about COVID-19 after the Florida Department of Health asked the Miami Poison Control Center, a cooperative venture between the Miller School and Jackson Memorial Hospital, to relieve the department’s call burden and staff a COVID hotline. As a supervisor, Tardino worked alongside the poison specialists, residents, and pharmacy and nursing students who also volunteered. She took part in daily conference calls with the Department of Health. “It was exciting,” Tardino said. “There were new developments every day — new changes, new CDC guidelines, new information. It was also a little intimidating because we didn’t know that much. We often didn’t have many answers to give callers, but I like to think we stopped some of the spread, helped ease some people’s worries, and provided some public health education.”

BRANDON ROSE

JARED SILBERLUST

Silberlust’s lecture was assigned to all third-year students. More than 400 have viewed it, and more than 100 were paired with physicians to gain more telemedicine experience. “Our results were extremely successful,” he said. “Everyone improved in every single competency we tested, including overall ability, note writing ability, physical exam ability, and communication skills. Now, because it was successful, parts of that curriculum are being incorporated into the clerkship.”

ALLISON KUMNICK Program: M.D./M.P.H. How Rose’s work has been related to COVID-19: Rose spent the month of April 2020 enrolling study participants in the Surveillance Program Assessing Risk and Knowledge of Coronavirus (SPARK-C) initiative. This past spring, as COVID-19 surged in the U.S., Miami-Dade County reached out and asked Erin Kobetz, Ph.D., M.P.H., the UM’s vice provost for research, to implement a testing program to show how prevalent the disease was in the county. The SPARK initiative, an alternative to symptom-based testing, provided a more representative view of the coronavirus in the community. “At the time, it was the closest thing we could get to a random sample,” Rose said. “If you test people who are sick, that doesn’t give you the same information as if you were to take people out of the population randomly.” The other SPARK-C captains were students Tomas Delgado, Heather Herman, Maya Lubarsky, Maria Lugo, Brianna Mussman, Varsha Prabhakar, Apoorva Rangan, and Nicole Vecin.

Program: M.D./M.P.H. How Silberlust’s work has been related to COVID-19: After his clinical rotations were canceled in March 2020, Silberlust looked for alternative ways to care for patients, and he learned that other schools were offering telemedicine opportunities. Silberlust recognized the many complications that could arise from virtual patient care and reached out to Gauri G. Agarwal, M.D., associate dean for clinical curriculum on the Regional Medical Campus, to ask how Miller School students can learn more about telemedicine. “I wanted the tools to be a better doctor,” Silberlust said. Silberlust worked on condensing telemedicine resources that Dr. Agarwal shared with him, and he created a presentation and recorded himself giving the lecture. “Basically, the lecture was ‘Telemedicine 101’ — how to use telemedicine, what the implications are, why medical students should care how to do a remote physical exam, and what website manner is versus bedside manner,” Silberlust said. “These are things that I know I wouldn’t have necessarily thought of if I hadn’t specifically looked into it.”

Degree: M.D./M.P.H. How Kumnick’s work has been related to COVID-19: While studying for exams during Spring 2020, Kumnick was also recording podcasts for Regional Medical Campus (RMC) students preparing to begin their third-year rotations. She listens to podcasts often and used the format because of the long commutes to some rotation sites for RMC students. Kumnick aimed to provide future students with information to help them prepare for rotations, and encourage them to prioritize their well-being and take time to reflect during challenging times. “We talked about the first time a

patient dies, which is a hard thing during your third year,” Kumnick said. “One of my friends and I were in the same patient group, and one of our patients died early — like in our first four weeks of third year. So, we talked a little bit about that and how to reflect.” The podcast episodes also have information that’s especially helpful for students in RMC rotations and not generally found in orientation guides, such as what students should keep in their pockets during the day and what a typical day might look like. The series consists of an hour-long podcast, in which Kumnick discusses wellness, and six, 10- to 15-minute episodes that offer advice from her classmates on rotations for specific specialties. “It was fun interviewing people because I hadn’t seen my friends in two months,” she said. “And every time I finished an interview, we ended up talking for 30 minutes because everyone was socially deprived.”

ALLISON DRAPER LEEN HAMMAM KATHLEEN KELLY Program: M.D./M.P.H. How Draper, Hamman, and Kelly’s work has been related to COVID-19: “Our capstone project is working with Dr. Shirin Shafazand to characterize the long-term outcomes of individuals who have tested positive with COVID-19,” they noted. “We are investigating the medical, socio-economic, and psychological complications of COVID-19 within the University of Miami community. In characterizing these outcomes, we aim to inform future investigations and interventions to improve quality of life, medical needs, and socio-economic needs after COVID-19 infection.”

FACULTY, STUDENTS AND ALUMNI:

NATIONAL IMPACT

STUDY SHOWS PFIZER AND MODERNA ARE EFFECTIVE IN PREVENTING COVID-19 AMONG HEALTH CARE AND FRONTLINE WORKERS Written by Amanda Torres Published on March 29, 2021 Category: Faculty, Research A new study published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report Series has found that Pfizer-BioNTech and Moderna — two messenger-RNA vaccines — were effective in preventing COVID-19 among health care, first responders, and frontline workers. These interim findings, published on March 29, reinforce the success of current COVID-19 vaccination campaigns and can reassure the public and these workers that they begin gaining protection after their first dose of the vaccines. "Individuals employed as first responders, health care, and essential frontline workers now have evidence on the importance and effectiveness of these new messenger-RNA COVID-19 vaccines,” said Alberto J. Caban-Martinez, D.O., Ph.D., M.P.H., associate professor in the University of Miami Miller School of Medicine’s

Department of Public Health Sciences, who was co-author of the study. Mark Thompson, Ph.D., epidemiologist and deputy branch chief of science at the CDC’s Influenza Division of the National Center for Immunization and Respiratory Diseases, served as the overall study principal investigator. The study analyzed data from two ongoing national COVID-19 cohort studies — Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) and Health Care, Emergency Response, and Other Essential Workers Surveillance (HEROES) — both sponsored by the CDC. In addition to Florida, other study sites were located in Texas, Minnesota, Oregon, Arizona, and Utah. Prospective cohorts of 3,950 health care personnel, first responders, and other essential frontline workers completed weekly SARS-CoV-2 testing for 13 consecutive weeks. Dr. Caban-Martinez, who served as principal investigator of RECOVER, began to lead the Florida site in May

2020, which included participants from Miami-Dade, Broward, and Palm Beach counties. He and a team of collaborative experts began to track symptomatic and asymptomatic SARSCoV-2 infection in Florida participants. After 13 weeks, the national study collectively found that the two recommended doses of messenger-RNA vaccines — Pfizer-BioNTech and Moderna — were 84 percent effective in preventing laboratory-confirmed SARS-CoV-2 infection. “As we continue to longitudinally follow these high-risk worker groups for COVID-19 infections, we will learn more about factors beyond vaccine administration that limit the spread of coronavirus, such as regular use of personal protective equipment,” Dr. Caban-Martinez said. “The RECOVER and HEROES cohort studies provide critical insight on the COVID-19 pandemic and allow us as public health professionals and occupational health and safety specialists to protect our most vulnerable worker groups.”

COVID-19 HAS LED TO THE REFORMATION AND REINVIGORATION OF THE PUBLIC HEALTH WORKFORCE Written by Amanda Torres Published on February 11, 2021 Category: Alumna, Published Commentary

the pandemic ends, it will be necessary to examine not only the nation’s emergency response, but also the future of domestic public health.”

The COVID-19 pandemic has highlighted the importance of having a robust public health system that can actively respond to the next public health emergency and ongoing health disparities. In a paper published in the American Bar Association’s Health Law Section, Emely Sanchez, M.P.H., who is an alumna of the University of Miami Miller School of Medicine’s Master of Public Health program and now a third-year J.D. candidate at the School of Law, describes how the pandemic has led to the reformation and reinvigoration of the public health workforce.

Sanchez emphasized that increasing workforce development through skill-building and infrastructure, strengthening and improving technology, and prioritizing health equity are fundamental areas that will likely be further developed and implemented during and after the pandemic.

“The pandemic, caused by SARSCoV-2, has brought a reckoning in public health worldwide,” noted Sanchez, who served as the sole author of the paper. “Throughout this time, the public health workforce has been exposed, overburdened, under-resourced, and overly criticized. When

The paper, which is the first for Sanchez, details the ways in which the public health workforce should be assisted. These include: » Being continuously funded and expanded to address future emergency health threats, improve social determinants of health, and address ongoing health disparities » Help bolster skills and training in the public health workforce, such as in strategic skills and systems thinking, which are two skills that are considered critical needs in the workforce » Viewing public health as a tool for social justice and inclusive health

policy, as it is crucial to address persistent structural health disparities » Assist in building collaborative partnerships to tackle future public health emergencies and disparities by facilitating action through increasing resources and expanding capacity » Being provided training to understand, use, and explain public health law and policy » Strengthen effective communication skills to translate important policy decisions and crucial public health measures, as well as invest in communication initiatives and skill-building in order to reduce misinformation and loss of public trust » Include technological advancements and services that will expand and facilitate the role of public health throughout the larger health ecosystem “Improvements to these fundamental areas will help create an innovative and efficient public health system,” noted Sanchez. “Public health postCOVID-19 will require a system that is actively becoming better prepared for the next pandemic.”

STUDY FINDS U.S. FIRST RESPONDERS HAVE MIXED FEELINGS ABOUT COVID-19 VACCINE Written by Amanda Torres Published on February 9, 2021 Category: Faculty, Research Firefighters and emergency medical services workers are at high risk of exposure to COVID-19 while on the job and pose an additional risk of transmitting the virus to others. Although vaccines are a promising public health tool for reducing COVID-19 transmission, little has been known about the perceptions of the COVID-19 vaccine among first responders. To provide insight, a University of Miami Miller School of Medicine-led study queried a national sample of U.S. firefighters and emergency medical services workers through an anonymous online survey. The study results, published online Feb. 1 in the Journal of Occupational and Environmental Medicine, revealed that more than half of the first responders who replied were uncertain about or reported low acceptance of the vaccine. “Through the national sample of firefighters and emergency medical services workers, we gained insight into the workforce’s hesitancy about

the COVID-19 vaccine,” said study lead and senior author Alberto J. Caban-Martinez, D.O., Ph.D., M.P.H., associate professor of public health sciences in the Division of Environment and Public Health at the Miller School. “We can leverage this study’s information to design workplace interventions that educate and encourage our first responders to receive the COVID-19 vaccine.” DEMOGRAPHICS DETERMINE PERCEPTIONS Of the 3,169 respondents to the survey, 48.2% expressed high acceptability of the COVID-19 vaccine, 24.2% were unsure, and 27.6% reported low acceptability. The results also revealed key demographic characteristics — such as age, race, ethnicity, education, marital status, and job ranking — for each group of respondents. Additionally, across all ten geographic regions of the Federal Emergency Management Agency, the southeast (43.1%), the southwest (32.7%) and the west (34.1%) had the highest proportion of first responders who showed low COVID-19 vaccine acceptability.

“An important predictor we discovered from our study was that first responders who had not reported receipt of the influenza vaccine in the prior season had higher odds of being unsure about or not wanting to receive the COVID-19 vaccine,” Dr. Caban-Martinez said. In the study, the co-authors note the importance of tailoring public health campaigns for educating those sub-groups of firefighters and emergency medical service workers who identified as unsure or expressed low vaccine acceptability.

Alberto J. Caban-Martinez, D.O., Ph.D., M.P.H.

MILLER SCHOOL LEADS GROUNDBREAKING TRIAL TREATING SEVERE COVID-19 WITH MESENCHYMAL STEM CELLS Written by Lisette Hilton Published on January 5, 2021 Category: Faculty, Research

University of Miami Miller School of Medicine researchers led a unique and groundbreaking randomized controlled trial showing umbilical-cord derived mesenchymal stem cell infusions safely reduce risk of death and quicken time to recovery for the severest COVID-19 patients, according to results published in STEM CELLS Translational Medicine on January 5. The study’s senior author, Camillo Ricordi, M.D., said treating COVID-19 with mesenchymal stem cells makes sense. The paper describes findings from 24 patients hospitalized at UHealth Tower or UM/Jackson Memorial Hospital with COVID-19 who developed severe acute respiratory distress syndrome. Each received two infusions given days apart of either mesenchymal stem cells or a placebo. “It was a double-blind study. Doctors and patients didn’t know what was infused,” Dr. Ricordi said. “Two infusions of 100 million stem cells were delivered within three days, for a total of 200 million cells in each subject in the treatment group.” Researchers found the treatment was

safe, with no infusion-related serious adverse events. Patient survival at one month was 91% in the stem cell treated group versus 42% in the control group. Among patients younger than 85 years old, 100% of those treated with mesenchymal stem cells survived at one month. Dr. Ricordi and colleagues also found that recovery was faster among those in the treatment arm. More than half of patients treated with mesenchymal stem cell infusions recovered and went home from the hospital within two weeks after the last treatment. More than 80% of the treatment group recovered by day 30, versus less than 37% in the control group. “The umbilical cord contains progenitor stem cells, or mesenchymal stem cells, that can be expanded and provide therapeutic doses for over 10,000 patients from a single umbilical cord,” Dr. Ricordi said. “It’s a unique resource of cells that are under investigation for their possible use in cell therapy applications, anytime you have to modulate immune response or inflammatory response. We’ve been studying them with our collaborators in China for

more than 10 years in type 1 diabetes, and there are currently over 260 clinical studies listed in clinicaltrials.gov for treatment of other autoimmune diseases.” MESENCHYMAL STEM CELLS’ POTENTIAL TO RESTORE NORMAL IMMUNE RESPONSE Mesenchymal cells not only help correct immune and inflammatory responses that go awry, they also have antimicrobial activity and have been shown to promote tissue regeneration. “Our results confirm the powerful anti-inflammatory, immunomodulatory effect of UC-MSC (umbilical-cord derived mesenchymal stem cells). These cells have clearly inhibited the ‘cytokine storm,’ a hallmark of severe COVID-19,” said Giacomo Lanzoni, Ph.D., lead author of the paper and assistant research professor at the Diabetes Research Institute. “The results are critically important not only for COVID-19 but also for other diseases characterized by aberrant and hyperinflammatory immune responses, such as autoimmune type 1 diabetes.” When given intravenously, mesenchy-

mal stem cells migrate naturally to the lungs. That’s where therapy is needed in COVID-19 patients with acute respiratory distress syndrome, a dangerous complication associated with severe inflammation and fluid buildup in the lungs. “It seemed to me that these stem cells could be an ideal treatment option for severe COVID-19,” said Dr. Ricordi, Stacy Joy Goodman Professor of Surgery, Distinguished Professor of Medicine, and professor of biomedical engineering, microbiology and immunology. “It requires only an intravenous infusion, like a blood transfusion. It’s like smart bomb technology in the lung to restore normal immune response and reverse life-threatening complications.” EARLY SUCCESS WITH MESENCHYMAL STEM CELLS When the pandemic emerged, Dr. Ricordi asked collaborators in China if they had studied mesenchymal stem cell treatment in COVID-19 patients. In fact, they and Israeli researchers reported great success treating COVID-19 patients with the stem cells, in many cases with 100% of treated patients surviving and recovering faster than those without stem cell treatment. But there was widespread skepticism about these initial results, because none of the studies had been randomized, where patients randomly received treatment or a control solution (placebo), to compare results in similar groups of patients. “We approached the FDA and they approved our proposed randomized controlled trial in one week, and we started as quickly as possible,” Dr. Ricordi said. Dr. Ricordi worked with several key collaborators at the Miller School, the University of Miami Health System, and Jackson Health System, and with others in the U.S. and internationally, including Arnold I. Caplan, Ph.D., of Case Western Reserve University, who first described mesenchymal stem cells.

NEXT STEPS

islet transplant locally.”

The next step is to study use of the stem cells in COVID-19 patients who have not yet become severely ill but are at risk of having to be intubated, to determine if the infusions prevent disease progression.

Funding by The Cure Alliance made launching the initial trial possible, while a $3 million grant from North America’s Building Trades Unions (NABTU) allowed Dr. Ricordi and colleagues to complete the clinical trial and expand research with mesenchymal stem cells.

The findings have implications for studies in other diseases, too, according to Dr. Ricordi. Hyper-immune and hyper-inflammatory responses in autoimmune diseases might share a common thread with why some COVID-19 patients transition to severe forms of the disease and others don’t. “Autoimmunity is a big challenge for health care, as is COVID-19. Autoimmunity affects 20% of the American population and includes over 100 disease conditions, of which type 1 diabetes can be considered just the tip of the iceberg,” Dr. Ricordi said. “What we are learning is that there may be a common thread and risk factors that can predispose to both an autoimmune disease or to a severe reaction following viral infections, such as SARS-CoV-2.” The DRI Cell Transplant Center is planning to create a large repository of mesenchymal stem cells that are ready to use and can be distributed to hospitals and centers in North America, he said. “These could be used not only for COVID-19 but also for clinical trials to treat autoimmune diseases, like type 1 diabetes,” Dr. Ricordi said. “If we could infuse these cells at the onset of type 1 diabetes, we might be able to block progression of autoimmunity in newly diagnosed subjects, and progression of complications in patients affected by the disease long term. We are planning such a trial specifically for diabetes nephropathy, a kidney disease that is one of the major causes of dialysis and kidney transplantation. We are also planning to do a study on umbilical cord mesenchymal stem cell transplantation in combination with pancreatic islets to see if you can modulate the immune response to an

“North America’s Building Trades Unions have been a major supporter of the Diabetes Research Institute since 1984, when they started a campaign to fund, and build, our state-of-the-art research and treatment facility,” Dr. Ricordi said. “NABTU has continued to support our work through the years, including our mesenchymal stem cell research that helped lead the way to this clinical trial.” All the organizations funding the research are nonprofit entities, including the Barilla Group and Family, The Fondazione Silvio Tronchetti Provera, the Simkins Family Foundation, and the Diabetes Research Institute Foundation. The National Center for Advancing Translational Sciences also provided funding. Coauthors of the study included a wide range group of experts, including Shari Messinger Cayetano, Ph.D., associate professor of public health sciences at the Miller School.

Shari Messinger Cayetano, Ph.D.

COVID-19 INFECTION IS ASSOCIATED WITH ECONOMIC DISADVANTAGE IN A PARTICULAR GEOGRAPHIC AREA, STUDY FINDS Written by Amanda Torres Published on December 9, 2020 Category: Faculty, Research

According to a new ecological study led by the University of Miami Miller School of Medicine, understanding how social determinants of health play a role in COVID-19 infections could help with the development of strategies to prevent the spread of the virus. Social determinants of health are conditions in the place where people live, learn, work, and interact, which in turn affect a wide range of health and quality-of-life risks and outcomes. The cross-sectional study — published in the November 2020 issue of the Journal of General Internal Medicine — found that COVID-19 infection is associated specifically with economic disadvantage and stress reported in a particular geographical area and not with its racial/ethnic distribution. “These findings are consistent with reports from many other conditions. Racial health disparities are driven by socio-economic disadvantage and not by biological or genetic differences,” said study lead author Ana Palacio, M.D., M.P.H., professor of clinical medicine in the Miller School’s Department of Public Health Sciences.

“Therefore, as we consider the steps to contain the pandemic, addressing or mitigating social determinants of health should be among the top priorities.” “Our findings highlight the importance of integrating clinical, social and geographic data in a privacy compliant manner. Where we live affects our health trajectory,” added study senior author Leonardo Tamariz, M.D., M.P.H., professor of medicine in the Miller School’s Department of Medicine. “Having this information is pivotal to develop the necessary policies or programs to improve health outcomes in our community.” Dr. Palacio and Dr. Tamariz analyzed 95,594 COVID-19 positive cases across 79 ZIP codes within Miami-Dade County. They found that the highest COVID-19 incidence was for ZIP code 33125, where residents had a median household income of $21,106, 6 percent were Black, and 93 percent were Hispanic. Within this ZIP code, there were 69.8 COVID-19 cases per 1,000 inhabitants. The lowest incident rate ratio, they found, was for ZIP code 33146, which

had a median household income of $96,609, had 3 percent Black residents and 53 percent Hispanic residents. There were 26.1 COVID-19 cases per 1,000 inhabitants within this ZIP code. Dr. Palacio and Dr. Tamariz conducted the study using COVID-19 cases reported by the Florida Department of Health’s COVID-19 data and surveillance dashboard, which reports the cumulative number of positive COVID-19 tests by county and by ZIP code. Using 2010 Census data, experts imputed race/ethnicity from each ZIP code, as well as described median household income by ZIP code. The study included two sources of social determinants of health data. The first was ZIP code-level data from 2010 Census population data using Mami-Dade projections. Data included total population, race and ethnicity, median household income, and average household size by ZIP code to match how the COVID-19 cases are reported in Florida. The second source was individual-level self-reported social determinants of

health from a survey of 11,113 primary care UHealth patients — collected between September 2016 and April of 2019 — who responded to a validated questionnaire based on the recommendations of the National Academy of Medicine. The individual-level data included race and ethnicity, education, financial strain, stress, social isolation scale, health literacy, and delays in receiving health care. Another important finding from the study is that self-reported stress aggregated to the ZIP code level is directly associated with COVID-19 infection. The study says that potential explanations for the expanding evidence of COVID-19 disparities generally include the higher prevalence of comorbidities among racial/ethnic minority populations and the socio-economic factors that may affect minorities’ ability to physically distance. The study showed that groups most at risk of COVID-19 infection indeed had low median household income — according to ZIP code-level data — and also had a higher proportion of people reporting financial difficulties paying for basic needs, such as food or medications. Groups with these characteristics are potentially less likely to have the option of staying at home for long periods of time and more likely to be exposed for work-related demands.

Ana Palacio, M.D., M.P.H.

Leonardo Tamariz, M.D., M.P.H.

“Our prior work has found that these same neighborhoods suffer the highest rates of cardiovascular disease, creating a perfect storm for these communities,” said Dr. Tamariz. “They have higher stress levels, more comorbidities and less ability to socially distance.” “Creating policies that improve living conditions in these communities would not only improve COVID-19 outcomes but also outcomes in cardiovascular disease and other conditions,” added Dr. Palacio. “Inaction could lead to increasing the health disparities gap between the affluent and less affluent neighborhoods for years to come.”

MILLER SCHOOL’S PUBLIC HEALTH GRADUATE STUDENTS PLAY KEY ROLE IN UNITING FOR ACTION’S NEW VACCINE CONSIDERATIONS PROJECT Written by Amanda Torres Published on December 9, 2020 Category: Students, Faculty, Project During the Fall 2020 semester, Uniting for Action virtually visited a course filled with eager public health graduate students at the University of Miami Miller School of Medicine. The organization—founded in 2017—is facilitating the strategic and collective actions required to effectively address current and future health challenges faced in local, national, and global communities.

of how our public health students are getting actively involved in the community to advance COVID-19 research and dissemination of preventive strategies,” said Dr. Eric C. Brown, Ph.D., associate professor in the Miller School’s Department of Public Health Sciences, who teaches the department’s Disease Prevention and Health Promotion course, which the organization visited.

Now, students are involved in Uniting for Action’s new Vaccine Considerations Project, which will help gather and share information to address health concerns and considerations regarding the new COVID-19 vaccines.

Jared Krupnick, the founder of Uniting for Action, spoke to students about the organization’s new Vaccine Considerations Project.

“This is a great example

“Working with Dr. Brown to prepare my presentations for his classes has taught me so much,” said Krupnick. “What I’ve learned

has crucially helped shape how the Vaccine Considerations Project is now moving forward. This has also been a great opportunity to expand COVID-19 research through student class projects, capstones, and theses around the work we’re doing. I appreciate the commitment from Dr. Brown and his students to creating a connection between the theories and the concepts in the classroom and the practical application of those principles out in the world.” The Vaccine Considerations Project is consolidating, organizing, and amplifying collective COVID-19 vaccine health and safety concerns primarily of the medical community, epidemiologists, public health

experts, and the community at large. The project’s team is. creating a repository of information that is being made available to individuals, advisory panels, national associations, medical professionals, researchers, and the media. Students from the Miller School’s Department of Public Health Sciences are playing a key role in developing the repository. “The students that have joined the team have really been going above and beyond to bring the vision of the project into reality, from research to content creation to outreach,” said Krupnick. “We’re all focused on creating wins for each of the students on the team, for the project, and for the

public. We’re all doing a really great job of that. UM students are the ones that helped get this project off the ground and through their outreach across the country, we’ve now added team members from three other universities this past week. There’s a palpable electricity and energy right now as we can all see our efforts beginning to quickly bear fruit on a national level.” Students from Baylor University, George Washington University, and Boston University are now also involved in the project. Miller School’s Vanessa Morales, a second year M.S.P.H. candidate in the Department of Public Health Sciences, who is the student team leader in the Vaccine Considerations Project, is responsible for the coordinating efforts to develop the student outreach strategy that is building the workforce for the project, as well as managing consistent and coordinated outreach to students at universities across the nation. “Throughout this past semester, Dr. Brown has capitalized on the virtual modality of classes by bringing in an exciting group of guest speakers to present on various topics to the class,” said Morales. “This is how we were connected to Uniting for Action and the Vaccine Considerations Project. This project is giving us the opportunity to engage in the very timely COVID-19 vaccine considerations. We are identifying, and amplifying concerns expressed by the medical and public health community regarding the COVID-19

vaccine.” Their aim, Morales shared, is to ensure that these concerns be thoroughly addressed by the Florida Drug Administration (FDA) as they work to approve vaccines and make these concerns available to the public through the Information for Action System, so that individuals can use these considerations to form an informed plan of action for themselves, and family members regarding the COVID-19 vaccination. Miller School’s Jasmine N. Jackson, a first year M.S.P.H. candidate, has also taken the role as one of the national student network liaison and researcher for the project. As a student liaison, she has helped network with students across the country and disseminate information regarding the project—a role that is imperative in expanding the team and network of students across many disciplines and states. “As a part of the research team, I am also contributing to the repository of information by consolidating and organizing the collective COVID-19 vaccine health and safety concerns that have surfaced,” Jackson said. “I hope to take this experience in an interdisciplinary team, building a repository of information, and disseminating knowledge to stakeholders and communities and apply it to my future career in global health.” “Dr. Brown seamlessly introduced Jared’s work while discussing prevention systems and system thinking,” she added. “Jared spoke about the project

and immediately caught my attention. Dr. Brown made concepts come to life in a real-world application. I put what I was learning in class to the test outside of my class lecture. I believe that to reinforce knowledge taught in a class, I must be presented with real-world examples and impacts.” Amid the ongoing pandemic and the new recent advances in vaccines, developing widespread COVID-19 immunity is a key public health strategy in eliminating the transmission of the virus. Current vaccine hesitancy poses significant challenges. The Vaccine Considerations Project is working with its senior medical advisor, David Berger, M.D., F.A.A.P.—a board-certified pediatrician with over 20 years of experience as a clinician—who has decades of experience educating people with concerns and hesitancies about vaccines through his family practice. Dr. Berger is helping direct the students on the team to collect and provide information for individuals who have health conditions and concerns that may need to be specifically addressed. For example, there may be adverse reactions from the COVID-19 vaccines that may emerge in individuals who have hyperinflammatory conditions, cancers, poor health or nutrition, and past exposure/immunity to the COVID-19 virus. On December 10th, Dr. Berger and the Vaccine Considerations Project team will be providing oral presentations at the FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) Meeting. The

Advisory Committee will be evaluating whether to recommend that the FDA grants an Emergency Use Authorization for the Pfizer COVID-19 vaccine. The Vaccine Considerations Project team is suggesting ways the FDA and the Advisory Committee can increase trust and confidence by rigorously and comprehensively addressing unresolved and unaddressed concerns. “The decisions being made right now regarding the authorization of use of COVID-19 vaccines affects tens of millions of people,” Krupnick said. “The students understand the urgent and critical roles they can play to ensure the public’s health and safety, and they’re all making personal sacrifices to contribute as much as they can to the project, even in the midst of finals, and everything else they have going on in their lives. It’s really inspiring to see their selfless willingness to be leaders, right now, when the stakes are so high, and we need them the most. Up until now, very few people have been aware of the crucial work they’ve been doing behind the scenes, but very deservedly that’s all changing now.” Uniting for Action is urging all concerned stakeholders to collectively contribute to and share information addressing the health and safety concerns of COVID-19 vaccines through the Vaccine Considerations Project. The organization is also actively recruiting interested individuals to help with this critical project. For more information on the project, visit http://VaccineConsiderations.com.

NEW STUDY EXAMINES LONELINESS, MENTAL HEALTH, AND SUBSTANCE USE AMONG U.S. YOUNG ADULTS DURING COVID-19 Written by Amanda Torres Published on December 9, 2020 Category: Faculty, Research Staff, Alumna, Research As the COVID-19 pandemic converged with the loneliness and addiction epidemics in the United States this year, public health and mental health experts forecast increases in substance use and mental health conditions.

and drug use among young adults during COVID-19. The findings — published in the November 2020 issue of the Journal of Psychoactive Drugs — underscore the importance of prevention and intervention to address these public health challenges.

In a new study led by the University of Miami Miller School of Medicine, public health experts found that there have been elevated levels of loneliness, depression, anxiety, alcohol use,

“Our study highlights two main findings,” said study lead author Viviana E. Horigian, M.D., M.H.A., professor in the Miller School’s Department of Public Health Sciences. “The first is

that loneliness and mental health conditions are elevated in young adults following the onset of the pandemic in the U.S. Second, that these increases in loneliness, depression, anxiety and substance abuse are related. We believe that addressing mental health and substance use problems in young adults, both during and after the COVID-19 pandemic, is imperative.” Between April 22 and May 11, 2020, co-authors of the study recruited

the pandemic. “Warnings of the mental health consequences of COVID-19 have been highlighted since the pandemic began,” said study co-author Renae D. Schmidt, M.P.H. a research associate in the Department of Public Health Sciences. “Our study confirms the need for this call to action.”

we invest in developing the sense of cohesion and social connectedness in these generations, we can address resiliency in our communities at large.”

The study provides insight into the maladaptive symptoms and possible disorders among young adults who were affected by the restrictions put in place to control COVID-19 during the short nationwide stay-at-home order this year. The study also captured the co-occurrence of a myriad of clinical symptoms and behaviors among U.S. adults. “The findings of this study are particularly important because life will continue to be affected by COVID-19 for some time,” said study senior author Daniel J. Feaster, Ph.D., professor in the Department of Public Health Sciences. “The potential for lingering economic impact of the epidemic may further exacerbate these elevations in mental health symptoms and substance use.” 1,008 participants aged 18 to 35 through social media to a one-time, online anonymous survey. Findings showed that 49 percent of respondents reported loneliness, 80 percent reported significant depressive symptoms, 61 percent reported moderate to severe anxiety, and 30 percent disclosed harmful levels of drinking. The study also found that while 22 percent of the population reported using drugs, 38 percent reported severe drug use. Participants also reported significant increases across mental health and substance use symptoms during COVID-19. Co-authors note that while direct impacts of COVID-19 could only be calculated with pre-pandemic assessments of these symptoms, estimates indicate elevated psychosocial symptoms and suggest that symptoms could have worsened since the start of

This research builds on previous work by Schmidt and Dr. Horigian on the association between loneliness, social connectedness, and its counterpart, social isolation, and drug overdose deaths. The idea came about during one advising session where Schmidt and Dr. Horigian reflected on overdose deaths and Dr. Horigian’s interest in their relationship with suicidality and isolation.

Viviana E. Horigian, M.D., M.H.A.

Renae D. Schmidt, M.P.H.

The study is one of 24 University of Miami COVID-19 related projects that received rapid response grants for areas of research that are providing information about the effects of the pandemic. “These young adults are the future of our nation’s social fabric. Our study highlights high prevalence of loneliness and other mental health problems, directing attention to the importance of early identification and intervention,” said Dr. Horigian. “As

NEW PAPER HIGHLIGHTS CHALLENGES AND INNOVATIONS IN LATINX HEALTH DISPARITIES RESEARCH AMID COVID-19 Written by Amanda Torres Published on September 9, 2020 Category: Faculty, Research In a paper published in the journal Annals of Behavioral Medicine, experts at the University of Miami’s Miller School of Medicine and School of Nursing and Health Studies describe the challenges and innovative research methods developed to continue Latinx health disparities research amid COVID-19. Principal investigators of five pilot studies within the Center for Latino Health Research Opportunities (CLaRO) developed innovative research methods in response to COVID-19 for research continuity. CLaRO, a National Institutes of Health-funded center housed in the School of Health and Nursing Studies, supports and facilitates research addressing substance abuse, violence/trauma, and HIV/ AIDS among diverse and underserved Latinx populations. “In the face of challenges related to COVID-19, we optimized CLaRO funded Latinx health disparities research to protect participant and research staff physical safety, adhere to human subjects protections, address cultural factors related to engaging Latinx populations in research, and capture emerging COVID-19-related health

disparities,” said paper lead author Audrey Harkness, Ph.D., research assistant professor at the Miller School of Medicine’s Department of Public Health Sciences. “This resulted in innovative approaches to conducting research with Latinx populations that may enhance future health disparities research, even after the COVID-19 crisis subsides.” Amid the pandemic, CLaRO’s five pilot studies that faced challenges and adapted innovations included Mobile Intervention Prototypes, Feasibility and Acceptability of the Family Acceptance Project (FAP), DÍMELO, Happy Older Latinos are Active (HOLA), and PROGRESO-II. Challenges found were the following: » COVID-19 prompted college-aged Latinx youth to move in with their families, potentially exacerbating stressors that may be addressed in the interventions » COVID-19 likely impacted key variables, such as sexual behavior, mental health, substance use, use of HIV-prevention, and behavioral health services » Data collection by phone led to the

difficulty in collecting biological/ physiological outcomes » Digital divides, such as the use of flip phones, affected participants who were older Latinos Despite the challenges COVID-19 presented to Latinx health disparities research, it also presented opportunities to innovate. Innovations established by project investigators included: » Remote recruitment through phone, email, and word of mouth » Informed consent and assent by videoconferencing » Adolescents providing feedback on intervention prototypes by videoconference focus groups » The Family Acceptance Project designed as a home-based intervention, transitioned to a videoconferencing format, creating the opportunity to reach Latinx families across Florida and the U.S. » Developed Pandemic Stress Index to assess COVID-19 psychosocial and behavioral impacts, protecting the scientific integrity of the project and potentially contributing to knowledge about Latinx health disparities related to COVID-19 » Participants and community health

workers met by phone during group walk time to motivate physical activity and activity scheduling, modeling personalism and emphasizing trust » Explored how Latinx cultural factors remain central to engaging Latinx participants in research, particularly during a global pandemic. “Innovative and tailored research approaches are needed to solve scientific, public health, and clinical challenges related to ongoing and emerging health disparities brought about by the pandemic,” said paper senior author Victoria Behar-Zusman, Ph.D., professor at the School of Nursing and Health Studies and principal investigator of CLaRO. “We hope the examples presented in the paper provide a launching point for other investigators to meet COVID-19 with innovation to support the goals of achieving health equity for those who are most impacted by past, present, and future health crises.”

MILLER SCHOOL PUBLIC HEALTH RESEARCHERS STUDY COVID-19 ANTIBODIES IN FIRST RESPONDERS Written by Diana Gonzalez Published on August 12, 2020 Category: Faculty, Research

Audrey Harkness, Ph.D.

Victoria Behar-Zusman, Ph.D.

The international peer-reviewed journal Occupational and Environmental Medicine has released a report by a team from the University of Miami Miller School of Medicine on the prevalence of COVID-19 antibodies in a group of South Florida firefighters/paramedics. The paper, published August 6, is the first in the U.S. to document the seroprevalence of SARS-CoV-2 in a first-responder workforce. “Prior research has suggested that first responders are at high risk of exposure to coronavirus due to the frequent and multiple encounters with members of the general public,” said Alberto J. Caban-Martinez, D.O., Ph.D., M.P.H., associate professor of public health sciences in the Division of Environment & Public Health at the Miller School. “Understanding risk factors and mitigators of exposure to coronavirus are important steps to

controlling the spread of the virus, particularly for our first responders.” Dr. Caban-Martinez is the lead investigator of this research, called the Firefighter Tracking, Resources, Assessment of COVID-19 Epidemiology (F-TRACE). He is also deputy director of the Firefighter Cancer Initiative at Sylvester Comprehensive Cancer Center, along with Natasha Schaefer Solle, Ph.D., RN, and Director Erin Kobetz, Ph.D., M.P.H., who are co-authors of the report. On April 16, the City of Hialeah Fire Department was the first in the country to undergo finger-prick coronavirus antibody screening using a rapid immunoglobulin (Ig)M-IgG combined point-of-care lateral flow immunoassay to estimate the prevalence of the virus that causes COVID-19. Over a two-day period, 203 firefighters/paramedics were tested. Of those, 18, or 8.9%, tested positive for the antibod-

ies, which was low compared to the community infection rate, which was double that. Dr. Caban-Martinez says the discrepancy is likely due to the regular and consistent use of personal protective equipment and decontamination practices adhered to by the fire department workers. For the past several months, numerous fire departments have undergone antibody testing and those results are being compiled for publication. As part of a multi-prong approach to COVID-19 surveillance and control for first responders, the F-TRACE project will continue to provide firefighters/ paramedics with the resources and guidance to minimize the burden of COVID-19 within their workforce and the communities they serve.

DR. ADAM CARRICO RECEIVES NIH GRANT TO STUDY RISK FOR COVID-19 AMID METHAMPHETAMINE USE AND HIV Written by Amanda Torres Published on July 29, 2020 Category: Faculty, Funded Project Adam Carrico, Ph.D., professor with the University of Miami Miller School of Medicine’s Department of Public Health Sciences, has been awarded a grant from the National Institutes of Health to study how methamphetamine use and HIV could create an increased risk for infection with the novel coronavirus in sexual minority men. The population includes gay, bisexual, and other men who have sex with men. The two-year project will be among the first to examine the potentially synergistic associations of methamphetamine and HIV with rates of infection with the novel coronavirus in sexual minority men. “This project will advance our understanding of who may be at greater risk of infection with the novel coronavirus, which is critical to inform targeted public health approaches to flatten the curve of the COVID-19 pandemic,” said Dr. Carrico, who is also the newly-named director of the Division of Prevention Science and Community Health in the Department of Public Health Sciences. Dr. Carrico and his team will enroll 200 sexual minority men to participate in the study – COVID-19 Research for Understanding

the role of Substances and HIV (CRUSH). CRUSH is a prospective cohort where participants will provide nasal swabs and blood samples to determine if they have been exposed to the novel coronavirus over six months. With support from the Miller School’s Miami Center for AIDS Research (CFAR), these specimens will be tested by the laboratories of Savita Pahwa, M.D, and Mario Stevenson, Ph.D. to determine if individuals have been exposed to the novel coronavirus. “South Florida is a domestic epicenter for the HIV and COVID-19 pandemics,” said Dr. Carrico “Our work will assist with identifying whether and how methamphetamine users, as well as people living with HIV, are at elevated risk for infection with the novel coronavirus.” With the support of Dr. Pahwa’s laboratory, CRUSH will also examine the extent to which co-occurring methamphetamine use and HIV are indirectly linked to higher rates of infection with the novel coronavirus via alterations in gut-immune dysregulation. “The success of the CFAR is driven by investigators who utilize its resources to enhance research in various

aspects of HIV/AIDS," said Dr. Pahwa. "We are delighted that the Miami CFAR will be supporting this important study by conducting laboratory assays to answer the important question of whether meth use increases the risk of SARS-CoV-2 infection and if heightened inflammation is an underlying factor." “Dr. Carrico is to be commended for the CRUSH project, which will lead to an understanding of the impact of meth use and HIV on the acquisition of SARS-CoV-2 infection. This research is especially relevant for us, given the astronomically high rates of SARS-CoV-2 infection in Miami/Dade, and Florida in general," Dr. Pahwa added. Dr. Carrico and Dr. Pahwa have previously demonstrated that recent methamphetamine use is associated with greater gut-immune dysregulation, even in those with treated HIV infection.

infection » Substance-associated elevations in monocyte activation among methamphetamine users with treated HIV infection Dr. Carrico’s team will also examine key behavioral risk factors such as smoking and decreased adherence to social distancing guidelines that could explain higher rates of infection with the novel coronavirus in methamphetamine users. Results will inform the development of biomedical and behavioral interventions to reduce community transmission of the novel coronavirus and decrease the risk for COVID-19 in high priority populations, such as sexual minority men living with HIV and who use methamphetamine.

Their previous studies include: » Getting to the point: Methamphetamine injection is associated with biomarkers relevant to HIV pathogenesis » Recent stimulant use and leukocyte gene expression in methamphetamine users with treated HIV

Adam Carrico, Ph.D

CLIMATE-DRIVEN ATLANTIC HURRICANES AND COVID-19 TRANSMISSION: MITIGATING BETWEEN THE CONCURRENT THREATS Written by Amanda Torres Published on July 29, 2020 Category: Faculty, Event In a paper published in the July issue of Disaster Medicine and Public Health Preparedness, a multi-disciplinary group of experts have provided critical information on the intersection of climate-driven Atlantic hurricanes and COVID-19 transmission – highlighting the complexities and potential solutions to addressing these two threats. “Dealing with the potential for a hurricane strike while COVID-19 is actively circulating poses a dilemma. The proven mitigation approaches for hurricanes-evacuation and sheltering-huddle people together, while the most effective means for controlling the spread of COVID-19 prioritizes keeping people apart,” said James Shultz, Ph.D., Director of the Center for Disaster and Extreme Event Preparedness (DEEP Center) at the Miller School of Medicine’s Department of Public Health Sciences, who served as

lead author on the paper. As seen with Hurricane Harvey in 2017 and Hurricane Dorian in 2019, climate change has likely led to stronger, wetter, slower-moving, and more dangerous hurricanes. Now more than ever, it is crucial for storm-threatened populations to heed warnings, respond to evacuation orders, and shelter safely in well-fortified homes or community structures away from the coasts. However, these measures necessarily bring people into close proximity. To prevent COVID-19 transmission, on the other hand, effective strategies involve separating people – sheltering at home, physical distancing, shutdowns, and lockdowns, coupled with wearing masks, hand washing, and hygiene practices. These measures have been credited with preventing an estimated 60 million people from contracting COVID-19 in the United States. Now, experts are questioning how populations will react when warned to shelter from an oncoming Atlantic

hurricane – while COVID-19 is actively circulating in the community. Recently, Hurricane Hanna provided a glimpse and analyzing what happened to be helpful when planning for more powerful storms to come. Emergency managers, healthcare providers, and public health preparedness professionals should create viable solutions to confront these potential scenarios tom minimize the possibilities of increased rates of hurricane-related injury and mortality among persons who refuse to evacuate due to fear of COVID-19 and increased spread of COVID-19 cases among hurricane evacuees who shelter together. Improvising solutions to concurrent hurricane and pandemic threats in 2020 that were noted in the Disaster Medicine and Public Health Preparedness paper include: »

Focus on the 2020 hurricane season. Experts predict that a safe and effective COVID-19 vaccine may be available for popula-

tion-wide immunization before the 2021 hurricane season. If so, the double risk scenario may not reoccur again during future hurricane seasons. Maintain a COVID-19 prevention lifestyle. To minimize harm from a combined hurricane-pandemic disaster scenario, experts recommend continuing to observe precautions to limit the spread of COVID-19. It is much safer to shelter or evacuate, and easier to motivate people to do so if COVID-19 transmission in the storm-threatened community remains subdued. Adapt community sheltering to COVID-19: The Centers for Diseases Control and Prevention released guidance on sheltering that attempts to balance the competing risks of minimizing exposure to hurricane hazards and reducing the likelihood of COVID-19 transmission. The National Mass Care Strategy has also produced documents on related themes, such as COVID-19 congregate sheltering, feeding procedures in congregate shelters, and non-congregate sheltering. FEMA’s 2020 COVID-19 Pandemic Operation Guidance for the 2020 Hurricane Season provides high-level guidance for local

emergency managers to consider when dealing with the COVID-19transformed risk landscape in their communities. Adapt in-home sheltering to COVID-19 and educate the public. Many of the same principles apply in mass shelters and in homes or smaller sheltered enclaves. Experts note that critical information on how to shelter safely with friends and family is not being widely communicated to the public. Evacuation behavior is a major question mark. Framing and communicating the risks will be critical. The public needs to be informed that Atlantic hurricanes have never been more hazardous, so responding to evacuation orders is essential for family safety – and that sheltering options can be made safer by taking precautions to minimize the spread of COVID-19. Apply lessons from infectious disease outbreaks in shelters during previous hurricanes. Several states along the hurricane coast have a special system in place to identify, register, transport, and shelter persons who have special medical needs, particularly those who are electronically dependent. These shelters have auxiliary power gen-

erators and are staffed by public health nurses. Infection control measures that have been successful in special needs shelters can be adapted for congregate mass care settings. Learn from each 2020 storm and continuously refine protocols. Lessons learned early in the season can refine and shape evacuation and sheltering protocols to improve mitigation procedures when stronger storms threaten and strike later in the season. For example, examining what happened during Hurricane Hanna can be useful for fine-tuning responses to stronger storms expected during the peak of the season. Placing COVID-19, climate change, and synchronous threats in context. Evidence shows that the frequency, duration, and intensity of extreme events affecting populations are on the rise. The distinction between naturally occurring disasters and man-made crises is becoming less relevant in light of current multifaceted crises.

“It is possible to successfully diminish both hurricane and pandemic risks, but very difficult to completely neutralize them,” said Dr. Shultz. “Since the time we wrote this paper, just a number of weeks ago, COVID-19 has resurged dramatically throughout all states comprising the ‘hurricane coast’ from Texas to the Carolinas. That certainly increases the degree of challenge.”

James Shultz, Ph.D.

UM TO LAUNCH COVID-19 VACCINE TESTING SITE FOR THE COVID-19 PREVENTION TRIALS NETWORK Written by Kai Hill Published on July 20, 2020 Category: Alumna, Clinical Trials The University of Miami Miller School of Medicine has been selected to be part of the National Institutes of Health COVID-19 Prevention Trials Network (CoVPN) to launch clinical trials to test investigational COVID-19 vaccines. Led by infectious diseases expert Susanne Doblecki-Lewis, M.D., M.S.P.H., associate professor of clinical medicine and alumna of the Master of Science in Public Health Program in the Department of Public Health Sciences, the initiative at the Miller School of Medicine is part of a large-scale study established by the NIH’s National Institute of Allergy and Infectious Diseases (NIAID). “The COVID-19 pandemic is having a tremendous impact in South Florida and across the world,” said Dr. Doblecki-Lewis. “We are testing vaccines with the goal of finding a safe and effective way to halt the spread of the virus.”

will be to test the vaccine developed by NIAID scientists and their collaborators at the biotechnology company Moderna, Inc. The Miller School plans to enroll 1,000 volunteers in South Florida in that clinical trial, expected to begin this summer. Prospective study volunteers will need to be 18 or older and can register to participate through an online registry. Using community outreach and mobile operations, Miller School clinical researchers plan to recruit young and older adults, including groups with existing co-morbidities. “We are committed to engaging people who represent the range of residents impacted by COVID-19 in South Florida by gender, age, race, and ethnicity, as well as those who are particularly at risk because of medical conditions,” said Dr. Doblecki-Lewis. “This is how we will help ensure that any vaccine that is developed will be relevant for those who could benefit most from it.” The Miller School of Medicine is a major research center for infectious diseases, particularly HIV and AIDS. The University’s affiliation with the HIV Vaccine Trials Network made it a natural location to test COVID-19 vaccines. The new NIH-led COVID-19 Prevention Trials Network, which is spearheading the nation’s vaccine efforts, was established by merging four existing NIAID-funded clinical trials networks: the HIV Vaccine Trials Network (HVTN), based in Seattle; the HIV Prevention Trials Network (HPTN), based in Durham, N.C.; the Infectious Diseases Clinical Research Consortium (IDCRC), based in Atlanta; and the AIDS Clinical Trials Group, based in Los Angeles.

The first Phase 3 clinical trial that the CoVPN will conduct

QUALITY OF INDOOR AIR PLUMMETED IN SOME HOMES DURING COVID-19 SHUTDOWN Written by Robert C. Jones Jr. Published on July 14, 2020 Category: Faculty, Research, Service Environmental sensors placed in Miami- and Baltimore-area homes by University of Miami public health researcher Naresh Kumar recorded elevated levels of particulate matter, carbon monoxide, and other harmful substances during a two-month, stay-at-home period. Daily commutes to and from the office grounded to a halt. Restaurants closed their dining rooms, operating as takeout establishments, only. Gyms, barbershops, and nail salons shuttered. And people, except for trips to the grocery store or pharmacy, pretty much stayed at home. When the nation’s governors imposed shelter-in-place orders in their states earlier this year in hopes of reining in surging cases of COVID-19, Naresh Kumar, a University of Miami public health scientist who studies the environmental burden of disease, knew that the special sensors he had placed in more than 30 residential homes in

Miami and the city of Baltimore would eventually have a story to tell. Now, as most states have started to lift restrictions and reopen their economies, those sensors are telling that story. During a two-month period from April through May, when residents spent the majority of their time indoors complying with COVID-19 lockdown orders, levels of harmful substances in those homes increased dramatically, degrading the quality of indoor air. And shutdown directives imposed to curtail the coronavirus were the cause of those spikes, said Kumar, an associate professor of environmental health at the Miller School of Medicine. While his findings are still preliminary, the numbers he has downloaded from his environmental sensors are nonetheless startling. Amounts of fine particulate pollution, which is also known as PM2.5 because the particles are less than 2.5 micrometers in diameter, rose by 30 percent over that twomonth span. Meanwhile, concentrations of ammonia, carbon monoxide,

and nitrogen dioxide climbed by 2.7 percent, 15 percent, and 4 percent, respectively. “But it’s what people did inside their residences during stay-athome orders that contributed to those increases,” Kumar said. With restaurants offering only takeout, more people cooked meals at home, some using gas-powered ranges that produced carbon monoxide and which didn’t have effective exhaust hoods. And as concerns over the spread of COVID-19 grew, people took disinfecting to a new level, often overusing harsh cleaning products and exposing themselves to dangerous compounds like ammonium chloride, Kumar noted. From January to March, poison control centers reported a 20 percent increase in calls compared to the same period last year, according to the Centers for Disease Control Prevention, which used data from the National Poison Data System. While National Ambient Air Quality Standards imposed by the EPA have helped mitigate outdoor air pollution,

indoor air quality—which is unregulated—remains largely poor. This results in toxic conditions that may lead to such illnesses as cardiopulmonary disease, asthma, C.O.P.D., and other respiratory ailments. “Outdoor air quality in the United States has largely gotten better over the past four to five decades,” Kumar said. “People in impoverished countries now breathe the same poor quality of outdoor air that we used to breathe in the 1960s and ’70s. “But there’s a public health paradox, in that along with the declines in outdoor air pollution we’ve experienced, we should have seen corresponding drops in the disease burden of certain ailments like asthma, allergies, and dry eye,” Kumar continued. “But we’re not seeing those declines. They’re actually getting worse. And part of the reason, I believe, is largely because people are spending most of their time indoors, where the air quality is bad.” As part of Kumar’s ongoing research on indoor environmental conditions, the 33 sensors he has placed in residential homes—15 in Miami and 18 in Baltimore—continue to track levels of particulate matter and other substances in real time. A long-range study examining whether those harmful substances led to respiratory illnesses remains a possibility, he said. But at least one investigation has already found a link between indoor air quality and a specific ailment. In a study recently published online in the Journal of the American Medical Association, Kumar and others established a connection between the indoor environment—specifically, humidity and air pollutants—and symptoms of dry eye. Funded in part by the National Eye Institute, the study sampled 97 subjects from the Miami VA Hospital, monitoring indoor environmental conditions in their homes within seven days of a clinical visit and ultimately finding that levels of indoor particulate matter were associated with dry eye metrics.

Studies examining the effect of indoor air quality on health are rare, even though sources of indoor air pollution run the gamut—from building materials and furniture made of pressed wood to deteriorating asbestos in insulation, flooring, upholstery, and carpet. Household cleaning and personal-care products also are a contributing factor, Kumar said. As such, more such studies are needed, he pointed out. Kumar recommended the following measures to help reduce indoor air pollutants. » » » »

» » »

Ensure that gas stoves are well ventilated. Use carbon monoxide detectors. Use a dehumidifier to reduce moisture. Buy certain indoor plants that are proven to help absorb harmful toxins in the air—such as formaldehyde and carbon monoxide. Don’t smoke indoors, or better yet, quit altogether. Dust surfaces. Avoid using strong disinfectants with chlorine, which is highly reactive and can irritate the eyes, nose, and throat. If using disinfectants with chlorine, open doors and windows to ventilate.

SYRINGE SERVICE PROGRAMS ACROSS THE U.S. HAVE BEEN IMPACTED BY THE COVID-19 PANDEMIC, STUDY FINDS Written by Amanda Torres Published on June 29, 2020 Category: Alumni, Research Across the U.S., there are currently over 400 syringe service programs, including the Miller School of Medicine’s Infectious Disease Elimination Act (IDEA) Exchange. These programs are crucial to the community as they offer social and medical services to people who inject drugs, including access to sterile and clean injection equipment, onsite and referrals to substance use treatment, HIV, and Hepatitis C (HCV) testing, as well as overdose prevention through naloxone distribution. With the unprecedented developments of COVID-19 this year, experts at the University of Miami Miller

service programs in 44 states across the U.S., including 14 sites in New York City, in a one-week period in March 2020. The findings showed disruption of services provided at the programs amid COVID-19. Findings included the following: » » »

» School of Medicine and Columbia University’s Mailman School of Public Health examined operational and service delivery changes in a new study published in the June issue of the International Journal of Drug Policy. “Persons with substance use disorder, particularly persons who inject drugs, are at higher risk of suffering complications from COVID-19 due to poor pulmonary health from smoking, HIV and TB infection, and overall compromised immune systems,” said study lead author Tyler Bartholomew, a Ph.D. in Prevention Science and Community Health candidate in the Miller School of Medicine’s Department of Public Health Sciences. “With increased stress, anxiety, and the resurgence of mental health comorbidities with the implementation of social distancing, coupled with the existing social determinants, such as poverty and homelessness, the need for substance use disorder prevention and harm reduction services has increased. However, these venues, particularly syringe service programs, may experience severe disruption in services due to COVID-19.” Data were collected from 65 syringe

6 percent program sites remained open, with 15.4 percent discontinuing operations due to COVID-19 6 percent have switched to mobile delivery of new injection equipment The 10 programs that discontinued services represented nine different states, suggesting no geographical concentration of closures Programs that remained open implemented COVID-19 prevention measures to protect on-site staff operating the programs, as well as to protect participants of the syringe service programs The 72.3 percent of programs that have remained open are operating under restricted hours of operation Only 26.1 percent of programs have continued to provide HIV/ HCV testing onsite, with the majority discontinuing their medical services

Another important finding is that the majority of syringe service programs have ceased their provision of HIV/ HCV testing. The study suggests that innovative strategies must be developed in order to provide HIV and HCV testing during the COVID-19 era of social distancing, including provisional temperature and symptom screenings for COVID-19 alongside rapid HIV/ HCV testing. “Syringe service programs have become medial homes for PWID, providing wraparound services such as wound care, linkage to substance use treatment, and, in particular, onsite HIV/HCV testing and linkage to care,” said Bartholomew. “With the disruption in these services, there will be an increased risk of silent HIV and HCV outbreaks, masked by the COVID-19 pandemic.”

Syringe service programs can be utilized in the public health response to COVID-19 in this vulnerable and underserved population, which can mitigate demand on hospital systems. The study also highlights the need for program support in providing education, prevention, and strategies to avoid emerging infectious disease outbreaks, such as: » »

Diagnosing and conducting surveillance of COVID-19 in people who inject drugs Integrating prevention through mask provision and health promotion through education, hand sanitizer, and food distribution Educating participants on the increased risks of overdose through disruptions and deterioration of the drug supply and should include recommendations to cautiously increase personal supply in the case of a shortage, if the action is feasible due to personal use patterns and safety as well as legal ramifications Practice a needs-based syringe distribution to account for program service disruptions and provision of fentanyl testing strips and naloxone for overdose prevention Adapt social distancing guidelines that include innovative strategies, such as scheduling a phone check-in after use for people who are using alone Implementation of telehealth delivery systems, such as buprenorphine and antiretroviral, initiation at program sites to reduce physical physician visits, maintain access to lifesaving medications, and prioritizing meeting people who inject drugs where they are

“The COVID-19 pandemic has dramatically changed how we deliver and serve those at SSPs. However, SSPs will remain critical venues for our agile public health response to COVID-19 among this vulnerable population,” said Bartholomew. Co-authors of the study also included Nobuyo Nakamura, a candidate in the Master of Science in Biomedical Sciences at the Miller School of

Medicine, and Lisa R. Metsch, Ph.D., professor at Columbia University’s Mailman School of Public Health. Hansel E. Tookes, M.D., M.P.H., assistant professor at the Miller School of Medicine’s and founder of the IDEA Exchange, served as senior author.

Tyler Bartholomew, Ph.D.

Hansel E. Tookes, M.D., M.P.H.

STRATEGIES TO HELP THE HARD OF HEARING DURING COVID-19 PRECAUTIONS Written by Amanda Torres Published on May 1, 2020 Category: Chair, Faculty, Published Commentary

make communication easier under the challenging circumstances presented by the COVID-19 pandemic,” Dr. Lee said.

Amid the physical distancing restrictions for the COVID-19 outbreak, audiology and public health experts at the University of Miami Miller School of Medicine and the Hispanic Hearing Healthcare Access Coalition strongly recommend that communities take special measures to continue communicating and stay connected with people who are hard of hearing.

In the United States, there are approximately 60 million Americans who are living with hearing loss in one or both ears.

In an article published in The Conversation, co-authored by David J. Lee, Ph.D., professor of public health sciences at the Miller School, and colleagues from the University of Arizona, noted that wearing masks and physical distancing — two recommendations from the Centers for Disease Control and Prevention — can pose potential communication challenges for people with hearing loss. “Our hope is that this information is helpful to health care providers, nurses, doctors and patients alike, to

“Human brains are designed to use visual cues, like watching one another’s lips move, to help understand speech,” noted lead author Nicole Marrone, Ph.D., associate professor in speech, language, and hearing sciences at the University of Arizona. “Wearing a mask eliminates this vital visual information. Acoustically, face masks muffle speech. Donning a mask over a hearing aid or cochlear implant can be problematic or uncomfortable — causing some to remove their hearing devices.” Dr. Lee, Dr. Marrone, patients and other experts from the Coalition suggested 10 simple but effective strategies that can boost communication: »

Face each other at a safe distance of at least six feet.

» »

Maintain eye contact to enhance social connection and keep attention focused on communication. Speak slowly and with care to make it easier for listeners. Speakers often naturally try to compensate by projecting, but a more effective approach is to speak clearly with greater enunciation. Ask others to repeat back what you said to confirm the message is being understood and not just heard. Real-time captioning can improve communication access in telehealth, virtual meetings and online education. Ask the deaf or hard-of-hearing person, “How can I best communicate with you?” Try re-phrasing the information if the listener is having difficulty understanding your message. Write your message down or try speech-to-text if someone is having trouble hearing you. Select quiet spaces with little background noise for improved listening. If available, use or make clear masks or face shields, which will help by restoring visual information in speech. Seek out and offer multiple forms of communication, such as written text or real-time captioning and assistive technology. For those who use American Sign Language, qualified interpreters can be accessed through video relay. People with hearing loss or

combined hearing and vision loss may want to bring a printed communication card along with them to the hospital. More resources and guidance for patients and providers can be found from the Hearing Loss Association of America and the National Association of the Deaf and other associations. Brendaly Rodríguez, M.A., manager for community stakeholder engagement in the Clinical and Translational Science Institute (CTSI) at the Miller School and patient engagement lead for the Coalition, has translated these strategies into Spanish and shared them via radio on Para Mayores, with the recording now available through the CTSI’s YouTube channel.

David J. Lee, Ph.D.

“Following these recommendations can empower people to communicate more effectively,” Dr. Marrone further noted. “While many things are out of control at this time, everyone can choose communication strategies that will help each other.”

METHAMPHETAMINE USE AND HIV CREATE PERFECT STORM FOR COVID-19 TRANSMISSION Written by Amanda Torres Published on April 8, 2020 Category: Faculty, Research Methamphetamine use and HIV – two intertwining epidemics – now compounded by the novel coronavirus outbreak could create double jeopardy among men who have sex with men, according to a newly published editorial by Adam Carrico, Ph.D., professor with the University of Miami Miller School of Medicine’s Department of Public Health Sciences. To prevent community spread of the coronavirus in this population, the editorial highlights important areas for further research related to methamphetamine use, HIV, and COVID-19. We raise the possibility that the combination of methamphetamine use and HIV represents a ‘perfect storm’ for the COVID-19 pandemic in men who have sex with men,” said Dr. Carrico, lead author on the AIDS and Behavior editorial, “Double Jeopardy: Methamphetamine Use and HIV as Risk Factors for COVID-19.” In a process referred to as residual immune dysregulation, HIV damages the immune system, even when people are taking medicine to reduce the viral load. Methamphetamine further damages the immune system, which could increase the risk for COVID-19, according to those studying these vulnerable populations. For the editorial, Dr. Carrico collaborated with a group of experts from San Diego State University’s Department of Psychology, CUNY Graduate School of Public Health and Health Policy, Northwestern University’s Feinberg School of Medicine, and SUNY Downstate Health Sciences University. The authors provide an overview of biological and behavioral risks and how methamphetamine use and HIV impact COVID-19 risk and fuel com-

munity-level transmission. Among those risks, the authors cited:

adherence to social distancing guidelines,” he said.

» Methamphetamine and HIV could synergistically enhance immune dysregulation, increasing the risk for coronavirus infection. » Methamphetamine users may have greater difficulties adhering to COVID-19 social distancing guidelines. Researchers note that men will continue to seek out partners for substance use and sex, causing coronavirus and COVID-19 clusters among the group. » Authors found that those living with HIV who use methamphetamine and other stimulants have greater challenges navigating the HIV care continuum. Also, the COVID-19 pandemic may delay lab results or prescription refills for HIV treatment. These barriers to sustained HIV suppression could increase coronavirus infection. » COVID-19-related stress and social isolation could exacerbate psychiatric disorders, trigger increased use of alcohol and substance use, and make it more challenging for those receiving substance use disorder treatment to follow their program. Psychiatric symptoms and active substance use could negatively affect adherence to social distancing guidelines and increase risk for coronavirus infection.

In the editorial, the authors suggest the use of mobile devices, such as smartphones or tablets, to provide support to those with mental health and substance use disorders while promoting greater adherence to social distancing adherence in people living with HIV who use stimulants. Dr. Carrico is currently leading a randomized controlled trial funded by the National Institute on Drug Abuse to test the efficacy of a mHealth intervention for this population in collaboration with Keith Horvath, Ph.D., San Diego State University, and Sabina Hirshfield, Ph.D., SUNY Downstate Health Sciences University, who serve as multiple principal investigators. This trial builds upon Dr. Carrico’s prior research demonstrating the efficacy of a behavioral intervention for achieving durable clinically meaningful reductions in HIV viral load with this population.

“These risks emphasize the urgent need for further research to halt the COVID-19 spread and to further protect at-risk populations like those with co-occurring meth use and HIV,” Dr. Carrico said. He points to recent clusters of COVID-19 infections that were reportedly associated with a Miami circuit party in March 2020. “The infections stress the need for research that will examine substance use and other behavioral correlates of

Adam Carrico, Ph.D

RUSSELL SALTZMAN

DELARAM GHANOONI, M.D., M.P.H., CPH

Program: Master of Science in Public Health How Saltzman’s work has been related to COVID-19: “We have completed two drug trials for patients hospitalized with COVID-19 (Aviptadil and Favipiravir). My department has also been giving cell therapy for patients with severe COVID-19 as an emergency use authorization (EUA). We plan to start a new multi-center randomized clinical trial in which hospitalized patients will receive stem cells or placebo. Also, I am currently working on my MSPH thesis which will focus on public knowledge attitudes and practices related to the pandemic with a focus on hesitancy towards participating in clinical trials.” – Saltzman

Program: Ph.D. in Prevention Science and Community Health How Ghanooni’s work has been related to COVID-19: “I have been part of a COVID-related research called CRUSH (COVID-19 Research for Understanding the role of Substance use and HIV) since August 2020 as part of Dr. Adam Carrico’s ICARUS lab ongoing research projects. I have been involved in writing the study’s IRB and consent forms as well as conducting in-person research, biospecimen collection, and biospecimen delivery since last year.”– Ghanooni

DANIEL SAMANO, M.D., M.P.H.

2020, as well as in this year so far.” – Samano

Khaila Prather, M.P.H.

Program: Master of Public Health How Samano’s work has been related to COVID-19: “I’ve continued to give talks to several groups, including support groups of people living with spinal cord injury in Miami Dade and Broward counties, general public in LatAm, and doctors about updates on tests for COVID-19, vaccines and Q/A sessions. I’m also working and managing a couple of research studies regarding neurological manifestations of COVID-19 (one is an international collaboration with France and LatAm, the second is focusing towards PTSD).

Program: Master of Public Health How Prather’s work has been related to COVID-19: “I am working on the Centers for Disease Control and Prevention’s COVID-19 Research Studies. Specifically, I am working on their study called RECOVER—Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel. I am excited to be getting more involved in working on some of the company’s exciting and impactful projects.” – Prather

Last summer, I co-mentored an undergraduate student through Clinical and Translational Science Institute. The student presented a poster on COVID-19 related research. I have also voluntarily participated in CNN and CNN en Español interviews in

FELIX ROMERO

MINJI KIM

that focused on demographics, discrimination, and health care. “The three of us spent a good month just calling Asian community members throughout Florida in our broken Korean and broken Mandarin, asking everyone to distribute our surveys,” Kim said. They also went to churches and grocery stores to distribute the surveys. They received 258 responses — about 200 of the respondents were Asian Americans.

Program: Master of Science in Prevention Science and Community Health

Program: M.D./M.P.H.

How Romero’s work has been related to COVID-19:

Kim and two other M.D. students, Nick Lee and Seiya Liu, conducted research studies examining the effects of anti-Asian rhetoric and discrimination on Asian American communities in Florida. The project came from stories M.D. student Liu had heard from family members in California about the discrimination they faced when COVID-19 cases began to increase in the U.S.

“The vaccine consideration project is a project that highlights health and safety throughout the COVID-19 vaccine evaluation process. As a part of the Student and Research Team my responsibilities are to develop student outreach strategies, manage consistent and coordinated outreach, conduct research and data entry to address Vaccine Hesitancy.” – Romero

How Kim’s work has been related to COVID-19:

“Our studies found that Asians are significantly more likely to experience discrimination during COVID than non-Asians,” Kim said. “We also looked into anticipation of discrimination after the pandemic.” Kim, Liu, and M.D. student Lee hope to collaborate with researchers in California to compare data and broaden the scope of their work.

“I wanted to look at the experience of Asian Americans and the Asian people here, and how that might have changed with COVID,” Liu said. “My parents were experiencing racism,” added M.D./M.P.H. student Kim. “People were rolling their windows down and yelling at my dad.” They created a survey for Asian Americans in Florida

FACULTY, STUDENTS AND ALUMNI:

GLOBAL IMPACT

NEW MILLER SCHOOL-LED LANCET STUDY ON REDEFINING THE FUTURE OF PANDEMICS Written by Amanda Torres Published on May 21, 2021 Category: University of Miami President, Faculty, Research

A pioneering study led by researchers with the University of Miami Miller School of Medicine aims to prevent and better respond to pandemics by advocating for a global public health convention for the 21st century. Published on May 5 in the prestigious Lancet Public Health journal, the study outlines 10 recommendations by an international group of thought leaders on how the world can better prevent and prepare for pandemics such as COVID-19 by adopting a robust global public health convention or treaty. “One of the lessons of the pandemic is that global crises require global responses,” said University of Miami President Julio Frenk. “When faced with a novel pathogen, what happens in one country affects every other country. This analysis of our current global governance arrangements is essential to facilitating collective action when hu-

manity as a whole is faced with a health crisis.” The study was conducted by a research team at the Miller School’s Department of Public Health Sciences under the leadership of José Szapocznik, professor and chair emeritus of the Department of Public Health Sciences. The team compiled the recommendations after gathering and analyzing input from 29 leading experts in a diverse range of disciplines, including public health, public policy, medicine, diplomacy, and economics. “To ensure that pandemics are prevented in the future, we must have the systems in place to effectively prevent, prepare and respond to infectious disease outbreaks and public health emergencies,” Szapocznik said. “There are several proposals that are likely to be brought to the World Health Assembly to establish a new binding treaty on pandemics. For a treaty to be effective, however, we

believe that there is need for some form of inspection function and the ability to require governments to take action. This itself may require incentives, disincentives, and possibly sanctions.” The international group of leaders who outlined the recommendations are part of the Panel for a Global Public Health Convention, which was launched by Szapocznik on April 27. Szapocznik hopes that the study will make valuable contributions to the dialogue around what the future of public health should look like, but also emphasized that a change in governance of pandemics is required for the benefits of all people around the world. Dame Barbara Stocking, chair of the panel and president of Murray Edwards College, University of Cambridge, said that the recommendations in the newly published Lancet study are central to the pan-

el’s efforts to bring about a much-needed paradigm shift in the global public health architecture in the wake of COVID-19. “We are grateful to the experts who shared their knowledge and experience and to the University of Miami team who devised and conducted the study,” said Stocking. “Now, we must ensure these recommendations reach high-level decision makers and lay the groundwork for a new legally binding public health treaty or convention.” The publication of the study is timely considering the devastating impact of COVID-19 on health, the economy, and wellbeing of people globally. “Our goal is to ultimately ensure the world learns from the painful lessons of this pandemic so that we are better prepared to protect global health against future outbreaks,” said Szapocznik.

This study was supported from the AIDS Healthcare Foundation (AHF) and was conducted in collaboration with the AHF Public Health Institute at the University of Miami. The Panel for a Global Public Health Convention (GPHC) is an independent coalition of global leaders working to strengthen the world’s ability to prevent, prepare, and respond to infectious disease outbreaks before they become widespread pandemics. The Panel was founded in 2020 in response to the emergence of the COVID-19 pandemic with the aim of bridging critical gaps in the global public health architecture and policy frameworks by promulgating a new global public health treaty or convention in an effort to ensure another pandemic of such magnitude does not happen again.

José Szapocznik, Ph.D.

PERSONAL PERSPECTIVES ON THE COVID-19 CRISIS IN INDIA Written by Janette Neuwahl Tannen and Robert C. Jones Jr. Ashley A. Williams contributed to this report Published on May 13, 2021 Category: Faculty, COVID-19 Insight University students and staff and faculty members with direct links to the nation, which is struggling with a massive second wave of coronavirus infections, shed light on the situation. Hargun Kaur, a junior studying nursing who hails from Punjab, India, is anxious about picking up her phone each time it rings or chimes with a new message. Although she desperately wants to hear from her family members in India, the tragedies of the recent COVID-19 surge are often too overwhelming for her and some extended family members living in the United States. “They don’t want to hear who else is in the hospital or who has died because of COVID-19,” she said, adding that her Instagram feed from friends in India is

devastating. “It’s very hard to see.” While the news images of people struggling to breathe or family members desperately searching for oxygen canisters are difficult for anyone to watch, they are even more distressing for natives of India, said students and staff and faculty members at the University of Miami with roots in the nation. They know that their siblings, aunts, uncles, parents, or grandparents could be next. “It’s hard for everyone away from home to watch that happen and know you can’t do anything right now,” said Kaur. Every day after her shift ends in the COVID-19 intensive care unit at UHealth Tower, nurse practitioner Sheeba Farhat logs onto a series of video calls with her

family in India. She often suggests protocols they should follow to protect themselves from the virus that is ravaging the country. She does her best to calm their fears. “Most of the time, they are concerned about the shortage of medical supplies at hospitals and are worried that if they should contract the virus, there wouldn’t be enough oxygen,” she said. Farhat hopes the crisis in India will subside, but that hope faces adversity. With the world’s second largest population, India’s 1.3 billion residents are experiencing one of the globe’s most severe outbreaks of COVID-19 since the pandemic began. The country has been reporting more than 300,000 daily cases of COVID-19 in the past three weeks, with total deaths exceeding 250,000.

And although the nation stemmed the spread at the beginning—by imposing a stringent national lockdown—after just a few weeks, India reopened for business. This was a hasty decision, though, according to some natives. “India is a very, very crowded country. So, once people go out, and transportation, offices, and shops are open, isolation is practically impossible,” said Dilip Sarkar, a computer science associate professor whose family lives on the outskirts of New Delhi. “All of the buses and trains are jam-packed.” EACH STATE DECIDES RESTRAINTS Faculty members and students noted that the national government likely has not reimposed the harsh restrictions because of the economic fallout created by the first lockdown. Today, India’s national leadership is leaving COVID-19 restrictions up to the leaders of its 28 states, to impose whatever quarantine measures they see fit. Yet, these leaders face a tough choice since many of India’s poorest residents rely on their daily income to eat and to pay rent, as well as to send money to their families in rural villages. Therefore, if these people cannot work because of a shutdown, they and their families could starve or lose their homes. “It’s a helpless situation,” Kaur said. “The world can’t stop for those who are dying; otherwise, many of those who are living will die because they can’t feed themselves.” Still, the country’s extensive health care system is buck-

ling under the weight of the massive second wave, with hospitals running low on beds, medical supplies, and especially oxygen. “India has a very robust health care system in both the private and public sector, it’s just the sheer number and magnitude of the surge that has overwhelmed the system,” said Dr. Dipen J. Parekh, chief operating officer of UHealth and chair of the Miller School of Medicine’s Department of Urology. He grew up in India and his parents and brother live in the massive city of Mumbai, one of the areas hardest hit in the recent surge. Jyotika Ramaprasad, a journalism professor in the School of Communication, has a sister, Vandana Patel, in the western city of Vadodara. Patel, who is an obstetrician, owns and operates two hospitals for women. Although the obstetrician already contracted COVID-19 last spring, Ramaprasad is concerned that her sister, niece, and nephew—who are all obstetricians and sometimes deliver babies from mothers who are infected with COVID-19—could be reinfected. Sarkar is also in touch with friends and extended family in cities across India, and he has learned of people being infected with COVID-19 a second time. He also has heard from loved ones in the cities of Kolkata and Mumbai that some who have been vaccinated are now testing positive for COVID-19. “I’m not a doctor, but this worries me,” he said. The associate professor’s

brother and his 88-year-old mother share an apartment just outside of New Delhi. Fortunately, so far, everyone is healthy. And, Sarkar said, the adults were vaccinated, but they haven’t left the apartment in a long time. The situation is so dire that because four families in the apartment complex got COVID-19 recently, a team of government security guards are now patrolling the entrance. So, none of the residents can leave, and visitors cannot enter. According to Sarkar, the guards bring the family’s food deliveries upstairs and drop them at the door. LARGE SCALE EVENTS FUELED SPREAD Some wish India’s federal government had imposed more lockdowns when the second surge began in early March. Sumita Chatterjee—a lecturer of South Asian history, as well as gender and sexuality studies—grew up in Lucknow, a large city in northern India, where her siblings still live. Chatterjee said that she believes the latest outbreak escalated so quickly because several states in India held elections recently; and in the weeks leading up to it, many crowded in-person rallies occurred. In addition, she pointed out, the government allowed a Hindu religious festival to be held in person, attracting millions of people. “The government was overconfident they had beaten COVID-19, and then continued on as if the pandemic was over, when it wasn’t,” Chatterjee said. “Now, they need to stop and listen to the scientific and medical knowledge available

in India and to follow the directions. I am hoping the government responds to this like it is a military emergency, because the capabilities are there.” Latha Chandran, the Miller School of Medicine’s executive dean for education and policy, grew up in the state of Kerala, along India’s southwestern coast. Her mother, brother, sister, and extended family still live there. Chandran said it is a tragedy that this is happening to a nation that is a training ground for medical professionals, herself included. She is also surprised that in India—which produces 70 percent of the world’s vaccines—just 2 percent of the population is vaccinated against COVID-19. “The logistics and distribution of the COVID-19 vaccines is not commensurate with the need,” she said. “It shows there is a huge struggle.” While her family members have received one dose of the two-shot vaccine, Chandran still worries about them and talks to her family at least once a week. She also messages with friends from medical school on WhatsApp. “I don’t know of anyone who hasn’t had COVID-19 touch them in the second wave,” she said. AIR POLLUTION MAY BE A CONTRIBUTOR But Naresh Kumar, an associate professor of environmental health at the Miller School of Medicine, said there may be other reasons for the swiftness of the latest wave. Kumar, who works in the Department of Public Health Sciences, said India’s air pollution is “well

above acceptable standards established by the World Health Organization.” According to a recent study in The Lancet, air pollution could be blamed for more than 1.6 million deaths in India during 2019. “Some people who are chronically exposed to that pollution and then get COVID-19 most likely already have weakened immune systems,” said Kumar, who also has several relatives in India. “So, their chances of having a favorable outcome are greatly diminished.” Although he is grateful that the case numbers in India are starting to trickle down, Parekh is regularly in touch with Indian doctors he has trained through the Miller School’s fellowship program. He believes that the most useful things that the United States and other nations can offer India are medical support and expertise, as well as supplies, like oxygen and vaccines. While India has vaccinated more than 100 million people, it needs a larger supply to make an impact because the population is so immense, Parekh pointed out, so ramping up vaccinations could be the most effective way to end the surge. “There are so many unutilized vaccines around the world that could be sent there to help,” he said. “And if the world works to help India, they are helping themselves. Because this is a global crisis.” Despite his anxiety, Pratim Biswas, dean of the College of Engineering, who specializes in aerosol science, is also looking for ways he can

use his expertise to help curb the crisis in his native country. Biswas’ 90-year-old mother lives in Mumbai. In fact, a new variant of COVID-19 (called B.1.617) which many believe is fueling the current Indian outbreak, may have originated just outside of Mumbai in a smaller city called Amravati in February, news reports indicate. Working with scientists at the Indian Institute of Technology (IIT), Bombay, Biswas is refining some innovative strategies to detect the novel coronavirus and designing systems to control the spread in indoor environments, along with designs for some more effective face masks. Some of his colleagues at IIT are even working on producing medical oxygen that could help ease the shortage for coronavirus patients in India and beyond. Tested successfully at the IIT, the method converts a pressure swing adsorption (PSA) nitrogen unit into PSA oxygen unit. “While the process doesn’t produce 100 percent oxygen, like cryogenic techniques, it can generate up to 60 percent oxygen, which can be good for a patient in dire need,” said Biswas, who is building a partnership with colleagues at IIT in environmental engineering science and chemical engineering. India’s many nitrogen-producing facilities, which take air from the atmosphere as raw material, could be potentially converted into oxygen-generating industrial plants to help ramp up the supply of medical oxygen, Biswas noted. Meanwhile, Biswas is

continuing his National Institutes of Health-funded research to develop remote sensors that could be used in health care settings to detect COVID-19 aerosols. He is glad that the United States is starting to send help to India and hopes that the situation will improve. “The United States and other countries are helping, and that’s good because this is a global pandemic,” he said. “Public health experts are on the ground in India, but they can get advice on best practices from the experts here. And we can collaborate to come up with the best solutions to prevent dramatic surges in the pandemic.” Chatterjee is also hopeful that India will expand its vaccine distribution efforts and recover soon. “I’m keeping my fingers crossed because things are alive and changing,” she said. “The health system, as well as the knowledge and skills, are there. We just need to get people vaccinated in a proper manner, and India did this with smallpox. So, it can do it, but it just needs proper management.”

Naresh Kumar, Ph.D.

NEW PANEL TO ADVOCATE FOR A GLOBAL PUBLIC HEALTH CONVENTION FOR THE 21ST CENTURY Written by Amanda Torres Published on April 28, 2021 Category: Faculty, Initiative A renowned public health researcher with the University of Miami Miller School of Medicine has formed a new global panel of public health leaders working to strengthen the world’s ability to prevent pandemics and respond to infectious disease outbreaks. The panel was officially launched on Monday, April 26, 2021. Titled, “Panel for a Global Health Convention,” the group will work towards developing a global public health convention by bridging critical gaps in global

» public health architecture and policy frameworks. “It is an honor to act as head of the secretariat that is providing support to all panel activities for the next two years,” said José Szapocznik Ph.D., professor and chair emeritus of the Miller School’s Department of Public Health Sciences, who will serve as the secretariat of the panel. “We know what to do to avert pandemics, but there is still much work to do to mobilize the political will needed to accomplish a treaty that can move the world toward a pandemic-free future.” Dr. Szapocznik was instrumental in forming the group of leaders in 2020. The panel, including heads of state, would advocate for the adoption of recommendations for a new legally binding treaty or convention. This would build hope and trust in the global community by ensuring timely cooperation, transparency, accountability, and compliance with agreed-upon rules among countries—ac-

cording to Dr. Szapocznik— to effectively prepare, prevent, and respond to public health outbreaks. In addition, the panel will advocate for financial support for preparedness and response for low- and middle-income countries willing to adhere to pandemic regulations as well as sanctions for any country that places itself and the rest of the world at risk. The Panel for a Global Health Convention will be chaired by Dame Barbara Stocking, president of Murray Edwards College, Cambridge, former chief executive of Oxfam GB, and former Chair of the World Health Organization’s Ebola Interim Assessment Panel. Members will also include: »

Jane Halton, P.S.M., officer of the Order of Australia, chair of the Coalition for Epidemic Preparedness Innovations, former president of the World Health Assembly, former secretary of Australian Department of Finance,

and former secretary of Australian Department of Health Laura Chinchilla Miranda, M.P.P., former president of Costa Rica, and former vice president and minister of justice in the Government of Costa Rica Ricardo B. Leite, M.D., vice president of the Social Democratic Party Parliamentary Board, National Parliament of Portugal, and president and founder of UNITE Global Parliamentarians Network to End Infectious Diseases Lawrence O. Gostin, J.D., university professor and founding O’Neill Chair in Global Health Law at Georgetown University, and director of the WHO Collaborating Center on National and Global Health Law Jemilah Mahmood, M.D., FRCOG, Special Advisor to the Prime Minister on Public Health, Government of Malaysia, Former Under Secretary General, International Federation of Red Cross & Red Crescent Society, Former Chief, UN World Humanitarian Summit Angel Gurria, secretary general of the Organization of Economic Co-operation and Development, will serve as an observer.

The panel’s work will also be informed by an advisory group of global experts in a diverse range of disciplines, including public health, medicine, domestic and global health policy, journalism, and economics.

“The Panel for a Global Health Convention will direct its activities toward reaching heads of state and senior decision-makers across the world, with a focus on engaging relevant dialogues at the World Health Assembly, G20 and G7 summits, United Nations General Assemblies, and other multilateral forums,” said Dr. Szapocznik. The expertise of its members will be leveraged to inform country leaders about the steps that need to be taken to achieve lasting positive change in global pandemic preparedness and response, as well as build momentum toward the adoption of the global public health convention that by ensuring cooperation, transparency, accountability, and compliance can change the future. For more information on the panel, please email secretariat@gphcpanel.org. Follow the panel on Twitter to stay up to date. This work is funded by the AIDS Healthcare Foundation and its AHF Global Public Health Institute at UM.

José Szapocznik, Ph.D.

NEXT STEPS

PUBLIC HEALTH LEADERS DISCUSS STEPS NEEDED TO EMPOWER WOMEN Written by Barbara Gutierrez Published on March 25, 2021 Category: Faculty, Event

During a virtual dialogue held Thursday, panelists of the “Leading Women in Global Health: Equity and Health” forum focused on how the ongoing pandemic has impacted women in Latin America. What are the challenges and opportunities that women in Latin America face during and after the pandemic? How can those societies change to address some of the pressing issues that affect women in particular? These are some of the topics that were explored by an esteemed panel in the virtual seminar “Leading Women in Global Health: Equity and Health,” hosted by the University of Miami Institute for Advanced Study of the Americas on Thursday. Part of an ongoing series called Latin American Women in Global Health, it was sponsored by the University of Miami, the Institute for Advanced Study of the Americas, Tomatelo a Pecho, Women in Global Health, and Fundacion Mexicana para La Salud. Felicia Knaul, an international health economist and director of the institute, welcomed the participants by pointing out that they are untiring defenders of women’s health who

would impart their knowledge and experience on gender leadership and gender health inequities with a particular focus on the effects of the pandemic. Gabriela Ramos, assistant director general for social and human services of UNESCO, opened the session. She shared that when the Generation Equality Forum meets in Mexico next week, the pandemic will be a major topic. “This pandemic has sent us back years,” she said. “It has set us back in life expectancy, it has set us back in how children learn, and it has set us back in poverty. There are 130 million more poor people in the world and the clock keeps ticking.” “Esta pandemia tiene cara de mujer” (this pandemic has a woman’s face), Ramos said. Because women have borne the heaviest burdens in health, in the economy, and having to deal with the highest cost of schooling children at home, she stated. In addition, many women have had to face the increase of domestic violence during the pandemic, she said. “It is really troubling, and we must put the

theme of health as a top theme in the forum.” Ramos also said that the issue of helping women achieve leadership positions within the business and public work sectors was also important. “The fact is that when you have women in positions of power, you have diversity, you look at things differently,” she said. “Decisions are better made when women are added to positions of power.” Knaul said that the violence against women and girls was a pandemic that would continue unless there was a focus on developing public awareness, changes in norms and behaviors, and the enlisting of leaders—including men—willing to defend the rights of women. One out of every three women in the world is affected by domestic violence, according to the World Health Organization, she said. “The cost of not acting is enormous,” said Knaul, who is co-chair of the Lancet Commission on Gender-based Violence and Maltreatment of Young People.

So, it is critical for children (both girls and boys) to be systematically educated at home and in schools to respect and value women. Public institutions must also make it easier for women to access legal protections when they have been the victims of abuse, she said. When talking about inequity of labor and income for women as compared to men, Knaul indicated that women make up the greater number of caretakers both at home and in the health sectors.

“What can our women offer to the global movement of violence against women and which programs work?” Knaul asked the group. “This problem must be approached from different areas,” said Helia Molina, former minister of health in Chile and professor at the University of Santiago Faculty of Medical Sciences. She said that in Chile there was a very strong social movement defending women’s rights and that she believed keeping the issue of women’s rights in the forefront of the public consciousness was important. Molina also noted that the Latin American region must accept that there are cultural patterns that differentiate it from other regions. So, learning what other regions were doing to combat gender violence was critical. Providing women’s shelters and personal help to victims was important, she added. Beatriz Londoño, former minister of health in Colombia and steering technical director of the Interamerican-Health Task Force, said that “violence is learned from an early age.”

But women who are homemakers are not paid and not recognized, she said. Previous estimates show that women’s paid and unpaid contributions to the health sector amounted to 5 percent of global GDP, Knaul pointed out. With updated methodology accounting for discrimination, preliminary estimates suggest the figure will increase by 2-3 percentage points.

Ortiz stated that the government must establish public policies to address this issue. Children and the disabled should have access to scholarships so they can easily access education. She also said that informational programs to empower families and decrease the machismo culture that undervalues women’s work were a must in every municipality. “There is a lot of work to do in this regard,” said Ortiz. ”But we must work hard on this issue.” Other participants included Patricia Garcia Funegara, former minister of health in Peru; Valentina Pantoja, co-director of Women in Global Health in Chile; and Jeanette Godinez Alejandre, youth leader for Women in Global Health in Mexico.

This gender disparity has become more relevant as many women have been forced to stay at home during the pandemic to care for children or other relatives. “What must we do to achieve a balance in the responsibilities at home and to access employment?” Knaul asked the panelists. Maki Esther Ortiz, municipal president of Reynosa, Tamaulipas, in Mexico and former undersecretary of the Ministry of Health in the country, said that in her homeland work that is not remunerated represents 5.6 million pesos, or 16.8 percent of the country’s GDP.

Felicia Knaul, Ph.D.

“Of course, the ones that bear the burden are women,” Ortiz remarked. “Not only do women not get paid but that means not having those taxes flow into municipal budgets so that there could be more services to help women.” The pandemic has worsened this because the majority of those who lost jobs during the pandemic were women, she said.

Commission, the gap between universal health coverage and access to palliative care and pain relief in Mexico rapidly became more apparent. As a result, considerable progress was made on the legislative, policy, and programmatic fronts between 2014 and 2019. The Seguro Popular program, for example, which provided public health insurance for more than 50 million Mexicans and focused on the poorest populations, was a part of that progress, as it included pain relief and palliative care to be provided at primary and secondary levels of care. A SUDDEN INCREASE IN SERIOUS HEALTH-RELATED SUFFERING

DR. FELICIA KNAUL: ACCESS TO PAIN RELIEF MEDICINES IN MEXICO SHOULD BE A PRIORITY FOR POLICY MAKERS Written by Amanda Torres Published on March 9, 2021 Category: Faculty, Paper In a commentary published in the February issue of The Lancet Public Health, Felicia Knaul, Ph.D., director of the University of Miami’s Institute for Advanced Study of the Americas and professor in the Miller School of Medicine’s Department of Public Health Sciences, brings awareness to the disparities and crisis in Mexico in accessing opioid medicines for palliative care. “While the resources required to tackle the pandemic could have not been foreseen, if government officials had made policy changes based on the evidence put forward by The

Lancet Commission and Human Rights Watch, they could have been better prepared to facilitate guaranteed access to pain relief and palliative care,” Dr. Knaul said. In the paper, Dr. Knaul details factors from as far back as 2010 that have contributed to the scarcity of opioid medicines in Mexico, which has led to excess suffering for patients and their families — in a place where the COVID-19 pandemic continues to ravage. From 2010 to 2013, The Lancet Commission found that Mexico stocked only a third of the opioids needed for palliative care and less than 5% of the opioids required to meet overall need — despite the country being an upper-middle-income country that is widely recognized as a pioneer in universal health coverage. Largely due to the work of an interinstitutional group, which included representation from the executive and judicial branches of the Mexican government, civil society and academia, the work of the Human Rights Watch, and the launch of the Lancet

Yet, and despite that progress, in January 2020, Seguro Popular was dismantled, leaving most Mexicans without publicly funded insurance. The closure of the program was also done without establishing a replacement, leaving the health system in a vulnerable state — amid the COVID-19 pandemic. The pandemic caused a sudden increase in serious health-related suffering, resulting in a demand for opioid medicine to relieve pain. The palliative care unit of the National Cancer Institute of Mexico has also shown that as a result of fixed and limited supply of opioid medicines, cancer and other patients have been left in need. Dr. Knaul´s paper accompanied a major research study by David Goodman-Meza, M.D., M.A.S., assistant professor in the Division of Infectious Diseases at the David Geffen School of Medicine at UCLA, and co-authors, who provided an update on opioid access in Mexico in 2019. To conduct the study, they used novel prescription surveillance data from the Federal Commission for the Protection against Sanitary Risk. The study demonstrated that access to opioid medications increased significantly with the socioeconomic status of the state. When comparing states with very high socioeconomic status with those with very low socioeconomic status, they observed a 10-time higher level of access. “The innovative analysis by Dr. Good-

man-Meza and colleagues demonstrates that the abyss in access across countries is compounded by gross inequities within them,” Dr. Knaul said. “Such analysis should be replicated wherever data are available. “Going forward, coverage and access to pain relief should be a priority for policymakers to alleviate immediate and future serious health-related suffering. Monitoring access to opioid medicines is essential to ensure that pain and suffering, especially among the poorest populations, is neither ignored nor neglected.”

REPORT CONFIRMS PANDEMIC-RELATED SPIKES IN DOMESTIC VIOLENCE Written by Maya Bell Published on March 1, 2021 Category: Faculty, Report

Led by the University of Miami, a study suggests that quarantines spurred by coronavirus safety precautions have increased physical abuse across the nation and around the world. Felicia Knaul, Ph.D.

Last April, as the novel coronavirus marched relentlessly across the country, United Nations Secretary Antonio Guterres urged the world to address the “horrifying surge in domestic violence” that mandatory lockdowns were triggering across the globe.

request of the commission established to evaluate the pandemic’s impact on the justice system. “Add to that all the problems we’ve seen during the pandemic—with people losing their jobs, with children schooled at home, with increased alcohol sales and opioid use—it’s easy to imagine a world where people who are trapped together are going to lash out at each other.”

Now, a new analysis led by the University of Miami for the National Commission on COVID-19 and Criminal Justice, confirmed that stay-athome orders essential to suppressing the highly contagious virus had the negative consequence of increasing domestic violence incidents by more than 8 percent in the United States alone.

For their report, Domestic Violence During COVID-19, Piquero, and four co-authors, including Felicia Marie Knaul, director of the University’s Institute for Advanced Study of the Americas, analyzed 18 academic studies that compared the number of domestic violence incidents before and after multiple jurisdictions began imposing stay-at-home restrictions last spring. The studies included six from overseas, specifically from Australia, Brazil, India, Italy, Sweden, and Mexico.

“When you have individuals who are not used to being together 24/7, you’re going to have pent-up stress and anxiety,” said Alex Piquero, chair of the University’s Department of Sociology, who led the study at the

From those studies—which relied on administrative data from police logs for domestic violence calls, crime and incident reports, domestic violence hotlines, and health records—the researchers confirmed what social

workers, educators, police, and global humanitarians have been warning for months: that the pandemic’s isolation policies are exacerbating domestic violence. The researchers specifically found an average 7.9 percent increase in international domestic violence incidents and an average 8.1 percent spike in the U.S. But given that the researchers narrowed their analysis to academic studies that met specific criteria and were published in English, Piquero is certain that the increases are even far bigger than their report reflects. “There’s no doubt it is a lot worse than 8 percent. Just imagine all the stuff that we have no data on—the places where the machismo is so strong or where gender norms are so different,” he said. “And all we looked at is physical abuse. Imagine the emotional abuse that doesn’t get reported. Imagine the kids in those homes who witnessed the violence. There is a whole toll there that people haven’t talked about or studied.” Added Knaul, who co-chairs the Lancet Commission on Gender-Based Violence and Maltreatment of Young People, “Violence against women and children was a pandemic before COVID and will continue to be one after, unless we meet this public health crisis head on with policies, resources, and changes in attitudes and norms.” While the researchers found strong evidence of a spike, they said the dynamics driving the trend aren’t as clear. But they believe that lockdowns exacerbated the factors, including job loss, childcare stresses, and financial insecurity, typically associated with domestic violence. They also suggested that the use of alcohol and other substances as a coping strategy elevated the threat, as did isolation from friends, neighbors, teachers, and other people who ordinarily would report signs of abuse or intervene. Citing the report, Thomas Abt, director of the commission led by former Attorneys General Alberto Gonzales and Loretta Lynch, called on policymakers to provide additional resourc-

es for domestic abuse prevention and victim services—something Piquero said must happen before the next pandemic. “We need to make sure that the domestic violence shelters are ready for this. We need to make sure that police departments do welfare checks on prior victims, and we need to ensure people who need help can reach out—with apps that enable them to do so confidentially,” he said. “We also have to study what goes wrong during a lockdown, so we can prevent it the next time. The pandemic has wreaked havoc on so many people’s lives that we can see—with last week marking 500,000 deaths—but in so many other ways, we have just begun to scratch the surface.” In addition to Piquero and Knaul, the co-authors of the report included Wesley G. Jennings, chair and professor in the Department of Criminal Justice and Legal Studies at the University of Mississippi; Erin Jemison, manager at the Crime and Justice Institute; and Catherine (Katie) Kaukinen, chair and professor of the Department of Criminal Justice at the University of Central Florida.

CANCER PATIENTS IN MEXICO FACE DIRE SCENARIO IN WAKE OF COVID-19 Written by Michael R. Malone Published on February 5, 2021 Category: University of Miami President, Faculty, Event

Felicia Knaul, Ph.D.

In a recent webinar, public health experts explored what should be happening in the Latin American country to assist those facing the deadly disease during the pandemic. University of Miami President Julio Frenk joined a panel of other public health experts on World Cancer Day last week to explore how the battle against the COVID-19 virus in Mexico and fledgling health care reforms have

exacerbated an already critical situation for cancer patients.

don’t change,” she said, highlighting indicators and trends from the report.

The event, “Attention for Cancer Patients in Mexico during COVID-19,” hosted in part by the University’s Institute for Advanced Study of the Americas, was moderated by Felicia Knaul, institute director, public health expert, and a cancer survivor. The session aimed to inspire action and to raise awareness for the plight of patients in Mexico suffering from cancer.

Frenk lamented the Mexican government’s “abysmal” response to managing the pandemic and contrasted the newly implemented government-managed health program with the universal health care coverage offered for many years through Seguro Popular.

Knaul launched the session by sharing data from a newly released article in the The Lancet Oncologymedical journal that detailed the shortages of oncological medicines and documented how treatments for cancer patients in Mexico, especially those with breast cancer, have been delayed, eliminated, or modified in the wake of health care reforms and the government’s attempt to contain the coronavirus pandemic. “It’s likely that we will see a tsunami of deaths in the coming years if things

As Mexico’s health minister from 2000 to 2006, Frenk was instrumental in fueling the effort to create and implement that policy, which provided coverage and care to more than 50 million Mexicans. Seguro Popular was slowly dismantled and officially ceased to exist on Jan. 1, 2020, replaced by a health program known as INSABI [its Spanish-language acronym] and directed by the National Health Institute for Wellbeing. Cancer care for children and for women with breast cancer were among the priorities for Seguro Popular and a specific fund provided free care for all cancer treatment for children, accord-

ing to Frenk. Among the policy’s many successes, he highlighted the fact that, prior to Seguro Popular, some 30 percent of Mexican women with breast cancer abandoned their treatment and care due to lack of money; after its implementation, that percentage dropped to 3 percent. “What we’re seeing today are the results of the failure,” Frenk said, “and it’s not government officials but cancer patients in Mexico who are bearing the suffering.” Those participating in the two panels included Salomon Chertorivski, a former Mexican health minister and president of the consultancy coalition “Thinking About Mexico”; Rocio Saenz, dean of the University of Costa Rica School of Public Health and a former Costa Rican health minister; Alfonso Petersen, vice dean of Health Sciences Universidad of Guadalajara; Lizbeth Lopez, a researcher with the Mexican National Institute for Public Health; Hector Valle, executive president of the Mexican Health Foundation; Kenji Lopez, president of

Mexican Cancer Warriors; Alejandra De Cima, president of the Cima Foundation and member of the Mexican Breast Cancer Coalition; and Hector Arreola Ornelas, executive director of the Tomatelo a Pecho, an organization founded by Knaul. Chertorivski echoed Frenk’s concerns for the new health care reforms and said it was critical to look to the future. “We have to think about the next stage to come,” he said. “The health care system is changing radically, and we have to think about future needs. In terms of cancer, it’s critical to detect it. We understand that it’s a reality that we can’t escape—it’s in our hands to determine that at least those who die from cancer do so without pain and with dignity.” World Cancer Day, marked on Feb. 4, is promoted by the Union for International Cancer Control and geared to encouraging governments around the world to ensure that access to life-saving diagnosis, treatment, and care for cancer should be available for all.

University of Miami President Julio Frenk

MILLER SCHOOL PROFESSORS DEV SAMPLING BIAS Written by Amanda Torres Published on January 29, 2021 Category: Faculty, Research

COVID-19 testing has been a standard approach to estimate the prevalence of disease and assist with public health decision-making to mitigate the spread of the virus. But the sampling methods used are often biased — such as the over-representation of symptomatic people who are more likely to be tested. This leads to a biased sample that does not reflect a population’s true COVID-19 infection prevalence. A new study published in the Journal of Theoretical Biology presents a simple way to correct COVID-19 testing bias. J. Sunil Rao, Ph.D., professor and director of the Division of Biostatistics, and Daniel A. Díaz-Pachón, research assistant professor — both with the Department of Public Health Sciences at the University of Miami Miller School of Medicine — have developed a bias correction methodology to use on already collected information that reduces estimation errors dramatically. “The derived correction is simple and can be easily implemented in studies across the world,” said Dr. DíazPachón, lead author of the study. “We want the model to help guide public health decisions.” The researchers noted sample bias

also occurs in meta-analyses due to publication bias — papers that show no treatment effect (null hypothesis) are less likely to be published, which leads to overestimates of the effect of treatment. They discovered that modeling the null-favoring censoring mechanism could be used to correct COVID-19 sampling bias. “In the case of COVID-19 testing studies, biased sampling occurs when patients who are symptomatic are more likely to be tested than those who are asymptomatic,” said Dr. Rao, senior author of the study. “This essentially represents convenience samples. These studies are therefore missing key information about how specific populations are being affected by COVID-19. Random sampling is costly and inefficient and thus not widely done.” To provide a solution, Dr. Rao and Dr. Díaz-Pachón developed a model that led to a three-step correction general enough to allow customization. For instance, symptomatology may be extended to reflect different subpopulations, such as racial and ethnic subgroups, age groups, risk groups, and varying environments. The model can also be generalized to index more than one type of test.

VELOP MODEL TO CORRECT COVID-19

“Once we formalized our mathematical model and evaluated the nature of the bias in prevalence of COVID-19 convenience samples, we realized that this bias was modifying the true prevalence, multiplying it by a value coming from the population,” said Dr. Díaz-Pachón. “Therefore, in order to correct it, we needed to divide the biased estimation by the sample estimate of such value.” To do so, Dr. Díaz-Pachón and Dr. Rao extracted as much information as they could from the sample, and when it was not possible to advance any more, they resorted to a concept of information theory called maximum entropy, which reduces bias as much as possible, given their current level of knowledge of the sample.

is implemented. The results show the proposed method achieves significant reductions in sampling bias, particularly for the overall prevalence. Since the publishing of the paper, which was also included in the World Health Organization COVID-19 research repository, Dr. Rao and Dr. Díaz-Pachón have begun new collaborations in Israel and Colombia. In Israel, they are working with Central Statistics Bureau scientific leaders who are conducting their National Serological Survey for COVID-19. In Colombia, they are collaborating with researchers at the State of Antioquia’s Public Health Laboratory who are doing various novel surveillance testing studies for COVID-19.

J. Sunil Rao, Ph.D.

“The math was consistent and the model consonant with observations in that when it was compared to real data, we could see that it resembled reality much better than the original biased estimate,” said Dr. Díaz-Pachón. “However, the model provides a bias correction, not an elimination of bias.” The study provides examples of two real-life scenarios — COVID-19 outbreaks on a cruise ship and in Lombardy, Italy — where the model

Daniel A. Díaz-Pachón, Ph.D.

NEW STUDY FIRST TO USE PANDEMIC STRESS INDEX THE EFFECTS OF COVID-19 ON LATINX SEXUAL MINOR Written by Amanda Torres Published on January 29, 2021 Category: Faculty, Research

their responses by recent, established, and U.S. born immigration statuses.

Latinx sexual minority men are at the intersection of two communities disproportionately impacted by COVID-19. In a new University of Miami Miller School of Medicine-led study, public health experts utilized the Pandemic Stress Index, in which Latinx sexual minority men reported their behavioral, psychosocial, and medical experiences during COVID-19, as well as their current immigration statuses.

Researchers found that Latinx sexual minority men experienced anxieties, depression, sleep difficulties, substance use, loss of income or employment, and fears about how others in their lives were managing during COVID-19.

The study—published online in the Annals of LGBTQ Public and Population Health in January 2021—is the first to assess Latinx sexual minority men’s responses to the Pandemic Stress Index and the first to compare

Depending on their immigration status, each were also affected differently throughout the pandemic. Experts suggest that the findings should be accounted for as COVID-19 services and public health messages are developed and disseminated to communities hardest hit by the pandemic. “We’re finding that the experiences that Latinx sexual minority men during COVID-19 really differ among differ-

ent subgroups, specifically by immigration status, and that’s important for informing our public health efforts related to COVID-19,” said study lead author Audrey Harkness, Ph.D., research assistant professor at the Miller School of Medicine’s Department of Public Health Sciences. After the pandemic struck the U.S., UM health experts, public health scientists and mental health professionals developed the Pandemic Stress Index—a three-item inventory that assesses behavior changes and stressors that may have occurred in response to the novel coronavirus pandemic. “COVID-19 has really changed the way in which we have to look at sexual health among those who may be living with or at risk for HIV,” said study senior author Steve Safren, Ph.D.,

Latinx sexual minority men reported the following: » »

» »

X TO DOCUMENT RITY MEN University of Miami’s director of the Center for HIV and Research in Mental Health and the Health Promotion and Care Research Program in the Department of Psychology. “Dr. Harkness quickly amassed the team to develop this important tool, and already people from all over the country and from other countries as well are using it to help guide prevention and treatment research.”

“Carrying this work forward, it would be great to see how we can mitigate gaps in the reach of COVID-19 prevention efforts, while also leveraging unique strengths, such as the overall high altruistic attitudes participants are reporting and develop programs that are tailored to community needs and strengths,” said Dr. Harkness.

Audrey Harkness, Ph.D.

Latinx sexual minority men who are established immigrants, compared to US born participants, also were: »

COVID-19 IS DISPROPORTIONATELY AFFECTING LATINX SEXUAL MINORITY MEN Study participants who provided responses to the index included 290 Latinx sexual minority menin South Florida who were between the ages of 18 to 60. Data were collected between Feb. 18, 2020 and Aug. 26, 2020.

Over a quarter have not worked during COVID-19 and over half reported financial loss Approximately 8 percent reported being diagnosed with COVID-19, with about half tested for COVID-19 Approximately 75 percent feared getting and over half feared transmitting COVID-19 Over half reported anxiety, depression, loneliness, and sleep problems and over a quarter reported increased alcohol and substance in the context of COVID-19. 6 percent who changed their sexual activity levels, most decreasing. A minority of participants—32.4 percent and 20.4 percent—reported receiving emotional or financial support Over 40 percent reported feeling they contributed to the greater good by engaging in social distancing and COVID-19 preventive behaviors Impacts also differed across subgroups of participants. For example, Latinx sexual minority men who are established immigrants were 4.52 times more likely to report a COVID-19 diagnosis than those who were born in the U.S. There were also lower odds of practicing social distancing among them compared to those born in the U.S.

useful for Latinx sexual minority men overall and subgroups by immigration status are key as COVID-19 has disproportionately affected this population.

Nearly twice as likely to be unclear about what COVID-19 is, how to prevent it, or why social distancing is needed, potentially leading to less social distancing 77 times more likely to change their sexual activity during COVID-19—94% reporting a decrease—compared to those born in the U.S. The need to develop and implement relevant mental health and social support resources that are

PANEL: PANDEMIC INTENSIFIED NEED FOR PALLIATIVE CARE IN LATIN AMERICA Written by Michael R. Malone Published on January 13, 2021 Category: Faculty, Event In a virtual discussion on Tuesday, health care professionals from across the region advocated for increased resources to offer pain relief in response to the COVID-19 pandemic. Palliative care advocates from a host of Latin American countries participating in a webinar on Tuesday co-hosted by the University of Miami Institute for Advanced Study of the Americas asserted that pain-alleviating medicines and care are more critical than ever as the pandemic continues. Felicia Knaul, director of the institute and an economist and public health expert, opened the “Closing the Access Gap to Palliative Care and Pain Relief: An Imperative for Universal Health Care” virtual session by sharing her experience of administrating palliative care and offering a presentation that highlighted the results and recommendations from a Lancet Commission report. Jorge Saavedra, executive director of the University’s AHF Global Public Health Institute, moderated the conversation. The International Association of Providers of AIDS Care, the International Association for Hospice and Palliative Care, and Tómatelo a Pecho were also co-hosts of the webinar. “One of the key things we’ve learned from these conferences that explore the unfolding story of COVID-19 is that civic health organizations have to be at the forefront, speaking with one strong unified voice, sharing their evidence, and advocating on behalf of patients and their families for a radical change in access to palliative

care,” Knaul said. “This is not the time to reduce spending—just the opposite. Now’s the time to invest more,’’ she added. “Denying access to these medicines that help control pain and reduce suffering does not reduce the crisis, it creates an even greater crisis for patients and for health systems,” she continued. The Lancet Report on Global Access to Palliative Care and Pain Relief assessed the use of palliative medicines for 72 countries worldwide for the period 1990-2017, culling data from the Distributed Opioid Morphine-Equivalent and Serious Health-Related Suffering databases. An updated report charting data from the pandemic period is forthcoming. Knaul noted that the 35 health commissioners who generated the report marked the contrasts in access to palliative care and provision of medicines between low-, middle-, and high-income countries. “While we have seen improvement over time in nearly every region of the world, access remains very, very low compared with the need for this kind of care in all low-income and middle-income countries,” said Knaul, citing that in the latter only 4 to 5 percent of the demand for palliative care is being met. She noted that the price of palliative medicines varies and that the commission maintains that much could be accomplished with the cheaper or more basic medicines, yet no one is producing them because there is no incentive to do so. “We’re hopeful that the less-developed countries can introduce innovative ways to help guarantee the demand for these because palliative care is a human right,” Knaul pointed out. A panel of professionals from Latin America that included Liliana De Lima, Colombia; Silvia Allende, Mexico; Nisla Camaño Reyes, Panama; and Paola Ruiz, Colombia presented the experiences of their respective countries and recommendations for expanding

care and medicines in the wake of the devastating COVID-19 pandemic.

biases relating to substance abuse.

“We’ve learned that palliative medicines are every bit as critical as the mechanical ventilators, intravenous therapies, antipyretics, and antihistamines, and we recognize the extraordinary dedication and compassionate care that palliative care workers have provided every day of this pandemic in each and every interaction with patients, their families, co-workers from other disciplines, and in the community,” Allende said. Reyes emphasized the importance of collaboration between health care professionals. “We must not cease in our role to continue to advocate for what we believe to be our patients’ right—which is to receive palliative care,” she said.

Felicia Knaul, Ph.D.

Ruiz echoed the need for continued collaboration that would help to raise awareness for the value of palliative care and called for better planning. “Resources are never infinite,” she said, “so the money issue in terms of this pandemic, or in medicine in general, will only be resolved by better planning and emphasizing the needs of our patients.” “We have to reinvent ourselves and think outside the box,” urged De Lima. “Whatever national policy or response is enacted must take into consideration the people who are working with the patients—so the time of the government working apart and adopting policy is over.” Saavedra and Knaul both faulted governments that overly stigmatize morphine and other pain-relieving medicines that can become addictive. And because of this concern, they fail to fund training and education for doctors, nurses, and health care professionals on how to properly administer these critical medicines. Knaul recognized Dr. Hansel Tookes, University of Miami alumnus and assistant professor of medicine, for his novel needle exchange program and research that has served as a model for Florida and elsewhere to unravel

CARIBBEAN NATIONS EXPLORE NEW IDEAS, DIRECTIONS TO RECOVER FROM PANDEMIC Written by Michael R. Malone Published on November 20, 2020 Category: Faculty, Event

Caribbean experts assessed the coronavirus’s impact on the region in a webinar on Nov. 19 hosted by the University of Miami Institute for Advanced Study of the Americas. Owing in part to its geographic terrain, the Caribbean has fared relatively well from a health standpoint in managing the COVID-19 virus, yet the region has suffered economic devastation due to its historic dependence on trade and tourism, according to experts from the University of the West Indies (UWI), one of 14 member colleges of the Hemispheric University Consortium. Felicia Knaul, director of the University of Miami Institute for Advanced Study of the Americas, economist, and public health expert, moderated a virtual conversation together with three UWI representatives: Sandeep B. Maharaj, associate dean of distance education, projects, and planning; Jan Yves Remy, an international trade lawyer and deputy director of the Shridath Ramphal Centre; and Clive Landis, pro vice chancellor for undergraduate studies and chair of the UWI COVID-19 Task Force. Landis noted that the region has been developing its viral laboratories and improving testing systems in recent years and moved quickly to exploit its natural advantage—that many countries and territories are island nations—to limit spread.

“Testing, contact tracing, and isolation really work—and our testing capacity has been our backbone,” Landis said. “Some countries closed their borders before one death and some closed before one case; we were able to make use of the fact that we’re an island archipelago and get on top of this first wave.” The improved testing capacity owes in large part to the creation of the Caribbean Public Health Agency (CARPHA), which combined five regional health institutes into one entity that has been serving 24 Caribbean countries and territories since January 2013. Maharaj shared data showing that CARPHA countries have fared better in terms of percentages of people infected—0.3 percent compared with 0.7 percent globally—and for those who have recovered—77.1 compared with 64.7 percent worldwide. Percentages of those who have died from COVID-19 were also less than global averages. He noted that, despite the virus’s devastation, a number of successes have resulted—migrant populations in Trinidad and elsewhere are now starting to be served by the health system, the health system mobilized quickly and repurposed its workforce, and technology for telemedicine expanded. “These shifts offer immense opportunity to change the Caribbean positive-

ly, but we must be able to continue to be innovative and creative as we move ahead,” Maharaj said. Remy highlighted that pre-existing challenges, such as the dependence on trade and foreign investment, particularly with the United States, and the fact that many Caribbean countries are debtor nations have exacerbated the economic hardship. The implementation of the U.S. Defense Production Act in early April prompted a blockage of needed personal protection equipment and other medical supplies from the United States, she said. “The pandemic paralyzed the region’s export sectors, the tourism sector is decimated, and 50 percent of the workforce continues to struggle,” she said, noting that, unlike the United States, regional governments can offer little or no stimulus support to individuals. Still, Remy said there is reason for optimism. “The nascent tech community showed creative solutions, especially for local banks, and lots of companies are moving their brick-and-mortar stores online—these are new opportunities,” she said, also mentioning that the local rum industry repurposed alcohol to be used as much needed hand sanitizer.

“We’ve seen some great ideas, but we have to find ways to reclaim our industrial policy, better leverage trade agreements, and develop local capacity for food and medical responses,” Remy said. “We have to think about new economies to take our economies out of chronic debt and create viable new sectors.” Remy emphasized that the government cannot do this alone and said she was encouraged by actions from Huawei, the Chinese firm that has invested in the UWI innovation lab. Both Landis and Knaul recognized the role that Barbados played in serving as an isolation center to help 11 cruise ships repatriate their COVID-19-infected crews. “The fact that a small island nation did a global public good is something the world needs to hear about,” Knaul said, noting that the ships utilized the hospital systems that are part of the UWI. “So, this is a global debt to the Caribbean and to the UWI. It’s another reason why we might think about debt relief for the region,” Knaul said.

Felicia Knaul, Ph.D.

JULIO FRENK: EMPOWERED WHO NEEDED TO BATTLE PANDEMICS Written by Michael R. Malone Published on November 18, 2020 Category: University of Miami President, Faculty, Event

The University of Miami president called for increased cooperation, new powers for the World Health Organization, and transparency incentives as critical to manage and mitigate future health outbreaks.

logue, and economic advancement in the Americas. “Right now, if there’s an outbreak, there’s a strong incentive for countries to withhold information because it has huge economic implications.”

In a virtual conversation on Nov. 17 with the Americas Society/Council of the Americas (AS/COA), University of Miami President Julio Frenk detailed the University’s successful experience to return students to campus this fall, while highlighting how the pandemic has revealed a renewed respect for science and research, higher education, and the need to shift perceptions of sovereignty as they relate to public health.

He remarked on the difference between Mexico, “which immediately declared the H1N1 virus and paid an enormous economic price” in 2009, and information on the current coronavirus that China has been slow to disclose.

“We need to give the WHO (World Health Organization) much more power to intervene and the type of tools that the World Trade Organization and other multinationals have to actually enforce the international health regulations and impose sanctions,” said Frenk, speaking with Susan Segal, president and CEO of AS/COA, the premier forum for education, dia-

Frenk said that the world’s primary health body is “a pretty good instrument,” but needs reform. The WHO’s effectiveness has been deliberately weakened by members refusing to pay their dues and undermining the finances, depriving it of enforcement powers, he said. “This is not about giving up sovereignty, it’s about sharing sovereignty so that our common security improves—it’s a very different way of thinking,” the president told those who tuned in to the virtual event.

“Nothing compromises your sovereignty more than having an out-ofcontrol pandemic killing thousands and thousands of your citizens and an economic crisis destroying jobs—that is the real threat to security and sovereignty,” he said. Frenk, a global public health expert in his sixth year as University president, also expressed his hope that policymakers would maintain funding for public health research and innovation beyond the current pandemic crisis. “For an infinitesimal fraction of the cost of the stimulus packages that had to be enacted to mitigate the economic consequences, we could advance a much better permanent system of surveillance and response capabilities,” he said. He noted, too, the increased respect for science that has emerged from the devastating virus. “Experts are not elitists who look down on ordinary people—that’s the type of discourse that populist leaders try to exploit— but instead they are people who are there to orient us all,” he remarked. “Experts like Dr. (Anthony) Fauci and so many others have become folk

heroes, at least for a big part of the population, and it’s brought home the value of science, which is what’s going to get us out of this,” Frenk added. The purpose and role of higher education has been heightened as a result of the current crisis, according to Frenk. “The pandemic has brought to the forefront the historic role that universities play: our educational mission preparing the future leaders, the most educated component of the workforce, and also most of the research— the testing of drugs and vaccines— has been carried out in universities and research centers,” he said, noting that the University has been active in the clinical trials that have prompted anticipation for a COVID-19 vaccine. He also pointed out the historic role of universities as exemplary institutions. “Through the values we embrace and the behaviors we exhibit, we set an example to the larger society of which they are a part,” he said. “Especially at a time when people are so polarized, the value of using reason, respectful disagreement—not to achieve unanimity but to be able to disagree in a respective way—are

critical to civil discourse.”. He urged universities in Latin America, the region, and the world to better address the values of diversity and counter deepening social inequalities. “We must refocus on our role as the most legitimate avenue for upward social mobility,” Frenk said. “At a time of growing inequality, our role as the most legitimate avenue for upward mobility is going to be absolutely crucial.”

University of Miami President Julio Frenk

COVID-19 LESSONS FROM PERU AND ARGENTINA Written by Veronica Bustabad Published on October 26, 2020 Category: Faculty, Event The University of Miami Institute for Advanced Study of the Americas (UMIA) held a webinar on September 30th that focused on the COVID-19 outbreaks in Latin America — the region has become the epicenter of the pandemic, accounting for a disproportionate number of COVID-19 cases and deaths globally. The webinar provided an overview of the social, political, and economic factors contributing to the spread of the virus. Felicia Knaul, Ph.D., director of UMIA and professor at the Miller School of Medicine’s Department of Public Health Sciences, moderated the discussion.

“Peru and Argentina are two countries in Latin America that have been suffering from the COVID-19 pandemic,” Dr. Knaul said. “Both countries have had very interesting trajectories in terms of their public policies and efforts to control and respond to the COVID-19 pandemic. The cases of Peru and Argentina provide us with a regional perspective on health and health systems in the region.” Guest speakers included Patricia J. Garcia, M.D., M.P.H., Ph.D., professor at Universidad Peruana Cayetano Heredia in Lima, Peru, and Adolfo Rubinstein, M.D., M.Sc., Ph.D., director of the Center of Implementation and Innovation in Health Policies at the Institute for Clinical Effectiveness and Health Policy. Drs. Garcia and Rubin-

stein — former ministers of health in Peru and Argentina — discussed the COVID-19 pandemic and the public policy response in their respective countries. Both speakers mentioned that longstanding social and health disparities, political instability, a significant population of working poor (known as the informal sector), and fragmented and underbudgeted health systems exacerbated the COVID-19 pandemic in the region. PERU’S RESPONSE In response to the pandemic, Peru conducted 1.5 million rapid tests, which were used to identify new COVID-19 cases and contacts and

refer severe cases to the hospital for medical treatment. The rapid tests made it possible to assess many people with COVID-19 symptoms and their contacts and allowed for general surveillance of the population. They also offered an alternative to broadscale laboratory diagnostic testing, which wasn’t possible due to the limited availability of resources and supplies. Peru’s sizeable informal sector and lack of a risk communication plan made it difficult to contain the virus — many people couldn’t afford to stay at home, and many didn’t understand the importance of staying at home and social distancing. The rapid tests have also created a false sense of security. “Many people would have the test taken and remove their masks at work if they had a negative test result,” Dr. Garcia said. “Some individuals would have the test taken before visiting a family member or before a party, which has caused for some things to get lost in the process.” Dr. Garcia believes there are lessons to be learned from the experience. “This is not the first pandemic, and it won’t be the last one,” she said in her closing comments. “There are things that haven’t worked. Hopefully, we analyze them and understand them. This can serve as a catalyzer to get changes — changes that are needed in Latin America. I also believe that

science in all of its aspects can help provide guidance and move forward so that the public policies are based on the data.” ARGENTINA’S RESPONSE Argentina implemented a strict quarantine but still had a record number of COVID-19 cases and deaths. Some countries — like Uruguay, Costa Rica, Cuba, and Paraguay — implemented less restrictive, less extensive quarantines and still fared better. Countries that didn’t enact federal public policies, like Mexico and Brazil, have fared the worst. Throughout the pandemic, Argentina experienced increased unemployment, poverty, and school dropout rates. The unemployment rate reached 13.1% — the highest level since 2005 at percent. Overall gross domestic product (GDP) dropped by 13%, and the school dropout rate grew to 25 to 45%, depending on the local context. At the beginning of the pandemic, there was strong public support in favor of the quarantine.

According to Dr. Rubinstein, his experience as minister of health allowed him to understand public health from two perspectives — from activities that support decision-making, such as research and implementation, to the decision-making itself. “I believe it’s good that people who know what evidence is, what data are, and what public policies are based on evidence and strong data reach positions of leadership in public health — it’s very important,” Dr. Rubinstein said. The mission of the University Hemispheric Consortium is to facilitate problem-based collaborations in education, research, and innovation to generate the knowledge and solutions necessary to confronting the key challenges facing the hemispheric and global issues of health, climate, business, education, and more. The University of Miami currently serves as the secretariat of the organization, and Universidad Peruana Cayetano Heredia is a member.

“The quarantine was not enough as a measure to mitigate the COVID-19 pandemic,” Dr. Rubinstein said. “There were active policies that were needed as well — not only in terms of preparing the hospital response, but also a meaningful community response through testing, contact tracing, and isolation.”

from curbing a syndemic, she said. To curb the latter, society has to face issues that make victims vulnerable and create an integrated set of responses so that pandemic preparedness is better able to solve the problems of our world, she added. “COVID has exacerbated our existing social conditions,” even in the U.S., Clinton said. “We have to be quite candid about what about our social normative and legal structures has made women especially vulnerable in these times,” she added. From left, Felicia Knaul, Chelsea Clinton, Carolina Coll, and Beverley Essue

VIOLENCE AGAINST WOMEN, CHILDREN ESCALATES DURING PANDEMIC Written by Barbara Gutierrez Published on October 20, 2020 Category: Faculty, Event During an online seminar Tuesday, experts explored ways in which the coronavirus has increased domestic violence in Latin America. Violence against women and children in Latin America is an ongoing crisis. It is estimated that one in three women is a victim, and one in five young people have been subjected to violence. The COVID-19 pandemic has worsened the crisis. For the past seven months, while in social isolation, many victims have been closeted with their abusers, experts said. “These are huge issues,” said Felicia Knaul, director of the University of Miami Institute for Advanced Study of the Americas and founding president of Tomatelo a Pecho, a Mexican non-profit organization with the mission of contributing to the reduction of breast cancer. “Domestic violence was there before COVID-19, it is there during it, it will be there after, very sadly,” she added.

Knaul spoke on Tuesday as part of the online seminar “Flattening the Surge of Violence against Women and Children: COVID-19 and Beyond,” sponsored by the Institute for Advanced Study of the Americas and The Lancet Commission on Gender-based Violence and Maltreatment of Young People. Chelsea Clinton, vice chair of the Clinton Foundation and assistant professor at the Columbia University School of Public Health, was also a speaker during the event. Carolina Coll, post-doctoral fellow at the International Center for Equity in Health acted as moderator and Beverley Essue, associate professor of the University of Toronto’s Global Health Institute of Health Policy, joined as commentator. Decades of progress in advancing gender equality and empowerment were put at risk because of the pandemic, according to Knaul. And it should be seen as a syndemic, a synergistic set of pandemics that unite a set of non-communicable diseases of poverty and discrimination based on race, ethnicity, religion, and gender. Curbing a pandemic is very different

Women may be more vulnerable, she pointed out, perhaps because there is an “absence of equal pay,” and they also make up the majority of health and social workers who are in the front lines of the pandemic. It could also be the prevalence of gun violence, she remarked. “We have more than 1 million American women who are survivors of intimate partner gun violence in our country,” Clinton explained. While in many states it is illegal for domestic abusers to purchase guns, those laws are not enforced, she said. According to Clinton, solutions to curb domestic violence should include providing middle and high school education programs that teach children what “healthy relationships are” since data show that children who are involved in violent relationships as children tend to continue in them as adults. “It’s deeply painful to me that the Trump administration has cut funding for so many programs that really work,” Clinton noted. Knaul emphasized that at this time countries should not divest of public health and primary health programs or maternal and child health programs, as well as HIV/AIDS programs. These all are crucial to help women and families during the pandemic when many are losing their jobs. Mexico took away the Seguro Popular, a universal health program, at the beginning of 2020 leaving many

without health care, Knaul indicated. By contrast some other Latin American countries, such as Argentina, Brazil, and Bolivia, have established conditional cash transfer programs to families during the pandemic that have helped support many. Strong stewardship and leadership are also important in curbing both the pandemic and domestic violence, Knaul stated. She mentioned, as an example of failed leadership, when the president of Mexico denied that domestic violence was an issue even when faced with a surge of deaths. Both speakers also agreed that COVID-19 has brought to the fore the increase of cyber violence, particularly against women and children. Clinton acknowledged that for five years the World Health Organization has explored the ways that cyber violence can have real health consequences, but there are no legally successfully strategies to target this violence.

SCIENTIFIC EVIDENCE AND GLOBAL COLLABORATION CAN HELP END THE PANDEMIC Written by Janette Neuwahl Tannen Published on October 16, 2020 Category: University of Miami President, Faculty, Event

“We actually don’t have good evidence of what works to help prevent or treat the effects of cyberbullying,” she admitted. Adding that it was quite “painful to live under this leadership” and to see a “president that is actively fomenting cyber violence.”

During a virtual panel discussion hosted by the University of Washington, President Julio Frenk discussed global responses to the pandemic—and what is needed to move forward.

The Lancet Commission on Gender-based Violence and Maltreatment of Young People and the University of Miami will continue to hold monthly seminars to explore this topic.

University of Miami President Julio Frenk, a noted global public health scholar, said that as the boundaries between local and global populations continue to blur, we must collaborate with partners around the world to end the COVID-19 pandemic. “Global health is about understanding the way in which events that happen in one part of the world affect other parts of the world, and the pandemic has obviously brought that into amazing and sharp contrast,” said Frenk, who served as minister of health of Mexico as well as dean of the T.H. Chan School of Public Health at Harvard University before coming to the University of Miami. “It also underscores the need to take that population perspective to devise solutions because we can only address these challenges with global solutions.” Frenk spoke at a virtual panel dis-

cussion Thursday night hosted by the University of Washington, where University of Miami alumna Ana Mari Cauce, is president. The talk, “Creating a Better Normal: Improving Population Health for Everyone,” was moderated by Hanson Hosein, who leads the University of Washington’s Communication Leadership graduate program. The University of Washington’s Seattle campus is home to the offices of the Institute for Health Metrics and Evaluation (IHME), an independent population health research center that aims to provide an impartial, evidence-based picture of global health, where Frenk serves as chair of the board of directors. Projections from the IHME have been used widely by government officials and the media to gauge the future severity of the COVID-19 pandemic, both in the United States and now for nations around the world. The discussion included insights from University of Washington faculty members about how to improve population health—eliminating diseases and injuries while also considering the intersecting and overlapping factors that influence health—in the environment, infrastructure, and in the health care sector. In 2016 Cauce identified population health as a major initiative

for her institution, propelling research on ways to stem health disparities in the United States. Cauce emphasized the role scholarship can play in addressing the hardships that Black and indigenous people, as well as all people of color and women, face during the COVID-19 pandemic. “The pandemic has revealed economic, social, and environmental inequities that have been ignored for too long,” said Cauce, who also is a professor of psychology and American ethnic studies. “We have the opportunity to use this crisis to transform the world, addressing both longstanding inequities and looming crises, such as climate change.” During the discussion, Frenk shared his observations about how nations around the world have responded to COVID-19, including his surprise by the variation in response among nations. For example, in nations with populist leaders that offer isolationist perspectives, he said, often the rates of transmission tend to be the highest because there is a general distrust of scientists. Yetmany countries with female heads of government are taking a more balanced approach by listening to scientists’ advice. These nations have fared much better in their ability to curtail COVID-19 transmission rates, he noted. “The countries that have had the best responses have a disproportionate amount of governments led by women,” Frenk said. “And I hope that one of the effects of this pandemic is it puts to rest the absurd idea that women are not suited for leadership, which is still so prevalent.” Frenk also rejected the notion that governments must choose between protecting people’s health and reviving the economy. “Reactivating the economy while protecting health as twin and synergistic objectives are things we can pursue if we follow the evidence and do not politicize the way we face the pandemic,” he said. Shifting to his own population at the

University of Miami, Frenk explained how he made the decision to welcome students back to campus for blended instruction. He said that his decisions regarding COVID-19 are always grounded in scientific evidence. Armed with information from the IMHE and other sources, his team crafted a set of protocols for campus that included mandatory face coverings, investing in equipment to make physical distancing possible in classrooms, and creating a robust testing and tracing program. “What I saw was a dichotomous discourse, as if being on campus was full risk but telling people to stay at home was no risk. But there are risks in both approaches,” he said. “Using the data, I realized we could actually take

a calculated risk of opening if we did it the right way.” Finally, when asked about the deterioration of trust in science occurring now in the United States regarding COVID-19, Frenk said the strategies used by University leaders could serve as an example. “Universities are committed to the pursuit of truth,” Frenk said. “We understand that truth is never static; it’s a dynamic concept, but we have got to insist on the use of evidence to guide decision-making. This is what we do, and in educating the next generation of leaders, we need to emphasize those values.”

COVID-19 IS RAVAGING LATIN AMERICA Written by Barbara Gutierrez Published on September 3, 2020 Category: University of Miami President, Faculty, Event

In a virtual seminar hosted Wednesday by the Institute for Advanced Study of the Americas and the Institute for Health Metrics and Evaluation, participants presented projections for deaths in the region. Latin America continues to be a “hot spot” for COVID-19. The region has just 8 percent of the world’s population, yet it accounts for 43 percent of the deaths worldwide. “At the end of the year, the first cause of death in Latin America will be COVID-19,” said Rafael Lozano, director of Health Systems at the Institute for Health Metrics and Evaluation at

the University of Washington. Lozano presented his findings during the online conference “COVID-19 in the Americas: Policies and Perspectives,” sponsored by the University of Miami Institute for Advanced Study of the Americas and the Institute for Health Metrics and Evaluation. He was joined by University President Julio Frenk, a medical doctor and global public health expert who was the former minister of health of Mexico, and Felicia Knaul, health economist and professor at the Miller School of Medicine and director of the

Institute for Advanced Study of the Americas. Michael Touchton, associate professor of political science in the College of Arts and Sciences, moderated the discussion. The University of Miami was leveraging its “unique geographical advantage to forge research, education, academic exchange, and innovation-driven partnerships throughout the Americas,’’ according to Frenk. “Latin America has become a global hot spot for COVID-19 with more than 5 million confirmed cases,” he added. “Beyond the suffering caused by the pandemic itself, long-standing disparities based on poverty, ethnicity, sex, and gender have been laid bare by the pandemic. In addition to that, health systems in the region face a host of exacerbated challenges including shortages of medicine and staff.” Knaul gave an overview of findings from the COVID-19 Observatory, an interactive platform that the institute established that has analyzed national and subnational policies in Mexico, Brazil, Chile, Colombia, and Bolivia. One of the challenges in looking at the region is that every country has reacted to the pandemic in different ways, the experts agreed. Even within countries, individual towns and regions have reacted differently. While Mexico and Brazil continue to be the global hot spots in the pandemic, countries such as Chile are handling the pandemic well, said Knaul. “Chile is the example to follow,” Knaul pointed out. Colombia is also beginning to level the curve as well. The policies toward the mandatory use of masks in the different countries is also measured by the observatory. Although Mexico and Brazil lag in this area, all countries in the region, as of April, began some kind of policy requiring the use of masks. Colombia’s condition that masks be worn has been clear from the very beginning of the pandemic, and that may have played a role in its declining numbers.

“It isn’t enough for the country to say that you have to use a mask, but you have to say when, how it fits, and so on,” Knaul said.

Manuel Lopez Obrador has not issued any public policies to contain the pandemic, even as his country surpassed 17,000 deaths.

Most of the deaths forecasted by Lozano toward the end of this year is expected to take place in Mexico and Brazil, two countries that have not had sound national policies on how to respond to the virus. Brazil President Jair Bolsonaro first mocked the pandemic and often appeared publicly without a mask. Mexican president

“Pandemics should not be politicized,” said Knaul. “It is inappropriate to politicize an issue of public health.”

ORTHOPAEDIC TRAUMA UNITS ACROSS THE GLOBE GREATLY IMPACTED BY COVID-19, STUDY FINDS Written by Amanda Torres Published on June 25, 2020 Category: Student, Research A study led by medical and public health researchers at the University of Miami Miller School of Medicine found that orthopaedic trauma departments across the globe have been impacted by the COVID-19 pandemic in a myriad of ways. Among the impacts are reduced caseloads, shortages in equipment, and the implementation of telehealth. The study, published in the journal International Orthopaedics on June 17, includes the largest data set characterizing global COVID-19 situations and responses of orthopaedic trauma practices from around the world. “The goal of this study was to understand the experiences and lessons of

orthopaedic trauma surgeons internationally in combatting COVID-19,” said study lead author Bradley A. Lezak, a candidate in the M.D./M.P.H. program at the Miller School of Medicine and Department of Public Health Sciences. “We hoped to shed light on current practices and challenges in order to help manage the current pandemic in addition to preparing for future global pandemics that may arise.” During April, researchers sent a 20item questionnaire to 150 orthopaedic trauma surgeons representing 42 countries. The study was based on responses from 63 surgeons from 28 countries, including 14 from the U.S. Given the global and regional diversity represented by the sample pool, the researchers said, each participant provided a unique perspective on when and to what extent COVID-19 affected their orthopaedic practice.

Among the many key findings: »

» »

91 percent of participating hospitals reported having a reduced case load compared to preCOVID-19 conditions 17 percent of respondents performed elective orthopaedic surgery 30 percent of orthopaedic departments have deployed orthopaedic personnel to other floors to help mitigate the increased patient load 86 percent of respondents noted at least some shortage of personal protective equipment (PPE) 37 percent of participating orthopaedic departments, including those in low- and middle-income countries, have incorporated telemedicine into their practice with a majority stating that it would most likely become a permanent change to their practice postCOVID-19 “This study reinforced many of the common themes that have been discussed throughout the COVID-19 pandemic in terms of the PPE shortages, re-deployment of medical trainees to medical floors outside of their given field in order to help mitigate the COVID caseload, as well as the rapid adoption of telemedicine,” Lezak said. “The results highlight the need of hospitals across the world to develop strict Standard Operating Procedures for the allotment of PPE in order to minimize shortages and protect health care providers on the front line.

“The rapid implementation of video and telephone health care consultations across the world, including in low- and middle-income countries, as shown in the study, highlights the need for us to revisit telemedicine policies and understand how we can continue the momentum that COVID-19 has created around telemedicine into productive health care policies that can help those in need,” Lezak added. The surgeons were identified based on professional relationships and/ or prior involvement in international

meetings either led or participated in by Peter A. Cole, M.D., chief of orthopaedics at Regions Hospital and orthopaedic section head at HealthPartners Orthopaedics, who served as senior author on the study. The study was also co-authored by Peter A. Cole Jr., M.H.A., a graduate of the University of Miami Herbert Business School, as well as by Lisa K. Schroder, M.B.A., director of Orthopaedic Trauma Academic Programs at the University of Minnesota and Regions Hospital. EQUIPMENT SHORTAGES, STRATEGIES, AND ADOPTION OF TELEHEALTH Emerging literature on COVID-19 reveals the shortages in equipment, such as ventilators and PPE, and emphasizes the need for structural change and for policies to mitigate the shortages, researchers said. Surgeons who responded to the questionnaire noted the same challenges, signaling that the shortages are not unique to one region or country, but may be a global issue. The study suggests several strategies that have worked well for study respondents, which include: » » »

THE IMPORTANCE OF GLOBAL COMMUNICATION While there is much to be learned from each of the responses from participants, the distribution and completion of this questionnaire highlight the positive effects of worldwide communication and coordination. “This study was remarkable in that in just three days, we were able to gather information from over 60 surgeons in 28 different countries,” Lezak said. “This included surgeons from countries facing a significant COVID-19 caseload such as China and Spain, as well as countries that have yet to face COVID to the same extent with less than 100 confirmed cases at the time such as Malawi, Haiti, and Gabon. “By gathering the unique experiences of surgeons in various environments in terms of COVID-19 caseload and distributing their learnings and advice to those who have yet to experience it, we hope that localized planning may transition from rapid-fire response to informed expectations and processes. This study also highlighted the power of global communication and how shared experiences can help the world as a whole move forward.”

Donation of PPE by local community members and businesses Reduction in allotted PPE per provider per day Prioritizing the types of providers at highest risk of exposure to the virus, which has allowed hospitals to maintain supplies at a level necessary to continue to function and to treat patients during the pandemic. Researchers noted that future planning must account for the medical shortages to implement the new policies.

The study also revealed that the majority of orthopaedic trauma surgeons worldwide have implemented telehealth capabilities and believe that the use of telemedicine will be a permanent change in their practice moving forward.

Bradley A. Lezak, M.D./M.P.H. student

WHY BRAZIL IS NOW THE EPICENTER OF THE CORONAVIRUS PANDEMIC Written by Barbara Gutierrez Published on June 25, 2020 Category: Faculty, Event

In a webinar hosted by the Institute for Advanced Study of the Americas, experts discussed why the country has been impacted so deeply. The number of COVID-19 cases in Latin America has resulted in some experts saying the region has become the epicenter of the coronavirus pandemic. “But if Latin America is the epicenter of the pandemic, then Brazil is the epicenter of the epicenter,” said Felicia Knaul, director of the University of Miami Institute for Advanced Study of the Americas, who led a webinar called “COVID-19 in Brazil: one country, many epidemics” on Thursday afternoon. Knaul began the session by giving an overview of the region based on information by the Latin America COVID-19 Observatory, which was developed by faculty from the institute, the Miller School of Medicine, the College of Arts and Sciences, and the School of Communication in collaboration with research partners throughout Latin America. Knaul pointed out that Latin America has 51 percent of daily global deaths even though it holds only 9 percent of the population. Brazil has 22 percent of global deaths (53,895 deaths), second only to the United States. “These numbers are overwhelming

and unfortunately growing,” she said. While European countries—such as Spain and the United Kingdom—are seeing numbers tapering off, countries like Mexico and Brazil are surpassing the U.S. in deaths, she said. Deaths in Brazil are projected to reach 11,000 per day by early August, depending on how the population behaves and whether policymakers and health systems intervene with testing, she said. Brazil’s efforts against the virus have been hampered by political polarization and a president, Jair Bolsonaro, who continually downplays the virus and insists on going out in public without a mask. Cesar G. Victora, a Brazilian-born epidemiologist who has led Epicovid19, the first study to assess the prevalence of coronavirus in Brazil, gave a detailed report on a household analysis in 133 sentinel cities in Brazil. “We did not find one epidemic in Brazil but several epidemics in the country,” he said. The most affected areas were the cities and towns in the Amazon region, poor areas with limited access to health facilities. In the town of Manaus, cemeteries are full, he said. Michael Touchton, University of Miami associate professor of political science, who has studied governance and public health in Brazil and other

countries in Latin America, said the data from the Observatory shows a partisan pandemic. Some of the poorer states, with governors opposed to Bolsonaro, have the most stringent responses and insist on social distancing and mask wearing. Other states are reopening quickly, without requirements to wear masks or any other protective measures, and those states are not faring well, he said. Victora’s survey also revealed that the poor are much more affected by the virus than those in the upper echelons of society. Touchton reiterated Brazil’s position as the epicenter of the virus in the world. “We are seeing an absolutely devastating pandemic in Brazil,” Touchton said. As Brazil reopens, testing is low compared with other countries in the region. Peru and Chile test about five times higher, from a per capita standpoint. Many of the states that are reopening do not have the policies to protect the population. “So, the likelihood of the pandemic getting worse is very high,” Touchton said, adding that the political polarization has only compounded the problem. “Political polarization coupled with the pandemic is a recipe for disaster,” Touchton said.

EXPERTS DISCUSS A POTENTIAL GLOBAL PUBLIC HEALTH CONVENTION IN UNIVERSITY OF MIAMI-LED ADVISORY MEETING Written by Amanda Torres Published on June 25, 2020 Category: University of Miami President, Faculty, Event Distinguished global public health experts, academic leaders, parliamentarians, and journalists convened in a virtual advisory meeting held to discuss the development of a global public health convention for the 21st century. Earlier this year, José Szapocznik, Ph.D., chair emeritus of the University of Miami Miller School of Medicine’s Department of Public Health Sciences, was awarded a grant by the AIDS Healthcare Foundation (AHF), a global non-profit organization based in Los Angeles. AHF has operations in 14 states in the U.S., including Florida, as well as in 43 other countries worldwide. The aim of the AHF grant is to develop, in conjunction with the AHF Global Public Health Institute at the University of Miami – a partnership between UM and AHF – a global public health convention plan.

The convention would identify the principles on which to build a process and mechanism for increasing global health security against the spread of infectious diseases, as well as to improve infectious disease pandemic preparedness and rapid response. A meeting, led by the Department of Public Health Sciences and the AHF Global Public Health Institute at UM, took place virtually on June 4, 2020, where Dr. Szapocznik and Jorge Saavedra M.D., M.P.H., M.H.P.M, executive director of the AHF Public Health Institute at UM, served as moderators. President Julio Frenk and Michael Weinstein, president and founder of AHF, gave welcoming remarks at the advisory meeting, as well as emphasized the importance of global cooperation. “It’s really a pleasure to host this now virtual meeting and to see everyone,” President Frenk said, as the advisory meeting was initially going to be held on campus. “We're all united by a strong conviction about the value of global cooperation and healthy global

governance. Today, more than ever before, we are witnessing just how important it is.” “AHF’s original thinking on the need for a global public health convention started several years ago when our own staff, in Sierra Leone and Liberia, who were devoted to providing HIV services, suddenly confronted the need to respond to the Ebola outbreak. During that crisis, we lost a medical doctor and a lab technician,” said Mr. Weinstein. “We are very excited to support and be part of this joint effort based at the UM.” In the months prior to the meeting, each participant had been interviewed to develop an understanding of the facilitators and obstacles to implementing existing international conventions that address global public health security. This information was shared with the advisory group members who used the meeting to continue to develop a shared vision of how to better protect the world against future pandemics. Key stakeholders held fruitful conversations throughout the meeting,

convened by Dr. Julio Frenk, the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine to assess the global response to Ebola in West Africa,” Dr. Saavedra said. “Results and recommendations were published in The Lancet and the British Medical Journal. We are certain that this new effort led by the UM team and fed with inputs from more than 25 policy experts from all regions of the world will, together with lessons we are learning under the current COVID-19 pandemic, have a bigger impact.”

answering, and discussing the following questions: »

» » » » »

What body is needed to ensure the world’s public health security? Is that a new or existing organization? What characteristics should that body have? How much autonomy and authority should such a body have? How could it be funded? How should it be governed and who needs to be involved in its governance? They suggested that while there is a need for a global organization to coordinate the effort, every country must develop the capacity and political determination to stop novel pathogens before they spread beyond their borders.

“We now fully understand that as a result of globalization, pandemics of novel pathogens will occur with increasing frequency. Countries must enter into a new convention that will more effectively protect us from the spread of novel pathogens in the 21st Century,” said Dr. Szapocznik. “Countries will have to share their authority with a global organization that will be mandated to coordinate planning and strategic interventions to prevent future pandemics.”

“When we began to plan our initiative last summer, we never imagined that our work would be informed by the worst pandemic in a century. One concern has been that countries attend to pandemics when they occur and quickly de-prioritize pandemic prevention, preparedness, and response,” said Dr. Szapocznik. “It is unfortunate, but because of the human, economic, and possibly political devastation that has been caused by COVID-19, we believe that countries are more ready to act today that at any other time in a century.” The final results of this project will be presented at the UNITE conference in Portugal in September 2020. UNITE is a global parliamentarians’ network to end infectious diseases, composed of people who were or are currently parliamentarians in their countries.

University of Miami President Julio Frenk

José Szapocznik, Ph.D.

Based on UNITE’s input, the document will be further modified to ensure that it represents the views of UNITE’s members.

“We are not starting from scratch, in 2015, AHF joined an independent panel of global health experts

COVID-19 OBSERVATORY: BUNGLED RESPONSE COMPOUNDS MISERY IN BRAZIL Written by Michael R. Malone Published on June 2, 2020 Category: University of Miami President, Faculty, Event

The initiative has been tracking public health policy response data to determine how swift or lax implementation of mitigation efforts have impacted the spread of the virus in Latin American countries. Brazil, which has followed the inept example of Mexico in failing to swiftly enact national public health policies to contain the coronavirus pandemic, has now become the world leader in terms of infections and daily deaths, according to the latest round of data provided by the Latin America COVID-19 Observatory. In a trilingual webinar Tuesday, members of the University of Miami-led initiative that provides timely data in an effort to improve government public health policy responses and save lives, along with a leading Brazilian epidemiologist, analyzed the observatory’s study on Brazil. “This is a very timely discussion as Latin America has now become the world’s hot spot for COVID-19 infections and deaths, accounting for 40 percent of the daily registered deaths globally, and Brazil has reached a critical phase in its response to the COVID-19 pandemic,” said University of Miami President Julio Frenk, setting the context for the session.

Frenk, a former health minister in Mexico and global public health expert, highlighted the “enormous expressions of solidarity, service, and sacrifice in the region, particularly on the part of frontline health workers and researchers” in seeking to combat the contagion. “In that spirit of solidarity, we are presenting this data,” he said, “yet, sadly, we are witnessing the peril of delayed action by populist governments that tend to devalue science and evidence—and that has put millions of lives at risk.” The Latin America COVID-19 Observatory was developed by the Institute for Advanced Study of the Americas, Miller School of Medicine, College of Arts and Sciences, and the School of Communication, in collaboration with research partners throughout Latin America. A first round of data released several weeks ago focused on Mexico, and this second release centered on Brazil with a comparative regional data analysis. The observatory provides daily updates on public health and physical distancing policies—10 variables in total—implemented at the national and subnational level, the only consortium to offer state-level regional data

of this scope, explained Felicia Marie Knaul, director of the Institute for Advanced Study of the Americas and professor in the Department of Public Health Sciences at the Miller School. Knaul noted that the observatory plans next to continue its assessment of other countries in the region and also to strengthen its collaboration with Brazil. She emphasized the value of providing state-level data that can be easily visualized on the website. “From a research point of view, we will be able to look at differences across states and countries to help us explain what works and what doesn’t work in the face of a pandemic—and that should help with future preparedness and also what we might see in terms of second waves of the current pandemic,” said Knaul, who has been instrumental in advancing the initiative. “Also,” she continued, “what we’ve seen in Mexico, in Brazil, and other countries with major variance is that if you demonstrate that some states are performing better than others, you can encourage those states that have weak public policy or even those that have enacted strong policy, but are still seeing mobility, that they need to adjust their public policies.” Such

of political science and the global health associate faculty lead for the institute with expertise in Brazil, highlighted the impact of the disparities in the differing responses of Brazilian states and other more recent trends in his presentation.

sures of personal hygiene—that is the combination that allows you to open the economy safely and to control the pandemic.”

The best state performers were not limited to the wealthiest states, nor to those that are often considered the best governed, Touchton noted. Instead, political explanations—whether the state governor opposed or supported the Brazilian president—were a better indicator of how well the state was in controlling the contagion.

analysis, she said, can provide “an opportunity for an overall improvement at the national level by asking states to come together and do as well as the best-performing states.” Knaul noted that Brazil, with now nearly 1,000 deaths a day and a trajectory that is on the upswing, is now the hot spot of the global pandemic. “Our hearts and souls go out to all living in Brazil at the epicenter and to see how this is evolving, and we are here to do whatever we can to be supportive,” she said. Alberto Cairo, Knight Chair in Visual Journalism and associate professor with the School of Communication, moderated the webinar. Cairo formed part of a robust collaborative effort from the school that played a major role in translating—linguistically, textually, and visually—the website’s data and display. In pre-release findings on Brazil, the consortium observed that the administration of Brazil President Jair Bolsonaro wasted valuable time while COVID-19 spread across the country, a delay that obligated state and local governments to fend for themselves. Michael Touchton, assistant professor

The relatively marginalized states of the northeast part of the country have responded more aggressively and have fared better, as have some northern states. And, governors from opposition parties lead these states and have imposed much stricter measures than what the Bolsonaro administration recommended, Touchton pointed out.

University of Miami President Julio Frenk

Cesar Victora, Brazilian epidemiologist and lead of the International Center for Equity in Health at Universidade Federal de Pelotas, provided a detailed analysis based on household surveys of 133 sentinel cities in Brazil’s 27 states. In response to an audience question, Frenk said that the common element for both controlling the pandemic and opening the economy in Latin America and elsewhere is to do testing, both for surveillance and diagnostic in nature.

Felicia Knaul, Ph.D.

“It’s not a trade-off—the two objectives of controlling and opening have to go hand in hand,” Frenk said. “If you reopen the economy in an accelerated, reckless way, you will have a spike in cases. And, you may have to shut down the economy a second time.” “And the third piece is clear, clear communication,” Frenk continued. “Communicating to the people so that they adhere to the physical distancing, protection of personal space by using masks, and extensive mea-

A NEW SURVEY SHEDS LIGHT ON ‘VULNERABLE’ CANNABIS USERS Written by Maya Bell Published on May 12, 2020 Category: Alumna, Secondary Faculty, Research The international study led by the University of Miami School of Nursing and Health Studies aims to help guide public policy about marijuana use amid the coronavirus pandemic. The health warnings against smoking or vaping cannabis while the novel coronavirus continues its global assault are clear: Because COVID-19 attacks the lungs, cannabis users should quit inhaling cannabis. Yet the preliminary results of an international survey of both medicinal and recreational cannabis users suggest that a majority are continuing the risky behavior. Only 16 percent of more than 2,000 self-identified cannabis users who have answered the anonymous questionnaire so far said they have changed how they consume

cannabis. Of those, only a third said they had curtailed inhaling it. “Whether they are recreational or medical users, all cannabis users are a vulnerable population right now for different reasons. But the one thing they have in common is that the majority continue to smoke or vape,’’ said Denise Vidot, assistant professor and an expert on the health effects of cannabis at the University of Miami School of Nursing and Health Studies, who is leading a study based on the survey. That’s concerning, Vidot said, not only because of growing evidence that shows smokers who contract COVID-19 have more severe symptoms and complications than those who don’t smoke. But many recreational cannabis smokers are also known to share their product—which is a sure-fire way to spread the disease that has killed more than 288,000 people globally.

“In mouth-to-mouth contact, you’re literally sharing saliva, especially if you’re passing an electronic vaporizing device,” Vidot said. At last count, the 2,000-plus self-identified cannabis users who voluntarily answered questions about how the pandemic has changed their access to cannabis—and their frequency, dose, and method of ingesting the substance—were from at least 46 countries. The University’s Hemispheric University Consortium, which advances research and education throughout the Americas, has been particularly helpful in disseminating the electronic survey across the hemisphere, but Vidot and fellow researchers at the University of Texas, State University of New York, and the University of North Carolina Chapel Hill hope to collect information from approximately 10,000 respondents who are 18 or older from every country in the world. Their long-term goal is to help guide future public policy and education

their jobs and health insurance, which didn’t pay for their cannabis products under normal circumstances. “The actual product is not covered by conventional health insurance, so imagine any medicine you have to buy without health insurance,” she said. “What is the market value? That’s what medicinal cannabis users have to pay.” Vidot also noted that some recreational cannabis users identify themselves as such only because they can’t afford to acquire a state-issued medical marijuana card, which would enable them to obtain cannabis for medicinal use with a doctor’s recommendation. So, they are also facing economic hardships that may put cannabis products out of their reach—products that now come in so many medicinal forms that Vidot is surprised medicinal users continue to smoke cannabis in the highly contagious world of COVID-19.

campaigns by having enough information to generalize how COVID-19 is changing cannabis use and impacting users, particularly medicinal users who consume it in myriad forms—oils, ointments, creams, pills, and other edibles—to ease anxiety and depression; post-traumatic stress; chronic pain; or living with cancer, HIV, or other debilitating diseases. “If COVID-19 has taught us anything, it is that population-based data is vital to make informed decisions,” Vidot said. “So, we are combining our skills to do our part to provide that data.” Since the World Health Organization declared COVID-19 a pandemic, Vidot said, more than 20 U.S. states have taken steps to ensure that state-licensed cannabis dispensaries can remain open as essential services. But the preliminary survey data shows that a third of medicinal cannabis users have no more than a two-week supply on hand, and more than half are worried about how they’ll continue to afford their prescriptions.

“I am not surprised about recreational users because, by definition, they get it from illicit sources,’’ she said. “I am surprised that the medicinal users are reporting as much smoking as they are, especially considering that lots of the states have legalized cannabis in multiple forms.’’ Though not surprised by it, Vidot is also concerned that anxiety and depression were the most common preexisting chronic conditions that survey respondents cited for depending on cannabis. “These were the most prevalent preexisting conditions prior to COVID-19,” she said. “So, if anxiety and depression were already the most prevalent preexisting chronic conditions, imagine it now.”

Like millions of people around the world, Vidot pointed out, many medicinal cannabis users are losing

EXPERTS DEVELOP NEW TOOL TO HELP CONTAIN COVID-19 IN LATIN AMERICA Written by Amanda Torres Published on May 11, 2020 Category: Faculty, Alumna, Initiative

The tool, officially called the State-Level Observatory for the Containment of COVID-19, presents a daily portrait on the extent of social distancing measures adopted by state governments in Latin America, in accordance with international recommendations, the timeliness of their adoption, and the population’s response in terms of reduced mobility.

and leading researchers from Mexico, have created and shared a new tool that will help access this information.

COVID-19 at the state level in Latin America and is innovative for low- and middle-income countries.

Mexico, for example, has entered the most critical phase of COVID-19 Phase 3 involves maximum intensification of measures to decrease virus transmission and deaths. Now more than ever, it is critical to have accurate and timely information on the measures to contain the disease, as well as to know whether the population is complying with the measures.

“Resource-poor health systems in Latin America are going to be much harder hit by this pandemic than anything we have seen in Canada or the United States. It is crucial that policymakers at the state level have reliable data to monitor and inform their efforts to contain COVID-19,” said Dr. Knaul, who is also a professor at the Department of Public Health Sciences. “Experts from across the University of Miami and Mexico built this tool as a public good and largely working as volunteers, hoping that it can be used to save lives. I am especially grateful for the generous contributions of my colleagues from the Department of Public Health Sciences.”

The first contribution of the observatory is the calculation of an index based on the Oxford COVID-19 Government Response Tracker (OxCGRT) – a tool developed by the University of Oxford that consists of a list of measures available to governments to reduce the speed of transmission of the virus.

Felicia M. Knaul, Ph.D., director of the Institute for the Study of the Americas at the University of Miami, with experts from the Miller School of Medicine's Department of Public Health Sciences, UM's College of Arts and Sciences and School of Communication, organizations across the country

The new observatory – developed by Raymond Balise, Ph.D., professor at the Department of Public Health Sciences and Layla Bouzoubaa, M.S.P.H., a lead research analyst at the Miller School of Medicine – is the only database that provides information on the behavior of public policy towards

The University of Miami-led observatory is based on the OxCGRT framework and codifies the response of the state governments in Mexico, based on the information available on the official websites of each of the states. UM experts used the OxCGRT to identify seven preventive measures relevant to the situation in Mexico. They include: » » » » »

Closing schools Suspending on-site work activities Canceling public events Suspending public transportation Developing information campaigns

» »

Restricting travel and travel within the state Controlling international travel and travelers

For each state, each of the seven public policies mentioned is measured on a daily basis, starting from the date of the first officially recognized case in the country, which was on February 27. Experts note that each data passes through three independent reviews before being added to the database. The observatory reviews not only what has been done so far, but also what is being done at the moment in order to contain COVID-19. Experts note that they have made it available to the public and state authorities to provide timely information that will help make better decisions for the future. The observatory is in its initial phase and experts are looking at the next steps, such as: » »

To update the composite indicator based on the 5.0 version of the OxCGRT Add key data on mortality and

cases and access to health services, as well as to secondary effects such as domestic violence and economic downturn, to expand the scope of the tool. Link the observatory with other information sources and databases to strengthen the global capacity to respond to the pandemic. The first would be the Institute for Health Metrics and Evaluation. Build and make available information on other countries in the Latin American and Caribbean region, starting with the case of Brazil. Conduct a political, epidemiological, and economic science analysis, as the information becomes available, and publish the results in a timely manner.

“Our primary goal in building and deploying the website was to disseminate information on COVID-19 and the policies that can help contain it as quickly as possible. Because teaching is my passion, my secondary goal was to build a platform that can be used for teaching data science,” said Dr. Balise. “During the first summer session, Layla Bouzoubaa and I will be teaching a class in the Medical School that focuses on the data science behind this project. Our students will learn about the pipeline we built that pulls in data, processes it, and produce the website. In the upcoming days, we will release all the code and the data to allow people from around the world to expand on what we have built.” “There is an excellent team driving this initiative forward and every day I get the chance to observe experts in the fields of Global Health and Public Health Policy in action,” added Bouzoubaa, who is an alumna of the M.S.P.H. program in the Department of Public Health Sciences. “Applying my programming skills towards building something that has the potential to make a significant impact on a multi-national scale is immensely rewarding. Working with people across the hemisphere with such deep knowledge of health policy, statistics, visualization, and communication is every data scientist’s dream.”

Felicia Knaul, Ph.D.

Raymond Balise, Ph.D.

Layla Bouzoubaa, M.S.P.H.

FRENK: LATIN AMERICA, CARIBBEAN CAN LEARN FROM OTHER COVID-19 RESPONSES Written by Janette Neuwahl Tannen Published on April 9, 2020 Category: University of Miami President, Faculty, Event

University of Miami President Julio Frenk participated in a webinar that examined how the countries can respond to the coronavirus pandemic. Countries in Latin America and the Caribbean should look to nations that took proactive measures to contain the spread of COVID-19, not those that trivialized the threat, said Julio Frenk, president of the University of Miami and a global health expert, during a webinar examining the pandemic in the Western Hemisphere. He expressed hope that these countries will not repeat the mistakes of others as the region begins to be impacted by the pandemic. “The advantage of a pandemic—if there is any—is that the countries that have the first cases start providing lessons for those coming in later. And Latin America is coming in later,” Frenk said. “The evidence that other countries are turning the corner should be an incentive to not give up and not listen to calls for normalcy, because then you are risking a second and a third wave and then the eco-

nomic consequences are going to be much, much worse.” Frenk made these comments while highlighting the response of different countries to COVID-19 as part of a live webinar—“COVID-19 in the Americas: Systemic Responses”—Wednesday afternoon hosted by the University’s Institute for Advanced Study of the Americas. Moderated by Robert Yates, international health economist of Chatham House, a policy institute in the United Kingdom, the virtual discussion was attended by nearly 500 participants who could send questions to the organizer, Felicia Marie Knaul, director of the institute and a global health economist and expert in Latin American health systems. Toward the beginning of the conversation, Frenk, who was Mexico’s minister of health for six years and the former dean of the Harvard T.H. Chan School of Public health before coming to the University, explained how the novel coronavirus can spread so quickly. First, he pointed out, it is a respiratory virus, which is traditionally hard to contain. Second, COVID-19

can be transmitted by people who have no symptoms or who have mild symptoms, and no one realized this until recently. So, people were walking around transmitting the virus undetected for some time. “Coupled with a delay in testing, the basic public health response of identification [of those with the virus] and isolation of contacts really was quickly overwhelmed, and we had to move to this generic policy of social distancing,” he said. Yates then asked Frenk about the impact of COVID-19 in the Americas. Since cases of COVID-19 are still relatively small in Latin America and the Caribbean, Frenk said these nations can try to replicate the policies of forward-thinking leaders that were able to stem the flow of transmission, such as South Korea and Singapore. Frenk explained that there are two things countries can do to slow the spread of a pandemic: create contingency plans for a number of scenarios and have constant, clear, concise, and credible communication with residents.

“Success is when you stop a scenario from being a reality, but that’s why you need to imagine what can happen,” he said. “It’s a sign of success when the number of deaths is lower than projected.”

insight. “We’ve realized today that viruses are contagious, but so is positivity and so is work for the common good,” Knaul said.

Although Frenk said he is concerned that the pandemic has made some nations in Latin America more isolationist, he hopes that from this experience, all national leaders will acknowledge the importance of working together. He also touted the idea of creating an international stockpile of health care supplies for the next pandemic, pushing nations to improve their public health and allowing the World Health Organization to organize and enforce public health mandates. “When there’s a global challenge, the only solutions have to be global and they have to be found in cooperation,” he said. “Health security is an integral part of national and international security.”

University of Miami President Julio Frenk

When Yates asked about the opportunities that may come out of the crisis, Frenk responded that it is critical that nations do not forget about improving public health infrastructure and policies once the coronavirus pandemic subsides. “When there is a crisis, particularly a health-related emergency, we owe it to the people who are suffering to make sure we don’t go back to status quo prior to the emergency,” he said. “We should use this situation to learn and to make sure we are better prepared.” Yates agreed, saying that China has some insight for the world about how to respond to a pandemic that they learned after the SARS epidemic in 2002.

Felicia Knaul, Ph.D.

“It’s been a wake-up call in Europe for us,” Yates said. “We thought we had these great robust universal health coverage systems, but you’ve just got to look at the statistics and we haven’t done so well.” Closing out the conversation, Knaul thanked Yates and Frenk for their

NEW GRANT TARGETS GLOBAL HEALTH PROTECTION AGAINST THE SPREAD OF INFECTIOUS DISEASES The AIDS Healthcare Foundation Global Public Health Institute at the University of Miami has awarded José Szapocznik, Ph.D., chair emeritus of the Miller School of Medicine’s Department of Public Health Sciences, a grant to develop a project to promote global health protection against the spread of infectious diseases.

resolve and capabilities would be needed to contain early the spread of novel pathogens within and across countries. That would be using a model that is informed not only by prior outbreaks of AIDS, Ebola, Zika, MERS and SARS, but also the novel coronavirus or COVID-19. “The hope is that this project can mobilize the whole world around an outbreak in a coordinated fashion. We must continue to strive to have all countries work together in a concerted effort to stop epidemics.”

“We are analyzing how countries collaborate when infectious disease outbreaks occur,” said Dr. Szapocznik, who is also professor of public health sciences, architecture, psychology, and educational and psychological studies at UM. “Both infectious diseases that are transmitted human to human or animal to human, and what kind of political, fiscal and technical

A global agreement or convention, for example, would identify what the responsibility of affected countries and the global community is to ensure quick containment and eradication of an outbreak. For new multilateral agreements or mechanisms to be effective, it would be important to understand what the facilitators and obstacles have been to implementa-

Written by Amanda Torres Published on February 27, 2020 Category: Faculty, Funded Project

tion of existing international conventions and bilateral agreements that address global public health security. “In a unique collaboration with the Department of Public Health Sciences, we will engage in global public health policy analysis and research to identify principles to improve adherence to existing multilateral agreements,” said Jorge Saavedra M.D., M.P.H., M.H.P.M, executive director of the AIDS Healthcare Foundation Global Public Health Institute at UM. “We aim to greatly improve infectious disease pandemic preparedness and rapid response to ensure containment of novel pathogens, with the goal of stopping the spread of novel pathogens early.” Dr. Szapocznik and Dr. Saavedra propose to develop a set of principles on global public health protection based on the input of global stakeholders

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and informed by existing international accords and regulations, as well as barriers and facilitators to their implementation. They will create a framework where advocates can initiate discussions in their respective countries about the nature of a convention that could be adopted by all countries. They would also make suggestions for a governance model and principles for response, and identify incentives that may be sufficiently attractive to encourage countries, academic entities and other non-governmental entities to adhere to, as well as explore the right balance between sovereignty and global public health. Eventually, they will create a report that will be presented at the UNITE conference in Portugal in September 2020. UNITE is a global parliamentarians’ network to end infectious diseases, composed of people who were or are currently parliamentarians in their countries. Based on UNITE’s input, the document will be further modified to ensure that it represents the views of UNITE’s members.

their countries for this more effective multilateral agreement or mechanisms,” said Dr. Szapocznik.

José Szapocznik, Ph.D.

“If they are willing to adopt this, then they will hopefully advocate within

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DEPARTMENT OF PUBLIC HEALTH SCIENCES 1120 NW 14TH STREET, CRB 918 MIAMI, FL 33136 PH: 305-243-9105 WWW.PUBLICHEALTH.MED.MIAMI.EDU WWW.GRADUATESTUDIES.PUBLICHEALTH.MED.MIAMI.EDU University of Miami Public Health Sciences @UMPublicHealth @umpublichealth

DPHS COVID-19 Impact Report_06_03_21

Articles inside

» New Grant Targets Global Health Protection Against the Spread of Infectious Diseases

» Experts Develop New Tool to Help Contain COVID-19 in Latin America

» A New Survey Sheds Light on ‘Vulnerable’ Cannabis Users

» Frenk: Latin America, Caribbean Can Learn From Other Covid-19 Responses

» COVID-19 Lessons From Peru and Argentina

» COVID-19 Observatory: Bungled Response Compounds Misery in Brazil

sory Meeting

» Why Brazil Is Now the Epicenter of the Coronavirus Pandemic » Experts Discuss a Potential Global Public Health Convention in University of Miami-Led Advi-

» Violence Against Women, Children Escalates During Pandemic

» Orthopaedic Trauma Units Across the Globe Greatly Impacted by COVID-19, Study Finds

» Scientific Evidence And Global Collaboration Can Help End The Pandemic

» COVID-19 is Ravaging Latin America

Makers

» Julio Frenk: Empowered Who Needed to Battle Pandemics

» Panel: Pandemic Intensified Need for Palliative Care in Latin America

» Caribbean Nations Explore New Ideas, Directions to Recover From Pandemic

» Report Confirms Pandemic-Related Spikes in Domestic Violence

inx Sexual Minority Men

» Cancer Patients in Mexico Face Dire Scenario in Wake of COVID-19

» Miller School Professors Develop Model to Correct COVID-19 Sampling Bias » New Study First to Use Pandemic Stress Index to Document the Effects of COVID-19 on Lat-

» Public Health Leaders Discuss Steps Needed to Empower Women » Dr. Felicia Knaul: Access to Pain Relief Medicines in Mexico Should Be a Priority for Policy

» New Panel to Advocate for a Global Public Health Convention for the 21st Century

» Personal Perspectives on the Covid-19 Crisis in India

» New Miller School-Led Lancet Study on Redefining the Future of Pandemics

» Additional Student and Alumni National Impact

» Strategies to Help the Hard of Hearing During COVID-19 Precautions

Study Finds

» Methamphetamine Use and HIV Create Perfect Storm for COVID-19 Transmission

» Quality of Indoor Air Plummeted in Some Homes During COVID-19 Shutdown » Syringe Service Programs Across the U.S. Have Been Impacted by the COVID-19 Pandemic,

work

current Threats

And HIV

cine Considerations Project

During COVID-19

» Miller School Public Health Researchers Study COVID-19 Antibodies in First Responders » Dr. Adam Carrico Receives NIH Grant to Study Risk for COVID-19 Amid Methamphetamine Use

Area, Study Finds

COVID-19

Cells

» Study Finds U.S. First Responders Have Mixed Feelings About COVID-19 Vaccine

» COVID-19 Has Led to the Reformation and Reinvigoration of the Public Health Workforce

» Sylvester Researchers to Collaborate with Miami-Dade County on Coronavirus Testing

» Mindfulness During Uncertain Times

» U-TRACE Initiative to Address COVID-19 Public Health Crisis

and Frontline Workers

» Additional Student And Alumni Local Impact

» A Pandemic Strikes, and an Academic Community Responds

» Student Garners Reflections on the Importance of Public Health

» Course Explores Global Health and Disparities During the Pandemic

» COVID-19 Vaccine Trials Exhibit Early Success

» Mobile Clinic Takes Vaccines to Underserved Aeas

munities

Future

MESSAGE FROM THE CHAIR

» Battles Being Waged to Overcome Vaccine Hesitancy

» UHealth Pediatric Mobile Teams Surpass 10,000 COVID-19 Tests