Vol. 14, Issue 2 by Frontiers: Washington University Review of Health

In This Issue Politicization and Polarization of COVID-19 • 6 Breathing Through a Pandemic • 10 Medicinal Music: Music Therapy as a Means to Treat Depressive Symptoms • 14

POLARIZE • VOLUME 14 ISSUE 2

FRONTIERS • TABLE OF CONTENTS

POLARIZE Frontiers Magazine: WU Review of Health focuses on health as it related to the entire Washington University community. We strive to make health-including physical and life sciences, engineering, public health, health policy, economics, the humanities, the social sciences, and medicine more understandable and relevant to people’s lives. Not only does Frontiers provide an opportunity for undergraduates to publish opinions and analyses of issues related to health, but it also allows the WUSTL community to engage in current events in the health field and explore the many intersections of health. Regardless of major or interest, Frontiers is open for all to engage. As Frontiers Executive Board, we would like to thank all our contributors, our writers, editors , and illustrators as well as WashU faculty for making this magazine possible. Cover design by Lucy Chen.

Executive Board Daniel Berkovich, Keshav Kailash Co-Executive Directors

Anhthi Luong, Soyi Sarkar Co-Editors in Chief

Casey Connelly, Jennifer Broza Co-Directors of Public Relations

Isaac Mordukhovich Managing Editor

Alyssa Hyman Director of Finances

Lucy Chen, Eugenia Yoh, Victoria Xu Co-Directors of Design

Ayda Oktem, Shubhanjali “Shub” Minhas Co-Directors of Outreach

Amaan Qazi, Ryan Chang Co-Web Editors

Want to get involved?

Writers

Please email us or visit our website.

Alexandra Dram, Alicia Yang, Carson Codel, Frank Lin, Gina Wiste, Haleigh Pine, Kimberly Hwang, Soyi Sarkar

Website

Editors

frontiersmag.wustl.edu

Writers and Editors

eic.frontiersmag@gmail.com

Illustrators

design.frontiersmag@gmail.com

Exec Board

frontiersmag@gmail.com

Caelan Miller, Haleigh Pine, Isaac Mordukhovich, Julia Bulova, Neha Adari, Rehan Mehta, Ryan Chang

Illustrators Alexandra Laufer, Clair Huang, Jennifer Broza, Neha Adari, Noor Ghanam, Shelly Xu

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Letter from the Editors Soyi Sarkar, Anhthi Luong

Dr. William Danforth Illustrator: Neha Adari

POLICY

What Will Healthcare Look Like Under Biden’s Presidency Writer: Kimberly Hwang Editor: Isaac Mordukhovich Illustrator: Noor Ghanam

Politicization and Polarization of COVID-19 Writer: Alicia Yang Editor: Ryan Chang Illustrator: Neha Adari

RESEARCH

The ‘Cutting’ Edge Technology of CRISPR-Cas9 Writer: Gina Wiste Editor: Caelan Miller

The Heartbreaking Story of SARS-CoV-2 Writer: Soyi Sarkar Editor: Caelan Miller Illustrator: Alexandra Laufer

10 Breathing Through a Pandemic Writer: Haleigh Pine Editor: Rehan Mehta Illustrator: Alexandra Laufer

12 Hydroxychloroquine: What Even is this Mysterious Drug? Writer: Frank Lin Editor: Haleigh Pine Illustrator: Shelly Xu

SOCIOCULTURAL

14 Medicinal Music: Music Therapy as a Means to Treat Depressive Symptoms Writer: Carsen Codel Editor: Julia Bulova Illustrator: Jennifer Broza

16 How Can We Promote Preventative Care to the Underserved? Writer: Alexandra Dram Editor: Neha Adari Illustrator: Clair Huang

18 References

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FRONTIERS • LETTER FROM THE EDITORS

Dear Reader, In an era defined by a global pandemic, political turmoil, and social justice movements, it’s undeniably clear that our actions and words have historical implications. As students and members of the WashU community, we receive a constant stream of information about the world at unimaginable speeds. In an ever-changing world, we hope this message finds you healthy and well. As a student-led interdisciplinary health magazine, Frontiers is dedicated to educate, inform, and relay information to the public, while upholding the integrity of medical journalism. At our core, we are a group of passionate undergraduate students working to express our love for science, medicine, healthcare, and more. Now more than ever, we hope our commitment to medical journalism brings you relevant information that piques your curiosity during these tumultuous times. We are proud to present you with a diverse collection of articles engaging many multi-faceted aspects of medicine including public health, biomedical research advances and reflections on health policy, focused on our theme: Polarize. Whether it be the political climate or scientific opinions, many of us have begun to organize into distinct, often conflicting, categories. This issue, our writers, editors and illustrators have continued to work on creating a magazine that inspires meaningful relationships and breaks down boundaries between categories to facilitate purposeful journalism. We seek, above all, to create an environment that cultivates creativity, engages investigative writing and fosters open-mindedness amongst all members. Each article has been crafted by our passionate writers, critiqued with care by our attentive editors, designed by our imaginative illustrators and published behindthe-scenes by our dedicated executive members. If you would like to become a part of our Frontiers family, there is definitely a place for you! While our operations are currently remote, we are always excited to welcome new members, whether as a writer, an editor, an illustrator or a member of our Executive Board. We would also love to hear any of your comments, questions, suggestions and/or concerns. Please contact us at eic.frontiersmag@gmail.com or visit frontiersmag.wustl.edu for more information. Please take a glimpse of what our accomplished members have put into this issue. We are confident that it can shed a little light in our community, and perhaps, even beyond. “In times of profound change, the learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.” - Eric Hoffer Happy reading, Soyi Sarkar, Anhthi Luong Editors-in-Chief

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Thank you Dr. Danforth for your many contributions! “We see grand opportunities to use science to benefit humankind -- to feed the hungry, to protect the world’s environment for our grandchildren and great-grandchildren, and to provide discoveries that will help spark the next generation of science-based industry.” - Dr. William H. Danforth

FRONTIERS • POLICY

What Will Healthcare Look Like Under Biden’s Presidency? Writer: Kimberly Hwang • Editor: Isaac Mordukhovich

ealthcare was one of the most important topics in this year’s presidential election. Within healthcare, each candidate’s COVID-19 plans also became a hot topic during their debates. Now that Biden has become the president-elect, many are wondering what Biden’s healthcare plans will look like. Although Trump “has significantly ramped up [COVID] testing since the spring, [his] administration was initially painfully slow to distribute tests and personal protective equipment”[1]. Statistics of recovery and death rates demonstrate that early action was a key strategy in most countries that succeeded in curbing the effects of the pandemic, such as what New Zealand and Taiwan implemented [2]. Therefore, Biden does have limited power in how fast he can mitigate the effects of Trump’s decisions. However, he plans to increase accessibility for at-home testing so that people can avoid crowd gatherings and lower their risk of infection by avoiding testing centers. In addition to producing more personal protective equipment, he also wishes to allocate double the amount of funds that Trump did in order to produce and distribute vaccines to civilians [9].

In addition to producing more personal protective equipment, he also wishes to allocate double the amount of funds that Trump did in order to produce and distribute vaccines to civilians.

Vice-president elect Kamala Harris also plans to create “the COVID-19 Racial and Ethnic Disparities Task Force” in order to address causes that make minority populations much more vulnerable to infection than others. This task force would decide how to distribute “PPE… vaccinations” and “testing supplies”. It would also collect data on hospital treatment for different minority groups [4].

Biden promised to ensure that women could still have abortions even if the Supreme Court overturns Roe v. Wade. The pandemic is not the only important health issue that Trump and Biden disagree on. When it comes to reproductive health like abortion, Trump guaranteed that if he were re-elected, he would appoint judges to overrule Roe v. Wade, which has protected women’s legal rights to terminate their pregnancies since 1973. On the other hand, Biden promised to ensure that women could still have abortions even if the Supreme Court overturns Roe v. Wade. Biden is also going to reverse Trump’s cut down of the resources of Title X, the “federal program for affordable birth control and reproductive care”[7]. This has dramatically reduced Title X’s capacity to provide “contraceptive services” to “1.6 million patients” [3]. Biden wishes to replace his cabinet with more women and people of color [8]. One of the divisions of the Cabinet is called Health and Human Services

(HHS), which “protects the health of all Americans” through public health measures [5]. This executive department has a lot of influence over coronavirus measures as well as supporting The Affordable Health Act. Up until a few days ago, Biden’s top choices for this division’s secretary position were the“former Surgeon General Vivek Murthy, New Mexico Gov. Michelle Lujan Grisham and North Carolina Health Secretary Mandy Cohen” [8]. While Grisham is the only one already directly working with Biden, Murthy’s medical reputation and Cohen’s role in Medicare and Medicaid also makes her a strong candidate for this position [8, 11]. However, just a couple of days ago, Biden revealed his choice - Xavier Becerra. Biden’s choice surprised many people, as Becerra’s name was not on the potential candidates list predicted by different newspapers. Becerra is currently the “attorney general in California” and has led almost half of the US “in a campaign to protect the Affordable Care Act from being disman-

Biden wishes to replace his cabinet with more women and people of color. tled by his Republican counterparts. He has also been vocal in the Democratic Party about fighting for women’s health” [10]. As part of the Latinx community, Becerra will likely concentrate more of HHS’s resources on minority communities that are the most affected by the pandemic. However, Becerra has

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Illustrator: Noor Ghanam never led a “bureaucracy as large and diverse as HHS”. He also has little background in public health since a large portion of his previous work focused on “criminal justice and immigration” [6, 10]. Though it seems like Biden is more trusting of science and welcomes diversity more than Trump did during his presidency, we are yet to know whether

Biden will actually implement what he promised. Hopefully, this new administration will bring a long-overdue end to the pandemic. •

FRONTIERS • POLICY

Politicization and Polarization of COVID-19 Writer: Alicia Yang • Editor: Ryan Chang

“Y

ou stay completely apolitical and non-ideological. I’m a scientist and I’m a physician. And that’s it.” Anthony Fauci, the scientist-turned-public health activist who has run the National Institute of Allergy and Infectious Diseases for the past 36 years, shared his wisdom on how to function in a highly politicized and polarized nation. Fauci has worked with both political parties in six administrations to face public health crises caused by diverse pathogens including HIV, SARS, avian and swine influenzas, Zika and Ebola [3]. He has had to adapt throughout his career, first from a conventional bench scientist to a public health activist. But perhaps his greatest battle has been with the novel coronavirus and political entanglements.

He has had to adapt throughout his career, first from a conventional bench scientist to a public health activist. Politicians and the media amplify politicization and polarization of COVID-19, which influence the public, exacerbating the public health emergency and partisan divides. Even though Fauci has the approval of 78% of Americans for his high pressure position of advising President Trump on the government’s response to the pandemic and just 7% disapproval, he is not immune to critics. On right wing social media and talk radio, Fauci is routinely accused of being a “closet lefty” who overestimates the consequences of COVID-19 [3]. Even a scientist who swears by repeatable

and testable facts can be molded to the political games of our times. Politicization can be measured by the degree that politicians are mentioned in the context of another issue. Hart, Chinn and Soroka analyzed the degree to which newspaper and network news coverage of COVID-19 was politicized from March to May. They found that politicization significantly increased between March 6 and 13 and stayed elevated throughout the study period [2]. Using dictionary and unsupervised machine learning, they found that scientists were mentioned more than politicians. Compared to global warming news coverage — another highly politicized national issue — COVID-19 was slightly more politicized. Unlike the gradual entry of politics into climate science, the novel coronavirus that has taken the lives of over two hundred thousand Americans became politicized almost immediately [2].

of COVID-19 — primarily driven by conflict between the federal and state responses — has muddled the communication of accurate science [2].

The lack of a political consensus contributed to a lack of a unified and strong response to the pandemic.

The researchers also found that “both newspaper and network news coverage are highly polarized.” Polarization is the extent of division in political attitudes and can be measured by how discussion varies based on the presence of representatives of different political parties. The highly polarized coverage

In conjunction, politicization and polarization undermine the importance of expert objective knowledge and lead people to act based on their political affiliation rather than truth. Conflicting information broadcasted by political figures influences public attitudes and behavior. Indeed, members of Congress quickly polarized along party lines at the start of the pandemic. Democrats started discussing COVID-19 earlier and more frequently and tended to emphasize affected workers while Republicans focused more on the consequences of coronavirus-related restrictions [1]. The lack of a political consensus contributed to a lack of a unified and strong response to the pandemic.

The highly polarized coverage of COVID-19 — primarily driven by conflict between the federal and state responses — has muddled the communication of accurate science.

This divided response was also observed in the general public. Reported by the Pew Research Center on April 2, 78% of Democrats and left-leaning individuals responded that the outbreak was a major threat to the US population as a whole compared to only 52% of Republicans and right-leaning survey participants. Based on their political parties, respondents also differed in their opinion on Trump’s response to the outbreak and the

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long-term economic impact of the outbreak. Notably, more Republicans said that people across the country were overreacting (39%) as opposed to not taking the safety measures seriously enough (31%). Democrats, however, thought that people were not taking the pandemic seriously enough [4]. These perceptions have behavioral consequences, such as compliance with social distancing and mask-wearing guidelines [1]. There are, fortunately, points of agreement among all Americans regardless of political party affiliation. The majority of Democrats and Republicans agree that it has been necessary to close K-12 schools [4]. Most Americans also believe that public health officials have been doing an excellent or good job despite sharing experiences with unemployment. The points of agreement between partisans underscores the devastating effects of COVID-19. If we can depoliticize and depolarize public health and return to Fauci’s ideals of staying apolitical and non-ideological, perhaps we can coalesce a victory against prolonged sickness and isolation. Now is the time for a multilateral fight for life. •

Illustrator: Neha Adari

FRONTIERS • RESEARCH

The ‘Cutting’ Edge Technology of CRISPR-Cas9 Writer: Gina Wiste • Editor: Caelan Miller

his year, the Nobel Prize in Chemistry went to two women, Emmanuelle Charpentier and Jennifer Doudna, for the first time in the history of the award. The importance of two women receiving such a prestigious award in a field that has been historically dominated by men is evident, but what likely remains obscure to many people is what they received the prize for: CRISPR-Cas9 technology. CRISPR is an acronym that stands for “Clusters of Regularly Interspaced Short Palindromic Repeats” [4]. This is one of many natural defense mechanisms utilized by bacteriophages to protect against viral infections via matching sequences in the viral genome. When a virus infects the bacteria, the bacteria transcribes a single guide RNA (sgRNA) from the CRISPR locus in the bacterial genome. This sgRNA guides a nuclease, a protein with DNA-cleaving capabilities, to a target sequence in the viral DNA, which the nuclease then cleaves [4] . Since the viral genome has been cut, it can no longer infect the bacteria, and the bacteria is protected. CRISPR has implications as a potential gene editing tool through its ability to target specific DNA sequences via sequence complementation [1]. For example, if a DNA sequence is C-C-C, its complementary sequence is G-G-G. An sgRNA containing a G-G-G sequence would target the C-C-C sequence on the

CRISPR is an acronym that stands for “Clusters of Regularly Interspaced Short Palindromic Repeats”

Since the viral genome has been cut, it can no longer infect the bacteria, and the bacteria is protected.

California Berkeley have developed a diagnostic test for SARS-CoV-2 that delivers results within five minutes. Jennifer Doudna and her team reported that with a “single guide RNA, they could detect as few as 100,000 viruses per microliter of solution,” demonstrat-

DNA, bind to it and recruit a Cas nuclease to cleave the DNA at that sequence. In 2012, Charpentier and Doudna demonstrated that gRNAs could be constructed via molecular cloning to guide a Cas nuclease to any DNA sequence [1]. This means that scientists can now target specific DNA sequences through engineered gRNAs and recruit the Cas9 complex to cleave the complementary sequence.

Their test, which does not rely on viral genome amplification, can reveal “not just whether a sample was positive, but also how much virus a patient had”

CRISPR revolutionized the field of biomedical research as “it greatly reduces the time and expense of developing animal models with specific genomic

Additionally, CRISPR is also being considered as a weapon in the fight against COVID-19. changes” [4]. It has been used in humans as a treatment for sickle cell disease and is in clinical trials for treating human diseases caused by known DNA mutations, such as cystic fibrosis and certain inherited forms of blindness [4]. Additionally, CRISPR is also being considered as a weapon in the fight against COVID-19. Researchers at University of

ing a high degree of sensitivity [3]. Additionally, their test, which does not rely on viral genome amplification, can reveal “not just whether a sample was positive, but also how much virus a patient had” [3]. Data so far suggests that “amongst the [patients] hospitalized with COVID-19… a higher prevalence of detectable SARS-CoV-2 plasma viral load is associated with worse respiratory disease severity” [2]. CRISPR-Cas technology is challenging the world of science and pushing it forward day by day, and so, it seems only fitting that the people who spearheaded its discovery were two women who made Nobel Prize history. •

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The Heartbreaking Story of SARS-CoV-2 Writer: Soyi Sarkar • Editor: Caelan Miller • Illustrator: Alexandra Laufer

tiologically, SARS-CoV-2 is a virus that predominantly affects the respiratory tract: that is, our lungs and intricate airways. In the year that COVID-19 spread to every corner of our world, an increasing body of research demonstrates that this virus can wreak havoc on cardiac and vascular tissue. The ability for SARS-CoV-2 to lead to prolonged vascular implications, even years after recovery from typical viral symptoms renders SARS-CoV-2 research incredibly relevant [8]. In the early months of the pandemic, many researchers agreed that heart health was only compromised in cases of high viral load or severity of infection. In a study published in July, Valentina Puntmann et al. found that of 100 SARS-CoV-2 patients, 78% of them showed continued cardiac involvement while 60% of patients showed ongoing myocarditis [6]. Cardiac involvement includes abnormal cardiovascular magnetic resonance (CMR) readings, which measures irregularities, injury and inflammation to the heart tissue, while myocarditis is inflammation in the tissues of the heart that can result in arrhythmias or irregular pumping patterns [5]. The implications of these data are alarming; our heart health is in danger even in recovered patients [3]. While the recency of the SARS-CoV-2 pandemic has limited the study of longterm effects on cardiac health, the concern that heart failure could affect the younger infected population decades from now still remains [3]. There are a few methods to measure the cardiac implications of SARS-CoV-2. One way to measure the degree of cardiac inflammation is to measure the blood levels of troponin, an enzyme that is released from injured cardiac tissue.

Mitrani et al. showed that 20-30% of hospitalized patients with SARS-CoV-2 had elevated levels of troponin, indicating worse short term effects due to cardiac problems, and increased presence of ventricular arrhythmias [4]. Arrhythmias and other rhythmic and electrical abnormalities of the heart can be monitored using electrocardiograms

[4]. Interestingly, research has demonstrated that myocarditis can occur through both direct viral infections and immune inflammatory responses, enabling the possibility for asymptomatic individuals to potentially develop cardiac defects [4]. While poor cardiovascular health can be a downstream effect of SARS-CoV-2, it can also serve as a risk factor for severe illness. The angiotensin converting enzyme 2 (ACE-2) receptor is the main receptor that allows host cell invasion for SARS-CoV-2. That is to say, ACE2 receptors serve as the “gateway” of infection into our bodies. ACE-2 receptors are also known for their extensive role in modulating blood pressure and establishing homeostasis by negatively

...research demonstrates that this virus can wreak havoc on cardiac and vascular tissue. feedbacking on the renin-angiotensin-aldosterone system [3]. Since ACE-2 is known to increase blood pressure, many individuals afflicted with hypertension use ACE-2 inhibitors to lower their chronically high blood pressure [4]. In turn, “ACE inhibitors (ACEIs)… may upregulate ACE-2 [receptor] expression, thus increasing the availability of target molecules for SARSCoV-2,” thereby increasing host cell invasion and propagation [1]. This leads to the concern that individuals medicated with ACE inhibitors could be at a higher risk of contracting SARS-CoV-2 [1]. Another risk factor for SARS-CoV-2 that leads to poorer cardiac outcomes is obesity due to the presence of ACE-2 receptors in adipose tissues. In obese individuals, the contiguity of the myocardium and the epicardial adipose tissue leads to more infiltration of the SARS-CoV-2 via ACE-2 receptors and an overall increased inflammatory response, leading to tissue damage and long term cardiac damage [4]. In this way, obese patients are more at risk for tissue damage than non-obese patients. One area of further study would center around developing protocols for prognostic techniques for individuals postCOVID-19 infection. Patients with baseline elevated troponin levels and other risk factors like obesity should be monitored more closely to assess long term cardiac damage [3]. However, regardless of risk factors and presence of symptoms, vascular health and SARSCoV-2 are more intimately related than early research indicated them to be. •

FRONTIERS • RESEARCH

Breathing Through a Pandemic Writer: Haleigh Pine • Editor: Rehan Mehta

s most people have probably experienced by now, testing for COVID-19 can be uncomfortable, expensive, time-consuming or a combination of all three. The current standard for testing involves a nasal swab to collect a sample from the back of the nose and throat, which is then analyzed for SARSCoV-2 RNA by a reverse transcriptase polymerase reaction (RT-PCR). This process involves turning RNA into complementary DNA, adding fluorescent dye and then amplifying the DNA. This can indicate whether the virus is present and also how much viral load exists, which correlates to infection severity [3]. In some areas, results can take days, which only exacerbates transmission and mortality rates, while increasing the burden on healthcare systems [8]. Washington University in St. Louis’s saliva test does not require RNA extraction, so results are available in a few hours and can be communicated within a day [4]. However, as the number of cases continues to increase across the country and issues with accessibility advance, testing capacity needs more improvements. This is where the breathalyzer test comes in. Multiple research groups have developed a nanomaterial-based sensor that detects COVID-19 through disease-specific biomarkers [5]. Specifically, viruses and the cells they infect release volatile organic compounds (VOCs) that can be detected in an exhaled breath. Researchers linked an array of gold nanoparticles to molecules that are sensitive to various VOCs. Molecular interactions with the VOCS lead to changes in electrical resistance, which can then be detected by a sensor. In Wuhan, China, the machine was trained with 49 confirmed COVID-19 patients and 58 positive controls, along with 33 patients

Washington University in St. Louis’s saliva test does not require RNA extraction, so results are available in a few hours and can be communicated within a day. with lung infections but not COVID. In testing, the device has 76% accuracy in distinguishing positive cases from the control and 95% accuracy in distinguishing positive cases from lung infections. There was also 88% accuracy for discriminating between sick and recovered COVID-19 patients. The promise in this technology lies in its affordability, its potential for widespread distribution and increasing accuracy rates. A company in Singapore has been developing a breathalyzer test that will employ this technology. A clinical trial of their Breathonix device has shown an overall sensitivity of 93% and a specificity of 95% [2]. They liken the technology to creating a bio-fingerprint of COVID-19 through machine learning and see promise in high-traffic areas like airports and hotels, where they hope to incorporate disposable mouthpieces and one-way valves along with the breathalyzer. Even if the accuracy does not improve, it can be useful to screen large populations to decide who needs to undergo further testing [2]. Texas A&M is one of the colleges pioneering this effort, although the technology is still in the process of FDA approval for widespread use. The testing device the researchers developed looks like a kiosk where individuals use

a disposable straw to blow into a copper tube. Results can be sent to one’s personal cell phone in less than a minute and the copper tube is superheated between tests so future results are not contaminated. Currently, there are five kiosks on Texas A&M’s campus, and the mobility of the kiosk holds promise for bringing the device to large group settings such as concerts, sporting events and religious services [7]. Preliminary results show the accuracy is comparable to PCR tests, the current standard for diagnosis [6]. The University of Miami has a similar setup, where participants breathe a few puffs into a disposable, sterile TeraTube. The sample is sealed and fed into a BioSafety station to analyze the test in less than one minute and at the same cost as a cup of coffee. When students participate in their routine nasal swab test, they are also asked to use the breathalyzer for comparison of accuracy to the RT-PCR [1].

Specifically, viruses and the cells they infect release volatile organic compounds (VOCs) that can be detected in an exhaled breath. The chair of the Miller School of Medicine at the University of Miami, Roy E. Weiss, highlights the benefits: “It’s as simple as a kazoo—you just blow into it… It would allow us to test at a fraction of the cost and time of our current nasal swab test and as frequently and wherever necessary. There could

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provide the opportunity to assess risk in real time, which may help us more effectively curb transmission” [1]. Individuals are constantly being forced to make risk assessments. Is it okay to take public transportation just a couple of stops? If I take a sip of my coffee inside, what are the odds the stranger next to me is infected? The breathalyzer test would help to curb this constant worry with the knowledge that people are only let into areas after they have received negative results. Of course, there still must be caution, but breathalyzer tests compounded with social distancing efforts could decrease virus spread.

Illustrator: Alexandra Laufer even be stations before a football game. People would blow into the tube, get their results in a minute, and then if they’re negative, go in and enjoy the game” [1]. There are a variety of benefits beyond social interactions. Often more sophisticated and advanced tests are used to verify results from these more basic preliminary tests, but increased accuracy in breathalyzers could reduce the number of unnecessary confirmatory tests. There would also be decreased burden and exposure risk for hospitals, as symptomatic and anxious asymptomatic patients that enter the emergency room could be quickly tested or even sent back home if they were not in distress. There would be an improvement in the efficacy of point of care

facilities, where testing and patient care are provided on site in the same visit. Thinking ahead, this could be applied to other disease infection models as a diagnostic tool in the case of a new outbreak [5].

Thinking ahead, this could be applied to other disease infection models as a diagnostic tool in the case of a new outbreak. Erin Kobetz, the vice provost for research and scholarship at the University of Miami, expands on this by saying, “if approved, this test could

Of course, there still must be caution, but breathalyzer tests compounded with social distancing efforts could decrease virus spread. Although more testing is needed to determine the efficacy of these devices, it acts as a small step towards the normalcy we yearn to return to and serves as a reminder of the unrelenting efforts of the scientific community during this pandemic. The breathalyzer’s appeal comes from its ease of use, accessibility and distribution. As we begin to immunize the population, we must simultaneously focus on mitigating transmission among those still vulnerable and looking towards future public health crises in the context of emerging technology. •

FRONTIERS • RESEARCH

Hydroxychloroquine: What Even is this Mysterious Drug? Writer: Frank Lin • Editor: Haleigh Pine

oronavirus reached the United States on Jan. 13, introducing the first large-scale respiratory epidemic since the Spanish Flu [13]. In the panic of the following months, hydroxychloroquine, a drug that most people had likely never heard of before, became prematurely touted as an effective treatment for coronavirus patients. When a short, uncontrolled French trial of 40 participants purportedly showed hydroxychloroquine treating COVID-19 patients, certain politicians heavily promoted its results [8,5]. The U.S. President Donald Trump even touted it to the American people as a “game changer,” and as “very powerful” [2]. The statements of these politicians influenced the public’s actions greatly: in certain parts of France, hydroxychloroquine prescriptions increased by 7,000% [9]. Unfortunately, later controlled studies showed no benefit of hydroxychloroquine, and the drug has since faded from the public eye and the hospital wards [3]. Despite hydroxychloroquine’s sudden publicity, some questions exist that are not often answered for the general public. What does hydroxychloroquine do and why did scientists even think it could treat COVID-19? There are a wide variety of pharmacological effects that hydroxychloroquine has on the body, some of which cause deleterious side effects like heart problems and some of which can be beneficial in certain infections. Many of hydroxychloroquine’s pharmacological effects come from its action in the lysosome, the acidic and hydrolytic compartment of the cell that breaks down waste and phagocytose pathogens. In a phenomenon called lysosomal trapping, high concentrations of hydroxychloroquine can get trapped inside of

lysosomes. This phenomenon is due to the fact that uncharged hydroxychloroquine can enter the lysosome, but cannot exit the lysosome since it becomes positively charged in the lysosome’s acidic atmosphere [6]. By accumulating in the lysosome, the slightly basic hydroxychloroquine makes the lysosome less acidic, which inhibits the activation of lysosomal hydrolytic enzymes [10]. This inhibition confers some pharmacological benefits in treating malaria and certain viruses, but studies have not shown benefits in SARS-CoV-2.

What does hydroxychloroquine do and why did scientists even think it could treat COVID-19? In the case of malaria, hydroxychloroquine enters the parasite lysosomes, prevents the crystallization of an ingested chemical group called heme, and causes the buildup of toxic heme groups that eventually kill the parasite [12]. In the case of viruses, hydroxychloroquine interferes with the deployment of the spike protein, a viral structure that allows for it to bind to the host membrane and fuse the host and viral membrane together, in turn allowing for viral genetic material to enter and infect the cell. These spike proteins activate in the lysosome when specific acid-activated proteases cleave spike protein precursors on the viral membrane [1]. Since hydroxychloroquine makes lysosomes less acidic, these proteases cannot be activated, and hence, the virus theoretically would not be able to use its spike proteins to infect the host cell. This kind of logic is what

guided initial guesses of hydroxychloroquine working against COVID-19. Beyond getting trapped in the lysosome, hydroxychloroquine can also suppress excessive immune responses by inhibiting antigen presentation on professional antigen-presenting cells. It also inhibits the TLR9 innate immune receptor, which leads to suppressed inflammation; this is beneficial because inflammation causes many of the issues associated with autoimmune diseases [14,4]. For these two reasons, hydroxychloroquine is prescribed for patients with certain autoimmune diseases like rheumatoid arthritis or lupus. The pharmacology of hydroxychloroquine shows how a promising, multi-application drug that should work in theory must be thoroughly tested through scientific procedures in practice before being widely promoted. The consequences of our haste have caught up to us. The U.S. bought 29 million pills of hydroxychloroquine – money that could have been spent on PPE, funding research or providing economic relief [7]. People who actually needed hydroxychloroquine were also affected; in a survey done by the Lupus Research Alliance, over 31% of US lupus patients who needed hydroxychloroquine struggled to fill prescriptions from March to May [11]. Finally, the hydroxychloroquine may have caused side effects with lasting damage in an untold number of patients. The story of hydroxychloroquine is a sobering reminder that we cannot afford to handle scientific results in a reckless manner no matter how much we want them to be true. Influential figures must realize that public health is not a game – people die, livelihoods are shattered and everyone suffers. •

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Illustrator: Shelly Xu

FRONTIERS • SOCIOCULTURAL

Medicinal Music: Music Therapy as a Means to Treat Depressive Symptoms Writer: Carsen Codel • Editor: Julia Bulova • Illlustrator: Jennifer Broza

ith the days getting shorter, the cold settling in and finals approaching, it can be easy to fall into the winter blues. Stress and anxiety can spike and sadness encroaches on our minds without welcome. However, recent studies in the field of music therapy may reveal some methods to help turn one’s mood around. One psychological study examined the effects of music on fostering well-being for young people aged 15-25. The study found that music helped to increase positive relationship building, modify negative emotions, improve the mental state and deal with emotions in a healthy way [4]. It should be noted that since the study was based on surveying and interviews, it is unclear if some music may work better than others; the use of music was very individualized to each respondent. However, many reported that music created an improved sense of well-being. A review of both active (physically playing/making music) and receptive (listening and responding to music) music therapy concluded that, when added to regular treatment of depression, music therapy has a positive effect on reducing depressive symptoms [1]. Both actively making music and listening to music reduced anxiety symptoms and helped treat depression when paired with traditional treatment. Maratos et al.’s review of music therapy analyzes what specific aspects of music therapy can help depressive patients [3]. In the context of this article, a trained music therapist utilized active music therapy by playing music with a patient in an improvised fashion. The therapist assisted the patient in making music by providing a bass line, or

accompaniment, to the patient’s improvised melody. Together, the therapist and patient built a positive relationship through the shared experience of making music together. For example, if the music therapist plays a satisfying chord progression overlaid with a cool melody by the patient, both the patient and therapist experience the shared joy of an enjoyable musical moment, further developing their positive relationship. The patient is also able to find meaning-making and pleasure through the satisfaction of creating an interesting melody or reaching the closure of a chord progression. Additionally, music

therapy enables patients to engage in the physical activity of playing an instrument, and physical activity is one means of counteracting depressive symptoms. Sometimes, the best medicine for a bad mood is a good night’s rest. One meta-analysis of five different studies looked into the use of music-assisted relaxation as a means to improve subjective sleep quality. The meta-analysis found a statistically significant improvement in sleep quality from listening to music before sleep [2].

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“ ...music helped to increase positive relationship building, modify negative emotions, improve the mental state and deal with emotions in a healthy way” I myself am a rather musical person. I listen to music all throughout my day, play the piano, sing and even produce my own songs in my free time. I wanted to recommend some of my go-to albums and songs for when I am in a bad mood, or just need a moment to reflect. Hopefully these songs can instill the same positivity or reflection in you as they do in me. For Relaxing: One of my favorite albums for relaxation is “Getz/Gilberto”, a jazz bossa-nova album featuring the smooth saxophone of Stan Getz and the beautiful vocals of Astrud and Joao Gilberto, with a mix of English and Portuguese lyricism. All of the songs on the album are very soft and gentle and help to put me in a relaxed mood. Perhaps one could even improvise along to Stan Getz’s solos, akin to the active music therapy from Maratos et al.’s article. Another of my favorite albums for relaxation is “Solitude.” by Jinsang. Jinsang is a lofi hip-hop producer, and Solitude. is my favorite album of his. His use of vintage samples and great drum sounds creates a relaxed atmosphere that is conducive

for studying. A third great album for relaxing is “a word becomes a sound EP” by Kate Bollinger. Bollinger is a new artist who melds touches of alternative, jazz and pop together into a smooth, warm sound. For Jamming: Music therapy studies often note that listening to music can be a great way to lift a mood or alter negative emotions [4]. I have three songs that always get my foot tapping and put a smile on my face. The first is “Funky Galileo” by Sure Sure. The song features tongue-in-cheek lyrics about heliocentrism and an infectious chorus. Another song is “Baby I’m Yours” by Breakbot. This song has been used in several memes throughout the years and is extremely upbeat. A third song that can help me out of a bad mood is “Dreaming” by Master Soul Boy. Master Soul Boy’s beautiful musical arrangement, driving beat and joyous background vocals and ad-libs throughout the song always lift my mood. For Getting in my Feels: The review of music and well-being for youth I referenced earlier highlighted how youth often used music to get in touch with their feelings, often using lyricism to relate to their current situations [4]. I often find myself using music to fully experience my emotions; the album that does this best for me is “Apricot Princess” by Rex Orange County. Rex’s deeply personal lyrics and beautiful instrumentals create the perfect way for me to get in touch with my emotions. Music therapy, when paired with traditional treatment, has been demonstrated to help alleviate depressive symptoms through helping a patient cope with emotions, get better sleep,

engage their brains and modify negative emotions and mental states. In the dark of winter and the grind of school, sometimes the best thing you can do is take a break, listen to your favorite song and take a deep breath. The best prescription for a bad mood may just be some good tunes. So put on your headphones and jam out. You may just feel better afterwards. •

FRONTIERS • SOCIOCULTURAL

How Can We Promote Preventative Care to the Underserved? Writer: Alexandra Dram • Editor: Neha Adari

ith cancer as the second leading cause of death, bureaucratic and financial support for preventative care is needed now, more than ever. Indeed, an estimated 42% of cancers are preventable; however, underserved communities are characterized by “inadequate access to, or reduced utilization of, high quality cancer prevention, screening and early detection, treatment, and/or rehabilitation services” [1]. Furthermore, studies demonstrate inequities across ethnic and racial groups propagated by fewer opportunities for medical screenings, provider counseling and clinician recommendations. Sociocultural factors, including differential environmental exposures, psychological stressors, poor diet and lacking health risk education contribute to disparities across socioeconomic statuses. Insufficient job security, child care opportunities and transportation availability present significant difficulties for underserved populations.

Indeed, an estimated 42% of cancers are preventable... Reducing these disparities first requires a frameshift for disseminating prevention strategies through educational materials. A 2013 study conducted by the Center for Disease Control investigated how patient knowledge and beliefs impacts the prevalence of pap smear testing for cervical cancer prevention. Results revealed that 57% of low income women participants would get more frequently if instructed to do so by their physician [2]. Furthermore, between 58%–72% of study participants

Illustrator: Clair Huang

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believed false information about the purpose of the exam itself [2]. Providing tailored educational resources for underserved communities would help increase awareness and decrease misinformation even when primary care facilities fail to provide adequate assistance on this front. Primary care is indeed lacking for many underserved communities, where about 6700 primary care Health Professional Shortage Areas (HPSAs) were identified across the country as of July 2017 [3]. Increasing access to information about screening health benefits, warning signs and symptoms of contributory disorders, institutional resources for underserved persons and lifestyle wellness habit development are only part of the first steps towards acknowledging existing health barriers and seeking alternative solutions to increase promotion of preventative measures. Connecting underserved individuals with counseling services and positive networks would also ensure the often lacking continuity in follow-up care. Measures for reducing prevalent risk factors are also key pillars in the promotion of preventative health. An estimated 13% of global cancer incidence was attributed to infection in 2018, a statistic particularly concerning for underserved communities experiencing higher risks of developing cancer linked infections due to reduced availability for medical care and prevalent environmental exposures [4]. Thus, vaccine promotion is a critical step in reducing cancer rates. Encouraging more regular testing for environmental toxins is another measure that would have significant impacts on reducing cancer risks. Studies have shown that a major source of exposure to ionizing radiation is the naturally occurring

radon gas in the basement of homes; however, the “significant and negative correlation between income and radon levels” demonstrates how dangerous environmental exposure for radon disproportionately affects the underserved [5]. Additional opportunities for reducing prevalent cancer risks are associated with facilitating greater distribution of fruits and non-starchy vegetables, as concluded to be associated with decreased cancers of the mouth, esophagus and stomach by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) [5]. Promoting good health overall as a preventative measure also assists in reducing an array of cancer comorbidities, which lead to worse health outcomes.

An estimated 13% of global cancer incidence was attributed to infection in 2018, a statistic particularly concerning for underserved communities experiencing higher risks of developing cancer... Expediting progress on preventative care promotion through education reform on these topics and opening pathways for connecting individuals to resources they need is critical. As new opportunities for revitalizing healthcare open in 2021, cancer prevention care in underserved communities warrants greater attention and action than ever before. •

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Hydroxychloroquine: What Even is this Mysterious Drug? Author: Frank Lin

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p.14-15 Medicinal Music: Music Therapy as a Means to Treat Depressive Symptoms Author: Carsen Codel

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How Can We Promote Preventative Care to the Underserved? Author: Alexandra Dram [1] Fair, A. M., Wujcik, D., Lin, J. M., Zheng, W., Egan, K. M., Grau, A. M., Champion, V. L., & Wallston, K. A. (2010, Aug. 25). Psychosocial determinants of mammography follow-up after receipt of abnormal mammography results in medically underserved women. Retrieved from https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC2927817/ [2] Hawkins, N., Benard, V., Greek, A., Roland, K.,

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