Vol. 14, Issue 1

In This Issue Designing Spaces Around Diseases • 5 In Support of Revitalizing Public Health • 17 Anti-Vaccination Sentiment in the Face of COVID-19 • 26

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FRONTIERS • TABLE OF CONTENTS

NORMALCY 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.

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

Writers Alexandra Dram, Alicia Yang, Alyssa Hyman, Annie Feng, Ayda Oktem, Ben Lieberman, Carsen Codel, Casey Connelly, Eileen Yang, Gina Wiste, Haleigh Pine, Jason Zhang, Jihoon Kiel, Kevin Oloomi, Kimberly Hwang, Maya Kovacevic, Maya Patel, Meher Arora, Neha Adari, Rehan Mehta, Ricky Illindala, Rida Qureshi, Soyi Sarkar, Zoe Dolinsky

Want to get involved?

Please email us or visit our website.

Website

frontiersmag.wustl.edu

Editors

Writers and Editors

Akshay Govindan, Alexandra Dram, Anhthi Luong, Annie Feng, Caelan Miller, Daniel Berkovich, Eileen Yang, Haleigh Pine, Haley Pak, Isaac Mordukhovich, Jessica Wu, Keshav Kailash, Morgan Leff, Neha Adari, Ryan Chang, Sophia Dutton, Sophia Xiao, Soyi Sarkar

Illustrators

eic.frontiersmag@gmail.com

design.frontiersmag@gmail.com

Exec Board

Illustrators Alexandra Laufer, Angela Chen, Annie Liu, Elena Bosak, Eugenia Yoh, Haley Pak, Jennifer Broza, Lucy Chen, Neha Adari, Noor Ghanam, Shelly Xu, Zoe Dolinsky

frontiersmag@gmail.com

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Letter from the Editors Soyi Sarkar, Anhthi Luong

ENVIRONMENT

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Class Spotlight: Writing and Medicine Dr. Jennifer Arch, Ph.D

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The Pandemic Phenomenon Writer: Alyssa Hyman Editor: Caelan Miller Illustrator: Jennifer Broza

GLOBAL

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Designing Spaces Around Diseases Writer: Zoe Dolinsky Editor: Neha Adari

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The Blast Only Exposed A Bigger Problem: A Timeline of Lebanon’s Struggling Healthcare Writer: Jihoon Kiel Editor: Ryan Chang Illustrator: Noor Ghanam

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The State of Abortion Clinics During the Pandemic Writer: Ayda Oktem Editor: Haleigh Pine Illustrator: Noor Ghanam

10 The Future Course of Pandemics Writer: Neha Adari Editor: Haley Pak Illustrator: Neha Adari

POLICY

12 From Cowpox to COVID-19: A Brief Overview of Vaccination Writer: Gina Wiste Editor: Soyi Sarkar Illustrator: Eugenia Yoh

15 Can Money Buy Happiness? A Look at UBI and Mental Health Writer: Carsen Codel Editor: Haleigh Pine

17 In Support of Revitalizing Public Health Writer: Alexandra Dram Editor: Soyi Sarkar

19 The Political Reality of “Curing” Cancer Writer: Meher Arora Editor: Annie Feng Illustrator: Angela Chen

PUBLIC HEALTH

So You Want To Be A Centenarian?: A Look into the World’s Lon22 gest-Living Populations Writer: Maya Patel Editor: Neha Adari Illustrator: Neha Adari

24 Could Vaccines Really Solve the Pandemic?

Writer: Kimberly Hwang Editor: Sophia Dutton Illustrator: Elena Bosak

26 Anti-Vaccination Sentiment in the Face of COVID-19 Writer: Eileen Yang Editor: Daniel Berkovich

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FRONTIERS • TABLE OF CONTENTS

27 The Weight of Quarantine: Impacts of COVID-19 Restrictions on Unhealthy Weight Gain and Obesity Writer: Jason Zhang Editor: Sophia Xiao Illustrator: Haley Pak

30 Herd Immunity: The Foolproof Solution to COVID-19 Writer: Ricky Illindala Editor: Akshay Govindan Illustrator: Noor Ghanam

32 Casual Cruelty: Pandemic Profiteering in a Failing Healthcare System Writer: Annie Feng Editor: Jessica Wu

34 Utilizing Technology in the Age of Addiction Writer: Haleigh Pine Editor: Daniel Berkovich

36 Time to Vaccinate Writer: Alicia Yang Editor: Haley Pak

37 A Double Whammy: Flu & Coronavirus Writer: Kevin Oloomi Editor: Eileen Yang Illustrator: Elena Bosak

39 To School or Not to School Writer: Casey Connelly Editor: Anhthi Luong Illustrator: Jennifer Broza

41 Blame it on the Alcohol: How Hand Sanitizer Overuse May Create a Superbug Writer: Rida Qureshi Editor: Haleigh Pine Illustrator: Angela Chen

RESEARCH

43 Expanding Telehealth for Diabetes Management Writer: Rehan Mehta Editor: Keshav Kailash Illustrator: Lucy Chen

45 PTSD and the Neurobiological Basis of Trauma Writer: Soyi Sarkar Editor: Alexandra Dram Illustrator: Shelly Xu

SOCIOCULTURAL

47 Breaking Down the Language Barrier Writer: Maya Kovacevic Editor: Isaac Murdokuvich Illustrator: Haley Pak

50 The Pandemic in Uniform Writer: Ben Lieberman Editor: Anhthi Luong

52 References

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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 as well as the opportunity to gain insight on how these tumultuous times have led to a “new normal”.

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, this time focused on our theme: Normalcy.

Whether it be adjusting to new public health guidelines or finding new ways to build connections with our peers, we have redefined changing circumstances as the “new normal.” This issue, our writers, editors and illustrators have continued to work to create a magazine showcasing meaningful relationships between contributors, while bringing insightful articles to readers, like you, to immerse themselves in the text. 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. We hope that some of these articles pique your curiosity and showcase the hard work and dedication devoted to publishing a magazine that enables us to spread informative and scientific ideas.

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 look at our website 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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FRONTIERS • ENVIRONMENT

Class Spotlight: Writing and Medicine Dr. Jennifer Arch, Ph.D • Senior Lecturer in the Department of English

What courses do you teach? What is your teaching philosophy in general?

Since 2003, I have taught a variety of courses in the English Department and the Medical Humanities Minor, including History of the English Language, Writing and Medicine, Argumentation, Literature and Medicine, The Sentence in English, Prose Style in English: History and Craft, and Early Texts and Contexts. In the spring I will teach a new first-year seminar called A World Without Time: The Literature of Pandemic Disease. With such a range of courses, I necessarily assign readings in a variety of genres: poetry and prose, lyric and epic, essays and journalism, fiction and non-fiction, Middle English and Modern English. My general aim in all these courses, however, is the same: to show students the power of language to create meaning, to describe experience, and—in a society in which discussions of public policy still are conducted mostly in long-form writing—to influence the thinking of those who are working to improve the lives of individuals or to change the shape of our society in positive ways.

What is Writing and Medicine? Why did you create it?

I created Writing and Medicine back in 2011 to give students the opportunity to read and discuss excellent recent essays on the general theme of medicine.

We study writings by patients, physicians, and journalists who use various rhetorical means to describe what it is like to be a patient or a physician in the modern American health care system.

The course fulfills the WI requirement; I have tried to create assignments that allow students to do their own thoughtful writing on the topics of illness and

medical care. Although many of the students who take the course are pre-medical and pre-dental, insofar as the subject of medicine is relevant to everyone, I’m happy to say that students with other professional aims also seem to have found value in it.

What do you hope students will learn in Writing and Medicine?

I hope students will learn from the course that good writing is essential for communication in any field related to medicine, whether in patient care, public conversation about policy, memoir, or any other kind of discussion. The

texts I choose—by influential writers such as Susan Sontag, Atul Gawande, Siddhartha Mukherjee, Michele Harper, Alice Trillin, Danielle Ofri, Terrence Holt, Nancy Mairs, Oliver Sacks, Audre Lorde, Laura Hillenbrand, Barbara Ehrenreich, Jerome Groopman, and Michael Specter—offer various models which students may choose to imitate in their own work. I also hope to impress upon students the value of reading longer-form works even if not directly related to their chosen fields, not only because reading itself is rewarding, but also because responsible citizenship requires being informed on matters of general interest. Reading is the best way to become so informed.

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The Pandemic Phenomenon Writer: Alyssa Hyman • Editor: Caelan Miller

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e are currently in the middle of the COVID-19 pandemic. We are faced with an extreme amount of uncertainty. Every day, we hope for the return to normalcy. We wish that life would just return to the way it was. We want this to end. Unless we change the way we interact with the environment, we will experience many, many more of these devastating diseases.

SARS-CoV-2 is a zoonotic disease, as were SARS and Ebola. A zoonotic disease is an infectious disease that is transmitted between vertebrate animals and humans [2]. Novel zoonoses are emerging at a rapid pace, yet were prominent prior to the most recent one, COVID-19. According to the CDC, six out of every 10 infectious diseases found in humans are zoonotic. Spill-over occurs when a pathogen has the ability to jump from an animal to a human, thus giving it the power to spread disease [5].This spillover of disease from animals to humans is directly correlated to the way society interacts with nature. The more rainforests that get cleared, the more likely an interaction there is to occur between humans and animals [3].

Surprising to some, the actions of our society are a reason for this continual rapid emergence of zoonoses [4]. “The closer humans are to animals… the greater the likelihood of interactions between them, and the greater the opportunity for zoonotic spillover.”

Animals have always lived in environments with each other, meaning they have interacted with the same species for decades without a pandemic like this one. It was not until the recent increase in deforestation that humans started entering ecosystems [4].

The Rainforest Alliance stated that by

Illustrator: Jennifer Broza not taking care of the planet, we are not taking care of ourselves [2]. When we destroy forests, we also destroy thriving and balanced ecosystems. This results in the concentration of animals into smaller areas, which enables them to more easily swap infectious diseases.

This also increases the chance of the emergence of a novel strain [3]. Studies show that “Stopping deforestation will not only reduce our exposure to new disasters but also tamp down the spread of a long list of other vicious diseases that have come from rainforest habitats—Zika, Nipah, malaria, cholera and HIV among them.”

There are feasible ways to prevent destruction, which will in turn decrease the chance of zoonotic disease transmission. If humans were to eat less meat, there would be a reduced demand for crops; if humans were to consume fewer processed foods, the palm oil demand would also decrease [3]. These lifestyle changes can save the forests, therefore decreasing the probability of another zoonotic disease being passed to humans. Currently, only “15 percent of the world’s rainforests still remain intact.” If humans do not make a concerted effort to stop deforestation, we will continue to suffer from deadly pandemics.

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FRONTIERS • ENVIRONMENT

Stopping deforestation will not only reduce our exposure to new disasters but also tamp down the spread of a long list of other vicious diseases...

Unless society as a whole makes an effort to save our planet, we will continue to experience and suffer from pandemics. Ecosystems are delicately balanced and when disturbed, previous inhabitants have the capability to interact with humans in a manner that can lead to the creation and spread of other novel zoonoses. Deforestation and pandemics are tightly linked, and the only way to stop the pandemic phenomenon is to change how we interact with the natural world. •

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Designing Spaces Around Diseases Writer: Zoe Dolinsky • Editor: Neha Adari

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t a TED talk in 2016, Michael Murphy, founding principal and executive director of MASS design group, described a hospital in Tugela Ferry, South Africa in which a person could walkin with a broken leg and leave with a drug-resistant strain of tuberculosis [3].

This hospital became the center of a tuberculosis outbreak. Why? Unventilated hallways and overcrowded waiting areas. A poorly designed hospital became a hub for the airborne virus, tuberculosis [3]. A building meant for its patients to heal was putting their health at a greater risk.

In healthcare design, every decision matters. The floorplan, the materials, and the circulation can all impact the functioning of a building as a space for treatment, recovery, and healing.

Understanding what went wrong in hospitals such as the one in Tugela Ferry can give insight into how buildings can be customized to limit the spread of disease. With the help of Dr. Paul Farmer, a leading global health activist, and Bruce Nizeye, a skilled local engineer, Murphy designed a hospital in Butaro, Rwanda with simple changes that allow the hospital to protect the health of its patients [2, 3]. Hallways were moved to the outside, natural ventilation was incorporated throughout the hospitals, and all patients were given a view of the natural surrounding area [3]. Murphy claims a simple view of nature can drastically improve health outcomes [3].

Designing spaces for disease control is particularly important during the current coronavirus pandemic. Similar to tuberculosis, the coronavirus is an airborne disease that can be transmitted via aerosolization. This means that the coronavirus not only spreads through close contact, but it also stays suspended in the air. In order to mitigate

Open windows, air filtration and fans are all effective ways to maintain air circulation and limit the spread of disease. close-contact transmission, spaces must be designed to adapt for social distancing. If possible, communal spaces could be redesigned to be outdoors such as the hallways in Butaro District Hospital in Rwanda [2]. There must also be effective ventilation systems to prevent aerosol transmission. Open windows, air filtration and fans are all effective ways to maintain air circulation and limit the spread of disease [1].

At Washington University, professor of advanced building systems and architectural design, Hongxi Yin, is exploring ways to effectively filter air before it leaves a building [5]. He explains that hospital operating rooms have negative air pressure, meaning that more air enters than leaves the room [5]. This is done so that the exhaust from the room can be collected and released outside from one main place in order to avert the contaminations from spreading throughout the rest of the building [5].

However, in densely populated places like Wuhan, China, the emission of the virus from buildings may be contributing to the spread of the coronavirus [5]. Yin has been exploring one way to prevent this: by exposing the exhaust to extremely high temperatures [5].

Although more research is needed, this is one potentially extremely effective possibility for treating the exhaust before it is taken out of the building.

Another consideration in COVID-era design is transmission via contaminated

surfaces. Traditionally, hospitals are designed with non-porous materials such as plastic and stainless steel [1]. This is because these materials are easy to clean for controlling the spread of infectious diseases. Porous materials such as wood, fibers and cotton are rarely used in hospitals. However, the coronavirus has been found to persist on porous surfaces for only about 24 hours compared to non-porous surfaces in which it can last much longer [1]. Thus, porous surfaces must be cleaned more often.

What may have worked for previous infectious diseases may not work for the coronavirus. Design needs to adapt and respond to present realities.

Beyond practical physical changes to our built environment, the MASS design group is representative of a timely shift in the way we think about architecture.

Architecture needs to put the health of people and their environment first.

Buildings can be powerful. A clinic in Haiti with a focus on water filtration could prevent the spread of cholera [3]. A birthing center in Malawi could encourage safe birthing and prevent maternal and infant mortality [3]. An educational center in the Congo could protect biodiversity [3]. These projects

by MASS represent the importance of design in mitigating health crises and prioritizing the well-being of its inhabitants.

In this global health crisis and any potential future ones, architecture must be resilient, adaptive and designed with intention and care. Ultimately, the buildings we inhabit need to be places of refuge, inspiration and healing. With cultural sensitivity and empathy, designers play an important role in the way we face health crises. In particular, architects must consider seemingly small details and larger systems that prioritize health. •

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FRONTIERS • GLOBAL

The Blast Only Exposed A Bigger Problem: A Timeline of Lebanon’s Struggling Healthcare Writer: Jihoon Kiel • Editor: Ryan Chang

Illustrator: Noor Ghanam

T

he world took notice on Aug. 4, 2020 when a large amount of ammonium nitrate at a port in Beirut, Lebanon exploded, killing at least 220, injuring 6000 more and leaving over 300,000 people homeless (1). As of Oct. 19, 2020, investigators suspect that a fire preceding the blast was responsible for the destruction. While the immediate list of injuries and casualties are truly horrific, the blast only revealed a deeper conflict of Lebanon’s struggling healthcare system resulting from economic and political unrest.

Before the explosion took place, Lebanon was already dealing with an unprecedented economic crisis.

Dating back to 2019, Lebanon saw its currency drop by almost 70 percent its original value and was already one of the most indebted countries globally mainly due to economic inequality between the wealthy and the poor (2).

According to the Washington Post, a series of controversial government taxes, including one on the technology program WhatsApp, followed by a long history of excessive reliance on imports

and government borrowing from banks slowly diminished both the nation’s currency and the images of the wealthy and political elites (3). Anti-government protests began in response, and while the majority were peaceful, impatience towards poverty and a refusal by the government to provide economic aid contributed to an eruption of violence between protestors and government officials. The coronavirus only worsened the conflict when the government enforced lockdowns to contain the virus, plummeting currency values further

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...impatience towards poverty and a refusal by the government to provide economic aid contributed to an eruption of violence... and increasing food prices to an economy already in free fall (4). Dissatisfied citizens began calling for change in the country’s government.

Lebanon’s healthcare system was already struggling to sustain operations as the economic and political crisis prevented many hospitals from accessing medical resources. The devaluing of its currency made it difficult for hospitals to purchase medicine and supplies abroad, while vaccinations, prescriptions and doctor visits became unaffordable for many patients (5). The violent government protests also created strain on hospitals to care for injured protestors in addition to regular patients. As Dr. Elie Saliba described in a National Public Radio interview, during the protests, his clinic at a children’s hospital treated protestors hurt by security at night and cared for children with cerebral palsy during the day (5).

The emergence of the coronavirus in 2020 only furthered the stress on hospitals, who now had to treat COVID-19 patients as well.

When the ammonium nitrate exploded in Beirut, the blast destroyed nearby warehouses and a portion of the sea port close to where the chemical compound was being stored. However, the explosion also severely damaged at least four major hospitals, including

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St. George, one of Lebanon’s largest (6). St. George, like many other hospitals in Lebanon, was already providing care for injured government protestors, coronavirus victims and other patients.

The explosion not only injured caregivers and patients inside the hospital, but also damaged medical equipment and compromised services. None could have felt the impact more directly than the cancer patients of young children.

According to an article by the New York Times, many children diagnosed with cancer were receiving chemotherapy treatment on a strict schedule by doctors prior to the explosion (6). Because of the lack of medical supplies and the immediate surge of hospital patients injured by the blast, young children became unable to receive their routine chemotherapy from doctors.

...political and economic tensions have only continued as Prime Minister Hassan Diab and his Lebanese government have resigned...

Global response to Lebanon’s healthcare and humanitarian crisis has been full of delay and struggle. While world leaders from countries like France and the United States have pledged to give approximately 300 million dollars in humanitarian aid to Lebanon, there have been increased calls for more substantial action aside from donations (2). After the ammonium nitrate explosion, French President Emmanuel

Macron visited Beirut and later called for significant economic and political reform during an international video conference with global leaders. In the video call, Macron urged Lebanese authorities to act and “respond to the aspirations that the Lebanese people are expressing right now, legitimately, in the streets of Beirut.” (7). However, in the weeks and months following the explosion, political and economic tensions have only continued as Prime Minister Hassan Diab and his Lebanese government have resigned following protests for change in the country (2).

Until now, Lebanon’s healthcare crisis has been left unnoticed by many, including the United States, with a system suffering from political and economic corruption. For several years, the Lebanese government has failed to meet the demands of its people, and it unfortunately took the explosion to pressure the country to address healthcare reform. While it appears unlikely that Lebanon will find an immediate solution, the rest of the world has made a collaborative effort to aid the country in the process. One would do a disservice to simply ignore the problem and wish it would resolve on its own.

Rather, every nation and individual has a moral obligation to remain informed and provide support in any form during unprecedented times. •

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FRONTIERS • GLOBAL

The State of Abortion Clinics During the Pandemic Writer: Ayda Oktem • Editor: Haleigh Pine

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oronavirus has affected the regular functioning of most systems in the United States, including healthcare. Especially in Missouri, accessing healthcare that is not considered essential has been extremely difficult.

The debate around abortion access, a time-sensitive and sometimes life-saving treatment, was accentuated during the pandemic. Some states, such as Mississippi and Alabama, have closed down abortion clinics or restricted hours, failing to acknowledge patients’ abilities to access safe abortions in other states (1). Travelling during a pandemic can increase the risk of contracting or transmitting the virus. While Missouri did not shut down its abortion clinic, the state legislature did try to limit their use. To understand how Missouri handled abortion procedures during the pandemic, it is reasonable to take a look at its political body.

There is only one abortion clinic in Missouri, at the Planned Parenthood in St. Louis.

When Donald Trump won the presidency, the anti-abortion platform had the majority in the House, Senate and Executive Branch. In 2018, long-time incumbent United States Senator Claire McCaskill lost to Josh Hawley, who is openly anti-choice. Since his election, he has cosponsored the No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act (2), which would enact a permanent, government wide ban on federal funding

for abortions. He also publicy stated that Roe v. Wade was “one of the most unjust decisions in US judicial history”, and that abortion is unconstitutional.

Within Missouri,there is legislative intent to restrict abortion to the extent that is allowed by Roe v. Wade.

Furthermore, there is only one abortion clinic in Missouri, at the Planned Parenthood in St. Louis.

The protestors do not wear masks and try to interfere with the patient’s personal space, creating a substantial health concern...

When abortion clinics started to file lawsuits against states asking to open back up full time to meet the demand, Missouri filed briefs to support states that restricted access to abortion clinics. While Planned Parenthood in St. Louis and Hope Clinic in Illinois (even though it is located in Illinois, Hope Clinic is a mere 31 minute drive from the WashU campus) remained open with regular hours, people seeking care were encountered with a different threat to their safety: anti-choice protesters (3).

An abortion clinic escort is responsible for assisting patients and sometimes staff to enter and exit abortion clinics safely. Planned Parenthood in St Louis could not allow clinic escorts to work during the height of the pandemic since escorts have to be in close proximity

with multiple people, including the pregnant person, anti-choice protesters, and other escorts. Escorts have to be especially close with the pregnant person as they are trying to walk to the clinic doors, so Planned Parenthood had to halt their important work.

While clinic escorts haven’t been reinstated in Missouri, Hope Clinic and Planned Parenthood Fairview Heights in Illinois have resumed this practice to ensure the patients feel safe and welcomed (4).

This doesn’t stop the antichoice protestors from coming to the abortion clinic and crowding the entrance, Antichoice groups tend to include more than five people. The protestors do not wear masks and try to interfere with the patient’s personal space, creating a substantial health concern for the pregnant person, healthcare professionals inside the clinic, and the protestors themselves(4). I have witnessed firsthand how protestors refuse to wear masks even when others ask. Planned Parenthood St Louis is doing the best it can under these circumstances, but protestors cause a real risk for the health of the patients.

Many states with anti-choice legislators have put restrictions on abortion care during the pandemic, affecting a lot of pregnant people and putting them at risk of of infection. While Missouri was not one of these states, protestors refusing to comply with mask regulations and not standing six ft apart increases the risk of COVID transmission, creating a dangerous environment for pregnant people needing to receive care. •

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Illustrator: Noor Ghanam

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The Future Course of Pandemics Writer: Neha Adari • Editor: Haley Pak

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ill we ever learn from our past?

Once news broke of COVID-19 and of it being classified as a pandemic, analysts have been reaching back, comparing previous coronavirus pandemics and the lessons that should have come with them. In our current standpoint, the outcome of how this pandemic will play out still remains unclear. Scientists are already preparing for how we should start handling matters of our “new normal.” The question remains, will we?

The suppression of these epidemics were found to be due to two factors: containment and transparency.

In order to understand the course of this pandemic, global health experts have been referring to previous coronavirus outbreaks such as the 20022003 global SARS (SARS-CoV) outbreak and the Mers-CoV epidemic in 2012 [2].

The suppression of these epidemics were found to be due to two factors: containment and transparency [6].

During the SARS epidemic, a measure that played a major role in diminishing the pandemic was global alert and containment through coordinated efforts.

This measure played in effect with other factors allowing for the pandemic to be short lived. Containment was enforced through strict contact tracing and 10 day quarantine guidelines.

There was an emphasis on interrupting future transmission of the virus, which caused patient isolation, negative pressure rooms, and barrier precautions.

With such rapid transmission and unpredictability during times when “the public is at risk of a real or potential health threat, treatment options may be limited,” transparency globally of public information allowed for the direct containment and thus a shortened span or the outbreak. These two factors have been ignored during the COVID-19 pandemic but should be noted for the foreseeable future.

By the time of the SARS-CoV epidemic in 2002, more information has been discovered of the culture of the virus and the traditional utilization of technology and practices like electron microscopy, pan viral microarray technology, genome sequencing and serology. With the limited knowledge known about these viruses, there is an advantage in how we can now study these viruses in preparation for the future.

Although the guidelines that other countries have followed can be looked up to, there is no specific response that will result in countries completely overcoming the pandemic.

The difference between the handling in both the SARS and MERS outbreak and the COVID-19 pandemic lies in the strict enforcement of safety guidelines worldwide and how that information has been portrayed to the public [8].

This has caused countries that have

overcome the pandemic to be applauded for their efforts and set as role models [1]. Although the guidelines that other countries have followed can be looked up to, there is no specific response that will result in countries completely overcoming the pandemic.

What is causing some countries not to be as successful in combatting the pandemic has been due to the influx of misinformation [7] As a result, this increased influx of misinformation creates a vortex of fear and anxiety. For the future, limiting the transmission of inaccurate information is vital in conveying truth to the public [9].

David Heymann, Executive Director for Communicable Diseases at the World Health Organization, examined these outbreaks from the past three decades and has summed up his reflection, highlighting increased struggles that are yet to be resolved: “interplay between infectious disease and global trade, the need for equitable access to health-care resources and the balance of individual rights and public welfare.” [3] The truth experts are preparing for is that these outbreaks are not going anywhere. Dr. Heymann also noted four key ethical issues of the reemergence of these zoonotic diseases: the role of healthcare workers on the frontline, consequences from issues between the government over infectious disease, commerce and public health measures [3].

According to Dr. Micheal Gillette, senior group leader in the Proteomics Platform at Broad, physician in pulmonary and critical care medicine at Massachusetts General Hospital (MGH) and assistant professor at Harvard Medical School, one of the biggest takeaways that the

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in occurrence. While the COVID-19 pandemic is still continuing, it is important to study and prevent these mistakes from occurring again and to better navigate and mitigate the rapid spread of these viruses in the future. Though there is uncertainty during times of global health emergencies, we should learn from our systems’ flaws in order to be better prepared for the future. •

Illustrator: Neha Adari

pandemic has highlighted are “fundamental inequities in the healthcare system and social structure” [4]. Hospitals have been reaching their capacity and necessary equipment such as N-95 masks and ventilators are in such shortage it brings up questions of who will receive care. Along with this, many healthcare workers are on the frontline as well as other doctors specialized in other specialties having to fill in spots where there is a lack of professionals.

and adaptability of our local health systems to deal with this once-in-acentury pandemic.” As expected by doctors, in order for better handling of these future pandemics, institutions that are having to deal with these cases upfront will need to have a supportive structure, increased resources and a balanced system to continue out their duties without having so much uncertainty [4].

From experience, Dr. Pradeep Natarajan, associate member of the Program in Medical and Population genetics at Broad, director of preventive cardiology at MGH, clinical cardiologist at MGH Cardiovascular Disease Prevention Center and assistant professor at Harvard Medical School, states that the knowledge gap that physicians were facing during this public health emergency required a lot of dependance on clinical intuition, rapidly gained experience and the immediate application to patients with COVID-19 [6]. These challenges, as said by Dr. Natarajan, “have tested the resilience

...institutions that are having to deal with these cases upfront will need to have a supportive structure, increased resources and a balanced system...

Throughout history, we have seen how it has repeated itself. Similarly, pandemics are only expected to increase

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FRONTIERS • GLOBAL

From Cowpox to COVID-19: A Brief Overview of Vaccination Writer: Gina Wiste • Editor: Soyi Sarkar

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nquiries seeking updates about the COVID-19 vaccine are no doubt common Google searches nowadays. The vaccine is the light at the end of the tunnel—the key that will set the world free from the nightmare of this pandemic.

People might be marvelling at the fact that they have gone from dreading the word shot as a child (or maybe even older than that) to actually hoping against hope to be poked in the arm in the near future.

What exactly makes this arm-poke so powerful? The vaccines of today operate by using some disease-causing agent or part of one, such as a dead virus or a part of a viral protein, to train the body’s immune system to be able to mount an attack against it. The body’s immune system mounts a small-scale attack against what’s in the vaccine, which is like the rehearsal before the big production. That way, when the body encounters the real live disease, the immune system already has experience against its kind and can fight it better.

This principle of training the immune system has its roots in the technique of variolation, which was developed by practitioners in Asia, as long ago as in the 12th century. Variolation is “the deliberate infection with smallpox” [5].

The practitioners blew dried smallpox scabs into the nose of the patient, who then contracted a mild form of smallpox. The mortality rate of smallpox infection by variolation ranged from 1-2 percent, as opposed to 30 percent in naturally-contracted cases of smallpox [5]. When variolated individuals recovered, they were then immune to the disease.

In the early 18th century, Lady Mary

Wortley Montague, the wife of a British ambassador in the Ottoman empire, learned about the practice and demanded that it be tested on prisoners.

Instead of having scabs blown in the nose, smallpox was injected under their skin. When the prisoners were deliberately exposed to smallpox, none got sick. The royal family then received the procedure, which went on to become fashionable in Europe [5].

...training the immune system has its roots in the technique of variolation, which was developed by practitioners in Asia, as long ago as in the 12th century.

Variolation was not without risk, however. Aside from the questionable ethics of the variolation techniques used on unsuspecting prisoners and the possibility of death from the procedure (a vaccine with a 1-2% mortality rate would never be deemed fit for use today), there was also the very real possibility that the mild disease contracted by the patient could spread and cause an epidemic [5].

Edward Jenner is credited with being the first person to provide scientific support of the practice of vaccination.

Tales of his day said that dairymaids were protected against smallpox if they had had cowpox, a minor disease.

In 1796, Jenner took matter from the

cowpox lesions of a dairymaid and inoculated an eight-year-old boy with the matter. The boy developed a mild fever but then recovered within nine days of the inoculation. Two months after the cowpox inoculation, Jenner injected the boy with matter from a smallpox lesion. The boy developed no disease [6]. After performing this experiment on a few more cases, he published a booklet on his findings, in which he coined the term “vaccination,” from the Latin vaccinia, meaning cowpox [6]. Subsequently, the practice of vaccination took hold in Europe and later in the United States.

Needless to say, vaccines today do not still contain their namesake cowpox.

Instead, the most common vaccines of today largely fall into four vaccine types [8]. Vaccines can contain a live, attenuated virus. This is the most similar to the original cowpox vaccine. Just as cowpox is a milder poxvirus than smallpox, an attenuated virus is weaker than its natural form. The difference is that attenuated viruses are modified in a lab to make them weaker so as to stimulate an immune response but not cause illness in otherwise healthy individuals [8]. Examples of common live attenuated vaccines are the varicella (chickenpox) and shingles vaccines.

...the most common vaccines of today largely fall into four vaccine types.

Vaccines can also be inactivated or killed. In a lab, the virus is inactivated, usually using formaldehyde as an

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agent. “Formaldehyde exerts its effect by a great diversity of modifications… which culminate in inactivation, stabilization, or immobilization of proteins with consequent loss of viral infectivity” [7]. Examples of this type of vaccine include the polio and rabies vaccinations. Another type of vaccines are subunit, recombinant, or conjugate vaccines, which use specific parts of the disease causing agent, like a protein or capsid casing. The vaccine uses these key bits to train the body to recognize that specific protein or capsid, and mount a targeted response accordingly [8]. Common examples of this type of vaccine are the vaccines against HPV and Hepatitis B. A final type of vaccine are toxoid vaccines, which function in a similar fashion to subunit vaccines.

Toxoid vaccines use a harmful product made by the disease agent to “create immunity to the parts of the germ that cause disease instead of the germ itself” [8].

There are more than 90 vaccines in development against SARS-CoV-2...

There are more than 90 vaccines in development against SARS-CoV-2, the virus that causes the COVID-19 infection [1]. Some vaccines are being developed using attenuated or inactivated forms of the SARS-Cov2 itself. Two of the frontrunners, the candidates from Johnson & Johnson and AstraZeneca, are viral-vector vaccines, a type of subunit vaccine [1]. This means that a virus such as adenovirus is “genetically engineered so that it can produce proteins

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in the body”. The adenovirus is a vector that delivers a gene from the SARS-Cov2 virus into the cells of the body, which “will read it and make coronavirus spike proteins” , which will cause an immune response [2]. The adenovirus itself is weakened, or attenuated, so it cannot cause disease, and key genes that allow the adenovirus to replicate have been disabled. No vaccines using this vector method have been approved yet for humans; although adenoviral vectors have a long history in gene therapy [4].

Two more frontrunners, the vaccines from Moderna and Pfizer, are using even more novel technology. They are mRNA vaccines. mRNA is a molecule with instructions to make proteins. In this case, proteins that help the virus replicate [4]. Once the mRNA from the vaccine is in the cell, the ribosomes of the cell start using that mRNA template to create SARS-CoV-2 spike proteins.

These proteins coat the surface of the virus and are harmless on their own.

The immune system then perceives the spike proteins as if the body has been infected by the actual virus, resulting in antibody creation [3]. If this mRNA technology proves effective on a large scale, it could change the way vaccines are manufactured. Rather than go through the long process of growing and inactivating an “entire germ or its proteins in a specific way,” as is necessary for all the previously mentioned vaccine techniques, scientists can instead manufacture pieces of mRNA that could prove more flexible and durable against viruses that evolve through mutation [9].

Much like variolation and Jenner’s vaccine led the charge against smallpox, a disease which caused the world much

suffering, the scientists behind today’s vaccines against COVID-19 infection are actively fighting to do the same.

Whether using cowpox, attenuated virus or viral mRNA, vaccines throughout history are designed to do the same thing: to help our bodies keep us safe in the face of a formidable disease. •

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Illustrator: Eugenia Yoh

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Can Money Buy Happiness? A Look at UBI and Mental Health Writer: Carsen Codel • Editor: Haleigh Pine

I

n an age when 7.1 percent of U.S. adults have had at least one major depressive episode and an estimated 31 percent of U.S. adults will experience any sort of anxiety disorder within their lives, it seems like our country has accepted the presence of mental illness as the new normal. With the ongoing pandemic, these numbers are certainly not in a position to improve. However, there is a policy proposal that has the potential to decrease the amount of Americans afflicted with mental illness and burdened by stress: Universal Basic Income (UBI).

A UBI program ensures a set amount of money to constituents, without a cutoff level for certain income levels.

If UBI was enacted in America, everybody from minimum wage workers to Jeff Bezos would receive a payment.

Andrew Yang, former 2020 Democratic presidential candidate, touted the Freedom Dividend proposal, which promised a $1000 per month payment to all American citizens ages 18 and older (1). Before Andrew Yang, the concept of UBI was also championed by Martin Luther King, Jr. and Thomas Paine, is in effect in Alaska and almost passed under the Nixon administration.

A UBI program ensures a set amount of money to constituents, without a cutoff level for certain income levels.

In April of 2020, many households across America received stimulus checks of $1200 in light of the ongoing

COVID-19 pandemic. The money was part of the CARES Act, a stimulus package implemented by the federal government to provide financial support to both citizens and corporations across America due to the economic turmoil caused by the pandemic. However, the one-time stimulus checks only put a band-aid on a festering wound of growing income inequality and deteriorating mental health in America. A UBI program would go further in solving these problems.

Enacting a UBI plan in the United States would be a large undertaking, though the PEW Research Center has reported that it is no longer considered a controversial proposal in the U.S., as nearly a majority of Americans would support enacting a UBI. There are obvious pros and cons to establishing a UBI in America. Still, it is important to acknowledge that UBI has vast potential to diminish health inequities and improve mental health for citizens.

While there is no major country that has implemented a permanent UBI program, several countries and organizations have conducted UBI pilots to examine the policy in action. Many have found a positive link between the cash transfers and the health of the recipients. For instance, Finland conducted a country-wide UBI experiment from November 2017 to October 2018 (2). When analyzing the effects of the UBI on mental health, the study found that survey respondents who received the basic income treatment described a more positive well-being, better mental health, more positive perception of economic wellbeing and higher level of trust in other people and societal institutions as compared to the control group.

Beyond general feelings, UBI programs can lower actual cases of injury. An article by Beck, et. al analyzed a randomized cluster UBI trial that was conducted in India in order to understand the relationship between a basic income and potential health benefits (3). The study examined minor illnesses and injuries, illness and injuries requiring hospitalization and child vaccination coverage. The study found that minor illnesses and injuries dropped by 46 percent for those receiving the basic income over the course of the study, with no marked change in major illness or vaccination rates, the latter of which was already high.

Beyond general feelings, UBI programs can lower actual cases of injury.

Two studies examined cash transfer programs (a similar concept to UBI) in Africa, with focus on mental health and food security. One study, an analysis by Ebenezer Owusu-Addo of Cash Transfer programs in Sub-Saharan Africa, found significant mental health improvements, including increased self-esteem and reduced stress and anxiety (4). The study also found a consistent positive effect on food security across all cases.

Another paper examined the impact of a Child Support Grant on the mental health of South African adults using the CES-D, a mental health assessment, to quantify their results. While not the exact same as a UBI plan, the study still analyzes the effects of cash influx to families. Data showed “a positive and statistically significant direct effect of

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the cash transfer on mental health...”

(5).

Beyond improving mental health and lowering injuries, a UBI program could help prepare future generations for healthy lives. An article by Herbert Jauch in the Global Labour Journal summarized findings from a Basic Income Grant trial in Namibia, conducted in 2004 (6). The research team monitoring developments found that poverty, child malnutrition and school dropouts had fallen significantly within the year. In addition, crime rates dropped and women were able to become more economically dependent.

Not only did mental health treatment, mental health diagnoses and general hospitalizations fall during the study, but the positive effects vanished after the trial ended.

One of the most remarkable UBI trial programs took place in the Canadian town of Dauphin in the 1970s. An article by Anthony Painter published in The BMJ analyzed the results of the trial, which demonstrated a correlation between UBI and improved health benefits (7). Not only did mental health treatment, mental health diagnoses and general hospitalizations fall during the study, but the positive effects vanished after the trial ended.

It is clear that enacting a UBI program would take the first steps towards addressing mental health issues and general health inequities in the United States. With the extra money in pocket, Americans would be better equipped to provide themselves with proper nutrition. Citizens would also have the mobility to seek out health services when needed, rather than staying home for fear of the cost. Americans would develop an increased sense of financial security, reducing the stress induced by worrying over the month’s bills.

We should not accept the new normal of our mental health situation in the United States. Encourage your local representatives to support enacting a UBI program in the US or your town (check out Mayors for a Guaranteed Income). In a world full of complicated problems, sometimes the simplest solution is giving people cash. •

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In Support of Revitalizing Public Health Writer: Alexandra Dram • Editor: Soyi Sarkar

A

s the field of public health faces a steep upward trajectory, growing pains are certainly felt as limited resources attempt to serve an expanding range of issues. Reshaping our collective approach to public health requires all of us, as a society, to drive progress on several key issues plaguing the current system.

Although healthcare advances are often ascribed to medical care developments and innovative research techniques, there is a clear disconnect in the application of new field knowledge to amplifying treatment and prevention initiatives. The gaps that occur in this paradigm originate from a weakened public health system, which is chronically underfunded yet burdened with heightened demand for new opportunities that match pace with research insights on effective treatment and prevention initiatives. Scientific literature on contemporary issues in public health, including increase in drug resistance, higher prevalence of risk factors such as diabetes and obesity, aging of the population and greater complexity of medical interventions, has consistently demonstrated a greater understanding of the complex roots of public health in social determinants [1]. This necessitates that public health initiatives grow in complexity and interdisciplinary collaboration when it is clear that even long-standing issues have yet to be effectively approached. For example, although front-line physicians have long understood how structural violence contributes to premature death and disability, a lacking public health infrastructure continues to enforce barriers against vaccines, diagnostics, and effective therapeutics [2].

Public health is a keystone in addressing

large-scale issues; yet, driving truly interdisciplinary collaboration towards the unified goal of improving human health still remains out-of-reach.

Recent pushes towards cross-sectoral collaboration in more comprehensive targeting of a host of health influencers - including education, safe environments, housing, transportation, economic development, food access - has been consistent with the refined public health vision pioneered through the Department of Health and Human Services’ Public Health 3.0 initiative [3]. Common challenges with pioneering collaborative projects under this vision include forming partnerships with community stakeholders, receiving timely feedback and actionable data, establishing clear metrics for community success and modifying funding models for greater financial support.

... there is a clear disconnect in the application of new field knowledge to amplifying treatment and prevention initiatives.

Addressing such challenges in interagency collaboration is critical for the formation of an actionable policy network. Evidence demonstrates how interagency collaboration does not necessarily provide an effective means to health improvement over standard services if such collaboration lacks goals, methods of working, monitoring and evaluation before implementation to protect programme fidelity and increase the potential for effectiveness

... simply creating transparency in methods and goals amongst initiatives is not enough to maximize efficiency.

[4]. In particular, improving community partnership requires acknowledging how mistrust undermines health promotion; a 2015 Oxford Academic Journal study found that 47 percent of study participants with previous experiences in partnership structures believed that “trust is assumed or presumed to be there in the partnership and that it is not actually discussed by the partners” [5]. Furthermore, simply creating transparency in methods and goals amongst initiatives is not enough to maximize efficiency. A 2018 study investigating Community Health Improvement Plan (CHIP) objectives of various public health agencies revealed that only a third of measurable objectives focused on changes in population outcomes [6]. Instead, the majority of targets were dedicated to the organizations own outputs and services without further study into the effectiveness of these programs. Instituting feedback mechanisms and adopting an outward perspective in creating CHIP objectives and similar targets are a clear area of improvement in maximizing efficiency in community public health initiatives.

Promoting the credibility and importance of public health presents additional challenge in an era rife with misinformation and skepticism.

Disseminating a clear and unified message through a singular agency communication outlet must be achieved before an additional health crisis to block the

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spread of misinformation, improve credibility amongst the general public, and mitigating the politicization of public health. Furthermore, it has become clear that improving public health relies both on changing large-scale governmental approaches and small-scale individualistic personal attitudes.

Although governments should be held accountable to upholding their key role in healthcare by protecting individuals from preventable harm caused by other individuals or groups, constituent concerns about sacrificing individual freedom and personal responsibility in the name of population health should also be addressed [7].

Recent difficulties in achieving a unified pandemic response were exacerbated by high-level government mismanagement in implementing safety

For example, although front-line physicians have long understood how structural violence contributes to premature death and disability, a lacking public health infrastructure continues to enforce barriers against vaccines, diagnostics, and effective therapeutics.

measures, misinformation and institutional lack of credibility amongst the general public, and lack of agency as well as interconnectivity among public health bodies. For the first time, many have come to face the alarming possibility that public health systems will largely, and quickly, need to be bolstered as COVID-like pandemics are expected to continue to shape this era.

It is time to stop neglecting the public health systems we so desperately continue to rely on. •

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The Political Reality of “Curing” Cancer Writer: Meher Arora • Editor: Annie Feng

“I

f I’m elected president, you’re going to see the single most important thing that changes in America, we’re going to cure cancer,” said Joe Biden, former Vice President and 2020 presidential candidate at a campaign in Iowa in June 2019 [5]. “We’re going to cure cancer” is an optimistic phrase that everyone wants to believe in, yet it continually sets unrealistic expectations. Candidates’ campaigning platforms and use of irresponsible political rhetoric give people false hope for a magic bullet, when in fact the scientific realities of cancer suggest that a cure is an unrealistic goal. According to the National Cancer Institute, it is estimated that nearly 606,520 people will die this year alone from cancer in the United States [4]. While Joe Biden is hardly the first politician to make such promises of curing cancer, how exactly do Biden and other candidates plan on achieving this goal?

Firstly, why is “curing cancer” not a realistic goal? There are a lot of factors that affect how a person’s cancer must be approached. It is important to account for the differences in biology among patients, especially when there are differences in age. Another factor is the type of cancer. Some cancers are simply easier to treat than others, usually because of where they are located.

For example, breast cancer is far less challenging to treat than pancreatic

Some cancers are simply easier to treat than others, usually because of where they are located.

cancer, because it is more surgically accessible (if surgery is the chosen method). According to the Memorial Sloan Kettering Cancer Center (MSKCC), the pancreas lies close to vital organs and therefore surgery is extremely challenging without risking damage to other organs. Another factor is if the cancer has metastasized or not, and this can depend on how soon the cancer is diagnosed. For example, the MSKCC also explains that in pancreatic cancer’s early stages, there are typically no symptoms, but by the time symptoms are detected, the cancer has already spread [8]. Generally, once a cancer has metastasized, surgery no longer becomes a viable option. Instead, radiation, or more commonly, chemotherapy is used. As oncologist and au-

Generally, once a cancer has metastasized, surgery no longer becomes a viable option. thor Siddhartha Mukherjee explains in his book, Emperor of All Maladies: A Biography of Cancer, there have been drastic improvements to cancer treatments. Back in the 1890’s, radical mastectomies were performed for patients with breast cancer, in which the breast and all the surrounding muscles were removed, giving women a very distorted appearance, but fortunately there are now more feasible options like radiation and chemotherapy [7]. However, the success of chemotherapy is now being called into question. Chemotherapy, a drug composed of a cocktail of chemicals, has been the standard cancer

treatment for decades. It has been more or less successful in wiping out cancer cells and leaving patients cancer-free.

However, similar to bacteria becoming resistant to antibiotics, cancer cells are

Saying that “we’re getting closer all the time” is a stretch, because although technology and resources are available, researchers are at a standstill.

posing a problem as they are becoming resistant to chemotherapy.

On June 18th 2019 at Donald Trump’s kick off rally in Orlando, Florida, he announced that “We will come up with the cures to many, many problems, to many, many diseases, including cancer, and others, and we’re getting closer all the time” [1]. Saying that “we’re getting closer all the time” is a stretch, because although technology and resources are available, researchers are at a standstill. Further study into this disease has revealed that cancer is much more complex and there are more factors inplay than anyone realized. The standard treatments of chemotherapy and radiation do not guarantee success for all patients. The only way to get closer to a solution is to keep researching and conducting experiments —it’s a cyclical process that will require patience and time. Vice President Mike Pence also shares similar viewpoints as Trump. An article written by Jason Silverstein from CBS News says when Pence was campaigning in 2001, Pence

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stated “Time for a quick reality check.

Despite the hysteria from the political class and the media, smoking doesn’t kill,” but according to the CDC, those who smoke are 15 to 30 times more likely to get lung cancer [6]. Like Trump, it seems that Pence’s trust in science is somewhat questionable.

The standard treatments of chemotherapy and radiation do not guarantee success for all patients.

Illustrator: Angela Chen

Between the two candidates, it appears that Joe Biden has the most comprehensive understanding of this disease. He has been working on tackling cancer since the end of Barack Obama’s presidency, when Obama asked Biden to lead the “Cancer Moonshot,” in order to allow more access to treatments. Biden then launched the Cancer Initiative with his wife in 2017, branching off of the White House Cancer Moonshot.

He then created the Biden Cancer Initiative, whose mission is to “accelerate progress in cancer prevention, detection, diagnosis, research, and care, and to reduce disparities in cancer outcomes”. Within this cancer initiative program is another program called the Biden Cancer Colloquia, which “provokes discussion and collaboration within the biotech, technology, science, and academic fields to drive innovation, technology, and breakthroughs against cancer.” The initiative also has a Clinical Trial Design and Enrollment group: “Clinical trials, a critical component in the development of innovative

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treatments, are especially critical in oncology, a field in which first line therapies aren’t always effective at delaying the disease progression and often aren’t curative” [3]. These efforts demonstrate the Biden campagin’s investment in spearheading clinically relevant breakthroughs in cancer research by working alongside experts in the field.

Interestingly, there are two sides to Biden’s take on curing cancer. In Biden’s initial statement, he guaranteed to the American people that if he was elected, he would cure cancer.

Although this is a rather bold promise to be making, we see that he has the most realistic approach to this issue, but there is a disconnect between his rhetoric and his actions. Despite Biden’s knowledge of cancer, he still chooses to use ignorant language in his statement.

Biden’s Cancer Initiative is taking the right steps, but the difference is that the end goal of curing cancer is neither achievable nor realistic.

These efforts demonstrate the Biden campagin’s investment in spearheading clinically relevant breakthroughs in cancer research by working alongside experts in the field.

Given the scientific realities of cancer, politicians saying they’re going to “cure” cancer is a promise to the American people that they do not have the ability

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to fulfill. Politicians reach for the word “cure” because it is a simple way of addressing a complex issue. If politicians blatantly state that curing cancer is unrealistic, they will lose the support of their voters. In order to resolve both ends of this issue, instead of declaring “we’re going to cure cancer,” it would be more appropriate to state “we’re going to come up with better approaches to treating cancer”. This rhetoric is more realistic and attainable. There is a difference between cure, versus treat.

For example, for a patient whose cancer has metastasized, it is not practical to tell them they will be cured of their cancer because at that stage, there is no guarantee. Instead, it is more appropriate to say they will be treated.

We know that in reality, many patients’ cancers relapse after treatment. Given that this difference in terminology is not that difficult to comprehend, it is puzzling why none of the politicians choose to use this term in their rhetoric—this makes them appear as if they do not understand the mechanisms of this disease.

...politicians should be focusing on as this is something that is actually within their control.

In addition to changing their rhetoric, something politicians do have control over is the prevention aspect of cancer.

For example, Biden does have a cancer prevention program in his Cancer Initiative [3]. In his program, they focus on improving lifestyle choices. The

article “Policy and action for American Institute for Cancer Research” by K. Beck et al. from the Nutrition Bulletin journal discusses the guidelines set to improve lifestyle choices in order to prevent cancer. The report focuses on how certain lifestyle choices, such as poor diet and nutrition, can be a risk factor for cancer [2]. Funding for cancer research and solving the root of the problem is what politicians should be focusing on as this is something that is actually within their control.

We know that in reality, many patients’ cancers relapse after treatment.

Simply put, cancer is a tragic, monstrous disease that hijacks your body and cannot be treated, or “cured” by a simple drug, vaccine, or operation.

The complexity of this disease is like no other. It took Richard Nixon much convincing in 1971 to sign the National Cancer Act to fund for cancer research [7]. Now that people are recognizing the cancer epidemic, it shouldn’t have to take nearly as much convincing for politicians to change their rhetoric and advocate for cancer prevention, rather than cancer cure. The way that the Biden and Trump campaigns address the topic of cancer is not only revealing about their views on cancer, but also reflective of their approach towards the coronavirus pandemic. Whether it’s a virus or cancer, we need politicians who believe in science and use their political rhetoric responsibly. •

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So You Want To Be A Centenarian?: A Look into the World’s Longest-Living Populations Writer: Maya Patel • Editor: Neha Adari The average life expectancy in the United States is 78.6 years, and yet, there are specific communities across the world with people thriving well past their 100th birthday [1]. The cause of this discrepancy has been hazy up until about a decade ago, and new discoveries and research has been conducted ever since.

With his team, National Geographic Fellow Dan Buettner traveled to communities around the world with the highest proportions of centenarians.

Building upon the demographic work conducted by researchers Gianni Pes and Michel Poulain, Buettner identified his first five locations: (1) The Barbagia region of Sardinia, (2) Ikaria, Greece, (3) the Nicoya Peninsula in Costa Rica, (4) Okinawa, Japan and (5) Loma Linda, California. From the blue circles Pes and Poulain drew around these “longevity hotspots” on their map, the term Blue Zones was coined [4]. Representing an incredibly diverse subset of the world, these five places have seemingly minimal similarities.

From the blue circles Pes and Poulain drew around these “longevity hotspots” on their map, the term Blue Zones was coined.

However, a Danish Twin Study found that longevity is only slightly heritable, and only about a quarter of the average lifespan is genetically determined— the rest, it is assumed, is left to external

factors [3].

Following this logic, Buettner went on to learn from the people in each of these communities, identifying the lifestyle practices that may contribute to their longer life spans [4]. While the cultures of the people in each Blue Zone differ quite significantly, Buettner was surprised to see patterns in their behavior and way of life, which essentially fell into nine main categories.

The first component of longevity: natural exercise.

The first component of longevity: natural exercise. Though gym memberships, Soul Cycle and Peloton may occupy our current weekly routines, none of the Blue Zone communities have strict exercise regimens. Instead, these people have more labor-intensive activities built into their day-to-day routines. The Seventh Day Adventists of Loma Linda go on nature walks as part of their religious following, and the other communities “grow gardens and don’t have mechanical conveniences for house and yard work” [5]. This distinction between exercise as an inherent part of life rather than an obligation may be a major factor to an extended life span.

A second facet of the Blue Zone life is the retention of a sense of purpose.

These longevity hotspots have different names for this— “ikigai” to the Okinawans and “plan de vida” to the Nicoyans [5]. A sense of purpose can

take many forms, but the general consensus is that having a reason to wake up in the morning increases happiness and motivation, in turn lengthening life span.

While stress is a normal part of the human condition, people living in Blue Zones have practices built into their routines to center themselves. As explained on the Blue Zones ® organization’s website, “Okinawans take a few moments each day to remember their ancestors, Adventists pray, Ikarians take a nap and Sardinians do happy hour” [5]. This management of a less stressful lifestyle lends itself to a decrease in chronic inflammation, which is associated with heart disease, cancer, diabetes and several other diseases with a direct impact on life expectancy [6].

This management of a less stressful lifestyle lends itself to a decrease in chronic inflammation

These three practices, along with others such as having a reliable support system, belonging to a faith-based community, maintaining a primarily plantbased diet and intermittent fasting are all contributors to the centenarian lifestyle. Now that the “secrets” to reaching three-digit birthdays are public knowledge, it is practical to want to implement them into your personal life. As Buettner outlines in his Ted Talk, his Blue Zone discovery is only one component of reaching 100 years [2]. Winning

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Illustrator: Neha Adari the “genetic lottery” is a large component, however, these particular lifestyle habits may still add a few years to life.

The principles can be used as a sort of roadmap— a guide for achieving longevity going forward. Buettner notes that an American’s body typically has the capacity of reaching 90 years of age, but again, the average is only 79.

Buettner notes that an American’s body typically has the capacity of reaching 90 years of age, but again, the average is only 79.

As habitual creatures, making the conscious decision to implement changes to our behavior can be formidable, even when the reward is as large as 11 more years of life. Small, practical steps may be the most realistic way to emulate the lives of our Blue Zone counterparts.

Slowly weaving these lifestyle practices into our daily routines like walking or biking more often, replacing red meat with plant-based protein and intentionally prioritizing family are just three objectives to begin with. After writing

a book and branding Blue Zones ® as an organization and business, Buettner has established a community of people intrigued with the prospect of extending their lives. A life like that of the Blue Zones people may be something to strive for, but if not, consider it just a fascinating look into the study of longevity. •

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Could Vaccines Really Solve the Pandemic?

Writer: Kimberly Hwang • Editor: Sophia Dutton

With the COVID-19 pandemic stretching into its tenth month this October, many people living in isolation are yearning for the chance to live life normally again. Current treatments for this disease span from simply staying at home and hoping people will recover naturally, to prevention via supplements, to direct treatment in hospitals through ventilators [1, 2]. For prevention treatments, there are still ongoing debates about whether or not they are truly useful. Amidst all the contradictory information, vaccines have become the light at the end of the tunnel for many. With this in mind, nations, laboratories, universities and many more have been scrambling to be the first to develop a working vaccine. According to BBC, currently, “240 vaccines are in early development, with 40 in clinical trials and nine already in the final stage of testing on thousands of people” [3].

Yet, looking beyond the promise of a normal life through vaccination, many questions still remain. Just how useful will vaccines be to stop the progression of the pandemic? Will these injections be accessible? What percent of the world’s population needs to be vaccinated before we are “safe” again? How much longer must we wait? In the bestcase scenario, “a vaccine is likely to become widely available by mid-2021” [4].

Amidst all the contradictory information, vaccines have become the light at the end of the tunnel for many.

However, as The New York Times reports, “It’s tempting to look at the first vaccine as President Trump does: an onoff switch that will bring back life as we know it. ‘As soon as it’s given the go-ahead, we will get it out, defeat the virus,’ he said at a September news conference. But vaccine experts say we should prepare instead for a perplexing, frustrating year” [5].

Social and scientific factors can complicate the situation in a multitude of ways, preventing vaccines from having the clean-cut effect they would otherwise be expected to have.

Under normal circumstances, vaccine development consists of three phases, which can take “a decade or more after the research has begun” before the vaccine can be commercially manufactured. However, this process has been sped up due to the emergent situation this year. The World Health Organization (WHO) has started the

What percent of the world’s population needs to be vaccinated before we are “safe” again?

“Solidarity Vaccines Trial” through which “several vaccines would be given at random to one large group of volunteers, while a smaller group would receive a placebo. All of the vaccines would be tested against the same placebo group, and all of the volunteers would be living in the same circumstances” [6]. This trial simultaneously

facilitates the comparison of these vaccines with each other as well as the placebo. Unfortunately, there are limitations to the speed of this study: just the process of starting this trial has already taken nine months, and approximately “200,000 volunteers” must still be recruited before this trial can be completed [7].

Vaccines that first reach the market will also slow down the research process for competitors. Since authorized vaccines have a higher chance of being effective, people might be tempted to buy vaccines that are already on the market and opt-out of clinical trials. It will be difficult for the “vaccines in earlier stages of testing” to “prove that they are better than the newly approved vaccine [since] the difference between two vaccines will be smaller than between a vaccine and a placebo.” As a result, companies will be less incentivized to continue developing their own vaccines [8].

Another cause for concern is accessibility. The Centers for Disease Control and Prevention have created a “preliminary ranking system” that states that “vital medical and national security officials” will be the first to be inoculated, then “other essential workers and those considered at high risk,” such as senior citizens and people with preexisting health conditions [9]. Moreover, since racial minorities, like African Americans, Latinx and indigenous peoples are at least three times as likely to pass away from the coronavirus infection [10], the CDC has considered also giving them access priority. Unfortunately, Executive of the Association of Immunization Managers Claire Hannan says that she hesitates to do so because “‘giving it to one race initially and not another race’”

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Even after these vaccines have been administered to those who want them, it will not mean we can immediately stop wearing masks or end social distancing. Because the clinical trials have only been going on for a few months, the protective durations and efficacies of these vaccines are still largely unknown. Moreover, people who are thought to be safely vaccinated could still catch the virus and unknowingly spread it as an asymptomatic carrier.

Moreover, people who are thought to be safely vaccinated could still catch the virus and unknowingly spread it as an asymptomatic carrier.

Illustrator: Elena Bosak may be ill-received by the public [11].

Even if all of these high-risk groups have access to the vaccine, 60-70 percent of the world still needs to receive the vaccine, which is about 4.7 -5.5 billion people in order for herd immunity to slow down infection rates [12].

However, accessibility is not the only issue we face when discussing vaccine administration. In August, 69 percent of the public said they would get vaccinated once vaccines become available, while only 58 percent said the same thing this October. This can likely be

attributed to the politicization of the vaccine due to the impending election [13]. In the recent vice presidential debate, Senator Harris indicated that “if the doctors tell us that we should take [the vaccine], I’ll be the first in line to take it, absolutely. But if Donald Trump tells us that I should...take it, I’m not taking it.” Her view can encourage the people who support her to refrain from taking the vaccine if the latter situation she describes happens. Thus, such adherence to politics rather than science may prevent herd immunity from being achieved [14].

With all of these unknown and uncontrollable factors before and after vaccine administration, definitive statements about the vaccines’ ability to end the pandemic should be put on hold. However, we can still hold onto hope as the combination of social distancing, hand-washing, mask-wearing and vaccines will still greatly mitigate the spread of the virus. •

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Anti-Vaccination Sentiment in the Face of COVID-19 Writer: Eileen Yang • Editor: Daniel Berkovich

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s most Americans enter their seventh month of COVID-19-related safety measures, restlessness has given way to overthinking, and the ranks of people who identify as “vaccine hesitant” are growing quickly.

This is especially true with regard to the long-promised COVID-19 vaccine.

Gallup performed a poll that presented Americans with an alluring hypothetical: immediate access to a free, FDAapproved vaccine. In July, 66 percent of Americans were willing to get vaccinated, but by late September, that number dwindled to 50 percent [10]. That 16 percent decrease represents more than 52 million people.

The world is watching the development of COVID-19 vaccines, but the information is riddled with unanswered questions. A month ago, AstraZeneca, a company leading the pack of potential vaccines, paused its UK trials with little explanation while other countries’ investigations into the same vaccine continued. Researchers fear that secrecy in these uncertain times will further erode public trust in the coming COVID-19 vaccine [2].

In July, 66 percent of Americans were willing to get vaccinated, but by late September, that number dwindled to 50 percent.

Vaccines are a cornerstone of modern preventive medicine. Since their discovery, areas where vaccines are readily available have seen greatly decreased incidence rates of diseases

like smallpox, malaria and polio [8)].

Because vaccine effectiveness depends heavily on herd immunity to block transmission of infection, it’s important that the number of vaccinated individuals in a population exceeds the herd immunity threshold, which varies by disease [9]. Though opposition to vaccination for spiritual or philosophical reasons has been around since the invention of vaccines, unwillingness to vaccinate and the “anti-vaccination” movement have been growing steadily in recent decades. This time, however, the influence of spiritual and philosophical arguments to become “vaccine hesitant” has been compounded by the media and digital misinformation [11].

unwillingness to vaccinate and the “anti-vaccination” movement have been growing steadily in recent decades.

The movement has grown so much that in March 2019, the World Health Organization (WHO) named “vaccine hesitancy” among ten global health threats they hoped to tackle in 2019 [12]. However, as the possibility of a Covid-19 vaccine looms ever closer, it’s important to remember that the “anti-vax” movement isn’t as homogenous as they seem at first glance. When one thinks of an “anti-vaxxer,” it’s easy to imagine a monolith: affluent, white mothers [7], and while they represent a significant (and vocal) portion of “vaccine hesitant” people, there is a diversity of communities who believe in that vaccination is inherently dangerous [4].

To conquer the potential risk of many

Americans refusing a vaccine, efforts must be made to address the unique concerns of all who are part of this group.

To conquer the potential risk of many Americans refusing a vaccine, efforts must be made to address the unique concerns of all who are part of this group.

Despite the rigorous safety and effectiveness standards that vaccines in the United States are held to before they can be disseminated [5], there are still myriad doubts. Some people oppose vaccination on the grounds of bodily autonomy, fighting mandatory vaccination requirements at any level [11].

Others reject a traditionally paternalistic doctor-patient relationship—in which medical professionals use their expertise to decide and implement care—in favor of one that weighs patient opinion more heavily [3]. While both of these hypothetical positions hold philosophical merit, they both partially stem from lack of accurate, accessible information on the safety of vaccines and their important role in creating herd immunity among a population. Transparency and fact-checking, rather than dismissive rhetoric, are necessary to combat vaccine hesitancy, especially as international efforts are made to rapidly develop a safe, functional COVID-19 vaccine [1, 6]. •

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The Weight of Quarantine: Impacts of COVID-19 Restrictions on Unhealthy Weight Gain and Obesity Writer: Jason Zhang • Editor: Sophia Xiao

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mpty shelves that once held Spam, canned soups, ramen, and of course, toilet paper were a common sight at the outset of the COVID-19 pandemic. Within the span of a month, much of America went into self-quarantine/lockdown as people self-isolated at home and non-essential businesses closed. As this country along with the rest of the world shifted towards a sedentary life at home, the uncertainty about the length of lockdowns led many to purchase more non-perishable foods- foods that last longer due to high amounts of fat, salt, and sugar [7][10]. Thus, health experts warned individuals under lockdown to pay attention to diet and exercise in order to prevent unhealthy weight gain and obesity. These also happen to be risk factors for developing COVID-19 [9], the exact disease that lockdowns tried to tackle. Therefore, this begs the question of whether there is actual evidence that lockdowns have led to weight gain and/or obesity. To put it bluntly, did we get fatter and unhealthier during lockdown?

...the uncertainty about the length of lockdowns led many to purchase more non-perishable foods- foods that last longer due to high amounts of fat, salt, and sugar.

Zachary Zeigler et al. attempted to answer this question by surveying one hundred seventy three adult Facebook users. The survey asked them to

To put it bluntly, did we get fatter and unhealthier during lockdown? describe their changes in weight and eating habits during lockdown, finding that although 59 percent of respondents described their weight as “relatively stable” during lockdown, a significant portion (22 percent) described gaining five to ten pounds [13]. Therefore, it appears that many individuals have experienced an actual increase in weight during lockdown.

Additionally, the researchers noted that users who reported gaining five to ten pounds were more likely to report changed eating habits including increased “eating in response to sight and smell,” “eating in response to stress” and “snacking after dinner.” However, such responses were also common among all other respondents [13].

These changes in eating behavior point to increases in impulsive eating, providing a potential and logical explanation for the reported weight gain. Thus, Zeigler et al. supports the hypothesis that lockdowns due to COVID-19 truly have impacted our diet and health for the worse, with many American adults gaining weight and therefore, potentially becoming more at risk for developing obesity.

However, Pamela Keel et al. caution against such interpretations, stating that studies like these tend to be retrospective and are therefore subject to inaccuracies arising from bias [6]. In a study analyzing undergraduate university students, they argue that in reality,

a significant difference exists between perceived and actual weight gain during lockdown. Although this study did ask the subjects to fill out surveys regarding their perceived weight gain, it differs from Zeigler et al. in that Keel et al. recorded Body Mass Index measurements (combinations of height and weight that the CDC uses to determine and classify obesity [2]) in January before campus closed and in April after it had closed in April. The purpose of recording BMI is that the CDC uses it to determine and classify obesity [2]. They found that among the 90 students who responded to both surveys, around 28 percent reported perceiving a weight increase in the later survey. Although a little more than a quarter of the stu-

...although 59 percent of respondents described their weight as “relatively stable” during lockdown, a significant portion (22 percent) described gaining five to ten pounds. dents reported unhealthy weight gain, they actually experienced no significant weight gain or BMI increase [6].

Thus, this suggests that most students who reported gaining weight did not actually gain unhealthy weight or even any weight for that matter.

The large gap between actual and perceived unhealthy weight gain suggests that college students are overestimating the weight they gained during lockdown. An explanation for this could be that our culture is obsessed

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with weight, falsely convincing some that they gained unhealthy weight (increased BMI). Therefore, it is likely that we as college students are not necessarily “fatter” and therefore unhealthier after lockdown than before. College students could have gained less weight than expected despite a pandemic because on average, college students come from wealthier backgrounds than the average American [5]. Thus, they often have greater access to healthy food options as a consequence of living in a wealthy neighborhood and/or owning a vehicle. Their ability to afford food also reduces unhealthy weight gain and the risk of obesity relative to those in food insecure households [4].

Although most college students might have not gained much weight during lockdown, students from low income families or who lack access to healthy food options could be at greater risk for weight gain and obesity during lockdown. Evidence has shown that among school-aged children, both prevalence of obesity and BMI increased at an accelerated rate over the summer when school was not in session [12].

Such impacts also tended to disproportionately affect children of Black, Hispanic, obese, and lower socio-economic populations [5]. Andrew Rundle et al. hypothesized that school closings combined with lockdowns’ impact on food options (and therefore diet) could exacerbate the observed pattern of increased BMI and obesity prevalence among children during the summer.

They claimed that students deprived of reduced school lunches could experience greater food insecurity which puts them at risk for unhealthy weight gain and obesity [4].

These concerns also extend to poorer

Therefore, it is likely that we as college students are not necessarily “fatter” and therefore unhealthier after lockdown than before.

American communities that have limited access to healthy food options.

Nathaniel Ashby conducted a study that used cell phone location data to examine eating behavior in 65 percent of all U.S. counties, tracking the frequency of visits to unhealthy versus healthy dining locations during the COVID-19 pandemic. When he compared this data to local obesity rates, he found that 10 percent of the most obese counties were more loyal to unhealthy food options compared to ten percent of the least obese [1]. Although visits to unhealthy dining options generally decreased due to closures in March, this decrease was reduced in counties with high obesity rates. Furthermore, those counties also saw the largest increase in April when restaurants began to reopen.

They claimed that students deprived of reduced school lunches could experience greater food insecurity which puts them at risk for unhealthy weight gain and obesity.

Candice Myers and Stephanie Broyles have pointed out that many of the counties with what Ashby describes as “fast food patronage” tended to be in the South where poverty rates were higher and access to healthy foods in grocery stores was limited. Additionally, while most restaurants were closed with limited takeout options, many drive-through fast food restaurants reopened, serving as one of the few food options for individuals from high obesity counties [8]. Therefore, lockdown may cause low income individuals to increase their consumption of unhealthy foods which increases their risk of weight gain and obesity.

Although certain portions of America can afford good health during this pandemic, low-income individuals and communities are less able to do so.

Thus, there exists concerns that these people could experience a significant increase in unhealthy weight gain and obesity. However, we need more research similar to Keel et al. to examine the true impact lockdown has had on the most vulnerable populations. As COVID-19 continues to reveal inequalities in our healthcare system and country as a whole, we must also continue to examine the inequalities that stem from our attempts to control the disease. If we fail to do so, we could be putting the most at-risk populations into a more precarious position than before the pandemic, exacerbating existing inequalities and complicating future efforts at remedying them. •

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Illustrator: Haley Pak

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Herd Immunity: The Foolproof Solution to COVID-19 Writer: Ricky Illindala • Editor: Akshay Govindan

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t has been nearly eight months of social distancing and mask-wearing since the coronavirus first started spreading rapidly in the US. Initially, many states predicted that a four to six week mandatory quarantine would halt the spread of the virus and allow us to return to normalcy. However, that was far from reality. Initial forecasts predicted that we would get over the pandemic during the summer, but now those forecasts have changed. The supposed “end” to the coronavirus pandemic has been delayed, and delayed, until the one question on almost everyone’s mind is: “When will this all end?”

One potential ending is when the population becomes herd immune to the coronavirus.

Herd immunity is a state in which a population becomes immune to a disease, where the risk of the disease continuing to spread is eliminated or greatly reduced due to enough, but not necessarily all, people in a population gaining immunity [4]. The percentage of immune people in the population required for herd immunity is known as the herd immunity threshold [10]. Not every person in a population is necessarily immune, but enough people are immune that they serve as a barrier to disease spread, which greatly lowers the rate of infection. Generally, there are two primary pathways to gaining herd immunity: vaccination or mass

As a result, vaccines protect both the person who is vaccinated as well as anyone else they might contact.

infection.

Vaccines are drugs that are administered as a pre-emptive defense against a pathogen. As more people in a population are vaccinated against a disease, they can no longer contract the infection nor spread it to someone else. As a result, vaccines protect both the person who is vaccinated as well as anyone else they might contact. This makes vaccines very effective in achieving herd immunity in a population [6]. However, vaccines are a recent discovery in the scope of human history.

Prior to the discovery of vaccines, herd immunity was achieved through more natural means: mass infection. This process is exactly as it sounds: as a disease spreads throughout a population, individuals will develop a resistance to the disease and be immune after the disease has run its course. However, the caveat is that this pathway could cause widespread illness in the population and potentially death [1]. For this reason, finding a vaccine to rapidly immunize a population is of the utmost priority when confronted with novel diseases.

A key historic example of the importance of vaccination in achieving herd immunity was the spread of polio during the first half of the 20th century. The polio virus initially emerged through sudden simultaneous outbreaks in Europe and the United States during the late 1800s. Epidemics repeated year after year, with cases rapidly rising to nearly 25 cases per 100,000 people from 1945 to 1954 [9].

Even though mass infections keep occurring, these epidemics affect smaller numbers of people, preventing the population from developing widespread

immunity. This resulted in an inability to build up herd immunity, allowing polio to reappear and spread illness and death through the affected populations, year after year. The course of the polio virus did not drastically change until the appearance of the inactivated polio vaccine in 1955 and oral polio vaccine in 1961. The number of annual paralytic cases were greater than 10,000 in the years prior to 1955, but the introduction of both vaccines dropped the annual number of cases to less than 100

For this reason, finding a vaccine to rapidly immunize a population is of the utmost priority when confronted with novel diseases.

by 1964 [9]. This highlights another significant danger with mass infection: it is not a foolproof method of obtaining herd immunity.

Unfortunately, we haven’t been able to produce a vaccine yet to rapidly curb the COVID-19 pandemic. However, we have been seeing mass infection occurring throughout the US. Hypothetically, if mass infection continued to occur without a vaccine in the near future, could we still reach herd immunity?

The answer is unclear. Given that we have no vaccine in this scenario, the only way for people to gain immunity is by contracting the coronavirus and surviving until their body develops immunity against it. To determine the

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percentage of the population who must contract COVID-19 to develop herd immunity, we utilize a very important statistic known as R0. R0, formally known

Given that we have no vaccine in this scenario, the only way for people to gain immunity is by contracting the coronavirus and surviving until their body develops immunity against it.

Illustrator: Noor Ghanam

as the “basic reproduction number,” is a measure of the contagiousness of a disease and is more colloquially explained as the number of people a person with coronavirus will infect, on average [3].

the US. The current number of deaths is not even one-tenth of the total number of deaths to reach herd immunity, and this number doesn’t even include the people who will survive but suffer in other ways [5]:

Every contagion has a unique R0 number, and the R0 is then used to determine the herd immunity threshold of that contagion. Estimates of the threshold for COVID-19 vary greatly, from 40 percent to 80 percent. Mathematician Tom Britton from Stockholm University assumed ideal conditions and developed a model that approximated the herd immunity threshold at 43 percent.

The US has a population of approximately 330 million, so 142 million people would need to contract coronavirus to achieve herd immunity [7]. If we also factor in the 2.7 percent fatality rate of COVID-19 cases, the side effect of herd immunity would be 3.8 million deaths.

In the last 8 months, there have been a total of about 220 thousand deaths in

“Imaging tests…have shown lasting damage to the heart muscle. This may increase the risk of heart failure or other heart complications in the future.

[Pneumonia] associated with COVID-19 can cause long-standing damage to the tiny air sacs (alveoli) in the lungs. The resulting scar tissue can lead to longterm breathing problems.” [8] The daunting amount of deaths and illness among people who contract the coronavirus is already plenty reason to minimize the spread of COVID-19.

However, there’s yet another barrier to herd immunity: the fact that it might be unachievable. Jeffrey Shaman, a professor of health sciences at Columbia University, conducted studies showing

that coronavirus can reinfect individuals. “If people can be mildly reinfected, then herd immunity simply would not work” [2]. Allowing people to get infected with the hopes of reaching herd immunity, only to fail ending the spread of COVID-19, would be devastating.

Given all of the dangers of following this path, it should seem obvious why most governments worldwide are stressing the importance of “flattening the curve” and reducing the spread of coronavirus. By not taking these dangers seriously and ignoring public health safety measures, such as wearing masks and keeping our distance, we not only endanger ourselves, but endanger the population as a whole.

Until a vaccine can be safely produced and distributed, reaching herd immunity is no short of a miracle. •

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Casual Cruelty: Pandemic Profiteering in a Failing Healthcare System Writer: Annie Feng • Editor: Jessica Wu

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hen President Donald Trump contracted Covid-19, he was taken to Walter Reed Medical Center and received the best medical treatment the United States had to offer. He was given an intense cocktail of drugs that showed promise against Covid-19.

Specialists flocked to his bedside in droves, and unlike most Americans, he did not have to worry about the bill afterwards. Shortly after leaving the hospital and returning to the White House, he urged his supporters not to let the coronavirus “dominate your life,” because “we have the best medicines in the world,” and yet, a third of U.S. adults do not fill a prescription, see a doctor when sick or get recommended care because of the cost of healthcare.

[3] In a survey by the Commonwealth

...a third of U.S. adults do not fill a prescription, see a doctor when sick or get recommended care because of the cost of healthcare.

Fund, 51 percent of Americans struggle to even find care in the evenings and on weekends without going to an emergency room.[3] The pandemic and ensuing economic downturn has only heightened the pressure on an already strained healthcare system, and people are falling through the cracks in a way that is becoming increasingly normalized.

The ongoing pandemic is continually exposing old weaknesses in the American

healthcare system. At the same time that the Trump administration attempts to tear down the Affordable Care Act, 8.5 percent of Americans are uninsured, an increase from when Trump took office.[3] Ironically, his own administration’s efforts would have led Trump to be discriminated against for having a pre-existing condition if he had been an average citizen who had contracted Covid-19. This debate about health insurance coverage during the pandemic also carries over to co-payments. In the first few months of the pandemic, both the Medicare program and private health insurance companies wanted to encourage telemedicine alternatives to in-person care by waiving the co-payments that would normally be charged for those appointments. However, starting October 1 two of the largest health insurers, Anthem and UnitedHealthcare, are no longer waiving copayments and deductibles for some customers.[2] In the midst of a historic economic downturn, even a $35 co-payment could end up discouraging Americans from seeing their doctors.

The ongoing pandemic is continually exposing old weaknesses in the American healthcare system

Meanwhile, health insurance companies have actually made massive profits during this pandemic while hospitals and private practices struggle. Although some hospitals have been overwhelmed by the rising tide of Covid-19 patients, many smaller practices and

rural hospitals are struggling to stay open because of the decrease of nonCovid-19 patients. Hospitals have been forced to cut staff in many cases as they struggle to stay afloat without their usual patient base. The patients too suffer from this, as many are no longer

Meanwhile, health insurance companies have actually made massive profits during this pandemic while hospitals and private practices struggle. receiving essential medical care. For example, elective surgery means any non-emergency surgery, so in many cases, elective surgery is not optional for survival or basic quality of life. It includes time-sensitive conditions such as breast cancer or kidney transplants.

Other forms of medical care such as access to prescription drugs or dialysis for impaired kidney function also became harder to access during the pandemic. However, during this crisis insurers have paid billions less in medical claims during the pandemic because elective surgeries have been postponed in many places, and fewer patients are going to emergency rooms and doctor’s offices. Some of the largest companies, including both Anthem and UnitedHealthcare, reported second-quarter earnings that are double what they were a year ago.[1] This pandemic profiteering is taking place during a time when state governments are facing massive budget shortfalls as businesses collapse, unemployment rises and tax revenues plummet.

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While the focus of public attention has justifiably been on Covid-19 patients, the development of a vaccine and increasing testing, there are other aspects of the healthcare system that teeter on the edge of complete breakdown. Rural

Hospitals have been forced to cut staff in many cases as they struggle to stay afloat without their usual patient base. hospitals that are the only source of care for entire towns are fighting to make ends meet. Doctors risking their own health in order to treat patients are being told they are being let go because the hospital cannot afford to keep them on staff during a public health crisis. Patients are dying of completely preventable causes because they cannot access healthcare or simply cannot afford it. The casual cruelty of the American healthcare system is not news to anyone. Indeed, it is hard to find anyone working in healthcare

Rural hospitals that are the only source of care for entire towns are fighting to make ends meet. who does not have a story about a patient who could not afford a treatment that would save their life or who would take less than the prescribed dose to

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make their prescriptions stretch longer. There needs to be serious reform of the healthcare system, expanded protections for patients receiving federal health insurance and regulations on private insurance companies. If the previous normal was not providing adequate care to Americans, then without further action this new normal will be a death sentence for many. •

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Utilizing Technology in the Age of Addiction Writer: Haleigh Pine • Editor: Daniel Berkovich

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magine you’re thrown into the middle of an emergency room, in charge of too many people, responsible for too many patients, having piles of paperwork. And you haven’t been trained for any of it. This is the reality for most social workers. The internship, residency, fellowship, attending structure we all know from Grey’s Anatomy doesn’t exist in the realm of addiction therapy.

Recent graduates don’t have clinics to practice in or resources on the level of students in medicine, psychiatry and even dentistry. They get thrown into an underfunded and chaotic system, which has only been exacerbated by the pandemic.

Dr. David Patterson Silver Wolf, associate professor at the Brown School and director of the Community Academic Partnership on Addiction (CAPA) is working towards dissolving this problem. As chief research officer, he has developed a clinic in which interns receive supervised patient interaction and are paid for time and billed for services, like in medical models. This initiative increased patient completion rates by 11% over six months. Patterson Silver Wolf compares this to graduating high school, where just the act of finishing the program leads to better health outcomes.

As chief research officer, he has developed a clinic in which interns receive supervised patient interaction and are paid for time and billed for services, like in medical models.

Therapists have unsustainable caseloads of 75-100 people and struggle to answer basic questions about both open and closed cases. When a patient walks into a clinic, they are often assigned the therapist that is “up next”— the one who has the lightest caseload or is free at that moment.

Furthermore, there are patient biases inherent in the treatment system.

When looking for therapists, patients don’t have access to information about their education, experience or other factors that are available when choosing a doctor. According to Patterson Silver Wolf, therapists aren’t necessarily rewarded for excellence and many times mediocre treatment is the norm.

Therapists have unsustainable caseloads of 75100 people and struggle to answer basic questions about both open and closed cases.

Social workers are taught that every patient has an equal chance at recovery, but there is evidence behind opposing claims. According to Patterson Silver Wolf, the field needs to consider that patient completion rates are at least partially dependent on the therapist’s demographic profile. In one study, white male therapists have statistically significant success rates in every race and gender match compared to other genders and demographics, while nonwhite male therapists had no female patients (1). This brings up concerns

In one study, white male therapists have statistically significant success rates in every race and gender match compared to other genders and demographics, while nonwhite male therapists had no female patients. about what is defined as “success” in therapy, as nobody would recommend to only employ white male therapists.

This relates to the importance of more accountability in therapy with higher standards, as well as matching patients with therapists based on demographics and other valuable data instead of random assignment.

A study by Dr. Lisa A. Marsch explains the benefits of technology-based therapeutic tools such as computerized assessments, behavior therapies, prevention interventions and recovery support programs (2). She suggests that tools can be used in addition to traditional treatment methods or to replace pieces of their patient interaction. This would allow clinicians to treat more clients and have more time to manage specific crises for those with the greatest needs. Another possibility is the implementation of technology as stand-alone intervention, benefiting those with limited access to care, such as residents of rural areas.

“Services are based on therapists’ good intentions and bad intuitions.

Therapists and the organizations they work, have no real-time and real-world

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data on the performance of their own services or on the health improvements of their patients,” according to Patterson Silver Wolf.

Patterson Silver Wolf incorporates technology to address many of the biases and lack of transparency in therapy with his St. Louis-based startup Takoda.

Takoda recognizes that recovery happens in the community, not in clinics.

Their user interface includes patient questionnaires, remote check-ins and access to schedules and trends over past sessions. Essentially, this quantitative and qualitative data can be sent to their therapist to better assess their day-to-day activities. The data includes the location of relapses, real-time measurements of anxiety and cravings, as well as demographics and retention rates.

Their user interface includes patient questionnaires, remote check-ins and access to schedules and trends over past sessions.

This constant contact helps with intervention and retention in Substance Use Disorder (SUD) outpatient programs.

After the initial dropouts after weeks 1 and 2, there is another spike after weeks 4 and 5 because patients feel like they’ve received all the new information they can about therapy. don’t hear much new information. There are also racial disparities, as non-white

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individuals spend an average of 65.99 days in the program compared to 115.45 days for white individuals. According to Patterson Silver Wolf, innovations in technology serve to “replace intuition and gut feelings with science, data and technology.”

According to Patterson Silver Wolf, innovations in technology serve to “replace intuition and gut feelings with science, data and technology.”

This new system has become even more relevant with the pandemic. From a physiological perspective, individuals with SUDs are more likely to have suppressed immune systems and have a greater risk of respiratory infections and lung and heart diseases (3). On top of that, they are often stigmatized and underserved by the healthcare system, experience housing instability and higher incarceration rates and may have difficulty accessing medication or therapy (4). Furthermore, from a social perspective, isolation negatively affects recovery from substance use disorders, increasing risk for relapse, withdrawal and suicide (5). Takoda has added a video-based telehealth service to their platform and encouraged distribution of their technology as a response to the pandemic.

“Social distancing and lack of face to face contact presents unique challenges and [we need] accelerated digital and telehealth communications in this

industry that historically is behind the tech adoption curve,” Patterson Silver Wolf elaborated.

With the new technology developed for contact tracing and other online platforms during the pandemic, there is hope for application in the field of social work to address systemic problems in the future. •

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Time to Vaccinate Writer: Alicia Yang • Editor: Haley Pak

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he United States leads the world in medical research and healthcare spending. In 2005, President George W. Bush announced a detailed and comprehensive plan written by the Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) to prevent and respond to infectious diseases at the state and federal levels. Congress allocated $8 billion to map outbreaks, accumulate resources, and create preparatory policies.

Despite nearly two decades of anticipation, the COVID-19 pandemic has provoked tremendous loss of life, exhausted the medical system, and started an economic downturn in the United States [1, 2, 3]. In hopes that the long-awaited vaccine will restore normalcy, Congress has directed almost $10 billion to Operation Warp Speed, an initiative by the U.S. Department of Health and Human Services and the Department of Defense to “produce and deliver 300 million doses of safe and effective vaccines with the initial doses available by January 2021.” The arrival seems a long ways away, but is a sprint in the research world.

The science of immunization makes progress slow. Coronaviruses such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and SARS-CoV-2–the disease agent of COVID–have a surface protein S that gives the viruses their characteristic crown-like appearance and their ability to attack host cells.

Previous research on SARS and MERS indicate that a weakened or killed coronavirus with modified S proteins could stimulate antibody production and confer immunity; however, these vaccines were never developed [4].

COVID vaccine candidates have been researched at unprecedented speed, but not at the expense of safety and effectiveness. Dr. Rachel Presti, a Principal Investigator of the NIH-AIDS Clinical Trials Unit at WUSM and Medical Director of the Infectious Disease Clinical Research Unit, underscored the importance of thorough and representative vaccine testing in the final Phase 3 human trials of COVID vaccines in a Zoom seminar from the Harvey A. Friedman Center for Aging at WashU. Isolating an agent that effectively targets human cells without causing the painful and dangerous symptoms of SARS-CoV-2 is the first challenge. Hasty vaccine administration could harm not only recipients, but also public perception of vaccinations—a historically contentious topic in the United States. After analyzing two telephone surveys from the National Immunization SurveyFlu and the Behavioral Risk Factor Surveillance System (BRFSS), the CDC estimated that flu vaccination coverage was only 62.6 percent among children and 45.3 percent among adults over 18 years old. Distrust in vaccines could be especially detrimental this winter. Dr. Presti underscored the importance of the influenza vaccine during the ongoing COVID pandemic. While the familiar flu vaccine does not protect against coronavirus, it would prevent an even worse scenario of co-infection. Vaccines can only give immunity if a critical mass of individuals receive it.

Since the highest priority is the health of clinical trial participants, studies often draw from a pool of relatively healthy volunteers. Lack of diverse participation may contribute to non-representative findings on the vaccine.

COVID-19, however, disproportionately affects people older than age 65 and

minority groups. Adults over 65 constituted 80 percent of COVID-related hospitalizations and have a 23-fold greater risk of death. To achieve maximum protection, “we need dedicated programs to expand vaccine coverage,” specifies Dr. Presti. This starts with clinical trial recruitment. Researchers must create a vaccine that works well for older adults with slower and weaker immune systems. Clinical trials must also recruit minorities and essential workers that have been most affected by the disease.

The COVID-19 Prevention Network formed by the National Institute of Allergy and Infectious Diseases, with an arm at WashU, is working to respond to this global pandemic, conduct Phase 3 efficacy trials for vaccines and antibody treatments, and ensure fair representation. For more information about vaccine testing at WUSTL, email idcru@ wustl.edu or call 314-454-0058.

Even if every individual was able to receive a dose, no vaccine works 100 percent of the time. Not all vaccinated individuals develop immunity. A vaccine would, however, be a major step toward recovery. Moderna, an American biotechnology company, is using messenger RNA—the transition molecule between DNA to proteins—to engineer a vaccine that is currently in Phase 3 testing. Their study is close to full enrollment of 30,000 participants.

Other Phase 3 studies are being conducted globally. While researchers work hard to deliver a vaccine, it is imperative that we act with vulnerable populations in mind. Physical distancing, face masks and good hygiene are here to stay.

For more information about vaccine testing at WUSTL, email idcru@wustl.edu or call 314-454-0058.

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A Double Whammy: Flu & Coronavirus Writer: Kevin Oloomi • Editor: Eileen Yang

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any countries across the globe are beginning to experience a second wave of SARS-CoV-2, the virus responsible for Covid-19. The horrific prospect of two epidemics, the flu and coronavirus, occurring at the same time is now an all too real possibility. Canadian Chief Public Health Officer Theresa Tam stated that “unless protective measures are strengthened the nation is on track for a major resurgence in cases” [9]. European cities are doing exactly that, with many of them re-imposing restrictions on indoor/outdoor gatherings in an attempt to prevent another nationwide lockdown[4]. However, the question remains: what will happen if and when Covid-19’s second wave arises, and how will it interact with the flu.

...unless protective measures are strengthened the nation is on track for a major resurgence in cases...

This raises an interesting question to researchers who are trying to understand the biochemical and cellular factors that give rise to Covid-19’s varying effects on the human body. Scientists at Washington University School of Medicine recently conducted a study[7] analyzing the immunopathology and causes of severe respiratory distress, like influenza and Covid-19. For the most part, these two viruses seem symptomatically similar except for some key molecular differences. For one, individuals with Covid-19 experience a cytokine storm, an aggressive

Illustrator: Elena Bosak inflammatory reaction to a virus. In humans, this storm typically leads to the deterioration of endothelial cells in the lungs and increases the risk of contracting pneumonia[11]. However, these scientists were intrigued that patients with Covid-19 experienced

“profound type I and type II IFN immunosuppression in comparison to influenza patients” [7]. It is believed that this immunosuppression is what leads to significantly high viral counts found in Covid-19 patients, as “IFN receptors are critical to modulating the antiviral

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immune response” [5]. These two viruses have vastly different underlying pathologies, regardless of the similarity of their visible phenotypes, so doctors need to adopt new protocols to treat each respective patient.

It is believed that this immunosuppression is what leads to significantly high viral counts found in Covid-19 patients.

Beyond the molecular scale, these two viruses pose a unique problem for the healthcare industry. There are significant similarities between the typical symptomatic representation of influenza and Covid-19, so distinguishing between the two based solely off of visible symptoms is almost impossible.

It is only through the various PCR and saliva tests that scientists are able to definitively differentiate the two from one another.

Now, as the seasonal flu commences, individuals who would otherwise have just treated themselves at home will now go and get tested for COVID-19. An estimated 25 to 50 million Americans are infected annually, and if a significant portion go to get tested, they will put an increased strain on the United States’ already overburdened testing apparatus[6]. At the present moment, United States labs conduct about “800,000 diagnostic tests daily, but various estimates assert that there needs to be 6-10 million tests per day” [6] In areas where access to these laboratories is limited, this can have significant

consequences, preventing individuals from obtaining the necessary testing and contact tracing they need. This, combined with the “mask and isolation fatigue”—exhaustion with lockdowns and significant healthcare precautions—sets the stage for an incredible burden on an already overdrawn healthcare industry.

However, it is not all doom and gloom.

An observational study conducted by Professor Benjamin Crowling determined that “influenza transmission [in Hong Kong] declined substantially after the implementation of social distancing measures and changes in population behaviours in late January [2020], with a 44 percent reduction in transmissibility in the community” [3].

The mandated masks, social distancing and handwashing proved to be effective in curtailing viral transmissions as a whole. Moreover, a separate study determined that “transient immune-mediated interference can cause a relatively ubiquitous common cold-like virus to diminish during peak activity of a seasonal virus” [10]. In essence, this means that because of the high infection rate of SARS-CoV-2, the human population’s burst of temporary immunity can

These two viruses have vastly different underlying pathologies, regardless of the similarity of their visible phenotypes, so doctors need to adopt new protocols to treat each respective patient.

protect against more common seasonal viruses like the flu and the common cold when they are most active[10].

It is important to understand that the only thing people are certain of during this time is uncertainty itself. These aforementioned studies are used to forecast what could happen in the coming months, and all of them can only be right to some degree of certainty.

It is important that we, as citizens, remain vigilant to combating this virus, following public health guidelines and amending our personal behaviors for the benefit of the community. •

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To School or Not to School Writer: Casey Connelly • Editor: Anhthi Luong

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hould we send children back to school during a pandemic? A year ago, attending school would have been mandatory. Now it’s up to the parents.

How have parents made this difficult decision, and what is the CDC’s advice?

On their website, there is a “School Decision-Making Tool for Parents, Caregivers and Guardians.” [1] The purpose of the tool is to help all people raising school-aged children to make appropriate decisions about their childrens’ learning this year amid the COVID-19 pandemic. Among the most important questions to determine is whether or not parents and guardians will send their children back to school for in-person education or interact with teachers remotely. Of course, the tool won’t tell anyone definitively what to do,but the CDC strongly suggests parents get in touch with their childrens’ school administration to find out more information or articulate their specific concerns.

The tool asks questions about how comfortable parents feel sending their children to school, the feasibility of virtual learning, academic and social-emotional wellbeing and school based services, such as Individualized Education Programs and nutrition services like breakfast and lunch. There are 27 questions, and caretakers are encouraged to answer with responses, such as, “agree,” “disagree,” “unsure” and “does not apply.” The point is this: the decision to send children back to school or not is a complicated and personal one.

It comes down to whether or not parents can support at-home learning, feel comfortable with their school’s reopening plan (and plans for when someone inevitably tests positive) and need assistance with providing special education programs, behavioral services and

Illustrator: Jennifer Broza

meals for their children. It depends on the location of the child and the caretaker, how well their respective state has gained control over the virus and whether there is safe transportation to and from schools. There may not be

a right decision, and the best decision may change over time. As helpful as the tool may be, it allocates a significant amount of responsibility onto the parents, who may have to watch over their children during remote classes or

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ensure that they themselves quarantine in the event of an outbreak.

Beyond personal feasibility and preference lie questions that don’t yet have definitive answers, such as how often children become infected [2], how sick they get and how much they spread the virus to adults. Studying transmission is very difficult, and though COVID-19 cases in children have been relatively low, they are on the rise. Another critical question (and arguably the most important) is what local transmission is like; in places with fewer cases, the chance that in-person learning will work smoothly is higher. COVID-19 can spread through close contact with others who are infectious, breathing in viral particles present in the air and touching surfaces that contain the virus [3]. As parents start making this complex decision with little definitive scientific information, and in places where the magnitude of spread can quickly shift from better to worse, it will be important for schools to remain both flexible and supportive throughout the school year. And perhaps most importantly, it will require everyone, including parents, school administrators, teachers and tutors to understand that this will be anything but a normal school year. Both parents and children will be met with unusual challenges, many going beyond health concerns; with limited social contact, everyone will feel the strain of social distancing.

Checking in on the mental well-being of children (and their guardians) will be imperative. Prioritizing safe social interaction, even if children can’t hug their friends, is important for a healthy school-year.

The decision to send children back to school is difficult, because there

is substantial support for both sides.

Those in favor of sending children back to school focus on the fact that children learn better in a traditional educational environment, and it is both challenging and even unhealthy for children to sit in front of a computer screen for many hours (eye strain is a concern, often called “computer vision syndrome”) [4]. Social interaction in school also has benefits to children’s mental well-being; staying home and severely limiting social interaction could be detrimental [5]. Some parents are considered essential workers and cannot stay home to watch their children or help them with schoolwork, and this may cause an economic strain on families who cannot hire babysitters or nannies, according to WUSTL’s Covid-19 course by Robin Nelson. Children who get most of their meals at school will need to be provided meals at home, which may not be feasible. Children living in abusive homes may be even more exposed to unsafe living conditions without the escape that school provides and the potential for intervention from teachers and other administrators.

On the other hand, sending children back to school puts at risk both public health and the safety of children and teachers. Children living with immunocompromised or at-risk adults could spread the virus to their caretakers.

Opening schools and risking a spread of COVID-19 could prolong the pandemic. Teachers will be put in particularly difficult positions–both risking their health and potentially their jobs, if they are not able to work. Should widespread viral infections occur in school, they could be difficult and costly to contain. In addition, children may have difficulty despite being in the classroom–long hours of mask-wearing

is difficult for children of any age, and learning from teachers without being able to read lips and facial expressions might pose more problems. Group work will be difficult with social distancing measures in place. With all of these inconveniences, many guardians and school administrators may decide that the learning experience will be more valuable at home.

Fortunately, we are in somewhat of a better position this Fall–schools were completely unprepared for learning when they shut down in the Spring.

Since then, schools have made modifications to their plans, have had time to research best health practices and properly train teachers. Parents have had the experience of remote learning with their children and have some insight about how their child functions in that environment. No matter which way children go back to school, whether it be in person or online, both parents, children and administrators are more prepared than they were in March. •

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Blame it on the Alcohol: How Hand Sanitizer Overuse May Create a Superbug Writer: Rida Qureshi • Editor: Haleigh Pine How many times today have you used hand sanitizer?

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n the midst of a pandemic — where reminders to wear a mask are more common than welcome mats, and Purell dispensers are located at every door—using antimicrobials has become second nature. The average WashU student comes into contact with hand sanitizer dozens of times a day, be it before entering a classroom, grabbing a meal at BD, walking by a Student Health Ambassador or using their own pocket sanitizer. No one thinks to count how many times they’ve washed their hands —at least, not while the health of their university depends on it. In truth, as every day brings conflicting political messages on how to handle the pandemic and unanticipated scientific findings on the virus itself, students feel helpless, and sanitizer stands as one of the few aspects of this pandemic they can control. But even though it keeps us safe in the present moment, is excessive sanitizer usage truly in our future’s best interest? Or are we setting ourselves up for an even worse public health crisis in the long term?

Popularized in the early 1990s for their ease of use, alcohol-based hand sanitizer became a staple in most healthcare settings and played a significant role in decreasing staph infections.

Illustrator: Angela Chen

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Popularized in the early 1990s for their ease of use, alcohol-based hand sanitizer became a staple in most healthcare settings and played a significant role in decreasing staph infections [1].

At the same time, however, hospitals saw a significant increase in resistant strains of certain pathogens, ranging from MRSA to enterococci [2]. Over the last decade, dozens of studies were published warning healthcare officials against the effects of hand sanitizer on the development of resistance in dangerous pathogens. Most recently, a 2018 Australian study comparing enterococci isolates between 1997 and 2015 found that “isolates after 2010 were 10-fold more tolerant to killing by alcohol than were older isolates.”

Additionally, due to the popularity of homemade hand sanitizer over the summer, toxicologist Winston Morgan worries that alcohol substitutes known to cause gene damage like phenols and hydrogen peroxide may encourage the acquisition of resistance through mutation [3]. Thus, it’s become increasingly clear that excessive use of hand sanitizer can cause resistance—but how?

Commercial hand sanitizers claim that they kill 99.9 percent of all microbes on one’s hands, and though 0.1 percent left alive seems miniscule at face value, this percentage becomes much more significant when you take into account that the average hand holds about 3,200 bacteria from 150 different species. Those few bacteria that survive have resistance that is either intrinsic, meaning their genome initially contained a resistant gene due to inheritance or mutation during reproduction, or acquired, meaning they gained resistance by transferring genes with other bacteria [4]. When we kill off all weak bacteria on our hands, we leave behind

the strong ones and allow them to reproduce, producing a colony of bacteria with a much higher frequency of resistant genes than before. This microcosmic form of natural selection is responsible for 2.8 million resistant infections and 35,000 deaths a year—and though it has currently taken a backseat to the pandemic, antimicrobial resistance has widely been considered one of the biggest public health crises around the globe since the early 2000s.

When we kill off all weak bacteria on our hands, we leave behind the strong ones and allow them to reproduce...

Unfortunately, these bacteria are not just becoming resistant to alcohols and disinfectants; they’re applying this resistance to antibiotics as well. A 1999 study of a common hospital disinfectant, benzalkonium chloride, found that strains of MRSA resistant to this disinfectant were also more likely to resist the very antibiotics commonly used to treat them [5]. This is because many of the mechanisms whereby alcohols kill bacteria or viruses, such as membrane damage and protein denaturation, are similar to the mechanisms antibiotics utilize to target infections [6]. Though little data is available linking alcohol resistance to antibiotic resistance, the implications of this possibility are grave—especially as our healthcare system still struggles under the weight of COVID-19.

“The prioritized allocation of isolation rooms to COVID-19 patients, management in open bays of patients colonized with [resistant bacteria]... and the inevitable higher workload of healthcare workers” are all factors identified in a “Journal of Antimicrobial Chemotherapy” article as consequences of the pandemic that will greatly exacerbate the spread of resistant bacteria [2]. Moreover, a recent report by the International Severe Acute Respiratory and Emerging Infections Consortium found that 62 percent of patients with COVID-19 had received broad spectrum antibiotics as part of their treatment despite few reports of a coinciding bacterial infection necessitating antibiotics.

From over prescribed antibiotics to overwhelmed hospital beds and laboratories, crucial aspects of American healthcare have been brought to their knees by the pandemic. Adding salt to the wound with an outbreak of resistant pathogens would prove outright disastrous for any chance at a ‘return to normal.’

As sparse as the data is regarding antimicrobial resistance in the pandemic, one truth is abundantly clear: a pump of hand sanitizer is much more than it seems at first glance. Rubbing sanitizer into their palms may have become muscle memory for the average WashU student, but the student body needs to understand the detriment that antimicrobials pose to their long-term health.

That’s not to say students shouldn’t be using sanitizer—hand sanitizer is proven to inactivate novel coronaviruses—but using Purell a dozen times a day means this pandemic will not end with the elimination of SARS-CoV-2 [7].

Rather, we may jump out of the frying pan and into the fire of antimicrobial resistance. •

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Expanding Telehealth for Diabetes Management Writer: Rehan Mehta • Editor: Keshav Kailash

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he COVID-19 pandemic has forced society to restructure and adapt.

Unsurprisingly, technology has been at the center of almost every adaptation and this is clearly evident in the field of medicine. This pandemic has dramatically accelerated the use of telehealth as a way to ensure the safety of patients and healthcare providers while still providing optimal care. The potential benefits of telehealth are now being realized, and it is now clear that telehealth will serve an important role in the future of healthcare.

One area in which telehealth is well suited for and can improve patient health outcomes, is diabetes management. According to the CDC, about 10.5 percent of the U.S. population has diabetes, which is about 34.2 million people. In addition to this, the total cost of diagnosed diabetes in the U.S. is estimated to be over $320 billion. Most of these costs are spent on treating complications that are a result of poorly controlled diabetes [1]. It is evident that diabetes and its resulting complications place a substantial economic and social burden on our society and that there is an urgent need for improvements in diabetes management. Existing evidence suggests that telehealth provides an opportunity to effectively monitor and manage people with diabetes at a distance and as frequently as needed. The goal of diabetes management is to keep one’s blood sugar levels as close to normal as possible and therefore reduce the risk of complications [7].

Hemoglobin A1c, or just A1c, is considered to be the gold standard for monitoring blood sugar levels in people with diabetes. According to the American Diabetes Association, adults with diabetes should aim to have an A1c level

Illustrator: Lucy Chen

of below seven percent [2]. The higher the A1c level, the greater one’s risk is of developing complications due to diabetes. This level can be maintained with a combination of a healthy diet, exercise and medication. One meta-analysis of 25 randomized controlled trials has shown that telehealth interventions

result in a small but statistically significant lowering of hemoglobin A1c levels when compared to usual care in adults with type two diabetes [7]. In these trials, telehealth involves patients sending their daily blood glucose readings to their healthcare professional who will then follow up by reviewing and

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discussing the values with his or her patient. The results of the meta-analysis provide evidence that telehealth can be beneficial and can effectively control A1c levels in people with type two diabetes.

In addition, several mobile applications are now available which can help people better manage diabetes by enabling blood sugar tracking, medication reminders and nutrition and physical activity tracking.

In addition to these findings, improvements in glucose monitoring systems allow for more data that is easily accessible and transmitted. The traditional way of measuring one’s glucose level is with a blood glucose meter which can only generate a single reading at a time. Continuous glucose monitoring is a newer method for evaluating glucose levels and generally consists of a sensor that is worn on the body that automatically obtains periodic glucose readings [5]. The data can then be wirelessly transmitted to be displayed on one’s phone. In addition, several mobile applications are now available which can help people better manage diabetes by enabling blood sugar tracking, medication reminders and nutrition and physical activity tracking. Continuous glucose monitoring systems can generate up to 288 readings per day and continually check glucose levels during both

day and night. With more readings, health professionals can determine patterns in glucose fluctuations, leading to more informed decisions about what the patient should do to control their A1c levels [5]. These aspects of continuous glucose monitoring make it well suited for and easily integrated with telehealth. One study designed to assess the feasibility of initiating continuous glucose monitoring through a telehealth approach consisted of 27 adults with type one diabetes and seven adults with type two diabetes using insulin who were interested in starting continuous glucose monitoring. The results revealed a statistically significant decrease in mean A1c levels and an increase in the percentage of time the patients’ blood glucose levels were in target range from 48 percent at baseline to 59 percent with continuous glucose monitoring [6]. Patients also reported a very positive impact on measures of quality-of-life [6]. These findings suggest that continuous glucose monitoring combined with telehealth has the potential to empower patients with diabetes and substantially improve glycemic control. Additionally, the study notes that telehealth could significantly increase the adoption of continuous glucose monitoring systems [6].

Often, many patients with diabetes do not reach treatment goals due to barriers in accessing healthcare, especially in underserved and rural areas. Telehealth has the advantage over traditional medicine in that it can potentially overcome these barriers and expand access to care. In one study evaluating telehealth’s effectiveness in delivering diabetes care to rural areas, 32 veterans with type one diabetes living in rural areas of Alabama and Georgia faced barriers to receiving

proper diabetes care due to a lack of endocrinologists in the area. The patients received care from endocrinologists not in the area and overall mean A1c levels decreased. More importantly, patients saved, on average, 78 minutes of travel time going one way and the Veterans Health Administration (VHA) saved $72.94 per patient for travel reimbursements [8]. It is estimated that the VHA would save $9,336.32 per year in reimbursements just for those 32 patients. Not only did telehealth expand access to care, but it led to substantial cost savings, suggesting that telehealth can deliver additional benefits while being a viable alternative to traditional diabetes management.

Given its benefits and with continuous glucose monitoring systems becoming more common, telehealth is poised to replace clinical visits when it comes to diabetes management. Not only has it demonstrated that it can enhance the quality of diabetes care, but it can also reduce the substantial costs associated with diabetes and expand access to care. As telehealth is further stud-

...telehealth is poised to replace clinical visits when it comes to diabetes management. ied and developed, it will soon be integrated into other areas of medicine.

Telehealth has paved the way for a new age of virtual medical care and will redefine the landscape of tomorrow’s medicine. •

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PTSD and the Neurobiological Basis of Trauma Writer: Soyi Sarkar • Editor: Alexandra Dram

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rauma is more common than you would think, and it encompasses events and experiences that impact a person’s integrity and well-being. The World Mental Health Survey estimates that around 70 percent of people will experience at least one traumatic incident in their lifetimes [4]. These events can be related to natural disasters, war, sexual or intimate partner violence, or other accidents/injuries [4]. The way an individual’s traumatic experiences manifest can vary significantly; thus, mental health advocates work to raise awareness by communicating that trauma can lead to differential emotional, physical, and behavioral adjustments.

Through investigating these behavioral variabilities, researchers have begun to develop theory and foundational knowledge on the physiological results of trauma. It can be all too easy to dismiss the experiences leading to emotional instability as ones to “just get over,”; however, new fields of study on the brain and body of traumatized individuals show that emotional injuries and physical injuries are well connected.

...emotional injuries and physical injuries are well connected.

Illustrator: Shelly Xu The identification of Post-Traumatic Stress Disorder in the 1970s following increased “psychological and social difficulties of the nearly three million veterans who had fought in Vietnam” acknowledged trauma’s pervasive effect [4]. Yet, almost 50 years passed until the DSM-5 updated PTSD’s narrow

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definition in 2018 to include three subcategories: reexperiencing, avoidance and hyperarousal [4]. These include intrusive thoughts of the trauma, presence of strategies to minimize the harm caused by the event and extreme startle or hypervigilance. Additionally, while PTSD diagnoses are commonly given to war veterans, psychologists have recently identified survivors of sexual assault and prolonged intimate partner violence (IPV) also frequently suffer from PTSD, with symptoms of “intrusions, nightmares, startle reactions, and numbness” [4]. The most striking

One of the hallmarks of trauma response is the “freezing” response that occurs when someone is unable to move physically or make self-benefitting decisions during a traumatic event. This is due to the activation of the brain’s “fear circuitry,” where neurons in the amygdala (fear center of the brain) are hyperactivated while neural pathways in the prefrontal cortex (center for behavior, higher functional thinking and memory) are inhibited. In this way, fear “takes over” and survivors may experience “tonic immobility,” furthering their inability to escape potentially dangerous situations [5].

The most striking outcome of recent psychology research regarding PTSD is the incidence rate.

In support of these hypotheses, fMRI analysis demonstrates decreased activity in both the hippocampus and the dorsolateral prefrontal cortex, brain regions that are responsible for encoding memories and temporally understanding experiences respectively.

“When those brain regions are deactivated, people … become trapped in the moment, without a sense of past, present or future” [1]. When the hippocampus is deactivated, memories are fascinatingly encoded physiologically differently in the brain. This can serve to explain why most of the peripheral details of particular traumatic experiences are unattended to (such as the timeline of events or the happening in the surroundings) leaving individuals with difficulty in explaining the situation as it occurred.

outcome of recent psychology research regarding PTSD is the incidence rate.

According to the National Comorbidity Survey Replication, “lifetime PTSD prevalence rates are 3.6 percent and 9.7 percent respectively among American men and women” and are even higher for individuals in post-conflict nations like Cambodia (28 percent) and Algeria (37 percent) [3]. Since PTSD was identified, more extensive research has led to a more detailed diagnosis and an awareness of the high incidence rate.

While not all trauma leads to a diagnosis of PTSD, the newfound understanding of the etiology of PTSD have shown researchers that all forms of trauma have far reaching consequences on mental and physical health.

Yet another effect of a decreased activation in the prefrontal cortex is the behavior that occurs when decisions are not made. These behaviors are survival reflexes that occur as a result of habituation or “auto-pilot” in a way that the person dissociates from their experiences [5]. In PTSD and other

continuous consequences of trauma, “the overwhelming [traumatic] experience is split off and fragmented… and the sensor fragments of memory intrude into the present” [2]. In this way, one may be not only hazy about the order of events that occur during a natural disaster, for example, but also seem disconnected from their experiences when explaining to others.

With the frontal lobe at the seat of decision making, higher order thinking and experience interpretation, the deactivation of its cognitive processing during periods of perceived danger creates a plethora of tangible consequences.

The research on the biological basis of trauma response has allowed healthcare providers and even the general public to further their understanding that behavior post-trauma is not an individual inherent weakness but rather a biological response to external etiological experiences. These affect not only a person’s comprehension of the experience they went through but also often dictate how this experience will be interpreted for years to come. •

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Breaking Down the Language Barrier Writer: Maya Kovacevic • Editor: Isaac Murdokuvich

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oing to the hospital is almost always a stressful process—navigating through the labyrinthine hallways, filling out infinite nit-picky forms, processing the medical jargon from test results.

And for many Americans, this is all done in their native language—English.

But for many others, English is not their most comfortable language. It’s bulky, unfamiliar, haphazard. None of which are helpful in understanding the critical information given by the physician.

So when the doctor and patient speak different languages, their relationship weakens. Not only are they unable to communicate about the patient’s health but also the feeling of trust and comfort also disintegrates. More plainly speaking, the language barrier denies non-English-proficient patients quality healthcare in the United States.

In every facet of daily living, the as-

In every facet of daily living, the assumption is that the general public can read, speak and understand English—and the healthcare system is no exception. sumption is that the general public can read, speak and understand English— and the healthcare system is no exception [6]. Some options are available within larger organizations to foster interlanguage communication, such as translation and interpretation services. However, the demographics of Americans who speak non-English

languages at home is rapidly increasing. The Center for Immigration Studies found that “as a share of the population, 21.9 percent of U.S. residents speak a foreign language at home.” They further report that “of those who speak a foreign language at home, 25.6 million (38 percent) told the Census Bureau that they speak English less than very well.” As the percentage of these foreign-language speakers continues to grow and the number of those who are not proficient in English, the demand for translation and interpretation services rises [10].

In addition to the increasing demand, a study by the Joint Commission in 2015 found that limited English proficient (LEP) patients “are at a higher risk for adverse events than Englishspeaking patients. Language barriers significantly impact safe and effective health care… The study found that 49.1 percent of LEP patients experienced physical harm versus 29.5 percent of English-speaking patients.” [2] As the LEP demographic grows, ending this trend is critical to bridge the divide in quality healthcare based on English language proficiency.

Yet this split in care is already rampant throughout the American healthcare system, and in March 2020, when the COVID-19 pandemic reached the continental US, its amplified effects were devastating. The New York Times reported that by April, “At Cambridge Health Alliance in Massachusetts, nearly half of the 126,000 patients in its primary care system have limited English proficiency. The Alliance has 100 staff interpreters who usually work in its emergency rooms and community clinics.” This disproportionate ratio between LEP patients and the resources

available to them has shifted the burden onto interpreters, who have had to cope with both an overwhelming number of cases and the shift to remote work. The New York Times elaborates, “Communicating through [an] interpreter doubles or triples the length of a medical exchange, adding new confusion and anxiety to situations that are already stressful for patients and their families [3]. And the conditions of COVID-19 care—the novelty of the virus and its possible effects, the desire of hospital workers to limit the duration of their exposure to patients and prohibit non-patient visitors (who often can serve as interpreters for the patients)— create numerous obstacles to effective interpretation.” [7] Without proper language services, non-English-proficient patients suffer from confusion about their situation and their physical health ailments.

Outside of the hospital, the language barrier has been hindering COVID-19 public health efforts. Contact trac-

Without proper language services, non-English-proficient patients suffer from confusion about their situation and their physical health ailments.

ing, an essential practice for curbing the spread among immigrant communities, has proven to be extremely difficult to maintain due to mistrust in the government and the lack of

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...translated information about the pandemic, mainly via public health announcements and updates, has been slow to update. non-English-proficient tracers. Contact tracers proficient in Polish, Spanish, Arabic, Vietnamese, Chinese and Hindi, to name a few, are needed throughout the country to adequately meet the needs of local communities [9]. Without them, the fear of being monitored for purposes apart from COVID-19 position these communities at greater transmission risk.

Furthermore, translated information

Inadequate translation services only reinforce the health disparity trends so prevalent in the United States.

about the pandemic, mainly via public health announcements and updates, has been slow to update. Often when it is updated, it is in lesser detail than in the English versions. Denying non-English speakers the opportunity to fully understand what is happening and how they should best protect themselves.

During an interview with Dr. Julia López, from Washington University

Illustrator: Haley Pak

School of Medicine’s Division for Infectious Diseases, she elaborated on the lack of timely public COVID-19 translations [5].

“That puts people at a disadvantage… already, just in the ability to understand what’s happening. Even for English speakers… what people are reading and hearing is already confusing, and they’re reading it in their language.

What can we imagine it feels like for people who already feel restricted?

Now things have picked up, and now there are systems in place but this kind of shows and highlights that when push

comes to shove, we’re not ready to provide the context of information in a timely way or at the same time. That there’s always a lag, and that lag can, and it often is, detrimental, unfortunately. What we see [here] kind of ties into also the disparity of health in these groups” López said.

Inadequate translation services only reinforce the health disparity trends so prevalent in the United States. To protect their communities, grassroots organizations have led the effort to provide equitable access to translated COVID-19 information. After meeting with local

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health clinics, Harvard Medical student Pooja Chandrashekar recognized the harm of the language barrier and rallied fellow students to compile a website with updated information sheets in over 30 languages called the “COVID-19 Health Literacy Project” [4].

Another example of this is in St. Louis, Missouri, where a small grassroots organization, STL Juntos, was created after its founders recognized the absence of Spanish COVID-19 information from the local and federal health departments. Starting from only translating the medical information as new announcements were made, STL Juntos now also serves the community though legal and rent assistance and food distributions [8]. In an interview with co-founder Lourdes T. Bailon, she emphasized how there continues to be a real need in the community for these Spanish-oriented organizations. Since the group posted their initial Facebook translations, there’s been an overwhelming positive response from the Spanish-speaking community. “[The] need to create a bond, or that trust, with the Latinos, or the Hispanics, because that’s how we work. We create

The understanding and empathy that can only develop from being immersed in a specific culture provides a layer of comfort and intimacy that navigating the standardized system could never have.

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a bond, a trust, and then we stick there,” Bailon explained.

Dr. López echoed this sentiment in her interview as well, stating the value of having a medical practitioner who not only understands and can communicate with a patient in their most familiar language, but also understands the patient’s cultural background. The understanding and empathy that can only develop from being immersed in a specific culture provides a layer of comfort and intimacy that navigating the standardized system could never have.

Regarding the responsibility of eliminating the language barrier, Dr. López recommends a multilevel perspective.

“The ideal combination is that you have grassroots organizing community members who Represent, or are the voice of a group of people, and, in doing so, there is a listening ear from the healthcare institutions and in a truly collaborative way, the institutions recognize the needs and focuses of the community,” López stated.

Acknowledging that the language barrier is real is the first step towards eliminating it. During the interview with Bailon, her message to those with a limited understanding of the breadth of this issue is one calling for empathy and respect for the variety in languages and in proficiencies Americans have: “There are way more people with a language barrier than we can even imagine. I think we all know that to a certain extent, but most people or at least more organizations that I have spoken to, they assume that these people understand- that they’re bilingual- that they understand the English. And maybe they do, but they would much rather

hear it in their own language and even if they understand the English, they’re not going to understand it completely and they’re not going to be comfortable. So it’s critical, I think, not just for Spanish, but for every other language as well,” Bailon said.

Language transforms and broadens the lens in which the world is viewed. It is an integral part of a patient’s identity, and the language a patient is most comfortable with should be treated with the same level of respect as any other aspect of identity. Healthcare organizations must address this barrier immediately: listening to the needs of the local community and working together to ensure equitable access to quality care, in every language. •

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FRONTIERS • SOCIOCULTURAL

The Pandemic in Uniform Writer: Ben Lieberman • Editor: Anhthi Luong

O

n March 29, 2020, Capt. Brett Crozier sent an email to three admirals with authority over him and copied it to a handful of Navy captains.

Crozier was the skipper commanding the aircraft carrier USS Roosevelt, deployed in the West Pacific at the time as part of the U.S. Seventh Fleet. The email detailed the depressing situation aboard the U.S.S. Roosevelt with an active COVID-19 outbreak on their hands and how ill-prepared the entire chain of command was to deal with a virus like SARS-CoV-2. He asked to depart Guam and evacuate most of the ship to test the sailors, the most valuable asset.

“I believe if there was ever a time to ask for help it is now regardless of the impact on my career” [1].

The email had a memo that the media got a hold of. Acting Navy Secretary Thomas Modly decided to relieve Crozier of command on grounds of involving the media. But Modly himself had to resign after the public heard he addressed the Roosevelt sailors by insulting Crozier [1].

“I believe if there was ever a time to ask for help it is now regardless of the impact on my career.”

The ship ultimately sailed into Guam and tested all 4800 sailors in April and May. The ship was on a mission to sail to Vietnam as part of a strategic show of strength and operational display in the face of a rising China. Admiral Philip S. Davidson, the highest-ranking officer in the Pacific, ordered the ship to continue as planned despite the risk of

COVID-19 at the time. But it backfired and Crozier’s supporters believe that he made the right decision as Washington projected calm and poise and did not act immediately to prevent any unnecessary service member deaths due to the COVID-19 pandemic. Overall, more than 1000 of the 4800 crew members would go on to test positive, with one crewmember passing away from COVID-19. [1].

Overall, more than 1000 of the 4800 crew members would go on to test positive, with one crewmember passing away from COVID-19.

While the Department of Defense (DOD) continues their scheduled military operations while preparing contingency plans, the DOD is responsible for COVID vaccine rollout program known as Operation Warp Speed (OWS) to distribute an approved vaccine to the American public and military [2]. The DOD announced the program on May 15, in which OWS should start rollouts by January 2021, while meeting the FDA standards that are normally sought. The DOD reports that after the vaccine candidate is submitted, the manufacturer will concurrently start production as they wait on the approval of the Biologics License Application and Emergency Use Authorization proposals by the FDA. OWS and the CDC will oversee the distribution process and priorities, with the Trump administration submitting a distribution plan,

published by the HHS in consultation with the DOD and CDC [3]. But beyond DOD vaccination plans, the armed forces are called on for new deployments not in any country across the sea but in the United States to render aid, at least in theory.

On March 30, with New York on the brink of collapse due to the COVID-19 pandemic, the 70,000-ton USNS Comfort pulled up into New York Harbor with 1000 beds ready to go [4]. They were tasked with acting as another medical facility not to treat COVID-19 specifically while the rest of the New York healthcare system could focus on COVID-19. It was supposed to be a symbol of hope in a dying city. But practically speaking, the ship only ended up treating fewer than 180 patients despite. Gov. Cuomo dismissed the ship, which sailed back to Virginia. Michael Dowling, head of New York’s hospital system, called the Comfort a “joke” as it would not accept coronavirus patients, the patient pop-

Michael Dowling, head of New York’s hospital system, called the Comfort a “joke” as it would not accept coronavirus patients, the patient population most in need of more beds. ulation most in need of more beds [3].

So President Trump allowed the ship to be configured into a 500-bed hospital for treating COVID patients. But the

FALL 2020 • VOL 14 ISSUE 1

same day the ship allowed coronavirus patients aboard for treatment, a crewmember tested positive. A similar situation happened in Los Angeles, where the ship docked from March 27 to May 15, treating 77 patients in total [5].

Despite such large holes in operational planning and execution during this pandemic, the Department of Defense is working tirelessly to protect as many units as possible from COVID and minimize risk while they continue routine operations [6, 7, 8]. Many non-deployed units have switched to remote work and U.S. bases have tried to socially distance themselves from non-essential work.

Various drills have been postponed or cancelled while essential units are given training on dealing with COVID-19 in the field. The reported numbers as of October 14 include almost 72,000 cases among all service branches which have millions of personnel, including contractors and non-affiliated DOD personnel, with 1426 hospitalized personnel and 99 deaths [9].

This probably means the DOD was effective in travel restrictions, one of the biggest tools used to quarantine and test entire bases to keep all COVID outside, and only letting personnel back in once they have been tested and isolated for two weeks. The very low hospitalization and fatality rates are probably because DOD personnel are younger and healthier than the general population. The question is how much these numbers underestimate the true impact of SARS-CoV-2 on our men and women who did not choose to die from a pandemic even if they are serving. •

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p.32-33 Casual Cruelty: Pandemic profiteering in a failing healthcare system Author: Annie Feng [1] Abelson, R. (2020, August 05). Major U.S. Health Insurers Report Big Profits, Benefiting From the Pandemic.

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Herd Immunity: The Foolproof Solution to COVID-19 Author: Ricky Illidala

Utilizing Technology in the Age of Addiction Author: Haleigh Pine

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Banner Health. https://www.banner health.com/healthcareblog/teach-me/what-is-herd-immunity [2] Brumfiel, G. (2020, July 24). Without a vaccine, researchers say, herd immunity may never be achieved. NPR: National Public Radio. https://www.npr.org/sections/ health -shots/2020/07/24/894148860/without-a-vaccineresearchers-say-herd-immunity-may-never-be-achieved [3] Delamater, P. L., Street, E. J., Leslie, T. F., Yang, Y., & Jacobsen, K. H. (2019). Complexity of the Basic Reproduction Number (R0). Emerging Infectious Diseases, 25(1), 1-4. https://dx.doi.org/10.3201/eid2501.171901 [4] Demarco, C. (2020, July 17). COVID-19 herd immunity: 7 questions, answered. MD Anderson Cancer Center. https://www.mdanderson.org/ cancerwise/what-is-covid-19- coronavirus-herd-immunity-when-will-we-achieve-herd-immunity.h00-159383523. html [5] Dong, E., Du, H., Gardner, L. (2020, January 23). An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. https://doi.org/10.1016/S14733099 (20)30120-1 [6] Kim, T. H., Johnstone, J., Loeb, M. (2011, May 23). Vaccine herd effect. Scandinavian journal of infectious diseases, 43(9), 683-689. https://doi.org/10.3109/00365548.2011.

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p.36 Time to Vaccinate Author: Alicia Yang

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p.37-38 A Double Whammy: Flu & Coronavirus Author: Kevin Oloomi [1] Bradford, M. (2020, Sept. 6) Coronavirus and the Flu: A Looming Double Threat. Retrieved from https://www. scientificamerican.com/article/coronavirus-and-the-flu-alooming-double-threat/ [2] Clayville, L. (2011, Oct. 10) Influenza Update A Review of Currently Available Vaccines. Retrieved from https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC3278149/#:~:text=Clayville%2C%20PharmD-,INTRODUCTION,to%20 500%2C000%20deaths%20each%20year [3] Cowling, B. Ali, S. Ng, T. Tsang, T. Li, J. Fong, M (2020, Apr. 17) Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Retrieved from https://www.thelancet.com/journals/lanpub/article/ PIIS2468-2667(20)30090-6/fulltext [4] Lander, M. (2020, Oct. 21) Europe, Which Thought It Had the Virus Tamed, Faces a Resurgence. Retrieved from https://www.nytimes.com/2020/10/14/world/europe/europe-coronavirus.html?auth=login-google [5] Lee, A. Ashkar, A. (2018, Sept. 11) The Dual Nature of Type I and Type II Interferons. Retrieved from https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC6141705/#:~:text=Type%20I%20and%20type%20II%20interferons%20 (IFN)%20are%20central%20to,virus%20replication%20 and%20reduced%20survival [6] Martell, A. Parker, N. (2020 Jul. 27) The U.S. has more COVID-19 testing than most. So why is it falling so short? Retrieved From https://www.reuters.com/article/ us-health-coronavirus-usa-testing-insigh/the-u-s-hasmore-covid-19-testing-than-most-so-why-is-it-falling-soshort-idUSKCN24S19H [7] Mudd, P. Crawford, J. Turner, J. Reynolds, A. Bender,

FALL 2020 • VOL 14 ISSUE 1

D. Bosanquet, J. Anand, N. Striker, D. Martin, R. Boon, A. House, S. Remy, K. Hotchkiss, R. Presti, R. O’Halloran, J. Powderly, W. Thomas, P. Ellebedy, A. (2020, Jun. 15) Targeted Immunosuppression Distinguishes COVID-19 from Influenza in Moderate and Severe Disease. Retrieved from https://www.medrxiv.org/content/10.1101/2020.05.28.20 115667v1 [8] NCIRD. (2020, Oct. 6) Similarities and Differences between Flu and COVID-19. Retrieved from https://www.cdc. gov/flu/symptoms/flu-vs-covid19.htm [9] Newton, P. (2020, Sept. 24) Trudeau warns Covid-19 second wave already happening in Canada. Retrieved from https://www.cnn.com/2020/09/24/americas/canadatrudeau-covid-19-second-wave-intl/index.html

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Expanding Telehealth for Diabetes Management Author: Rehan Mehta [1] American Diabetes Association. (2018). Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 41(5), 917928. https://doi.org/10.2337/dci18-0007 [2] American Diabetes Association. (n.d.). Understanding A1C. https://www.diabetes.org/a1c

To School or Not to School Author: Casey Connelly

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p.41-42 Blame it on the Alcohol: How Hand Sanitizer Overuse May Create a Superbug Author: Rida Qureshi [1] Schreiber, M. (2018, August 02). Some Bacteria Are Becoming ‘More Tolerant’ Of Hand Sanitizers, Study Finds.

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[5] Funtanilla, V. D., Candidate, P., Caliendo, T., & Hilas, O. (2019). Continuous Glucose Monitoring: A Review of Available Systems. Pharmacy and Therapeutics, 44(9), 550–553.

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p.45-46 PTSD and the Neurobiological Basis of Trauma Author: Soyi Sarkar [1] Fenster, R., Lebois, L., Ressler, K., & Suh, J. (2018, September). Brain circuit dysfunction in post-traumatic stress disorder: From mouse to man. Retrieved October 28, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6148363/ [2] Forte, T. (2020, February 01). The Body Keeps the Score: Brain, Mind, and Body in the Treatment of Trauma (Book

Summary). Retrieved October 28, 2020, from https://fortelabs.co/blog/the-body-keeps-the-score-summary/ [3] Friedman, M. J. (2007, January 31). VA.gov: Veterans Affairs. Retrieved October 28, 2020, from https://www.ptsd. va.gov/professional/treat/essentials/history_ptsd.asp [4] Kleber, R. (2019, June 25). Trauma and Public Mental Health: A Focused Review. Retrieved October 28, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6603306/ [5] Neurobiology of Trauma. Retrieved October 28, 2020, from https://www.unco.edu/assault-survivors-advocacy-program/learn_more/neurobiology_of_trauma.aspx [6] Rosenzweig, J. M., Jivanjee, P., Brennan, E. M., Grover, L., & Abshire, A. (2017). Understanding neuro- biology of psychological trauma: Tips for working with transi on-age youth. Portland, OR: Research and Training Center for Pathways to Posi ve Futures, Portland State University, https://www.pathwaysrtc.pdx.edu/pdf/projPTTP-neurobiology-tip-sheet.pdf.

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p.47-49 Breaking Down the Language Barrier Author: Maya Kovacevic [1] Chandrashekar, P. (2020). 19 Health Literacy Project.

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