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Drs. Emily Smith and Heather Young

The COVID-19 pandemic has thrown quite a lot of the problems the health sciences community is facing into sharp relief. Questions of equity, access, and resource allocation have all had their turn. While science communication has been a concern throughout the pandemic, the announcement that everyone 16 and older in the United States is now eligible for a COVID-19 vaccine has foregrounded the need to communicate efficiently and effectively with the general public. Drs. Emily Smith and Heather Young with the Milken School of Public Health have been working hard to communicate COVID-19 information to the general public since the beginning of the pandemic. I took this opportunity to speak with them about their experiences, and to ask their advice for how best to work with the public to combat misinformation and encourage those who might be vaccine hesitant to get vaccinated.

In early 2020, as the new SARS-CoV-2 virus spread around the globe, Dr. Smith noticed the questions her friends, family, and even strangers were posing on the internet. Often these were the same questions - what preventative measures can I take, what do I do if I or a family member think we have it, what is my risk, etc. Because the data and information were so new and this was a rapidly evolving situation, those without a health sciences background were encountering information that just wasn’t written for them. Even her fellow scientists were asking where information was coming from, since everything at this stage was coming from preprints and sourcing reliable numbers was vital. There was a clear need for someone to step in and help translate the science in a way anyone could understand, and to aggregate it into one central location that linked back to primary scientific literature. Thus, COVID-101.org was born. Dr. Smith and a few colleagues established the website as a resource they and their fellow science communicators could link to when asked these questions.

The backbone of COVID-101.org is its review process. Not only do scientists and experts write the articles answering questions and referencing primary scientific literature, their colleagues provide peer review before posting the articles. This is where Dr. Young comes in. Early on in the pandemic, Dr. Young gave a lecture to a group of medical students breaking down the basics of epidemiology. Dr. Smith had recently launched COVID-101.org, and sent out an email asking for contributions. Dr. Young adapted her lecture and submitted it, and she continued collaborating with the other volunteers working on COVID-101.org, both writing and reviewing posts. And that’s one of the key things to remember about COVID-101.org, that all of the contributors are volunteers. Everyone from epidemiologists to undergraduates to web developers, all are volunteering their time and talents. Both Drs. Smith and Young think of this as a silver lining - getting to connect with everyone working on the site, old colleagues and new.

As the pandemic progressed, Drs. Smith and Young saw the purpose of COVID-101.org shifting. In the early days, the site served as an aggregator, compiling information and responding to questions. Dr. Young recalls a specific pivotal moment in the evolution of the site: “When President Trump had his bleach injection moment, it was one of those times where five or six of us jumped on the Slack channel and were like ‘we have to get something out there, it has to be out there quick’... we kind of shifted gears from waiting for people to ask us stuff and decided that we needed to go put a message out there that we thought was important.” A little over a month later, COVID-101.org published a post on the social justice movement and why people may decide to protest during the pandemic, describing the “dual pandemic” of racial injustice and COVID-19. These two instances compelled COVID-101.org contributors to take a more active role in creating messaging and putting accurate information where the public could find it.

When they started working on COVID-101.org, neither Dr. Smith nor Dr. Young had extensive experience with science communication. Dr. Smith had some experience in her work with the Gates Foundation, translating scientific data and information for policy makers. Dr. Young, on the other hand, didn’t have any “formal” experience, though she believes teaching requires a similar mindset of distilling complex information in a way students can understand. I asked what they had learned through this process, and what advice they might have for others in the health sciences community who are trying to counter misinformation and, in particular, address vaccine hesitancy.

Both Dr. Smith and Dr. Young described two important things they’ve taken away from their work on COVID-101.org. First, you want to encourage people when they do ask a question. Let them know it’s a good thing that they have this question. Lead with that attitude, and people will be more receptive to your answer. Understand that the misinformation people encounter may have a kernel of truth in it. Acknowledge that, without dismissing their concerns or mocking whatever misinformation it is. As Dr. Young said, you have to “meet people where they are.” Have a conversation with them, rather than lecturing them. Frame the conversation as a way to equip them with information to come to their own decisions rather than convincing them one way or another. Second, you need to make your answer specific to a person’s life. Dr. Smith recalls one of the earliest posts on COVID-101.org

One of the first posts we put out before things were shut down was “no you shouldn’t go to a large gathering.” And the questions we got in response were things like “Can I go to this concert?” or “Can I go to this game?” These follow up questions that, to me, should have already been answered by the post. But it wasn’t specific enough, and it wasn’t specific to their life. As a scientist it feels kind of duplicative or I worry that it’s too much the same, but I think that’s one of the valuable ways that we can add here and same for anyone trying to communicate with other people.

Dr. Emily Smith

Dr. Young echoed this, describing the need to “repeat and repackage” for individuals. Everyone is approaching risk assessment and the pandemic with their own lived experiences. If we can make our information relevant to their experiences, it makes it easier for them to incorporate that information into their lives. A recent concept introduced on COVID-101.org, the risk budget, can help people situate the information they are getting within the context of their own life.

Not all of our work combating misinformation or vaccine hesitancy occurs with people on the internet, however. Quite often friends and family members will come to those of us who work in the health sciences with their questions, seeing us as a trusted and valuable source. While the information you’re providing doesn’t change, having that pre-existing relationship with someone can make it easier to encourage them to think critically about the misinformation they’ve encountered. Dr. Young describes telling friends and family “Well, okay, maybe you don’t trust the scientists in the lab, but you trust me, right? And I’m not going to tell you to do something that I legitimately would think is harmful.” Dr. Smith also sees the opportunity to give people the facts “within the context of their life.” You know these people and can tailor your response in a way that makes sense to them.

So how do we best communicate with our friends, family, and even strangers? It’s a difficult line to walk, and one that is becoming increasingly important as access to the COVID-19 vaccine expands. The best thing you can do is prepare yourself with readily available resources. Of course, COVID-101.org is an excellent place to start. If you can’t find an answer to your question, you can always ask them. Himmelfarb Library has also put together a Correcting Misinformation with Patients Research Guide. It has tons of resources, information on communication techniques, and even specifically addresses vaccine hesitancy. The Conversation: Between Us, About Us video series from the Kaiser Family Foundation and Black Coalition Against COVID is a living video library and a phenomenal resource for the black community featuring answers from black scientists, black doctors, and black nurses. While The Conversation's target audience is the black community, the information is clearly communicated and could be useful to others. NIH’s Community Engagement Alliance (CEAL) has some great resources focused on engaging communities most at risk. If you’re looking for continuing education (CE) opportunities, LearnToVaccinate.org has a number of CE activities related to patient communication. This is a pivotal moment for the health sciences community, and we as a whole need to be ready to answer questions empathetically and accurately. There has already been a great deal of progress and reason for optimism - over 50% of US adults have had at least one COVID-19 vaccine dose. Armed with these resources, we can meet the general public and encourage everyone to get fully vaccinated. And hopefully we can harness the tools and lessons learned from the pandemic and apply those to other areas of science communication. The more informed the public is the more we are all empowered to make the right decisions for our health and the health of our communities.

As always, if you have any questions you can reach us via email at himmelfarb@gwu.edu. If you’re interested in volunteering on the COVID-101.org project, reach out via the Ask Us page on the site.

In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, this week’s blog post will feature a conversation with Dr. Amanda Castel, MD, MPH.

Dr. Amanda Castel is a Professor of Epidemiology at GW. She received her BA in Biology from Brown, her MD from the University of Pennsylvania, and her MPH from Johns Hopkins. I was honored to speak with Dr. Castel about her work at GW, experiences as an infectious disease expert during a global pandemic, and her thoughts on health inequality and stigmatization.

From a young age, Dr. Castel wanted to be a doctor, and in particular a pediatrician. Born in Liberia in West Africa, Dr. Castel’s mother frequently told her about another baby born around the same time. They were both ill, but because Dr. Castel’s family is American they were able to fly her to the US for treatment. As she grew up, her family traveled internationally quite often for her parents’ work. She was able to see how other parts of the world deliver healthcare and was inspired by the idea she could “possibly make a difference and improve people’s lives.” During the course of her education, Dr. Castel took a year off to do a Fulbright Fellowship in Senegal, doing research on prevention and mother/child transmission of HIV. Through this experience, she caught the “public health bug” and decided to join her clinical interests with her public health experience. Speaking to Dr. Castel you can see her understanding of how privileged we are as Americans and her drive to create more equitable healthcare access.

After finishing her degrees, Dr. Castel worked in the CDC’s Epidemic Intelligence Service Program and was assigned to the Maryland Department of Health in their Communicable Disease Program. She describes the experience as being “a foot soldier. You are in the trenches, you’re working with county health departments… you’re doing all kinds of disease investigations.” This gave Dr. Castel the training to marry her clinical experience with her public health experience.

In early 2020, Dr. Castel watched as severely understaffed and under resourced health departments braced for the impending COVID-19 pandemic. On March 14th, 2020, Dr. Castel rolled up her sleeves, walked over to the DC Health Department, and told them “I’m here. What do you need?” In the early days of the pandemic, Dr. Castel recalls scrambling to keep ahead of the curve. The health department worked on case investigations with very limited contact tracing. The numbers were increasing so quickly they just didn’t have the bandwidth and workforce to keep up with them. As scary as those days were, from a scientific perspective they were “fascinating.” Learning how this virus worked, the transmission and symptomatology - it was a firsthand experience not many people get. Dr. Castel describes it as “professionally a very fulfilling experience.”

Alongside her work with the health department, Dr. Castel has been teaching infectious disease epidemiology at the GW School of Public Health. As part of that course, Dr. Castel tries to drive home the point that these diseases are everywhere, if you look at the news you can probably find something about an outbreak every day. January 2020, she and her students began tracking this new respiratory virus. As time went on and the pandemic progressed, these students had the opportunity to learn more about COVID within the course. When GW pivoted to online learning in March, that created a new set of challenges for educators. Dr. Castel commented on the difficulties that arise from not being in the same room as your students, that “the dynamic is different,” but even with these challenges “the students are continuing to learn and grow.” These same students are now working with health departments doing case investigations or other COVID response tasks. Those in the current cohort will be working in public health moving forward. Looking for a silver lining in times when finding them is hard, the preparation Dr. Castel gave these students is having a palpable impact on people’s lives. 

Given her research in HIV/AIDS, Dr. Castel was uniquely situated to understand the ways this pandemic might unfold. In July 2020, Dr. Castel and some of her colleagues from the School of Public Health published an article discussing the synergies between HIV and COVID-19. Despite the major differences between the two viruses, it is astonishing to consider the similarities. Looking back at the beginnings of the HIV epidemic, the process of learning “which populations were most at risk, how to get testing to people, how we prevent infections, contact tracing, these core public health methods” have all been applicable to COVID-19 as well. And what we have learned through these processes are incredibly similar. The populations most disproportionately affected, racial and ethnic minorities, are the same.

Dr. Castel has researched the social ramifications of HIV, the stigmatization and public misconceptions, and the way these intersect to make treating people living with HIV harder. She does see parallels with COVID-19, especially now as vaccines become more available. Seeing the different numbers coming out from Moderna, Pfizer, and Johnson & Johnson, Dr. Castel had a genuine concern that “the general public wouldn’t understand the nuances,” and that might translate into stigmatization based on the type of vaccine being offered. It might raise questions like “If you only offer me the one that’s less effective are you discriminating against me?” And that is part of why it is so important for medical professionals and public health professionals to be able to explain these differences to the public, to understand their fears and concerns and respond to them with the facts in a way they can understand. Dr. Castel felt this especially strongly “as an African American woman working in the field,” with friends and family coming to her with their questions and concerns. Translating that information can be difficult, but it’s a vital part of the work Dr. Castel does, and a crucial part of what she teaches her students.

Despite the difficulties of the past year, Dr. Castel is hopeful. The urgency with which the scientific community responded to the pandemic has the potential to impact other areas of healthcare as well. Perhaps there will be a chance to “take some of that innovation and technology and apply it to HIV research.” But she has tempered that hope with the understanding that “the calculus is different.” COVID-19 is a pandemic that has impacted everyone, put us all at risk. The population most at risk from exposure to HIV is not one that is prioritized in the same way. It’s a stark reminder that even in the United States healthcare is not inherently equitable. Despite the fact that HIV “drastically alters the world [of those infected] in the ways that COVID has altered the rest of ours” there is an unwillingness to apply the same sense of urgency to HIV. Hopefully, as we begin to return to some sense of normalcy, those of us in the health sciences will be empowered to advocate for this kind of research. Those of us in positions of privilege who can speak to the healthcare needs of stigmatized populations need to work on communicating those needs to the general public. We can advocate for change, and call on our government to end the cycle of failing people living with HIV. We need to reevaluate our current healthcare system and public health professionals, like Dr. Castel, are ready to rise to the occasion. Of the lessons we’ve learned from the COVID-19 pandemic, one of the most important is that with a sense of urgency, adequate funding, and research, it’s possible to develop long-term solutions to viruses and diseases that still harm marginalized communities.

To learn more about the history of HIV/AIDS health policy in the US, take a look at this article covering 35 years of policy. To learn more about advocating on behalf of people living with HIV/AIDS, read this commentary from Topics in Antiviral Medicine. To learn more about Dr. Castel’s work, browse her publications indexed in the Health Sciences Research Commons.

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In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year, and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, this week’s blog post will feature a conversation with Dr. Raymond Pla, MD.

A photo of Dr. Raymond Pla
Dr. Raymond Pla

Dr. Raymond Pla is an Assistant Professor of Anesthesiology and Critical Care Medicine at GW. He received his BS from Emory, then went on to Meharry Medical School, one of four HBCU medical schools, for his MD. I was honored to speak with Dr. Pla about his path to the health sciences, the work he does as a Professor at GW, and his people-first approach to advocacy, particularly when speaking with communities of color.

Dr. Pla did not always intend to go into medicine, he “had the same dreams that you commonly encounter when you're talking to young boys.” Even when he first started his BS program in Biology at Emory, he did not intend to go into medicine, though it was an option. The summer after his Junior year, however, that changed. Over the summer, he had the opportunity to shadow Dr. Clive Callendar at Howard University, going on rounds, in the ICU, and even observing in the OR. A titan in the field of transplantation, especially kidney and liver, Dr. Callendar’s high expectations of his residents, interns, and even the young Dr. Pla set a high standard for medical education. What most fascinated Dr. Pla during his time in the OR was “that person up at the head of the table, on the other side of what we call the ether screen… the anesthesiologist.” Eventually, Dr. Pla started observing with the anesthesiologist, learning what their role was in transplant surgery. Seeing the patients the next day, looking at their labs and seeing the changes in their clinical course overnight, was the second most impactful part of the experience. When Dr. Pla started at Meharry, his classmates reported he already had every intention of going into anesthesiology.

The impact Dr. Callendar had on Dr. Pla is evident, as is Dr. Pla’s desire to pay that influence forward in his practice and teaching. He described what he considers the two most important things doctors, especially those in academic medicine, do. First, “we care.” It is not just about an accurate diagnosis or a successful course of treatment. The foundation of those things is caring - thinking about a patient’s condition in the shower or on a jog or sitting in traffic, jotting down a realization and following up on it the next day, revising the patient’s treatment plan based on these considerations and reflections. And sticking with patients, following them throughout their course of treatment. Dr. Pla described the importance of making time for patients as a part of this, saying “We’ll sit and listen when we don’t have time. When we’re busy, we have someplace else that we need to be. We will redefine where we need to be and where we need to be at this moment is sitting with this person, with their family, to answer questions. Or sit and listen.”

The second of these most important things is “when we give of ourselves to the next generation, the same way that someone gave of themselves.” And he tied giving back into caring, as it is part of caring. Giving can take many forms. Reflecting on your teaching, updating what or how you teach. Dr. Pla recounted a story of a summer he spent at the United States Naval Academy, and a Professor of Electrical Engineering he met there. This Professor received word that a pilot had overshot the carrier deck and put their plane into the ocean. The pilot was not hurt, but this Professor asked himself “Was there something I didn’t teach that young man that had I taught him, had he known, would have prevented what could have been a fatal accident?” Hearing from graduates of the residency program about how something he taught them prevented an injury or a loss of life, particularly in airway management, reinforces that you are teaching those vital things.

When speaking with Dr. Pla it is abundantly evident that teaching is his favorite part of the work he does at GW. He lights up when talking about “The Forgotten Four,” encouraging his students to consider treatments and medications that tend to be overlooked or kept in the back of your mind, and bringing those forward. Because bringing those forward can quite literally save a life. He considers that an “ethical duty, a moral duty.” The themes of moral and ethical duties as medical practitioners echoed throughout our conversation.

Recently, Dr. Pla has made appearances on local news, encouraging the African-American community to get the COVID-19 vaccine. As one of the first people in DC to receive the vaccine, Dr. Pla says he felt an obligation to speak to his community and encourage them to get the vaccine. There is an understandable mistrust of the medical establishment within black and brown communities. Most of us can cite Tuskegee, World War II, Henrietta Lacks, Baltimore. But when we cite these infamous atrocities we overlook the personal atrocities people of color experience on a regular basis. While there is still a great deal of work to be done to rebuild that trust, to eliminate systemic racism within medicine, there is an immediate need to get vaccines to these communities that are being disproportionately affected by the virus. Because when these communities see those who have earned their mistrust saying this vaccine is the only way forward, they “[have] no hope for a better future… a pandemic-free future.” Dr. Pla sees his outreach as a way to help bring hope back to his community, to begin addressing the legacy of racism in medicine, and to hopefully earn back some trust. He hopes to continue this work in a meaningful way, to encourage colleagues and students to do their part as members of the medical community, and to address the other epidemics facing communities of color - infant mortality, maternal mortality, advanced heart disease, breast cancer, etc., all of which disproportionately affect people of color. It is “a moral calling for those of us who value lives.”

There is still so much work to be done. But, as Dr. Pla argues, just because this is a daunting task does not mean we should dismiss it. It does not mean we should despair, or give up hope. During our conversation he invoked a quote from Dr. Martin Luther King, Jr.: “The arc of the moral universe is long, but it bends towards justice.” It is a quote often invoked to remind us that the work we do today is but part of the work necessary. That the immediate is but a small part of the whole. Quite often allies, including myself at times, use this quote as an excuse to not take action when we are most needed. With Dr. Pla’s invocation, those of us who consider ourselves allies in the medical community should answer the call not to conversation, but to action. We must take steps to ensure communities of color are treated with dignity and receive a level of medical care that keeps them healthy, honoring their community-based needs and concerns.

To learn more about these issues and what you can do, explore the NEJM’s Race and Medicine collection; browse articles on systemic racism in the Himmelfarb Collection; engage with the resources and educational series from the Anti-Racism Coalition at SMHS.

To explore more of Dr. Pla’s work, you can browse his articles indexed in the Health Sciences Research Commons.