This is Dr. Wriston, and we're going to start our next session. I am the CME chair as president-elect, and I think we all enjoyed the ransomware comment, so again, I'm going to put in a plug. If you know of a good speaker, a good topic, or you yourself are a good speaker, please send an email to Rhonda at AOCOPM.com.org, or Jeffrey, same, and copy nwriston at hotmail.com. We need speakers for the OMED 2022, and also for next year's mid-year conference. We're having a panel now, and it shows that with occupational and preventive medicine, many topics will fit, so please give us the ideas or the speakers, and then we will screen through and help put together a good program. So thank any of you who can contribute to future meetings, and now Greg will introduce our next three speakers. And he ended up fixing the word that was going through. Hi, this is Ed Glade. I spoke yesterday about how our Medical Center Occupational Health Program served as a proxy for what was going on in the community, and I was invited to talk today about the employer perspective on this, and I wasn't exactly sure what that meant, so I made it my own. One thing that was really challenging as not only the medical director for the Occupational Health Service that cares for the 6,000 employees of Roper St. Francis, but our very large outward-facing occupational medicine program. So we have the county, we have Boeing, Bosch, Mercedes-Benz, IFA, we have a lot of large employers who, many of whom are internationally based, that we had to try to deal with. So I decided to make the topic my own and talk about, you know, what we as clinicians were dealing with when these non-clinicians are asking us either unanswerable questions or questions with whack-a-mole kind of answers, or questions or requests that are simply either not realistic or has no basis in touch with reality. So the challenges we faced and the messaging that we got from the employers were that the stakes were huge. The safety manager at Bosch, and the Bosch facility in Charleston, South Carolina, makes ABS and fuel injection systems. They said that they were going to be losing $100,000 per hour that production lines were down because of staffing issues or because of things of that nature. And certainly the perception issues and just dealing with everything going on in the community, the stakes were very, very high. The next thing that I think that we all had challenges with were people not being able to roll with the punches as the signs changed on a moment-to-moment basis. And, you know, we as clinicians, we know about how things can change. And again, the perception and the messaging that they were asking of us to message their employees. And then finally, the challenge that we had were the diverse corporate cultures. So Boeing, of course, is American, Mercedes-Benz, Bosch, IFA, and Malibu are all German corporations and well-established in the community. But nevertheless, a challenge in terms of what they asked for us in contrast to the American-owned corporations. So this is a list of some of the things that the employers asked us to consider. Certainly I think that telecommuting took over in a big-time kind of way, considering how easy my early morning commute over the Ravenel Bridge in the morning became. But then it started with how are we supposed to vet our employees before we're going to let them into the building? So there were people who wanted to do temperature checks. Mercedes-Benz spent a ton of money on this whole facial recognition kind of thing that you'd go up and put your face in front of, and it would green light, red light you to go into the building. And they would get a symptom checklist they'd have to attest to. And they had a security band, like you were going to a rock concert, that every single day you had to show your colored band before you would get in. And what was very interesting is talking with the safety, actually it was an HR guy at Mercedes-Benz who I dealt with, and we were thinking about was this detection versus deterrence in terms of what we were trying to do at the door. Certainly if people are sick, they should stay home. And so this detection versus deterrence issue was kind of interesting. All of this symptom checking, and early on we recognized just how many of our patients were asymptomatic and might have been infectious, even early on in the native virus before the variants took hold. There were steps to reconfigure the workspaces and put things six feet apart, and a lot of money spent on people who had big cubicle farms and spacing people around. They wanted help with break room and bathroom policies. But again, part of the COVID theater that I showed you yesterday in the slide, Mercedes-Benz closed down the production line at one time for a deep clean of the entire facility because of the concerns over the transmission in the workplace. The messaging was that, but part of the message was there were so many people who were sick, there was nobody to actually be out on the production line. But no matter how hard and diplomatically I tried to reassure them in terms of what is the contribution or the non-contribution to fomite transmission of COVID-19, it didn't matter. I think all of us who deal with employers certainly know you serve as a cultural intermediary. You have to understand what their level of their literacy is. You want to retain them as clients. And sometimes I think we're all a little bit flexible, not morally or ethically, but just in terms of pragmatically, what kind of mileage are we going to get out of telling somebody in a senior leadership position that, well, what you're asking for is unreasonable and it's wrong, by the way. They don't have a sense of humor about that, I think that we all know. So yeah, it's a whole bunch of fun, it's a whole bunch of fun. Yeah, yeah, well, you know, I'm from Latvia and Lithuania, you know, so it's the same kind of thing. So a number of the things we had to battle with, even early on, was sending people home for extended periods of time, getting doctor's notes to come back to work for people who didn't have primary care doctors. So they were flooding our urgent care centers, waiting, requesting doctor's notes, certainly test of cure, which we said early on, there's no role for test of cure. It didn't matter, they wanted negative tests. Now one of your speakers this weekend is Bob Harrison, he's going to be talking about respirator. So Bob, do you know Bob Harrison, he's from UCSF, one of the smartest guys I know and you are so lucky to be hearing from him. Bob early on warned me about persistent positives, you know, beyond the period of infectivity where the test would be kicked over just by fragments. So we tried to talk them out of test of cure, we tried to talk them out of doctor's notes and such. They wanted to test everybody, they wanted, they were talking about, we want to test everybody on Tuesdays, you know, test the entire plant on Tuesdays. Of course, this is early on before we had machines that could knock out a thousand tests, you know, a day and, you know, we just had to just tell them, no, you know, we couldn't do it. We took care of the Citadel, and that was a pretty interesting experience. So the Citadel was the military college that has got a very interesting history in South Carolina. And their number one and actually their only objective for the fall season of the pandemic of 2020 was to get through football season. Because there was so much money at stake in terms of the revenues for, and you know, Citadel, you know, my daughter went to the University of Alabama, trust me, University of Alabama didn't have anything to worry about going up against the Citadel. But the point is, there was a lot of money at stake. So we worked with them to do contact tracing and try to keep the school open. And as soon as the end of the football season, it was like crickets, we didn't hear from them again. No, no, I was dealing with the chancellor on a day in, day out basis and playing big shot epidemiologists. As soon as football season was over, they're fine. They were just fine. And then on the healthcare side of things, we have this little gem here, the emergency temporary standard in terms of what we had to do, you know, in healthcare, not only my employees, but, you know, the nursing homes and smaller groups. What we did at Roper is, again, we have these really just spectacular IT people who developed a hot link on the corporate homepage. So for you to clock in, if you were an hourly employee, you could not clock in until you did your wellness attestation. So you'd hit this button here on the left, and the screen would pop up and you would walk through it. And if you were okay, you'd say, I'm okay. And then you were allowed to clock in. And I think that it worked, I think, certainly overall, what saved our skin in healthcare was universal masking. I mean, that is absolutely it. But nevertheless, we did do this. And, you know, as I mentioned yesterday, the relationships that were engendered by being there for folks, you know, it's kind of like priceless. And the Charleston Metro Chamber of Commerce had just opened up a brand new gorgeous building, and they didn't know what to do. You know, they had these cubicles all over the place. And so they called Roper because of the relationship we had with them. So I went over, and this was from one of their webpages that Dr. Glade came in with his tape measure, and just started helping them understand how to safely space them and manage their shifts based upon the best information that we had at this time. And it worked out. And the relationship that my occupational medicine program has with the chamber in terms of opening doors for new clients and things like that in the community, it all started just with developing the relationship and being there for them. And they're a pretty sophisticated group, and they understood what they were up against, and they understood what the limitations were. But, you know, the photo ops and the relationships and dealing with reasonable people like the folks at the chamber, in contrast to some of our other clients, we had to kind of take a deep breath with, you know, you just have to be very, very flexible. So here's the Raveneau Bridge at night. Thank you very much. I think I got 10 minutes. I think I knocked it out, and we'll go from there. I'm going to turn it over to Dr. D. Is she going to get a really nice formal introduction, I hope? Where's the? I'll check. No questions here. Doesn't look like any Zoom questions. Okay. Good. Just one comment. That was an excellent overview of many of the, and usually HR folks have verbal interception. I'm usually known as a specialist, and so they ask very similar questions. The one thing that I encountered was the corporate attendance policies. So that was one thing that got thrown in the back burner. It's like, no, that's the worst thing you ever have to deal with. All those screen processes, and I, in my talks, I always said, there's a lot of medicine we talk about, the most important thing is to keep sick people away from well. Which is something that you don't like to understand. And so corporate attendance is a very big challenge. I'll report. I'm not sure how much was picked up by the mic. So from the audience, one of the comments was an incentive program for perfect attendance that had to be back burner because of this. And certainly making sure that people who are sick stayed home. And especially if you've got a driven workforce and people with a great work ethic, and that's okay, you know, I'll crawl my way to my desk, sniffle, sniffle, and become a miasma around, like, like pig pen, you know, that kind of, that cloud, things like that. It's an ongoing battle. And you just have to grab them by the scruff of the neck and send them home. And we'll see it in seven days or something like that. So I absolutely agree. Absolutely. It shows the reflection of your quality of your workforce that they're committed. Even so, well-intentioned, but, but no, but no. Anything else? Your experience in describing your administration and their resistance to some of your suggestions, such as trying to do testing negative before returning to work. We experienced the same thing in the FAA. Fortunately, the FAA listened to the docs and says, okay, we're not going to have back to work negative tests before people go back. We're going to follow CDC guidelines on that. But the second thing where they didn't agree with us was on deep cleaning. They felt that if anybody had had COVID up to 10 days before they had it, that the whole facility had to have deep cleaning. And this literally cost over a million dollars. And, you know, you didn't think that after this much time for two years, they would change their policy. But no, this policy, they say, has been working for the last two years. And so extreme expenses are being paid by taxpayer dollars out there because they're not listening to us. So thank you for relating your experience with your organization not always listening to recommendations. Yeah, yeah. I think we can all have similar kind of experiences, kind of misery loves company kind of thing. But I think that most of them, the problem with getting away with not doing a test of cure was you said, we don't have the reagents. We're too busy using those reagents to make diagnoses. This was early on when, you know, reagents were really at a premium. And I mean, early on, I was paying $75 to $90 for a test sent out to LabCorp that would take seven to nine days. And now I've got a Roche machine that can knock out a thousand a day at six bucks pop. So it was a different time. And a lot of what I think we end up talking about ends up being a historical, much of it's going to be a historical curiosity. And hopefully we'll be prepared to go forward at the last incident command that we had at Roper before we were able to shut down. My ID guy reminisced. He said, you know, Ed, you know, when we got off, this is like after the third time the incident command was activated. He said, you know, it's like we got the band back together again. And we all knew the tunes and we were all in tune. And I think we're prepared and hopefully we'll take these lessons learned. I'm going to turn it over to our next speaker. Thank you. You could start introducing them if you want, I'm just trying to read a second while you're on the screen. Okay, our next speaker is Dr. Joette Giambinco. She graduated from the University of South Florida with a degree in microbiology. After that, she attained dual degrees as a medical doctor and a master's in general public health from Tulane University. She continued her public health studies at the University of South Florida in environmental and occupational health. After completing an internal medicine residency at the University of South Florida, she became the first physician to complete the occupational medicine program, while also working as a CDC fellow for the Agency for Toxic Substances and Disease Registry. Dr. Giambinco earned board certifications in both internal medicine and occupational medicine, and practiced in the workplace, providing on-site medical support to employers, and off-site in clinics specializing in environmental and occupational health. More recently, she has been working on culinary medicine certification. Her career as a journalist began in 2002 as a member of the local news channel 9 in Tampa Bay. In 2005, she began reporting full-time for Fox Channel 13 in Tampa, and she remained in this position for more than 15 years. Most of that time, she was also part of the Fox medical team, providing both live and recorded content to Fox affiliate stations across the country. Many of her stories were broadcasted worldwide or on the web. She received four Suncoast Emmy nominations. You may recognize her more by her name on the air, Dr. Jo. She had planned to retire from Fox in April 2020, but remained in her position until July to help educate the public about COVID-19. This gave her a unique perspective on the first six months of the global pandemic and the nation's public health response to this crisis. Thank you. Thank you. Trying to minimize some of these. Sorry. Good afternoon. Well, you know, I've thought a lot about what I was going to say to you because I've thought so much about those first six months and the COVID response and what I saw from where I was sitting. So you have to remember for me, it all began as soon as we heard there was this virus circulating in Wuhan, China. And immediately I tried to get information. I really did. I looked anywhere and everywhere. I had a lot of amazing sources over the years. I worked very closely with the health departments in my regional area when we were covering H1N1, when we were covering Zika. I really tried to be there for them whenever they needed anything. They needed to get information out. And likewise, I wanted to keep our public informed and I hopefully did a good job doing that. But when this occurred, everything changed. I felt as though I was in a vacuum. I reached out immediately to the College of Public Health, I reached out to health departments, I reached out to the CDC, and I was essentially getting pretty much nothing. I have e-mails. I sent e-mails. Unfortunately, I didn't send as many as I should have. A lot of times I was panicked on the phone trying to call people up, people in my contacts, trying to just get a handle on what was going on. Initially, I think in those early days, I kept thinking from a public health perspective, what should we be doing or what can we do to prepare in the event that this does end up in our country, in our community? At that point in time, I think we were so focused on containment. They kept saying containment, containment, that was the strategy. I have a mindset of containment, but at the same time, I'm thinking, what can we do to start the preparations? Because I didn't have anyone really that I felt that I could reach out to in any significant way, I went to social media, I went to LinkedIn. There, I found someone from Johns Hopkins School of Public Health. I also found a couple of folks, and this is a physician from Pakistan and a medical student from Iran. We started sharing notes as to what was going on because they were telling me what was happening in their countries, which was devastating, obviously, because they didn't have the resources that we had as the pandemic progressed. Initially, I think some of the things that I thought might have been beneficial to our country would have been to make sure that people knew that they could come forward if they were to become symptomatic. Because remember, back at that time, we did not know that there were asymptomatic individuals that were carrying the virus, or if we did, it wasn't made known to us. I basically started thinking about what kinds of barriers would be in place if there were individuals who felt sick or felt ill. What barriers would be there for them to not come forward and to present themselves? Obviously, as public health, when we study public health, we think about barriers. Barriers is access to care, it's going to be cost. The other thing I was concerned about were potentially immigrant populations, maybe people who were undocumented. What were they going to do? Were they going to just ride it out? Were they going to be able to infect other people? At the same time all of this was occurring, we as a government were initiating these ICE raids. Essentially, they were going after undocumented immigrants. At the same time, I felt like we should start to just make sure that everybody's on board and that everybody would be comfortable with coming forward and disclosing if they had become ill. Because remember, we're still thinking we can contain this. This doesn't have to happen to our country. In the meantime, China had, clearly we know now that they weren't telling us what they should have been telling us. We didn't know that then, but we know that now. There was this very brave ophthalmologist who came forward, and he really was the whistleblower, God bless him. They took him in, they incarcerated him, he was let out, and then subsequently became ill and died. I don't know if it was because of the outcry that occurred in China after that occurred or not, but we started to get daily reports from China. They were streaming, and in English. We were hearing every morning, my phone would wake me up at 6 or 6.30 in the morning, and it was a notification that those particular press conferences were starting. I started to listen to what these doctors had to say. These were physicians, many were trained in the US, so they were fluent in English. They were telling us what was happening there, on the ground. Obviously, it's China, so you're thinking, is this censored, is this not censored? One day, there was this physician, and he got up and he started to speak about how bad things were. He said, we don't have PPE. He said, we are doing 12-hour shifts, and because we don't have PPE, we can't take breaks, we can't eat, and we can't change clothes. He said, so we're distributing diapers to some people, but I don't like wearing the diapers because it's really too hot for me to wear all of this and the diaper. Then they started talking about, the nurses started talking about, the goggles had been cleaned so many times, they couldn't see through them anymore to start IVs. They were running out of masks, they were running out of equipment. At the same time all of this is happening, we have the WHO, who, again, I watch pretty regularly because we didn't have a whole lot of other things going on there. They were talking about masks and whether or not we should, there are a lot of people who thought we should have started wearing masks much sooner than we did, but I think that there was this, honestly, this concern about the fact that there wasn't enough PPE for those on the front lines. I don't know if that maybe delayed the use of masks in our country, maybe a little bit, or affected maybe some of the decisions that were made. But I really felt very strongly that these doctors were trying to tell us something. So one day, there are two things that stood out to me. This was in February. One of the, a person who was kind of the equivalent of an OSHA representative, I would assume. He was talking about workplaces, and whether, how they would have to reopen and what they would have to do to reopen. And he basically said, in an indirect way, that they believed it was an aerosol. Because what he said was, there will have to be returns in every single room. If you have one case or one reported case, you're going to have to shut down and you're going to have to clean out the whole HVAC system. This was at a time when China really needed, or really was trying to get their manufacturing back on board. So I thought this was kind of a high bar to set. So I listened to that and I reported that back to whoever would listen to me. And then the other thing that was very troubling was one of the doctors said, we aren't counting the people that don't have symptoms that test positive. This was at a time when there was still that back and forth of, are there asymptomatic carriers? If there are, there are very few, and so I immediately called the WHO and reported that. Again, we're talking very early in this pandemic. So it was frustrating and difficult conveying a lot of this. And then there was social media. I looked up a lot, there have been a lot of studies and there have been some other things that have looked at some of the social media and its effect on people's perceptions and their adoptions of various mitigation efforts. So I remember, I mean, there are several that I can remember that were, unfortunately, they've all been taken down. But when you look at social media and how we need to interact and how we need to interact, I think, with the media, I mean, you interacting with the media is really, really important. I saw a statistic recently that since the pandemic, about 70% of physicians now are in a corporate setting. So generally speaking, for me, as a reporter, I can't reach out to a physician directly if they belong or work for a corporation. I have to call their PR person, right? I have to call their PR person, and then they have to make the determination if I'm able to speak to that person and what they're able to talk to me about. So I think that as physicians as a whole, maybe, we need to think a little bit about how we interact with the media, what kinds of provisions are out there to allow more of those frontline doctors, like I saw in China, you know, those frontline doctors that were right there, they were seeing these patients, being able to speak and talk. And I think that might be helpful in the future. I know we're supposed to talk about things that we could change for the next pandemic. I read a couple of books recently, Sanjay Gupta's book, I read Deborah Burke's book, very, very interesting reads, I would say, both good places for information. Does anyone have any questions? I have a question, but I think what happened at the beginning also is, as physicians, we didn't even know where to go for resources, and you obviously didn't either. And from a social media, so what I said is as physicians, I think that at the beginning, we didn't really know where to go for reliable information. And, you know, you're looking at the internet and you're seeing things and it's social media and you're like, I don't know. And then somewhere along the line, I remember being threatened as a physician that if I didn't talk the talk, whatever the talk might be at the time, my license could be potentially affected. Now, it wasn't a personal threat to me. I kept quiet and I kind of just looked at things, but I saw that and I thought it was very frightening because as we all know, there were physicians that were questioning things at the beginning and they were considered to be false people or whatever they were considered to be false. But now we're finding out that some of the stuff they said was probably along the right lines, even wearing masks at the beginning was, yeah, some people like wear them and others, not getting into political stuff, just, you know, just what was going on with the masks. And I just remember warning my family at the time, what you're seeing is real. This is a real thing. Please pay attention and be smart with your choices. But that was like just to my family. I didn't say that because I didn't want to be, I didn't want other people coming at me. I didn't want my employer potentially saying that I was doing something wrong. And I didn't, you know, I wasn't ready to fight that fight. I didn't have the details to feel like I could support really anything because there really wasn't much out there. So I think it was a very vulnerable type of position. I agree with you totally. There wasn't much out there. And I tried a lot to get information. I, you know, I saved a few emails of some of the things I was asking of individuals. And one of the other things, one of the most frustrating things was in late February, Nancy Massonnier of the CDC, she finally came out with a dire warning. She says, there's no question now. It's not if, it's when. This is going to hit us. And there were different projections as to the deaths. I think that Fauci came out with 72,000. It started to kind of hit us that this was probably coming. And at that point in time, she was taken, she was not allowed to go back and do any more media briefings after that. And I felt at that point, I reached out to our public schools because she says, as part of that, she says, I've already talked to the schools. I've talked to them about virtual learning because my children are still in school. So I immediately pick up the phone thinking, oh my gosh, I'm going to let, you know, the health department know what just happened. And I called the, I'm sorry, not the health department, the school board. I called them up and they said, I said, I can help you if you need computers. You know, our station would be more than happy to help you to try to get computers from the community. We can work with you. We can do whatever you need to help you to do what you need to do for these children. And they just basically acted like I was crazy. So we ended up getting an interview with a different person at a different school system in Sarasota. And again, I wasn't allowed to go do that interview. So a reporter did it. And he basically said, you know, there's really no need to do that at this point. Dr. Domenico, I have a question. Is the media as a whole, assembling a panel of experts to do a post-mortem on the daily press briefings in the way that we allow this pandemic to be so politicized? I mean, it was a coronavirus. So we know cold viruses don't typically result in immunity. So this thing about if you had it, you'd be immune forever. I mean, that was the pervasive message we were getting as a public, which, you know, it's really not a good thing, but it's like the subject matter experts weren't carrying the day, as the political people are. So I don't know if it's as a media field or doing a post-mortem to figure out how to better organize, you know, our, the info that we're giving to the public. I think that's an excellent idea. I just don't know how you tease out the politics. I mean, I tried so hard. I was so hopeful. I saw how we handled Zika. I saw how we handled Ebola. And that wasn't perfect and there were missteps, but if you remember in Liberia, we sent our military out and we contained Ebola. It was just, you know, I went into this thinking, as Deborah Burke says in her book, that even though we're not hearing so much, as you know, to your point, behind the scenes, they're fast and furiously doing all of this stuff and gathering all this data. And they're checking for the fomites to see if there's any need to deep clean anything. And they're doing all of these studies. They're looking for aerosols, but that wasn't happening. I did find one researcher at Tulane, my alma mater, and we did talk about the aerosolization. And he says, really and truly, the only people that can do the definitive study is Homeland Security. And I said, well, did they do it? I don't know. So, you know, a lot of that information would have been extremely beneficial early on. The other thing that Nancy Messonnier said, we are gonna do sentinel testing. We're gonna look at swabs of individuals in, I think it was five different major cities. We're gonna take the swabs for influenza-like illness that tested negative for flu, and we're gonna do some sampling to see if it's in our community. So I thought, oh, that's great. What a great idea. Couldn't find the information anywhere. Finally, Santa Clara published an MMWR that they did find it. And I think that might've been part of the reason why they were one of the early people to shut down. But I kept asking about New York. What about New York? What about New York? So during one of the press briefings with Clomo, their public health person said, we found it in the samples. I said, oh my gosh, they found it. Okay, where's the data? So I call up, I'm trying to message the public health department in New York. I get nothing. So I finally, in July of 2020, they published that they had found it. So it took them from, I'd say early March until July for us to access that information. So we had all known that in those five cities, it was already spreading. And I still don't know about the others. Then would we have acted differently? Would you have acted differently? And then, and to my point, about the 70% of physicians who are, you know, do work for corporations, they were, other people like you were afraid. I had one contact who I'd used a lot and she wanted to come on and speak. She worked for the VA and they told her no. I had another microbiologist who said no. So these are people that I had used in the past for whatever reason. Yeah, I've got it. I'm just having chat questions. Yeah. One of the things throughout this whole process that has bothered me, all politics and all the other stuff, out of the wake of 9-11, back in 2001, we created the National Defense, you know, or the National Disaster Life Support System and Education Consortium. And I was an instructor for that. I went through all the military, I gave lectures around, you know, many, many places and not one place did anything that they were taught to do. Not one, ever since that system was inaugurated. And that bothers me a lot because I'm sitting there saying, you know, you're not following your own guidance. You're not following what we said we were going to do when a mass casualty hits. And I can find nobody who's knowledgeable enough to give me a reason for why they decided not to follow their own guidance in what to do in these situations. Talking with a colleague last night in preventing medicine, we all have been in a system that those of us who we thought people would think would know, like nobody cares, preventing medicine, many times we're not even on the committee. They did not reach out to the people where we suddenly felt like we would, we'd come into our own, that this is our field of protection. And it's been mentioned that some employers, even though they literally pay a medical director for their facility, or within systems, that they were not, the ones on the committees were not always the ones that you would think that this was their field. So it's been a very interesting two and a half years. Both as a geopublic, I mean, we're all just individuals in the United States, but then as healthcare providers, that it may be a field that ain't just one of the ones that works mostly. No, and that's, I think that's probably the point I was trying to make, which I didn't make well, but is that you've got 70% of physicians that are tied up in a corporate setting, who's left to speak? And of those people, how many are qualified enough or should be out there speaking? You know, you've got this unfortunate, I think, mismatch with who's willing, able to speak. And in some communities, it sounds like things are good, that you've got enough experts out there, but in other communities, it's just not like that. So you have people trying to fill this void, and you have individuals who aren't on the committees, and that was the way it was in Hillsborough County. You know, with the committee that was trying to make all the decisions about all the things that were going to occur in our community, there weren't public health people. I mean, the health department was there as a representative, but they really weren't sitting on the committee voting. You know, the other thing that we don't do often enough within the profession is do media training, because you could be a subject matter expert on public health and epidemiology and infectious disease, but it's a whole different world. When you, you know, in front of a camera doing Q and A, inadvertently say the wrong things, that there's a lot of anxiety about it. I'm not sure how long it took you to get real comfortable in that environment, but it's a completely different environment. So just something, if you want to be the spokesmodel for your community or your industry or your employer, make sure you invest in media training. And what I can also say is that I still had my, eventually I still had those individuals who I had counted on previously, but every single conversation was off the record, pretty much. The only way I could get any information that I could convey was when they were in front of these committees, right, in public, and they said, just watch me then, and then you can quote me, you know, because otherwise I couldn't say anything. So I felt like, I almost felt like ignorance would have been bliss, you know, but at the same time I wanted to know what was going on. And I think a lot of the, some of the things that also dawned on me was like, okay, so I'm asking the state in the very, very early days, are you testing people? Because you said, the state decided that they weren't going to tell us anything until we had a positive case. I said, but you've got to start prepping the community, just give them the mindset that, hey, look, we think there might be some people in the community who are testing people, but they wouldn't release any of that information. Then they put the gag orders on all of the health departments so that we had to specifically ask Tallahassee. So then Tallahassee would either answer your question immediately, most of the time it wouldn't, it would take a few days. Well, I'm on a daily schedule. I'm usually on the air maybe two or three times a day. So it's very difficult to operate under those circumstances. So anyway, it was frustrating, difficult. I hope, I don't know what to say, but I think that the bottom line is more physicians just need to get out there. I don't know how, it may be small. It may be on social media. It may be in ways that we can, it's going to be with your employers or the people that you advise, but our voices just need to be there, truly. I'll just make a couple of comments that I think sort of tie into what other people have said. My last assignment on active duty, I was chief of staff for office for that time. And I was fortunate enough to be involved with the task force that contributed to the presidential pandemic response plan, which of course was supposed to be the guide for this. The problem with, I think one of the problems that came into being, this sort of addresses Murray's comments earlier, is when we did that, we were looking at death rates of 20 to 30%. And so when you look at COVID with maybe three, probably closer to one or less than one, it's a whole different, it doesn't fit. It doesn't fit the model that had been set up. I think also, at least from my own personal perspective, in February of 2020, I was in Tel Aviv at the airport, and they're asking everybody, have you been to China? Have you been to China? I'm like, I turned to my wife, I said, who goes to China? Why are they asking, you know? And I think part of the success that you mentioned with the Zika and Ebola and SARS as, hey, we did it before, we'll do it again. This is not getting contained, so we don't need to worry about it. That was my perspective. I think then to Jeffrey's comment, you know, well, why didn't we listen to the subject matter experts? There really wasn't any subject matter experts. This was a novel virus, right? So we had a lot of experience on both sides of what it might be and what it might not be. But early on, you know, it was a lot of people that thought they were experts, but I think very few experts. Now we've got a lot of people that truly are experts, and it was changing every month, right? Sometimes daily in what we were learning about it. So there's a lot of things that I think hopefully we've learned over the last two and a half years that has created now a new paradigm, and this didn't fit any paradigm we had that we were working against in the past. So I think Greg's ready now. I'm ready, but this is a panel discussion, so I'm happy for everybody to participate. So don't feel like you're taking my time at all. All right, so I'm going to give myself a very brief introduction because part of my introduction is actually interwoven into this discussion that I have here. We have, so I guess background. I am an occupational health and preventive medicine physician. I currently work with a major hospital system here in Tampa. My roles are mainly occupational medicine related, but because my center is joining with an urgent care, I did see a lot of patients. So I'm here to give the patient perspectives of COVID-19, and I think that we can all relate to this in certain ways and then not relate in other ways. So as physicians, we all have the experience in patient care, but as members of different states, we all have vastly different experiences because when you look at this pandemic as a whole, there wasn't a lot of traveling between different areas. So I'm looking at it almost as a multiple epidemics occurring in different areas. And I know we've also expressed frustrations with these non-healthcare people making healthcare decisions, some being a lot more appropriate than others. But if you look at each region, there's definitely different models, and hopefully we can discuss and learn what worked and what didn't work, because chances are we're going to have another zoonotic outbreak very similar to this. Certain areas of the world are still having this. I was discussing with one of our fellow members here that North Korea finally came out today and said, yes, okay, yes, we've had our first case. And then weeks later, well, they said it today. They said a couple of weeks ago, we had our first case. Now they're having, what, 187,000 confirmed cases in the last week or two. So different areas are really experiencing different, I'm going to say, epidemics within the pandemic. So as I was saying earlier, my clinical setting is an urgent care center and occupational medicine center. On the occupational medicine side, there's me. And then we have a nurse practitioner or PA on the other side, not supervised by me, by the way. So at the very beginning of the pandemic, I'm sure a lot of you experienced the same. Patient volumes just dropped off dramatically. Nobody knew what to think about it. At the center I had been at, we were seeing 60, 70 patients a day, dropped down to maybe 5, 10 a day. That was initially when people were scared to leave their homes. I'm sure you saw the news reports where the parents weren't saying their kids to the bus stop or they were spraying their kids with Lysol before getting and after getting off the bus. So at the peak of it, though, we started seeing in the urgent care side over 100 patients per day. These were not all sick visits. A lot of them were testing that was required by their employer. But a lot of them were sick. And what we know about health care is that typically, patients are poor consumers of health care. That's why we go to medical school. So we learn what we're doing. The patients will say, you know, I had diarrhea yesterday. I think I need a COVID test. And for a while, the evidence was saying, well, maybe that's the case. But we were finding that triage became a bit difficult with who to really use these tests on and who not to use them on. Because, you know, at first, it was a five to seven day turnaround. Tests were limited. It's not like it is right now where you go in there and you get a test result in 15 minutes. So we had people in there for screening, testing. We had sick patients. Mainly, for a while, when it started with that five to 10, it was people concerned of COVID. So we started wondering, well, what's happening to all these people, you know, and that was on the urgent care side, who have, you know, diverticulitis or chest pains or all these other non-infectious illnesses? Where are they going? So I was starting to think, well, you know, maybe the urgent care setting, people are starting to realize isn't appropriate for a lot of these things. So I was saying we did a lot of COVID testing, and as these non-healthcare decision makers started making decisions, we started checking for people going to work, going to school, traveling as well. And it was troublesome from our perspective, because a lot of the policies, they were not congruent. Okay, my employer says that I need to get it within five days of going in. Mine says I need two. I need three. I need four. Okay, my employer says that I need to get it within five days of going in. Mine says I need two. I need a PCR test. And there was a lot to balance. And I'm sure everybody in here has the same experiences, so I'm not going to dwell on that one too much. But I am hoping to open up discussion when I close out. From the occupational medicine standpoint, it was also a big learning experience. So my clinic is, I'm in charge of the healthcare system, the injured workers, as well as we have major contracts where I'm in charge and so those are the three main groups that I was dealing with the HR teams and trying to figure out exactly how to handle it. You know, the sick workers due to infectious illness, and of course, the traditional occupational medicine issues, right? We had a lot of first responders that were going on. Of course, yeah, they had their occupational medicine exposures, but they were also having their non-occupational exposures. You know, the bread and butter stuff, back injuries, knee sprains, things like that. So I was treating the sick workers, but in addition, taking on a much more active preventive medicine approach, which I like as a preventive medicine doctor. Contact tracing in the fire department, in the police department, hospital for sure. And then helping create policy development. How can we prevent future illness? Because the first responders couldn't isolate the way that everybody else could. So in the urgent care setting, as I was saying, oh, screening was a major part. At first, we really had to ration the tests. Okay, you meet this criteria. You know, you check three of the seven boxes we need. Okay, we'll go ahead and we'll give you a test. I know that your brother has COVID. I know you live with him, but you feel okay. So I'm sorry. We're just gonna, we're gonna have you assume you have COVID until proven otherwise. Please don't come back here again. That was going on with the evolving school regulations. As Dr. Janebanko said, the schools were a little bit behind the times. They were having trouble keeping up with the current recommendations for both the students and the teachers. And a lot of it was changing, you know, day to day. So it's very difficult for us to keep up with. And certain schools would actually require other requirements from other schools within the same district, creating further problem. And a lot of it even became teacher specific. I know that one of my son's teachers, and I don't want to go too much anecdotal evidence, was saying that her colleague was changing people, the students around the classroom every 15 minutes getting a new seat. Because she had read that if you're exposed to somebody for 15 minutes, well, then you're a contact exposure. So she was just playing musical chairs all around. So there's a lot of opportunities for education in this discussion. And as I was saying earlier, that a lot of this was state specific. Going to the screening, a lot of states were able to secure testing that other states weren't able to get. So because of that, we were able to, in Florida, we had a lot more testing than other states. So we were able to go ahead and administer it more so. Patient education, of course, that was, at first, that was a bit fun. And then you sound like a broken record. And I know that everybody has their own story of the patient misnomers and misunderstandings of things. I had patients saying, hey, I have family in the Caribbean. Can I just have them send me a Z-Pak so I don't have to worry about this? Or can't you just give me a SteriPak and send me on my way? All sorts of different fun stories that I'm sure people have great anecdotes of. So moving on more with the urgent care settings. When the vaccinations came out, it wasn't as public health professionals as I'm sure we were all hoping it would have been. The rollout, it was a bit fast, actually, where we were. But the hesitancy and the misinformation was really troublesome to combat on an individual basis. So that's when we have to consider as a public health approach, what can we do better to get out that information with the media, with the employers, all of those things. We've had issues with vaccine hesitancy until the point when they're already sick. Well, I've only been sick for a day. Can I go ahead and get the vaccine? I'm sorry. No, it doesn't work like that. We've actually had a lot of confrontation as well. I don't want to make this a political discussion. But I had a patient, I asked if she had been vaccinated against COVID-19. She said, well, that's a political discussion I don't want to have with you. We don't need to have that right now. Just fix me up. So I gave her her hydrochloroquine and Z-Pak and sent her on her way, right? We actually, in reality, I did have a lot of discussions with that. So treatment, patient confusion. So the patients come for us for the medical information. But we don't have all the information. So it was really eye-opening from that perspective. And that the guidelines just kept changing. How do we handle this? Are we offering supportive care? Are we giving them ivermectin? A couple of pulmonologists in the area have been doing that. And then monoclonal treatment. That one was really changing by the day, it seemed. OK, well, in Florida, we have access to this one, which I believe was more access than other states had. But they have to meet these certain guidelines. And the guidelines kept changing, which made it a bit difficult. So in the occupational medicine setting, that was a bit difficult as well, from the prevention of COVID in the workforce. As I said, I take care of the fire and police departments. And they're the ones that you call when you have an issue. So of course, they had their exposures. And at the very beginning, it was tough because the guidelines said, well, once you're exposed, I believe at that time, it was 14 days of isolation. Meanwhile, half the police department is out. And the other half, the same time, half the fire department is out. So we need to create some guidelines and say, OK, I know it says 14 days. But the evidence that's building suggests maybe we could find some solutions to get you back a little sooner and to prevent other people from becoming ill. So a lot of that ended up falling on COVID testing. So we're checking a bit before the CDC started recommending it. We're saying, OK, 7 to 10 days, let's start to see how you're showing. Do you have any contacts? Let's trace them and see what's going on. That was a population, as I said, that's just unable to work from home. That extends as well. I know I've talked about the police and fire department. That extends to the hospital workers as well, emergency room workers. So we started looking at other things. As I was saying, we were testing a bit sooner. How do we get people back? We also started looking at the temporary immunity. OK, well, we know that for other coronaviruses, you have immunity lasting six months to three years or so. So let's use some common sense and say, OK, if you're exposed twice within the month, you get it first in one month, and then the next month you're exposed, we're going to just look past that and allow you to keep working on that. And then that kind of falls within the timing of the vaccinations as well. So this is all just evolving as we're going through. With the vaccinations, we'll say, OK, the police department was requiring that everybody get it, but I know you had COVID three weeks ago, so we're going to go ahead and allow you to push it off a couple of months. So in the occupational medicine setting as well, quarantine versus isolation, to take everybody back to their residency days and discuss the difference. So quarantine is a term that's used once you have been exposed to an illness. The quarantine guidelines have changed over the years now for this. It dates back to, I believe it was back to the naval days, where they would say, OK, when a ship comes over here, we got to keep you off land for 40 days just to make sure everybody is healthy, hence the word quarantine. And then that's versus the isolation. Isolation is once you actually test positive you're sick, how do we treat them differently, and those two groups right there. And then, of course, the treating COVID positive patients. That was another guideline. So when I started with the police, the guideline was, OK, if you test positive from no matter what, even if you don't know of any exposures, we're just going to go ahead and cover you under work comp. That quickly became really overwhelming. We have 20 officers a day saying, OK, test it positive, and then I'm taking them out of work, we're putting them on workers' compensation. When do they return to work? As time went on, the police department said, OK, you know what? We understand it's endemic in the community now. Let's just go ahead and waive that work comp requirement. But that actually led me with a couple of police officers that stuck around with long COVID. And I was having that discussion with a lot of people yesterday. That's a frontier that we still don't know a lot about. And it may take us a while to start to learn a bit more about how to handle long COVID. So I have a workers' compensation patient right now, his first diagnosis was maybe 17, 18 months ago. Still no resolution of his taste or smell. Still shortness of breath with exertion. You know, we sent him to the specialists. OK, neurology doesn't know what to do about his taste or smell. ENT doesn't know what to do about his taste and smell. We did a pulmonary function test in the clinic which showed the fusion capacity was decreased. So I sent him over to pulmonology about, you know, is there any scarring in the lungs? Actually, the pulmonologist put him on ivermectin. Didn't work. And then workplace restrictions, you know, that's as evidenced, as we all know, with the required workers' compensation forms. So I really wanted to open up a discussion. As I was saying, I believe we have quite a bit of time here to talk about everybody's experiences, 20 minutes or so in both occupational medicine setting and other clinical settings. So if anybody wanted to share any anecdotes, anything that we've learned from this, I'd love to hear from you. Yes, we have a microphone. Okay, go for it then. Well, I mean, I don't see patients, but obviously the community, and what I've noticed, I mean, in general, in the media I consume, which is not Fox News, mostly news, to be honest, is that there's a lot of distrust in the media. I've also noticed a lot, like people are just telling me, oh, okay, this is requiring a proof of vaccination and a PCR. So I just bought that and I can now go on the plane and get it even though they weren't vaccinated this year, they were able to buy it very easily. And these are not like French people, like it is readily available. So I don't know, like to me, I'm concerned about the future of like people now distrust the media, they distrust like everything and people are telling them, when we get a more deadly disease, I'm like, we're all going to die. So for those of you that aren't able to hear what she said in the Zoom conference, we had a utilization management specialist saying, although she doesn't experience, she doesn't see patients, she is concerned about the distrust of the media and the government organizations that are handling, that have handled COVID-19. And she is concerned for the future of the next pandemic. I'm from California, I'm a county health officer now. I was not for the whole pandemic, so I have somewhat of a skewed perspective from public health. In California, we have 52 counties and then I think four cities that have health departments. And over the past two and a half years, over half of the, from my understanding, half of the health officers have resigned have resigned, some of them because they were fired by their board of supervisors because the stance took up COVID and others left because basically fear for their life, they were receiving death threats or people were coming to their house and protesting or painting graffiti or whatever. People who refer to me as the COVID Nazi, I sort of think that's kind of cool. But it breaks the ice when I'm talking to somebody and I said, yeah, I'm the public police. The people that know me, you know, it kind of takes down some of that hostility. But I think within public health, we're going to experience some degree of PTSD and not just amongst physicians, but amongst frontline staff that we did vaccine clinics that were run in California by the health department and people would come and protest at the vaccine clinics and confront public health staff who were doing vaccinations or testing or whatever. So I think there's going to be a lot of psychological fallout from this within the health department. Once again, those on the Zoom conference that weren't able to hear, we have a county health director from California that was saying that he saw a lot of mental and physical fatigue coming from the public health workforce. Anybody else with any questions? Comments? I don't know at what point it became, I mean, I remember early on the first three months, like February, March of 2020, I think it was, everybody's isolated. I mean quarantine, whether you had it or not, everybody stayed home. But literally had a friend from college, many, many, many years ago. In fact, she and her husband are both pharmacists. They're retired now. But she literally referred to it as the communist virus. And that was her name. I mean, that was the name of it. She said that communist virus. And I go, it's a virus, you know, it's a virus. But I just found it interesting how emotional, it wasn't just that this was a very developed disease. It became a very emotional time over the last two and a half years. And I think, which is your point about PTSD, I think some of that is still very much present in our society. Thank you once again for the Zoom people. We just had one of our members here in person speak about how polarized it was politically, even amongst healthcare professionals. So if you look at the history of the Spanish influenza, you look at some of those old photographs, everybody's in masks, which has proven to work well back then. The other thing is patients that received lymphatic pumping and other OMM techniques did a lot better than patients that did not. So I think as a profession, y'all should sing your story a little better. Because this time in the ICUs, they were doing proning and position changing and all these, they didn't know they were doing osteopathy, but they were. And that helped our outcomes as well. I sent Naomi some suggested topics via text. One of them I think we could do is looking at the ongoing family trauma that resulted of those patients that didn't survive and their family has survivor's guilt. And it's exacerbated by the fact that their family member died alone without their ability to hold their hand. So the next pandemic, I hope we rethink at least allowing a spouse, if you need them to sign waivers or whatever, but we need to have somebody in there, you know, especially now that we're post vaccines and all. But I think of the members not being able to be with their husband. I think of my stepmother dying alone in her ICU bed and those families are still hurting. So I don't know if we can't perhaps have some subject matter experts from our psychiatric college or some of the other groups because y'all are going to be dealing with those people, you know, in your workplaces as well. So anyway, and I think we need to look at some of the electoral long haul COVID, whether or not there's any public health policy changes that we can advocate for to help alleviate those people. So that was Jeffrey for the Zoom people. Endorsing OMT as an extra treatment that we can use or that was very helpful during the pandemic. He also spoke about emotional support for family members that have been devastated by COVID during the event and after as well. I was on the board of the Bureau of Public Health and Scientific Affairs and I had put together prior to that a bunch of stuff showing the evidence supporting the utilization of lymphatic OMT, et cetera. I sent that presentation to Fauci, Prickett's sent it to Collins, got somebody in his office who said, if you want to apply for a grant, follow this person. Okay. And no, that wasn't what I was saying. I was saying here's the evidence we can apply this, especially the part about duplicating what we were doing. I gave that to Stephanie of the DAOA for dissemination as appropriate. Again, more Prickett's from the hierarchy of the DAOA. So it wasn't like things weren't being put together by at least I did it. And I'm sure that if I did it, then there were a couple of other people who did it independently and were putting things together for people who just weren't paying attention. Yeah. Once again, for the Zoom. We've got the wrong people with the wrong qualifications leading sections. In other words, if you're going to do the CDC, then the director of the CDC and the surgeon general ought to be certified in one of the preventive medicine specials. As a matter of fact, Title 42 in general says that the surgeon general is supposed to be selected from the commission for, not that he's supposed to be, or she's supposed to be appointed to the commission for if confirmed as a surgeon general. It's supposed to be that they're selected from the commission for officers who spent their lives doing this. And again, go back to what I said earlier, we're not following our own guidance. And in some cases, we're not following our own laws. So as far as vaccine hesitancy, that was something that I was really, really monitoring very closely because I was on social media. And trust me, it was very difficult to stay on social media sometimes because it was some of the attacks that you got. But if you sat there and you really kind of went back and forth with the person, I remember there was one person I went back and forth with initially because he said there was no virus, this was all made up. And finally, at the very end, he says, well, you know, if you guys are so worried about it, how come your reporters are standing so close to the people they're interviewing? I mean, it came down to just that. And so I gave him that. I said, you know what? You're right. I'm going to go speak to my superiors. And so it really calmed down. He calmed down. And he really felt like somebody listened to him and somebody acknowledged him. And it really made a difference. And that gave me so much hope. But when I started looking at the vaccine hesitancy, what I would try to tell them is, look, I listened to those press conferences every single day with the WHO. And the way that the pharmaceutical communities came together with the manufacturers, we skipped a lot of time that would have been necessary for the vaccine development, for the manufacturer to then connect with that person, then to get the infrastructure ready to get the, I mean, it was to the point where they were concerned about not having enough silica to make the vials, but they made it all happen. And all of those things occurred really in a timeframe that we have never, ever experienced. And when I explained it to them that way, I think it gives them a little bit more confidence that the vaccine wasn't rushed, that there weren't steps that were missed. And again, it's just one element, but I was hoping that maybe you could give us some, tell us what you tell people and what things have worked for you for vaccine-hesitant people. Sure. Okay. So speaking to vaccine-hesitant patients, a lot of times, as you know, speaking with patients, you need to find a way to relate to them on an individual level. So we can't speak like physicians. We can't say, oh, well, you know, the mRNA triggers the DNA synthesis and it makes these proteins. Really, I think the discussion came down to the risks versus rewards. Okay. Well, we know that people that have these vaccinations have a better odds of surviving versus COVID-19. And then I would relate that to, well, what are the odds that you feel that you will be harmed by the vaccination? So I tried to appeal to that. One thing that I found, which was really tough to deal with, was that I didn't feel like I, maybe it was my approach was wrong. I didn't feel like I made a lot of headway with the patients. You know, I felt like I had them listening to me, but they had already made up their minds on whether or not they were going to go ahead and get it. So hesitancy was very tough to address for that purpose. So I try to be as educational as possible, but I have to say, I knew in the back of my head that it probably wasn't going to make a huge difference. So story on that and our own family. So we have six daughters. So it's a lawyer, an ICU, night shift, COVID on board, and then you've got a police officer, early in the Air Force, a pre-med major, a high school senior. Which one do you think was the COVID-19? The night shift ICU nurse. And we finally was able to get her vaccinated, but it was a chore because that particular work environment, you always have these little conspiracy theories going around. And I'm like, you're watching these patients die and stuff. You know, of all the kids, you would be the one that I would think would be lining up first, right next to your daddy to get the vaccine. So Jeffrey's just commenting on vaccine hesitancy in healthcare workers. And I actually, the head of our employee health, and it's really hard sometimes to talk with patients who have the hesitancy. And honestly, if you talk to a lot of the physicians at their family, we're talking brothers, sisters, extended family, half will throw a vaccine and we get it. And so in my own family, I had a brother and his daughter that did not get the vaccine. And then myself and this other brother and his family did get it. So you're saying that people get the vaccine. And if they had said to me, is all of your family vaccinated, I didn't think well, no. So yeah, it's a lot of that. So we're having a discussion here about vaccine acceptance rates. And that really varies by state if you look at the evidence. And it's not only the culture within each state, but what I found as well is that a lot of the states have offered some interesting incentives, which worked. I believe it was Ohio that said, okay, we're going to enter you into a lottery. If you get the vaccination and you can win $500,000. And incentives like that worked. So maybe that's something we could take away for the future. Ohio had multiple quality incentives. And then a major one for money. And it was amazing how many people stepped up to get in the draw. It's funny talking about people going for the incentives. One of the doctor groups I'm on, a doctor mentioned that one of his patients had gotten 70 or so vaccines. Because we'd go to Dunkin Donuts and say, hey, if you get a vaccine, you get a free donut. So they'd go across the street to Starbucks after that and get coffee to go with it. I think those of us that are above 50, we all remember post-folio patients. I remember my high school biology teacher, Ms. Tina. I think the media, we could have had a real positive impact by showing the successes of these struggle vaccines. Because my kids that are in their 30s and 20s, they don't know any of that. So to me, polio was the thing. So in terms of convincing me that vaccines can be miraculous and can eradicate diseases. So after this discussion, I hope you don't have too much COVID fatigue. Because we do have a one-hour presentation on COVID-19, where we are and where we're going.

COVID-19 pandemic

occupational medicine

preventive medicine

Dr. Wriston

medical conferences

Ed Glade

corporate culture

Joette Giambinco

medical journalism

misinformation

vaccine hesitancy

pandemic preparedness