Promoting Prevention in the Time of COVID-19

What follows is the final part of our Public Health Roundtable held Tuesday, Dec. 15 via Zoom. You can also read the transcript in its entirety in the January 2021 edition of The Business Journal.

The participants were Dr. James Kravec, chief medical officer, Mercy Health-Youngstown and medical director for the Mahoning County Board of Health; Dr. Michael Bigham, chief quality officer for Akron Children’s Hospital and pediatric intensivist of its intensive care unit; Dr. George Garrow, chief medical officer of Primary Health Network and board member of the Buhl Regional Health Foundation; Erin Bishop, commissioner of the Youngstown Board of Health; Ryan Tekac, commissioner of the Mahoning County Board of Health; Wes Vins, commissioner of the Columbiana County Board of Health; and Sarah Lowry, director of Healthy Community Partnership, Youngstown.

The Business Journal: The thing I’d like to touch on is this idea of awareness among the communities as far as preventive health measures, tying them into something that Erin Bishop and George Garrow touched on, this nervousness over the coronavirus vaccine, and the lack of trust.

[To Ryan Tekac] How can the health district bridge that communication gap with some of the minority populations to build that trust so we can start pushing that message of prevention?

Tekac, Mahoning County Board of Health commissioner: There are many opportunities for what a health department can do. One is we have what we call PIO [public information officer] teams. We ensure that we’re getting correct, positive messaging out to the public. But when we start to look at some of our urban areas, what these individuals need is trust that comes from individuals delivering the message who look like them.

When we look at people of color, we need to ensure that those going out to address these health issues and to educate them are individuals that they can relate to.

We have a model here through Mahoning County Public Health Pathways HUB program where we use community health workers. These are individuals throughout the community who can go out and work with individuals and educate them at a level that they would understand.

Erin Bishop, Youngstown City Health District commissioner: Since the very beginning of the pandemic, Mayor [Jamael Tito] Brown has worked with local churches. We were meeting weekly on Thursdays and would talk about the pandemic, what was happening. This is when a lot of the clergy wanted to know whether they should keep their churches open, what they could do to help.

I was the sounding board for them and we talked about things and then we spent the next 20 minutes in prayer for the community and everyone else knee deep in this.

As things went on, we started meeting every other week. I was able to build that relationship with them so that when we wanted to do testing, they were open, saying, “Hey, come have it at our church. You can have it here at our church.” They were more welcoming.

I remember going to the Rev. Michael Harrison’s church. [Union Baptist] When we did the testing there, I asked an older woman, where did you find out about this?

“Oh, my pastor said come and get it,” I was told.

It was good that their pastor would talk about it on a Zoom call because they weren’t having in-person services.

I asked, “What did he say? You aren’t going to Heaven if you don’t come?”

There were a lot of older Black women who didn’t want to leave their houses. But they came [to get testing] because their pastor told them to. That’s the approach we’re going to have moving on to the vaccine.

Already I have received a text from my very good friend, a minister on our board. He’s deathly afraid of needles. But he said he would do it, get the vaccine on TV if he had to, just to encourage his congregation to get it.

Using those faith leaders would be very important and talking about it. Just growing up in the church, as I did, you do trust your priests and your pastors. We’ll use that approach to build that trust.

Sarah Lowry, Healthy Community Partnership: We’re in a network of folks who represent various organizations throughout Ohio. The neighborhood approach to testing was something that a lot of folks said, “Oh, wow, that’s really incredible.” This is going to where people are in places that they find familiar, that they are comfortable with, faces and people they trust. 

I bring that up because building those deeply connected non-transactional relationships are so important and that takes time. It means showing up and being there, not when you need something from someone, but when you want to show that you care.

The Business Journal: Are infrastructure improvements needed? Earlier this year, we saw the Youngstown City School District, for instance, open up clinics in the schools to work with residents of need. 

James Kravec, chief medical officer, Mercy Health Youngstown and Mahoning County Board of Health medical director: We need to talk about access, focusing in on the telehealth we have available. I do know that use of the internet is a challenge for some. For those that have access to the internet, telehealth expands the capabilities of care to people. Even if they’re not able to leave their houses, they’re still able to see a primary care doctor or a specialist.

There was a time when doctors, patients, insurance companies and government payers didn’t embrace telehealth. Now it’s embraced by all four, at least during this pandemic.

We’ll see what the future holds, at least for the insurance companies. Patients and doctors seem to have gotten over their fear or dislike of telehealth.

In any given week, we’re seeing between 20% and 25% of our patients virtually, which is amazing. It’s positive. And we have clinics in schools. Mercy has vans for dental health, medical health and mammography.

We’re centering on pregnancy programs and primary care offices that are out in the communities. That is the key to access.

Every person should have a medical home or primary care doctor where he or she gets their care by a doctor, nurse practitioner or physician’s assistant. They need to be seen.

The Business Journal: Everyone has mentioned partnerships throughout this conversation. What about the business community? What role can the business community play? 

Lowry, Healthy Community Partnership: It’s a very important one and one that the Healthy Community Partnership has recognized as a critical voice. 

One of our focuses is talking about public transportation. We’ve seen a significant expansion of the WRTA’s service into Trumbull County. That allows more folks to get to more places so more individuals are able to get to jobs, grocery stores, medical appointments. Having that conversation about transportation has an impact on health. Transportation also has an impact on business.

Business leaders see and understand expanded transportation benefits them. It’s the same topic of conversation – expanded transportation access – but having it in a way that makes it clear that this one goal has a lot of implications for stakeholders. Everybody stands to benefit.

Kravec, chief medical officer, Mercy Health Youngstown and Mahoning County Board of Health medical director: From a business standpoint, the question arises all the time, what is the new normal? When will we go back to normal and what is the new normal? One thing that will not go back to normal, and this affects the business community, is how businesses deal with their employees who might be sick, who have sniffles, who have a slight fever. 

Once, and this is probably true for health care businesses, when someone had a cold or fever, they would take some medicine and come to work. Some business HR policies didn’t allow time off or for when their kids stayed home so people would send them to school sick. There’s going to be an increased sense of community so we don’t do that.

Business plays a big part in that as we think that through with their HR practices that encourage workers to work from home. That might still be in the future if they can take time off without incurring penalties. No matter what, whether it’s a common cold or influenza or COVID, whatever it is, that is something that the business community has a part to play.

Wes Vins, Columbiana County Health District commissioner: We have a greater understanding of that continuum among the economy, education, and health. We better understand the role of business and economy in this COVID response. An important piece of that is businesses have a greater understanding of their role as well.

We in public health have been very successful in Columbiana County. Our businesses have been fantastic. They’ve been there to help us and we’ve had a great exchange of information.

Public health has moved, at least in this response. We’ve moved to a position of talking with businesses instead of talking at businesses. Historically, we’ve been a regulatory piece to businesses, be it septic tanks or wells or inspecting restaurants or all these other mechanisms, campgrounds, you name it, landfills. Or we’ve been the regulator in overseeing businesses.

We’ve now moved to a new position of working with businesses. That partnership has evolved through this coronavirus response. Hopefully, that’s something that’ll move forward and businesses will understand that … If we can help them keep their workforce healthy, they’re going to be more successful. They’re going to generate revenue to create jobs and opportunity for the community and continue that relationship among health, the economy and education.

Bishop, Youngstown City Health District commissioner: I noticed that, too. This is the first time that businesses call us and ask for our advice about how can we keep their employees healthy. Then we found that certain businesses were putting things together. So they told us, “Hey, we want to show you this model.” They were creative on ways to keep their employees healthy. 

We still are getting calls from businesses. What more can we do? Do you have more information out there?

We’ve got to get businesses more involved. We have a relationship with some of our businesses that, as we move forward, I can go to and say, “We’re working on this. You did a great job earlier. Can you help us out?”

Michael Bigham, chief quality officer, Akron Children’s Hospital: It’s really that trust factor we were talking about with our public health and health systems: building trust and relationships with the community. That’s been strengthened also between public health and our business community.

Again, none of us want diametrically different things. We all want health and wellness in our communities. It’s just we’re sometimes coming at it from diametrically different perspectives.

There’s much more alignment, which is a real testament to the way we’re going to pull through this pandemic in a far better way than we came into it.

Vins, Columbiana County Health District commissioner: That continuum and all those pieces, the schools, the partnerships; we in our office, we’ve looked at it and said COVID-19 has made our community stronger. It’s hard to look at it from that perspective but it has.

It’s made our community stronger, both locally as well as regionally. We rely on our health partners. We rely on our business partners. We rely on a very broad spectrum of individuals and businesses and partnerships and organizations.

We talk about crisis. You get through something that’s really hard, and when you get out the other side, you’re a stronger family. You’re a stronger person. The coronavirus has done that for our community, both narrowly and broadly. We are stronger.

The Business Journal: Perfect segue into our last question. What are your projections for the first quarter of 2021 regarding COVID-19?

Kravec, chief medical officer, Mercy Health Youngstown and Mahoning County Board of Health medical director: It’s time for the vaccine. We’re excited about the vaccine rollout. It will take half a year to vaccinate everyone who needs to be vaccinated.

The first few months will see health care workers and the sickest patients in our extended care and assisted living facilities.

For every person who’s vaccinated, there’s one fewer person we will see in a clinic or hospital. We are absolutely going to see a downward trend but we absolutely cannot let our foot off the gas until a good portion of the population is vaccinated. And we are not there yet.

Continue social distancing, mask wearing, staying home when you’re sick. Those are all just as important now as they have been over the past year.

Bigham, chief quality officer, Akron Children’s Hospital: Just to build on that and echo as loudly as I can without shouting: We know in public health that vaccinations are critical to illness prevention.

The flu vaccine. There’s good data that one shot of flu vaccine, for every five patients who get a flu shot, prevents a case of influenza. That’s compelling data.

We won’t have the track record for some time on the COVID-19 vaccine. We can’t take a wait-and-see approach. That’s unsafe.

The health of our community is too fragile with the prevalence of COVID-19. A very reliable roll out of the COVID-19 vaccine is going to be critical to the maintenance and strengthening of our health care systems and public health infrastructure. But beyond that, our communities.

George Garrow, chief medical officer, Primary Health Network: One thing that I hope to see in the first quarter of 2021 is that we are all good neighbors and good stewards of the resources in our community and that we come together to do the public health 101 measures.

Wear your mask. Wash your hands. Avoid large crowds. Socially distance because we need to reserve those resources in the hospital, in the intensive care unit, for people who really need them.

Anything we can do as good neighbors to [provide] our brothers and sisters who are working on the disease in patient units and the emergency rooms the capacity and the space. Mitigation is essential right now.

Wes [Vins] mentioned the impact on rural communities, and for a long time early in the pandemic, this was an urban, suburban, dense population community concern. Now, in the rural communities in Ohio and Pennsylvania, the virus is here.

Everybody is tired, but guess what? This is not political. This is clinical. We have to hang in there, do public health 101 until we get enough people in the community vaccinated. Don’t let down your guard.

Related Coverage:

Jan. 12 | How Can Public Health Agencies Fill the Needs Gap?
Jan. 11 | Pandemic Brings Public Health to Forefront

Click HERE to watch the full roundtable as well as a selection of short vignettes.

Copyright 2021 The Business Journal, Youngstown, Ohio.