Just last week, it seemed OK to have lunch out or maybe meet up with friends for a game of pickup soccer.
Now, in the fast-moving world of the coronavirus response, that’s no longer the case. More and better social distancing is required. But what’s still acceptable?
We reached out to public health experts, who, admittedly, vary in their recommendations. But their main message remains: The better individuals are now at social distancing to slow transmission of the virus, the better off we’ll all be eventually.
Already, California has told people 65 and older to stay at home. In the San Francisco Bay Area, where community spread is a growing concern, just about everyone else has been ordered to do so, too. California is also among the states that have ordered restaurants, gyms and other facilities to close. And the Trump administration has instructed Americans to avoid gatherings of more than 10 people for the next 15 days and avoid sit-down meals in bars, restaurants and food courts. More restrictions from states, localities and the federal government could follow.
In the coming days, those rules and recommendations may expand as federal, state and local health officials weigh conditions on the ground. So what to do now?
“We ought to make risk-based decisions,” said Dr. Georges Benjamin, executive director of the American Public Health Association.
Expect change. Maybe daily. But also take a deep breath. Some things are still all right.
“At the end of the day, we have to take care of our kids, our family, we have to eat,” said Benjamin. “What people ought to do is think about how best to reduce risk and do as many less risky things as they can.”
So what about walking around the neighborhood?
“Yes, but not in groups,” said Benjamin, who added that he would wave at his neighbors while out for a stroll but “would not have a long conversation.”
If you do chat outside, maintain 6 feet of separation.
Dinner parties? Food for those shut in their homes?
“Inviting people over depends on whether or not they have symptoms, whether they have traveled overseas,” Benjamin suggested. “I would not have a BBQ on my deck with a bunch of people.”
If you bring food to a shut-in or a neighbor, “leave it on the porch,” he said, and always, always make sure you wash your hands before preparing the meal.
In a blog post titled “Social distancing: This is not a snow day,” Dr. Asaf Bitton, an assistant professor at the T.H. Chan School of Public Health at Harvard, takes a hard line, recommending no play dates or sleepovers for children. No sharing of toys with other families. Even playing outside with other kids is a no-go “if that means direct physical contact” such as in basketball or soccer.
Limit trips to stores. Cooking food at home, he wrote, is less risky than takeout. Don’t have other families over for dinner.
School closings won’t slow transmission if parents allow close play dates, or even activity on playgrounds, said Elizabeth Stuart, a professor of mental health, biostatistics and health policy at Johns Hopkins Bloomberg School of Public Health, in an interview with KHN.
Playgrounds are a problem because they put children, and their watching parents, in close proximity. There is also a chance the virus could remain on surfaces.
But some people need more flexible guidelines, especially those with young children or those who can’t work from home, such as health care workers.
For them, a “closed-network strategy” might work, Stuart, two epidemiologists and a health policy expert wrote in a piece that ran in USA Today.
That means a small, trusted circle can continue to interact while creating social distance from outsiders. If any member of an individual family within that circle, however, exhibits symptoms, the entire family should isolate — and let everyone else in their circle know.
“The ideal situation is everyone stays home, but that’s just not a reality for a lot of people,” Stuart said in an interview with KHN.
She said friends have asked what to do in specific situations, such as deciding whether a teenager should babysit for another family.
The key, she said, “is to think of the number of unique people you come in contact with.”
Each case involves a judgment call — and an element of risk. Maybe two families share child care, or a teenager babysits for one family. But the teen does not sit for 10 families, she said.
Bitton, in his column, took a tougher stance.
“Even if you choose only one friend to have over, you are creating new links and possibilities for the type of transmission that all of our school/work/public event closures are trying to prevent,” he wrote.
Do get outside every day, he wrote, as “it will be important during these strange times,” but “stay physically away from others.”
Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, agreed.
“We encourage people to go out and exercise, but in a solitary way. Your pickup soccer game, because of a lot of close contact, no. But maybe tennis because there’s a big distance from you and another player,” he said.
Maintain that 6-foot distance, whether outside or if you invite someone into your home, he said. If people come over, wipe down surfaces after they leave. And always wash your hands.
These recommendations — and the stricter ones being imposed in some cities, like San Francisco — are vitally important, Plescia said.
“Social distancing works. If we do it, we can keep the spread from going up. We can get ahead of this and slow it down,” he said.
For the past eight years, she’s been washing her hands pretty much every time she passes a sink. When she’s near a bottle of antibacterial gel, she uses it. She makes a point of avoiding people with contagious illnesses, even though it can be uncomfortable to ask to work from home or miss a date with friends. And she makes sure she gets plenty of sleep, not always easy at age 25.
Amelse was diagnosed in 2012 with lupus, an autoimmune disease that makes her vulnerable to infections. She’s since developed pulmonary arterial hypertension, a condition that requires intravenous therapy via a central line to her heart. Both illnesses place her at heightened risk for viral and bacterial illnesses. So, she has adapted as a matter of survival, taking to heart long-standing axioms on what constitutes good hygiene.
As the highly contagious new coronavirus continues its spread through the U.S., the general public could learn a thing or two from Amelse and the millions of other Americans with weakened immune systems who already live by rules of infection control. Whether it’s people who had recent organ transplants, people undergoing chemotherapy or people with chronic diseases, America has a broad community of immunosuppressed residents who long ago adopted the lifestyle changes public officials now tout as a means of avoiding contagion: Wash your hands, and wash them often. Don’t touch your face. Avoid that handshake. Keep your distance from people who cough and sneeze.
Amelse doesn’t follow the advice perfectly — of course she touches her face sometimes. “You do these things unknowingly, so forcing yourself to break these habits can be challenging,” she said. But the incentive to keep getting better is there. “If you get a cold and you give me that same cold, you might get it for a week. I’ll get it for a month.”
Even with her dedication, COVID-19 is proving a daunting prospect to face. And she has a stake in Americans adopting these habits because, while the disease is relatively minor for many people who get it, it can be life-threatening for people with preexisting conditions.
Amelse works at a health literacy startup in Minneapolis that helps patients with complicated diseases learn about their illness. She knows a lot about health and how to prevent infection. Still, the threat of COVID-19 is unnerving, for her and her doctors.
With a virus so new, official guidance on what people at heightened risk should do to steer clear of COVID-19 is limited. But the Centers for Disease Control and Prevention recently said the virus seems to hit hardest in people 60 and older with underlying health concerns. There is also concern for younger people with limited immune systems or complex diseases.
Health officials are asking those at risk to stockpile two-week supplies of essential groceries and medicines in case they need to shelter at home; to avoid crowds and heavily trafficked areas; to defer nonessential travel; and to track what’s going on in their community, so they know how strictly to follow this advice.
Infection control always follows a similar set of principles, said Dr. Jay Fishman, director of the Transplant Infectious Disease and Compromised Host Program at Massachusetts General Hospital and a professor at Harvard Medical School. The most important things for people to do right now are the things he always recommends to his organ transplant and cancer patients. Again, think hand-washing and avoiding spaces where sick people congregate.
Still, the recommendations aren’t one-size-fits-all. Some people are born with stronger immune systems, and immune deficits exist on a spectrum, said Fishman. How strict people need to be to prevent illness can vary depending on how susceptible they are.
Recommendations also need to take into account what people can and will do, he said. Children, for example, are among the greatest germ vectors of all time, but Fishman doesn’t ask his patients with grandchildren to stay away from their young family members. “We did the transplant so you can see your grandchildren,” he might tell them.
Similarly, avoiding crowds and staying away from sick people is easy for some but can be all but impossible if you work in food service, for example. Find ways to avoid the risks and reduce them where possible.
Though there isn’t great research on how well transplant patients and others manage to prevent infection, Fishman said many of his patients don’t get sick any more frequently than the general population, despite their vulnerabilities. But when they do, the illnesses tend to last longer, be more severe and put people at higher risk for additional infections. He counsels patients to be vigilant, but also to live their lives and not be ruled by fear.
Dr. Deborah Adey, a transplant nephrologist for UCSF Health, echoed Fishman, saying she likes to find ways to help her patients carry on with their lives. A patient recently asked if it was OK to fly to Salt Lake City, and she suggested they drive instead.
Gauging the risks can be tough. Amelse was relieved when a major health conference she was scheduled to attend recently in Florida was canceled at the last minute. She wasn’t sure it was safe to travel, but it also was unclear how to categorize an important work trip: Was this essential? Nonessential?
Adey conducts follow-up appointments via teleconferencing where possible, to keep her patients out of medical facilities. Hospitals are, by design, places for the sick, and people with compromised immune systems are generally advised to avoid them and the viruses and bacteria potentially inside.
That matches advice from officials in California and other states, asking people to stay out of emergency rooms unless absolutely necessary. They are asking people, when possible, to call ahead to their doctors and stay home unless an illness is serious.
And, similar to what public officials are advising the general population, Adey does not recommend that her patients wear face masks when out in public or even at the clinic. “The only people I would recommend is if they’ve got a lot of close contact with the general public, and they can’t afford to be off work.”
While much has been made of the hoarding sprees for face masks, the empty hand sanitizer shelves are equally frustrating for Amelse. Every 48 hours, she has to mix and administer drugs she places in an IV that goes into her heart. Everything must be sanitized, and she typically gets monthly shipments of antibacterial wipes and sanitizer. If suppliers run out, she’s worried she’ll have to go to a hospital to have the drugs administered — exactly where her doctors don’t want her to be.
Officials are desperately working on a vaccine for the coronavirus for use in as little as 12 to 18 months. But many vaccines are made from live viruses and can’t be given to some immunosuppressed people.
Given the risk COVID-19 poses for people with compromised immune systems, the government needs to stress how important it is for everyone to follow good hygiene protocols, said Fishman. “The worst thing we can do is downplay it.”
And for those just getting up to speed on preventing infections, Amelse has advice: “Viruses don’t pick and choose; they will latch on anywhere,” she said. Even if it’s not a serious illness for you, “there are people in your life that you can infect. You have the obligation and the responsibility to take care of your loved ones.”
With coronavirus cases exploding in China, the U.S. is once again responding to a global epidemic. Five years ago, when the Ebola virus infected more than 28,000 people in 10 countries, many people were surprised to learn that four of these cases were diagnosed on U.S. soil.
Based on research I conducted for a book about the Ebola crisis and prejudice against certain groups of people associated with it, I fear that Americans might make immigrants the villain instead of the virus during the coronavirus epidemic.
If the U.S.‘ experience with epidemics tell us anything, it is that these events will be followed by increased public attention aimed at immigrants from China. This is because during epidemics, attention is typically focused on groups from countries where they started. And, this attention is rarely accompanied by an understanding of immigrants’ complicated experiences.
This does not imply that the Ebola virus and the new coronavirus are similar. Yet, there are important facets of African immigrants’ experiences during the Ebola crisis that can inform how Americans think about the current experiences of Chinese immigrants.
Some immigrants experience the devastation firsthand, because they had traveled to their countries of origin when the outbreak occurred. During the 2014 Ebola epidemic, for example, African immigrants visiting West Africa when the outbreak began lived through the ensuing social disorder, witnessed the rising death toll and feared infection from the deadly virus.
More often, however, immigrants experience outbreaks from afar. During the Ebola epidemic, my research shows that immigrants who remained in the U.S. were not spared from these emotional experiences. While advances in global travel and communications technology have helped immigrants maintain connections with these countries, they also provide channels through which the consequences of disease outbreaks abroad are experienced.
News of the mounting deaths of family members created a paralyzing feeling for immigrants in the U.S. who knew that they couldn’t risk traveling to the endemic countries abroad. At the same time, they felt being guilty about their inability to participate in customary burial rites.
But worst of all, blame
In addition to fear and guilt, however, immigrants often experience a great deal of blame. During the Ebola crisis, negative responses from Americans who used caricatures of immigrants’ ethnicity to stigmatize them as carriers of disease only worsened immigrants’ stress and fear. For example, many heard racist tropes about Africans’ presumed penchant for kissing corpses and their habit of consuming exotic beasts.
Stigmatizing immigrants does nothing to contribute to the fight against epidemics. Instead, such actions are usually counterproductive because they fail to incorporate immigrants into broader efforts to combat the spread of disease.
How immigrant communities help
Immigrant communities provide a critical line of defense for detecting, monitoring and preventing the spread of the disease, as I discuss in my book. With Ebola, these included the development of strategies to prevent the spread of the virus and improve public health by African immigrants after the first case of Ebola was discovered in the U.S.
Accordingly, African immigrant communities promoted initiatives to discourage travel to affected countries. They also helped develop systems for ensuring that Africans returning from these countries abide by quarantine period required by the Centers for Disease Control and Prevention.
Beyond these actions, West African immigrants took other practical steps to reduce person-to-person transmissions of Ebola, while also supporting efforts to address the consequences of the disease abroad. In addition, these immigrants promoted the practice of frequent hand-washing with chlorine-based solutions and discouraged social norms of hand-shaking withing their communities. These actions were complemented by efforts to assist in contact tracing, the identification of people who may have come in contact with infected persons.
Building on these initiatives, they also collaborated with local businesses and other mainstream institutions to care for families affected by Ebola and assisted humanitarian organizations working to combat the spread of disease in West Africa.
When a nation responds to epidemics by stigmatizing immigrants, it misses opportunities to build strategic coalitions for preventing the spread of viruses. Now that the first person-to-person transmission of the coronavirus has been confirmed in the U.S., the need for such coalitions has become more urgent.
In my view, our nation’s response to Chinese immigrant communities should be based on actions informed by facts and not fear. Without such actions, we risk failure in our attempts to build the resilient communities needed to prevent the occurrence of a greater public health emergency within our borders.
Also, the 2015 Centers for Disease Control and Prevention’s biennial Youth Risk Behavior Survey reported that, compared to non-Hispanic white boys, black high-school age boys are more likely to have made serious suicide attempts that require medical attention.
Suicide has become a leading cause of death in the U.S. among all age groups, but particularly in youth and young adults. It is the second leading cause of death among 10- to 34-year-olds. Parents, teachers and professionals must be able to both talk about it and understand the risks for vulnerable children of any race. But those of us who work with black youth may also need to address some myths about suicide in the African American community.
For example, one such myth has its start almost three decades ago, Kevin Early and Ronald Akers’ interviews with African American pastors concluded that suicide is a “white thing” and that black people are accustomed to struggling through life challenges without succumbing to suicide. those authors concluded that black people see suicide as a “white thing” but it is a myth that black people do not die by suicide.
Based on anecdotal conversations that many others and I have heard in day-to-day conversations and that sometimes emerge in popular media, this opinion about suicide in the black community has shifted relatively little.
More importantly, black youth at risk may even be more difficult to identify than non-black youth. One study referred to college age racial/ethnic minority people, including African Americans, as “hidden ideators” who are less likely than other youth to disclose thoughts of suicide. Because suicide is occurring and at shockingly young ages, comprehensive efforts are needed to address this public health problem.
Studies suggest that stigma about mental illness and the feeling that one will be outcast further or ignored may keep black youth from sharing their thoughts. Also, public health and mental health experts may be unaware that suicide risk factors could show up differently depending on ethnic group.
Simply put, a one-size-fits-all approach does not work for identifying suicide risk. And little or no action has been taken to address the increasing crisis. As an African American psychologist, I find this frustrating when children’s lives are lost – lives that could be saved.
Unique needs in African American mental health
Most mental health services are not designed with cultural and social nuances in mind. My research team has found consistently that the challenges that black kids face in navigating dual cultural contexts may increase their risk of suicidal thoughts.
In research on adults, we found that black men and women who used more Eurocentric or individualist approaches that was more self-focused rather than managing stress via the belief in a Higher Power were more likely to consider suicide. This was not true for those who used more culturally meaningful, spiritual coping.
When there are cultural differences, therapists must be willing to “think outside of the box” to fully evaluate risk for suicide. As an example, the racism that black Americans encounter increases stress for many. Thus, their stressors and mental health issues will need different solutions and approaches than treatments that work for white people.
In another study published in Comprehensive Psychiatry, we observed different patterns of risk for black adults compared to white adults who were admitted for psychiatric care. We examined sleep-related problems, which are elevated among black Americans, and suicide because sleep issues are a serious but understudied risk factor for suicide crisis. It turns out that inadequate sleep can escalate an emotional crisis. Our research found that problems staying awake for activities such as driving or engaging in social activities, which reveal inadequate sleep, were associated with a four-fold greater risk for suicide crisis compared to non-suicide crisis in black adults who were admitted for psychiatric treatment.
Caring adults are a child’s first line of defense. If a child discloses that he is thinking about dying, it is important to ask him to share more about his ideas and if he knows he might die. If a child has a suicide plan, it is time to get professional help.
The Crisis Text Line at 741741 could be an option for teens who need help to cool down in a crisis.
When it comes to finding a mental health professional, parents need an expansive list of referral options, including university-affiliated mental health clinics that offer evidence-based services on a sliding scale and federally qualified health centers for the uninsured. Regardless of the setting, a well-trained therapist may be of a different race.
Parents and caregivers must be willing to sit, listen and try to fully understand what is most upsetting for a child who is experiencing a difficult situation and a lot of emotions.
For those who believe that the alarming statistics will eventually reverse course without any action, this may be true. In the meantime, saving one life is worth the effort.
Thoughts of suicide do not mean that a child or teen needs to be hospitalized. It means they are in emotional pain and want the pain to end. Adults can investigate the problem and remove it or help the child deal with it. Online resources such as Stopbullying.gov include interactive videos that are useful to parents, educators and youth. Suggesting to a child that she “get over it” is less than helpful. A child who is already in a vulnerable state cannot problem-solve without meaningful support from the caring adults in charge.
Sitting in the afternoon heat on her mom’s porch in Athens, Georgia, Hardy recollected how a recent “crisis” derailed her normal morning routine.
“It was time for my daughter to get on the bus, and she’s too young to go on her own,” Hardy recalled. “I was in so much pain I couldn’t walk. So, she missed school that day.”
Sickle cell disease affects red blood cells, which travel throughout the body carrying oxygen to tissues. Healthy red blood cells are shaped like plump and flexible doughnuts, but in people with sickle cell disease, the red blood cells are deformed, forming C-shaped “sickles” that are rigid and sticky.
These sickle-shaped cells can cause blockages in the blood vessels, slowing or even stopping normal blood flow. An episode of blockage is known as a sickle cell “crisis” — tissues and organs can be damaged because of lack of oxygen, and the patient experiences severe spells of pain.
‘It’s Like Torture’
Hardy tries to manage these crises on her own. She’ll take a hot bath or apply heating pads to try to increase her blood flow. Hardy also has a variety of pain medications she can take at home.
When she has exhausted those options, she needs more medical help. Hardy would prefer to go to a specialized clinic for sickle cell patients, but the closest is almost two hours away, and she doesn’t have a car.
So, Hardy often goes to the emergency room at nearby St. Mary’s Hospital for relief. Until recently, the doctors there would give her injections of the opioid hydromorphone, which she says would stop her pain.
Then, some months ago, the emergency room changed its process: “Now they will actually put that shot in a bag which is full of fluids, so it’s like you’re getting small drips of pain medicine,” Hardy said. “It’s like torture.”
It’s the same for her brother, Rico, who also has sickle cell disease and has sought treatment at St. Mary’s. The diluted medicine doesn’t give the same pain relief as a direct injection, they say.
Striking A Balance
St. Mary’s staffers explain that they’re trying to strike a balance with their new treatment protocol between adequate pain treatment and the risk that opioid use can lead to drug dependence.
It’s a local change that reflects a national concern. The U.S. is in the midst of an addiction and overdose crisis, fueled by powerful opioids like hydromorphone. That crisis has made medical providers more aware of the risks of administering these drugs. More than 47,000 Americans died in 2017 from an overdose involving an opioid, according to the Centers for Disease Control and Prevention.
That has prompted some emergency room leaders to rethink how they administer opioid medications, including how they treat people, such as Hardy, who suffer from episodes of severe pain.
“We have given sickle cell patients a pass [with the notion that] they don’t get addicted — which is completely false,” said Dr. Troy Johnson, who works in the emergency room at St. Mary’s. “For us to not address that addiction is doing them a disservice.”
Johnson proposed the ER’s shift to intravenous “drip delivery” of opioids for chronic pain patients because of personal experience. His son has sickle cell disease, and Johnson said he has seen firsthand how people with the disease are exposed to opioids when very young.
“We start creating people with addiction problems at a very early age in sickle cell disease,” Johnson said.
He brought his concerns to the director of the ER, Dr. Lewis Earnest, and found support for the change. Hospital officials say they also consulted national guidelines for treating sickle cell crises.
“We’re trying to alleviate suffering, but we’re also trying not to create addiction, and so we’re trying to find that balance,” Earnest said. “Some times it’s harder than others.”
St. Mary’s says the new IV-drip protocol is for all patients who come to the emergency room frequently for pain, and most of their sickle cell patients are fine with the change.
Caught In The Crossfire
The national guidelines cited by St. Mary’s also say doctors should reassess patient pain frequently and adjust levels of opioids as needed “until pain is under control per patient report.”
Some people who work closely with sickle cell patients, upon hearing about the new approach to pain management at St. Mary’s, called it “unusual.”
It’s more common for ERs to give those patients direct “pushes” of pain medication via injection, she noted, not slower IV drips.
People with sickle cell disease aren’t fueling the opioid problem, Andemariam said. One study published in 2018 found that opioid use has remained stable among sickle cell patients over time, even as opioid use has risen in the U.S. generally.
“If anything, individuals with sickle cell disease in our country have really been caught in the crossfire when it comes to this opioid epidemic,” Andemariam said.
She suggested that ER doctors and nurses need more education on how to care for people with sickle cell, especially during the painful crisis episodes, which can lead to death.
A study of some 16,000 deaths from 1979 to 2005 related to sickle cell found that men in the group lived to be only 33, on average. Women didn’t fare much better, living to an average age of 37. The same study suggested that a lack of access to quality care is a factor in the short life spans of people with sickle cell disease.
Researchers who study sickle cell say the opioid epidemic has made it harder for patients with the condition to get the pain medication they need. The American College of Emergency Physicians is focusing on the problem, asking federal health officials to speak out about sickle cell pain and fund research on how to treat it without opioids.
“We in the physician community are looking for ways to make sure they get adequate pain relief,” said Dr. Jon Mark Hirshon, vice president of the group. “We recognize that the process is not perfect, but this is what we’re striving for — to make a difference.”
Considering A Move To Find Relief
In the meantime, India Hardy said she feels those imperfections in the process every time she suffers a pain crisis, and she’s not alone.
In addition to her brother, Hardy said she has another friend in Athens with sickle cell disease, and that friend has also reported difficulty in finding pain relief at the St. Mary’s emergency room.
“It’s just really frustrating, because you go to the hospital for help — expecting to get equal help, and you don’t,” Hardy said, her voice breaking. “They treat us like we’re not wanted there or that we’re holding their time up or taking up a bed that someone else could be using.”
Hardy filed a complaint with the hospital but said nothing has changed, at least not yet. She still gets pain medication through an IV drip when she goes to the St. Mary’s emergency room.
At this point, she’s considering leaving her relatives and friends behind in Athens to move closer to a sickle cell clinic. She hopes doctors there will do a better job of helping to control her pain.
California’s head cheerleader on improving statewide health says it’s all about “bringing people together.”
And after almost a year on the job as the state’s first surgeon general, Dr. Nadine Burke Harris exudes optimism, saying she has enjoyed an “absolutely phenomenal outpouring of support” from various factions of California’s vast health care sector.
Harris, 44, a San Francisco Democrat, is a nationally recognized expert on the effects that childhood trauma (Adverse Childhood Experiences, or ACEs) has on victims during their entire lives – even into old age. She was appointed to the position in January by Gov. Gavin Newsom. California is the fourth state to have a surgeon general, joining Arkansas, Pennsylvania and Florida. Michigan eliminated the position in 2o10.
The surgeon general position is Newsom’s brainchild, although the specifics of the job are vague. Harris is sort of an advocate and promoter of the administration’s health care policies.
Separating children from their parents, as has been the practice for illegal immigrants scooped up by federal authorities along the U.S.-Mexico border, “is a recipe for childhood stress,” she told a recent gathering of the Sacramento Press Club. She supports state Atty. General Xavier Becerra’s legal moves against the practice.
In her press club appearance, Harris was careful not to stray outside generally accepted tenants of health care. She and her husband, for instance, have seen to it that all four of their children are vaccinated, not only for the children’s health, but to protect others and gain “herd immunity.”
She also took pains not to create any blaring headlines. Asked specifically whether she supported “Medicare for All,” she said “Access to care is critical, no matter how it happens” and she was willing to “leave it to my policy colleagues as to how to get there.”
The surgeon general position is Newsom’s brainchild, although the specifics of the job are vague.
Harris is sort of an advocate and promoter of the administration’s health care policies. The heavy lifting in California health care, however, is performed by the 16 departments — including the Department of Health Care Services, the Department of Public Health and the Department of Managed Health Care under the jurisdiction of the Health and Human Services Agency. A major player also is Covered California, the state’s entity that puts into effect the federal Affordable Care Act.
Harris, who has a Master’s Degree in public health from Harvard, a medical degree from UC Davis and served a residency at Stanford, is the founding CEO of the Center for Youth Wellness (CYW)
In the Jan. 21 news release announcing Harris’s appointment, Newson said Harris “will urge policymakers at every level of government and leaders across the state to consider the social determinants of health, especially for children. Her work will focus on combating the root causes of serious health conditions — like adverse childhood experiences and toxic stress — and using the platform of Surgeon General to reach young families across the state.”
Harris, who has a Master’s Degree in public health from Harvard, a medical degree from UC Davis and served a residency at Stanford, is the founding CEO of the Center for Youth Wellness (CYW), a group Newsom described as a “national leader in the effort to advance pediatric medicine, raise public awareness, and transform the way society responds to children exposed to adverse childhood experiences and toxic stress.”
She heads the Bay Area Research Consortium on Toxic Stress and Health, a partnership between CYW and UCSF Benioff Children’s Hospitals, to advance scientific screening and treatment of toxic stress, and serves as a member of the American Academy of Pediatrics’ National Advisory Board for Screening and on a committee for the National Academy of Medicine.
Capitol types involved in health care issues have questions.
Will Harris lobby for particular solutions to health care costs? On drug abuse? What about her relationship with the big Department or Public Health? Will there be an occasion where she might engage in head-to-head conflict with the Trump Administration, a la Becerra? (Early indications are she won’t.) Just how much clout will the engaging and idealistic Harris have within the Administration and with the Legislature?
“We are in a critical inflection point,” Harris told a gathering at the south san Francisco campus of Genentech during a discussion about the impacts of childhood trauma and adverse experiences. “Eight years ago, I would go into a room of 1,000 people and and I’d ask, “How many folks have heard of this before?” Literally three hands would go up. Two years ago, I gave a talk at the White House and I asked the same question, and every hand in the room went up. A new generation of scientists, teachers, doctors — people across disciplines — are recognizing the science, and leading the way.
“So, I believe that 20 years from now, we are going to be having a totally different conversation,” she said.