Healthy Rounds With Dr. Anthony Alessi

Hantavirus: How Worried Should We Be?

An outbreak of an uncommon but not unheard-of illness is responsible for the deaths of at least three people who were on an international cruise ship. With the rest of the passengers and crew under observation in their home countries — including 18 Americans who went to a quarantine facility at the University of Nebraska — how worried do we need to be about hantavirus? Dr. David Banach, UConn Health infectious diseases physician and hospital epidemiologist, explains what we're dealing with, the public health implications, and how, unlike COVID, the medical community at least has some history with this virus. Submit questions for Healthy Rounds: healthyrounds@uchc.edu [HealthyRounds@uchc.edu] Dr. David Banach: https://www.uconnhealth.org/providers/profiles/banach-david [https://www.uconnhealth.org/providers/profiles/banach-david] UConn Health Infectious Diseases Division: https://www.uconnhealth.org/infectious-diseases [https://www.uconnhealth.org/infectious-diseases] UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine [https://www.uconnhealth.org/orthopedics-sports-medicine] UConn Health: https://www.uconnhealth.org [https://www.uconnhealth.org/] Grant support from Coverys: www.coverys.com [http://www.coverys.com/] Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date and timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal healthcare, and that should only be done with your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have as my guest today Dr. David Banach. Dr. Banach is an infectious disease specialist and he is head of the infection prevention program here at UConn Health. David, welcome to the show. Dr. Banach: All right. Thank you. Dr. Alessi: Let’s talk. I mean, there’s a lot of information out there about the hantavirus and how this all came about. Let’s go back and really address how this infection developed. What does it mean to our listeners? Dr. Banach: Sure. So, kind of taking it back to the basics, hantavirus is a virus that we’ve known about now for many years, even maybe upwards of decades, that exists in the rodent population. So it’s primarily circulating among rodents, particularly in certain geographic areas. And then on certain situations it does infect humans, typically humans who are in close contact with rodents or rodent excrement. It causes what we call a zoonotic infection, where a virus that typically is present in animals moves into a human host. And in most situations, those are one-offs. Someone will have some sort of environmental exposure, could be in any part of the world, could be here in Connecticut, getting sick from this particular virus, and not pass it on to anyone else. But occasionally we do see it occur in clusters, and that’s what’s happened with this most recent situation on the cruise ship that returned and several individuals on that ship became sick and were eventually diagnosed with hantavirus. I think in terms of the big picture, again, this does seem to have caused a bit of an outbreak on that ship. What it means for the larger public, I think we’re still kind of keeping an eye on it right now. I think the general feeling is that the risk for the general population is low, but I think it’s something that we’ll have to keep a close eye on in the coming weeks. Dr. Alessi: What’s interesting when we talk about hantavirus, I’d never heard the term until Gene Hackman died of it, right? In the, in the past year, right, Gene Hackman and his wife die of hantavirus, and now we hear about hantavirus again. What’s the difference? He wasn’t in South America. Can you talk a little bit about why he’s dead and now these other people are dead. Dr. Banach: Sure. I think the illness that his wife, I believe, contracted was the hantavirus, and that, there’s different strains of hantavirus. This particular strain, on the cruise ship, is the Andes virus. That’s like a type of hantavirus, if you will, that causes a specific illness. But there’s also, as I mentioned earlier, hantavirus that’s present in rodents throughout the world, and I think the situation with Gene Hackman’s wife, I think, was linked to some sort of environmental exposure to rodents that she was in contact with. So it’s same virus, but a little bit different in terms of the way that it’s showing, in terms of individual cases versus, like, a cluster of infections like we’re seeing with this cruise ship. Dr. Alessi: Now, when we talk about viral outbreaks, right, everybody immediately thinks of COVID. And there’s that fear of, are we going to be dealing with another pandemic? And obviously, with the hantavirus, the mortality is much higher than COVID. So can you talk a little bit about the differences and why this should not be similar to COVID? Dr. Banach: Sure. “Viruses” is such a broad term. We think about our seasonal influenza viruses. COVID, of course, got so much attention over the last five years in the light of the pandemic. But then there’s other viruses. You remember Ebola was a big viral outbreak from a few years prior to the COVID pandemic, and they cause a wide range of illnesses. Hantavirus can cause quite severe illness. It causes a very severe cardiopulmonary symptom that can often lead to people needing ICU care and even succumbing to the virus. In contrast to COVID, where the virus tends to be sort of uniformly a respiratory virus, so a little bit different in terms of, like, the clinical illness that they cause. In terms of the way they spread, also different. So COVID was different in a lot of ways. It was a virus that, first of all, we had never seen circulating in human populations. As I mentioned, hantavirus is not new in that sense, so we’ve known about hantavirus, and we’ve seen individual infections. We’ve even seen clusters in the past. There was a large cluster around 2018, 2019 in South America that was well-studied and described. There’s actually a very notable New England Journal of Medicine publication on this hantavirus outbreak that came as COVID was starting to take off, so it went under the radar in that sense. But it was well-described, related to sort of a cluster of hantavirus infections, this particular type of hantavirus specifically. And so we understand a little bit more about how it’s transmitted. It doesn’t spread in the same way that COVID does in the sense that there’s no established sort of asymptomatic or pre-symptomatic spread. Remember, that was a big challenge with COVID, that people could potentially be contagious before they showed signs of illness. But then on the other end of the spectrum, hantavirus does cause quite severe illness, and often has a much higher morbidity and mortality associated with it than COVID. So, yeah, I think there’s differences. I think there’s some differences that make this less likely to spread in a larger fashion as COVID did. But I think it’s still early, that we have to kind of keep an eye on things, and what we’re going to be looking for in the coming weeks are any evidence of secondary transmission. At this point, the people with infections have all been directly linked to the ship and the original cases of the two individuals who were first ill. But if we start to see additional spread, that would raise some concern that there may be a little bit more going on in terms of its ability to transmit to a the broader population. Dr. Alessi: David, do antivirals help? I mean, these people who are being treated now who are symptomatic, and are they treating them with antivirals, or, what are they doing for these people? Dr. Banach: Yeah, at this point, it’s really supportive care. As I mentioned, these patients can develop really severe cardiopulmonary illness, requiring pretty intense supportive care at times. There’s a wide spectrum of illness. Some individuals may recover with sort of minimal support, but some do become quite sick. So it’s really supportive care at this point. We don’t have an established antiviral per se, and there’s no vaccine available for hantavirus at this point, and that’s largely because these infections, although we’ve known about them for many decades, are quite infrequent. I think, and the CDC I think, they reported that there’ve been something like 800 cases described since 1990 of hantavirus in the US. So it’s been circulating, but very sporadically. So there hasn’t been kind of a need for sort of a wide-scale public health intervention. But, I think we’ll have to keep an eye on this particular outbreak and see how things unfold. Dr. Alessi: Do we need to do anything here in Connecticut? Dr. Banach: I think at this point, the most important thing for people here in Connecticut is to kind of listen to what’s happening. There doesn’t seem to be a direct risk to people here in Connecticut from this infection, but listen to what you’re hearing on the news. See what’s being reported by the public health authorities and, how the situation evolves. My optimistic hope is that this will be very limited, and the outbreak will subside with now that the appropriate measures are being taken to try to quarantine people who are exposed and prevent spread, but we’ll have to keep an eye on things. Dr. Alessi: When you say listen, that raises a flag because we don’t know who to listen to anymore, right? We’ve had some issues with scientists leaving the CDC. Do you listen to the WHO? I- if you go on the internet, we’re all going to be dying in the next week from hantavirus. So who do you listen to? I mean, who should, who do you consider the reliable source here for our listeners? Dr. Banach: I think that is a real challenge for the public to really understand how to get accurate information. With this particular situation, the World Health Organization seems to be the most tied in. Remember, this is an outbreak that started outside the U.S. The initial cases were detected, and those patients are being taken care of in various countries, including, I think, countries in South Africa and other parts of the world. So the WHO is really leading this effort, and they’re keeping updated stats and updated reports on how things are unfolding. So I think that they’re the most attuned to what’s going on, and I would have confidence in what they’re reporting out. But now the news is taking hold of this story, sometimes for better, sometimes for worse. And take the information that you’re getting as it’s coming to you, but, think about, I think the CDC has been reporting updates on the hantavirus situation based on information they’re getting from WHO and other international sources. But I think those are the kinds of voices that we can listen to at the moment and learn as much as we can. Dr. Alessi: I want to talk to you a little bit about the incubation and the isolation period. In European countries, most notably Spain and France, people who were exposed on the ship are isolated for 42 days, and they feel that that’s the safest thing to do. Here in the United States, we’re kind of letting people decide for themselves how much they need to isolate, which always shakes me up a little bit. Can you talk about why we’ve taken this relaxed view of isolation as opposed to other countries? Dr. Banach: I think it is varied in terms of the way that isolation is handled. So the incubation period, like you mentioned, is up to 40 days, so that means patients may not become sick for that period of time. And different approaches are taken to how patients are going to be monitored who were potentially exposed, and different countries are taking different approaches. I think here in the U.S. we have a few different ways that we’ve handled it. I know there are, the highest risk individuals, I think, are being monitored very closely. I think several people, especially those who are showing any signs and symptoms, are being monitored in, like, a biocontainment unit in Nebraska, I believe. But other lower-risk exposed individuals can be monitored by public health authorities in a less invasive kind of way. And we’ve seen this also with, thinking about individuals who returned from Africa after taking care of Ebola patients, they were still monitored by public health authorities. For instance, the state or local health department would be checking on them frequently after they returned. They weren’t necessarily confined to their homes. They were allowed sort of limited public exposure as long as they were checking in with the appropriate public health authorities. So I think we, we sort of triage exposed individuals, the highest-risk individuals being monitored the most intensely. I mean, certainly anyone who has symptoms gets really the most intense monitoring. But we sort of triage based on the level of exposure and ensure that we have monitoring that’s appropriate. But I think the different countries are taking different approaches, and I think we have to rely on our public health authorities here in the United States to monitor exposed individuals appropriately. Dr. Alessi: David, thank you. Thank you for your time today. Thank you for jumping on this on short notice. You’re always our trusted resource when we have questions around here. So thanks again. Dr. Banach: Thanks, thanks for having me on, and happy to give any updates as needed. Dr. Alessi: Thanks again. If you have any questions or ideas for future programs, you can reach out to me at healthyrounds@uchc.edu. Jennifer Walker is the executive producer for the Healthy Rounds Podcast. Christ DeFrancesco is our studio producer. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

Stroke Prevention, Treatment, and Recovery

Gone are the days of stroke having only two outcomes — death or disability — now that we have a window of time to treat what still is very much a medical emergency. For Stroke Awareness Month, Dr. Priya Narwal, medical director of UConn Health’s stroke program, joins to discuss how stroke care, recovery, and even prevention have evolved over the years, how the UConn Health Stroke Center harness that expertise, and why it remains critically important to “BE FAST.” The UConn Health Stroke Center is certified as a Primary Stroke Center by the Joint Commission. Submit questions for Healthy Rounds: healthyrounds@uchc.edu [HealthyRounds@uchc.edu] Dr. Priya Narwal: https://www.uconnhealth.org/providers/profiles/narwal-priya [https://www.uconnhealth.org/providers/profiles/narwal-priya]  UConn Health Stroke Center: https://www.uconnhealth.org/neurology/stroke [https://www.uconnhealth.org/neurology/stroke]  UConn Today: “First in Connecticut: Ischemic Stroke Survivors Have Renewed Hope with the Vagus Nerve Stimulation Device Now Available at UConn Health” https://today.uconn.edu/?p=214132 [https://today.uconn.edu/?p=214132] UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine [https://www.uconnhealth.org/orthopedics-sports-medicine] UConn Health: https://www.uconnhealth.org [https://www.uconnhealth.org/] Grant support from Coverys: www.coverys.com [http://www.coverys.com/] Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up to date and timely medical information provided by national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. This podcast is not designed to direct your personal care in any way, but that should only be done in conjunction with your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have as my guest today, Dr. Priya Narwal. Dr. Narwal is an Assistant Professor here at UConn Health in the Department of Neurology. She’s also director of the stroke program. This is especially timely because the month of May is stroke month where we raise awareness about stroke and the treatments for stroke. And what better than to have an expert in that field with us. Priya, welcome to the show. Dr. Narwal: Thanks, Tony. Dr. Alessi: Let’s talk a little bit about your directorship of the stroke program. Again, that’s a fairly new term in terms of having a program in neurology to direct one specific entity. Can you talk about the stroke program here at the University of Connecticut? Dr. Narwal: Sure. So when we say a stroke program, it means that the hospital is equipped to provide specialized stroke care and meet the needs of patients who have stroke or are experiencing stroke-like symptoms. So, what that entails is being able to identify stroke symptoms, realizing how urgent it is to address stroke symptoms, and also have a team in place, a team that consists of different specialties and departments such as emergency department, radiology, neurology, neuro intervention, ICU, to be able to provide expedited care to these patients. Dr. Alessi: Let’s back up a little bit. Let’s define stroke because it’s an old term. We’ve been using this term for many, many decades, and yet it’s still so relevant. Can you share for our listeners a little bit about the specific types of stroke? Dr. Narwal: Sure. So, a stroke is a medical emergency that is caused by interruption of blood flow to the brain. When we typically use the term stroke, in general, we are alluding to ischemic stroke or strokes caused by a blood clot interrupting the blood flow. However, strokes can be ischemic due to lack of blood flow or hemorrhagic or bleeding types of strokes that are caused due to rupture of blood vessels in the brain. Dr. Alessi: So, when we talk a little bit about the history of stroke itself, I’m still old enough to know when it was an untreatable condition, right? Where you brought someone to the hospital and you had them do some physical therapy, but there was nothing to do, right? And then we went to baby aspirin or using aspirin only, and now we’re using terms like “neuroplasticity” and “penumbra” and “antithrombin therapy”. Can you take us through that history of treating strokes a little bit? Dr. Narwal: Right, so as you said, you know, earlier we did not have much to offer to our stroke patients in terms of acute treatment or minimizing the risk of disability going forward. The main focus was on secondary prevention, meaning you had a stroke, and what do we do to prevent it from happening again, which is where the aspirin came in. However, in the late 90s, we had this incredible drug that was FDA approved, which was Alteplays or tPA or loosely called the clot buster, which if patients met certain criteria, we could give that medication and it had a positive impact on their long-term functional outcome. So that was a huge game changer when it came to acute stroke treatment, and that was the case for a long time, however, the treatment window was four and a half hours. So, if you were last known well within, you know, the previous four and a half hours, then we could treat you with the medication. But if you know, someone went to bed, woke up with stroke-like symptoms, there wasn’t much more to offer. Also, if patients have a blood clot in the brain that is large, the clot buster may not work too effectively and those patients may not have as good of an outcome. So, in the past decade or so, we have this new intervention that we’re able to offer to patients, which is called “clot retrieval” or “mechanical thrombectomy”. So again, if patients meet certain criteria based on what their exam findings look like, what their imaging findings look like, and they have a blood clot that we can go after, we will do that, and that has shown to have a positive impact as well. Dr. Alessi: You know, it’s so interesting to me because as someone who doesn’t do that in the field of neurology, I think of it as literally they’re going in there and fishing out a clot from the brain. Dr. Narwal: Right.   Dr. Alessi: It’s something that we would never even think of. And then watching someone get their function back, I think, for of those of us who have used these clot busting drugs, watching someone get better before our eyes after the administration is, it’s a powerful experience. Dr. Narwal: It’s pretty incredible, and I think one particular case that left a mark on me was a patient who came with a top of the basilar occlusion, which as you know can be catastrophic. Dr. Alessi: Right.  Dr. Narwal: And the patient came in, we were able to do a thrombectomy and he was discharged the next day from the ICU. That’s how good the outcome was. The patient had practically no deficits. Dr. Alessi: Alright, and can you describe a little bit, I think our listeners may not know what a "top of the basilar syndrome” is. Dr. Narwal: Mm-hmm. Dr. Alessi: Can you explain that severity to folks? Dr. Narwal: Right, so the basilar artery is a big blood vessel in the back of the brain that supplies several critical areas that are essential to our basic function pretty much like being able to breathe and, you know, move our eyes and just be awake or conscious. So, when someone has an occlusion sitting at the very top of their basilar artery, this whole area of the brain that allows for wakefulness is disrupted and patients look comatose and have a really poor outcome. Dr. Alessi: So that is phenomenal, really. Lately, we’ve used the "BE FAST" acronym. Can you talk a little bit about the acronym itself, and you know, has it been effective? Dr. Narwal: I would like to think so. I do think it has helped a lot with community outreach. I do see patients in office who will tell me, you know, we called 911 because we saw this or read this somewhere. I don’t know if we have a way to measure how effective it’s been, but the "BE FAST" acronym itself stands for “balance issues or dizziness”, “eye problems”, which could be double vision or blurry vision, or missing parts of your vision, “facial droop”, “arm or leg weakness”, “speech changes”, which could be slurred speech or word finding difficulties, and T stands for “time to call 911.” Dr. Alessi: It’s kind of interesting because, you’re right, it’s probably hard to measure the success of it, but you know, I tend to think that anything that empowers a patient is important, whether it be breast exam, testicular exam cell, any self-examination, and certainly "BE FAST” lets somebody do their own self-examination. So, I’d have to think it’s effective. Dr. Narwal: Yeah, I’d like to think that too. And also, you know, earlier it used to be "FAST” and then we added the "BE” because very commonly, again, symptoms affecting the back of the brain can be a little bit subtle, like patients may just feel dizzy or unsteady, and oftentimes they wouldn’t think much of it. So that’s why having the "BE” in there has definitely made a positive impact as well. Dr. Alessi: I want to talk a little bit about the role of rehabilitation. And, I go back to share a story. Back in the early 80’s, actually, I had just finished medical school, it was 1981, and my wife to be’s uncle had a stroke, and her mother would go to the rehab to see her brother-in-law and make him squeeze a ball so many times with this bad hand. I mean, he would have to do it, so every day she would drive this home while he was in the rehab. And, you know, naturally I just graduated medical school, so I knew everything, right? So, I told my fiance at the time I say, “you know, I don’t know what she’s doing. That doesn’t do any good. OK? It’s a stroke, nothing’s going to get better.” And sure enough, the guy regained the use of his hand, left the hospital, went back to enjoy his boating and whatever. So, I was proven wrong. Now we go forward another 40 years, right? And that’s all we do. We know to now use the bad hand to the point where sometimes, right, we immobilize the good hand... Dr. Narwal: Right Dr. Alessi: ...to get it going. So, I like to tell people that I learned the most about stroke rehabilitation from my now deceased mother-in-law more than any conference I ever went to. So can you talk a little bit about rehabilitation and the importance of early rehabilitation after a stroke. Dr. Narwal: Absolutely. Rehab, you know, is still the cornerstone of post-stroke recovery. Early rehab is what we really like to emphasize on, which is why when patients are admitted to the hospital, they will be evaluated by physical therapy, occupational therapy, speech therapy, to make sure we have an appropriate plan in place when they leave the hospital, whether that’s going to a rehab or outpatient services. You know, rehab makes a huge amount of difference. There are times when I’ll see someone in the hospital and they come to see me in office and I don’t recognize them ’cause that’s how much better they’re doing, just with rehab alone. And there have been advances in rehab as well. So, the new device that was FDA approved was Vivistim, which is a vagal nerve stimulation. It’s approved for patients with ischemic stroke who have upper extremity weakness. So Vivistim combined with rehab has shown to have a positive outcome in terms of functional recovery. So that’s been incredible, and we have a bunch of patients here. We do offer Vivistim here at UConn as well. Dr. Alessi: Is it an external stimulator or an internal stimulator? How is that done? Dr. Narwal: Patient can do it themselves, but it’s an implant. Dr. Alessi: Yeah. Dr. Narwal: But the patient, so, either they do it during rehab with the therapist, or they can self-stimulate it as well. Dr. Alessi: OK. Going back to my mother-in-law story, do we ever do enough rehab? Right. Someone may go to a skilled facility, right, and they’ll get physical therapy once a day, right? Dr. Narwal: Right. Dr. Alessi: And even in the hospital, it’s not possible for the physical therapist to be there the whole time, right. And it impresses to me the importance of family involvement, right. And we see that in foreign countries, right. Dr. Narwal: Right. Dr. Alessi: I practiced in Italy before when I went to medical school, and you know, the family is always at the bedside, and, even in Haiti, we would instruct the family on how to do the therapy. Have we gotten to a point where we can increase that, but what’s the solution to that? Dr. Narwal: So, I think a lot depends on how much the patient can participate. I think that guides a lot of where they end up going. So, if someone is requiring a lot of support or cannot stand up without 2% assist, they cannot go to an acute rehab and undergo that intensive therapy, versus someone who was able to do that. So, I think how much therapy they end up getting also depends on how much they can tolerate. And, you know, once they leave the nursing facility, there’s always the option of doing at home rehab. And a lot of my patients actually just like you said, do exercises on their own. Like they will ask the therapist what can they do on their own and they will just, you know, squeeze the ball or open and close their fist and do all of that stuff all by themselves. Dr. Alessi: Priya and wrapping up, what’s the future? What are we looking at in the future of stroke care, and I know it’s such an exciting field, but when you go to meetings and talk to people, what could we expect? Dr. Narwal: I think in terms of acute treatment, one of the big next steps is broadening the number of patients we can offer acute treatments to, right? So like if someone has a large vessel occlusion and their scan doesn’t meet the current parameters that we look for, we’re trying to broaden those parameters. Like even if someone has a larger core infarct, can we still go in and perform thrombectomy? Will that have a positive outcome on them? So that’s absolutely the big next step. And the other thing that’s of great interest is focusing on etiology. You know, a lot of times people say, oh, they had a stroke. All you can do is give aspirin and that’s it. But it’s not that straightforward. I think a lot of focus is now shifting on doing targeted therapy in the sense of really, you know, focusing on the stroke etiology, trying to identify that and then addressing that as opposed to like a blanket approach. Dr. Alessi: Priya, thank you. Thank you for your time today, and really thank you for everything you do here at the University of Connecticut and for our patients. Dr. Narwal: Thank you for having me, Tony. Dr. Alessi: Many thanks to our guests today, Dr. Priya Narwal, who’s director of the stroke program here at the University of Connecticut. If you have any questions. Or ideas for future programs or any specific question for Dr. Narwal, you could just reach out to me at healthyrounds@uchc.edu [healthyrounds@uchc.edu]. Jennifer Walker is executive producer of the Healthy Rounds podcast. Chris DeFrancesco is the studio producer of the Healthy Rounds Podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

Tony’s Take: Acetaminophen Myths, Messenger RNA

In between studio guests, Dr. Alessi brings new information to earlier conversations about messenger RNA and how it’s showing promise in treating pancreatic cancer, a study further debunking the Trump Administration’s assertions about the safety of Tylenol, and whether reasonable solutions to physician licensing challenges could improve access to care. Submit questions for Healthy Rounds: healthyrounds@uchc.edu [HealthyRounds@uchc.edu] Jan. 27, 2026, with DPH Commissioner Manisha Juthani: https://healthyrounds.podbean.com/e/the-impact-of-public-health/ [https://healthyrounds.podbean.com/e/the-impact-of-public-health/]  Jan. 13, 2026: with Dr. Andy Agwunobi, UConn Health CEO: https://healthyrounds.podbean.com/e/premiere-with-dr-andy-agwunobi-uconn-health-ceo/ [https://healthyrounds.podbean.com/e/premiere-with-dr-andy-agwunobi-uconn-health-ceo/] Feb. 24, 2026: with DSS Commissioner Andrea Barton Reeves: https://healthyrounds.podbean.com/e/medicaid-myths-keeping-ct-families-healthy/ [https://healthyrounds.podbean.com/e/medicaid-myths-keeping-ct-families-healthy/] UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine [https://www.uconnhealth.org/orthopedics-sports-medicine] UConn Health: https://www.uconnhealth.org [https://www.uconnhealth.org/] Grant support from Coverys: www.coverys.com [http://www.coverys.com/] Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information brought to you from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal healthcare, which should only be done by your physician. I am your host, Dr. Anthony Alessi, and this week we’re going to chat a little bit about some topics that, some of which we’ve talked about in the past, but now we have new information on, and I think it’s information that we need to provide you, our listeners to provide best healthcare overall, and really pay attention to what’s going on that is publicized and how it affects all of you. And there are three specific topics I want to touch on. The first is pancreatic cancer. I also want to talk a little bit about a exciting study that was just published in The Lancet on Tylenol use in pregnancy, and then we’re going to talk about physician licensing in the United States. So with that, let’s get started. This week at the National Oncology meetings, they presented new data on the treatment of pancreatic cancer. Now, for those of you unfamiliar with pancreatic cancer, it is one of, if not the most deadliest cancer, and the reason being that typically by the time you find evidence for the tumor, it has already metastasized, it is already spread to vital organs. So with that, it’s very difficult to treat. In the studies published, one in particular I want to talk about, they use messenger RNA as the vehicle for treatment. Now, I know I’ve talked about this before, but it bears repeating messenger. RNA is just that, it’s a messenger, and we chatted with Dr. Juthani about this. It does not alter your DNA in any way, shape or form. So the best analogy I could come up with was, it’s a messenger. So if you get a delivery, right, to your house, whether it be from Amazon or GrubHub, a messenger comes and delivers a package, then they leave. That’s exactly how messenger RNA works. So when the messenger comes to your house, they don’t go in your house and start rearranging your furniture, right? And I think that’s the misunderstanding here is they think the messenger RNA goes in the cell and starts mixing things up. That’s not the case. But what it does do, it brings a message that trains your immune system to fight the cancer with your own body. Your own T cells are now redirected to fight the tumor. So in the case of pancreatic cancer, what they do is they go in, a surgeon goes in, removes the tumor. They take the tumor and use material from the tumor to create your own personal vaccine through messenger, RNA, which is injected by infusion. And the cases that were presented, it’s typically eight infusions. And the results have been fairly astounding. Now it’s a small, early study and only 16 people were studied, but eight of those had a positive response. The first patient has actually lived six years beyond the diagnosis, which is astounding for pancreatic cancer. For two people, their tumors actually returned and they worsened, and the other six had no benefit. So it’s interesting to look at this, but we also have to bear in mind that the federal government has stopped all research on Messenger RNA, because the person in charge of Health and Human Services, Bobby Kennedy, he is against messenger, RNA, because it’s a vaccine. Even if it’s a vaccine to kill cancer, he’s against it. So the research being done is being privately funded. Our government has walked away from this, what has become one of the greatest hopes we have in the treatment of cancer, and it just, it makes me personally upset. Because these cancers have affected my family, as many of you who listen to this podcast. So we need to stay on this and really follow this along, and it’s just so hopeful. The next topic is one to revisit, and this is a recent article published in Lancet Obstetrics and Gynecology, where again, there has been misinformation out there regarding the use of acetaminophen, where they are out there saying that during pregnancy, if you use acetaminophen, it increases the risk for autism and other neurodevelopmental conditions. So again, this comes directly from the president of the United States, who says, don’t take acetaminophenm and again, our esteemed director of Health and Human Services, who is a non-physician, non-scientist, Robert F. Kennedy Jr. And I wanna stress the “Junior” because he’s far from his father. But with that, what we have is a situation where they looked at retrospective studies. And they look back at 43 studies, so talk about a waste of time, but here they are. They go back and do a meta-analysis of 43 studies. And once again, when they focused on these studies, they found that there is no evidence that acetaminophen in any way causes ADHD or causes children to be on the autism spectrum. So I’m hoping we could put this aside. The next topic I wanted to touch on was licensure, physician licensure, and what happens is, in the United States, we don’t have national licensure for physicians. Every other country in the world, when you get a license, you could practice anywhere in that country. But in the United States, you have to have an individual license for every state, and it’s pretty costly. Here in Connecticut, I believe it’s now $575 a year we pay for a license. So in every state you, you pay a fee commensurate with that; some states, I know it’s 600, but you have to reapply. And and the reason that this becomes a problem is because there’s a shortage of physicians in many rural areas. So a field of telemedicine has developed, especially for neurology and other specialties, where there aren’t enough people in these rural communities, they can be accessed by video and through telecommunication, something we talk about a lot on this program. So what has happened is that even to do telemedicine in another state, you need a license In that state. That wasn’t the case during COVID. That rule was waived, but now they’re back on it. And it’s really sad, from the standpoint that they are in any way inhibiting physicians who are duly licensed and have credentials that have been presented to a state, from practicing in other states. But here’s what’s happened. So there’s been a push for national licensing, and what they’ve come up with is the Interstate Medical Licensing Compact, and this is the IMLC. This was just approved in March, and it’s basically a system where you can apply with all your credentials, and those credentials can then be shared with other states so that you can more easily get a license in another state. The one thing these states did not give in on was paying those fees in that state. So again, we come up with the problem of greed versus care, and it’s something we talked about with Dr. Andy Agwunobi and the fact that if we’re going to revise our healthcare system in any way, shape, or form, we have to have everybody having their incentives aligned. So the idea of a state saying, “Wait a second. I might be able to get more physicians, give the people of my state more access, should be something I want to do,” without trying to make a few hundred bucks off of a doctor who may only be called on to see one patient or two patients a year in that area in your state. But you want access to those doctors. So again, it’s something we really need to rethink. Apropos to that, commissioner Andrea Barton Reeves and I had a conversation off-mic when she did the podcast with me a few months ago, and that was regarding retired physicians. Many physicians are retiring at a younger age. So when they retire, often they give up the license, they give up their medical license ’cause they don’t want to pay the $575 each year. But many also have the desire to volunteer their time. They’re willing to volunteer to just stay active in medicine without being reimbursed. It’s kind of like paying back the system that supported you all this time. But clearly if you’re going to go volunteer, it’s not worth paying five or $600 so you can volunteer. So I introduced to her the idea that the state of Connecticut may want to consider that if a physician is willing to volunteer in a qualified health facility. And the one we used as an example was the Homeless Hospitality Center in New London, where homeless patients who are discharged from the hospital can come and get some extended care until they’re able to go live independently. So I know of several physicians who would be willing to volunteer and give their time. But again, there’s this hurdle, actually there are two hurdles: One, getting a license, and two, med malpractice insurance. Now, fortunately, when you participate in a federally qualified health facility, you are indemnified by the federal government, so there isn’t a need for additional malpractice insurance, but I’m hoping Commissioner Barton Reeves does bring this to the governor and possibly something could be worked out so that physicians who retire and may want to spend some time volunteering and giving back can do so without the encumbrance of having to pay for a license in their state. Many thanks to all you listeners for getting ideas into us about topics that we’re going to be talking about in some of these future sort of podcasts that we use in between having guests. This has been a lot of fun for me ’cause it’s a chance to really update everybody on topics we have been discussing over the past several months. So if you have questions or ideas for future programs, you can reach out to me at healthyorunds@uchc.edu. Next week we’re going to resume having guests, and our guest is going to be Dr. Priya Narwal. Dr. Narwal is a neurologist, she’s the chief of the stroke service here at the University of Connecticut, and we’re going to be chatting with her in honor of stroke awareness. Many thanks to Jennifer Walker, who is the executive producer for the Healthy Rounds Podcast. Chris DeFrancesco is our studio producer here, and Tessa Rickart is in charge of social media for the Healthy Rounds Podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

The Silent Success of Public Health

It’s impossible to definitively measure how many lives were saved or prolonged, or how much illness or disease prevented or made less severe, as a direct result of public health initiatives. Douglas Brugge, chair of the UConn School of Medicine’s Department of Public Health Sciences, explains the “invisible” benefits of things like policies that regulate toxins in our water or pollution in our air, and discusses how COVID changed the perception of public health (and lessons learned from that). Submit questions for Healthy Rounds: healthyrounds@uchc.edu [HealthyRounds@uchc.edu] Douglas Brugge https://health.uconn.edu/public-health-sciences/person/doug-brugge/ [https://health.uconn.edu/public-health-sciences/person/doug-brugge/] UConn School of Medicine Department of Public Health Sciences https://health.uconn.edu/public-health-sciences/ [https://health.uconn.edu/public-health-sciences/] UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine [https://www.uconnhealth.org/orthopedics-sports-medicine] UConn Health: https://www.uconnhealth.org [https://www.uconnhealth.org/] Grant support from Coverys: www.coverys.com [http://www.coverys.com/] Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to welcome as my guest today. Dr. Doug Brugge, who is professor and chair in the Department of Public Health Sciences here at the University of Connecticut. Doug, I really wanted to have you on the program today to talk a little bit about public health initiatives. You know, it’s been public health initiatives that have provided what are among the greatest contributions to humanity and medical sciences in general. When we think of sanitation, water purification, vaccines, these are all things that make people safe and healthy. And yet I don’t think a lot of people understand and appreciate that these are public health initiatives. Dr. Brugge: Yeah. Thank you for that. And I certainly agree with your introduction to public health. Public health is, I think frequently does not get the attention it deserves because the benefits are more invisible to people. If you have an illness, if you have a heart attack, or you have cancer and you go to a hospital, and you receive treatment, and you get good treatment and it makes you better, that is really tangible. You know that somebody has saved your life or improved your life. If you don’t get cancer or don’t have a heart attack because someone, as you said, regulated toxins in the drinking water, or in my field, the pollution in the air, it’s invisible. You just don’t know that it happens. And so, I think we in public health work in a bit of a obscurity and underrepresented the impact we have now. That said, we have a really nice department here at UConn Health. We’re a very, very vibrant and enthusiastic department within the medical school. We have over 30 faculty. We have over a hundred students in our graduate programs and we represent a very broad range of approaches to research and education, as well as topical foci, in terms of public health, including those you mentioned, but others, substance use, diet, and nutrition, many, many other things as well. And so, I’m proud of the department that I chair. I’m really privileged to sit here and be in this position. Dr. Alessi: Yeah. What’s interesting to me is actually your background and your background was in biology and chemistry. You got a PhD in biology and then went into industrial hygiene. Can you tell us about what pointed you in that direction personally, to go to industrial hygiene? Dr. Brugge: Yeah. From third grade onward, I wanted to be a biologist, basically. And in third grade I thought it was a naturalist, but I didn’t know the difference. But, and I pursued that all the way through college. And at some point in grad school, I began to realize that there were aspects of laboratory science that were not right for me. And the two main ones were one, that it was very far removed from real world impact. You’re doing basic science. Someday, somewhere down the road, someone might use it for good or even not for good. You don’t know. And I wanted to have a more direct impact on the world. The other thing was I found working in a laboratory socially isolating, and I preferred to interact with people. This department is great in that regard. There are all these wonderful people and I’m interacting with them all the time. But, so I had a choice to make. What was I going to do? And I did the degree, it’s a public health degree in industrial hygiene at Harvard School of Public Health in order to shift my emphasis over into public health and do something that was both science, and more directly impacting real world problems. And so that, so it solved a problem for me, and I wish sometimes that I had known about public health in third grade, but no one introduced it to me until much later in my life. So, you know, it’s worked out okay. Dr. Alessi: You mentioned before that, you know, people in public health are relatively anonymous and in the background, but that’s not the case anymore since COVID. Dr. Brugge: Right, yeah. Dr. Alessi: I mean, let’s face it. In the headlines today, right? Canada is going to lose their measles free designation, right? In 1998, they were a hotspot. In 2000, their cases were rare. COVID took away your veil of anonymity. Dr. Brugge: Yeah. Dr. Alessi: And now to the point where there are attacks, there are threats on public health professionals. Can you talk to us what it’s like from the public health side? I know what it’s like from the medical side looking at this, but from the public health side, is there fear? Do people not want to go into public health because of these changes? Dr. Brugge: Those are all very good questions, and probably the basis of several hours of conversation between us, Tony. Dr. Alessi: Absolutely. Dr. Brugge: But anyway, let me see if I can be brief. I agree with you that COVID was an inflection point for public health. Maybe before COVID we were somewhat obscure, but largely, more largely respected. Maybe people didn’t know how polluted the United States was in 1970. Maybe they didn’t appreciate how much public health measures led to clear skies and much better health. Again, to focus on my field of environmental health. But, they weren’t against it. They weren’t angry about it. They weren’t resisting it, I don’t think. COVID was a crisis, and it was a very intense national and global crisis. I remember the early months, it was very hard to tell what was happening, how great the risk was, and what to do. It was a very scary time in my opinion. I remember driving from Hartford to Boston, ’cause my wife and I have a place outside Boston, to hide away for the early month or two of COVID, and thinking how surreal it was that I was running away from this infection that was spreading wildly. So, I think one thing that gets lost in all of this, and some of it is exacerbated by the media and by politics, in my opinion. The media plays up the conflict. That’s what they want because it gets clicks and views. Dr. Alessi: Sure. Dr. Brugge: And politicians play up conflict and accusations in order to get elected and to pursue their agenda. And so, we have this really scary situation that’s exacerbated in the media and the political sphere. And I think it got really, instead of sort of a level-headed public health approach, it became something more than that. And I think public health image was tarnished in the process. Now, I think the biggest problem was the resistance to public health, the pushback, the politicization, the media exaggeration, and drama. But I also think the public health field fell short in communicating well in that context also. And, let me just speak for myself. I’m not speaking for anyone else. Dr. Alessi: Sure. Dr. Brugge: But, I do community-based participatory research where we bring the community in and we have them as partners in our research process. And what I think I’ve learned from that is that if you engage people, and you talk to them, and you respect where they’re coming from, and even if they disagree with you or they have misconceptions, you work with them over time, you can form a good relationship and mutual respect. And maybe it’s partly just things were happening at a national level and really fast, but I feel like public health failed to reach out and engage people who were scared, and then felt that they were being commanded to do things that they either didn’t understand or that they doubted were effective. And so I think that it’s the lesser of the evils, but I think public health could learn something from this experience and hopefully do better in the future if there, hopefully there isn’t another one of these, but if there is, I would hope we’d learn some lessons from the past experience. Dr. Alessi: You know, unfortunately, Doug, I think people don’t realize that as we’re kind of going through this process, people are dying. I mean, right now, I was reading where there are over a thousand state bills in this country addressing public health. Over 400 of them are designed to weaken our protections on vaccines. Right, fluoride, milk safety. Okay. Dr. Brugge: Yeah. Dr. Alessi: I mean, I think a lot of people are confusing ideology and science. And, how do we get past that? I know you’re talking about communication, but as we’re communicating and trying to reach out to these people, people are losing their lives. Dr. Brugge: You’re absolutely correct. And we should be pursuing evidence-based public health measures that are protective and that save lives or improve the quality of life, absolutely. I think where it becomes challenging is when the evidence is not fully convincing at a causal level. Now, in the COVID situation, it was almost impossible to come up with that because it was evolving and happening so fast. This is a question of science and evidence. It should be possible to discuss it. Dr. Alessi: Well, I think some of that comes from the sudden lack of scientists in the CDC in places such as that. And I think to have that health discussion, that’s where we get into politics, right? Dr. Brugge: Yeah. Well, maybe, and that is going to exacerbate it certainly. I feel like we in public health, we need to be more willing to engage with ideas that do not conform to our public health orthodoxy and to examine the evidence fairly and engage in discussion about these issues that are potentially politically and in the media controversial in a way that is transparent and informative rather than trying to shut them down. That’s my view. Dr. Alessi: Let me shift gears a little bit and give you a real world example that a pediatrician came to me with. And that was, had a student whose family did not want them to get the MMR vaccine or the second dose of the MMR vaccine. So, naturally, here in the state of Connecticut, they could not attend school. So, the family went and got a note. It was a stamped note from a doctor in Texas.  Dr. Brugge: Wow. Dr. Alessi: And, naturally, that was not accepted either. And so, the child was not able to attend preschool. And what was interesting, the pediatrician said, you know, I’ve been seeing more of this in certain ethnic communities where there’s more of a belief or whether it be rumor or whatever. How does that pediatrician get over that? Right? I mean, the parents are kind of locked in now because their neighbors, and members of their church, and members of their ethnic community are not, they’re all saying it’s bad for you, and yet, we’re going to have a problem. I mean, we’re having a problem now with taking measles. Dr. Brugge: Right. Dr. Alessi: So, how does a pediatrician, how does a doctor who’s listening to this podcast kind of get over that? How should they react or discuss this with a patient? Dr. Brugge: Yeah, so let’s be clear. MMR vaccination is not something that’s equivocal. The evidence is very strong. It’s something that children should all get, how to convince, and it’s a very, very unfortunate outcome of the COVID epidemic in again, in my opinion, that vaccine hesitancy and questioning of vaccines has spread to other vaccines beyond just specifically COVID. And I agree with you completely, that presents a substantial problem and an obstacle for us. I don’t know how, I’m not a clinician, so I don’t know how a pediatrician dealing with a specific family should approach this, but I would go back to my more public health roots, my approach to collaborating with communities and say that engaging, not necessarily on an in one-on-one basis, in a clinical setting, but in a broader community way, engaging the community in a mutually respectful conversation, in which they can ask questions, they can express their views, and we who have our knowledge and evidence can express ours. And people in public health who are behavioral experts, who are social scientists, can take what they’re hearing and think about how to address the concerns and fears and doubts that are out there. I think it’s more of a societal population approach than it is probably one-on-one because the one-on-one conversation, even if that pediatrician succeeds, it’s just one person. There’s still the rest of the community. So, that would be my thought. Now, vaccine hesitancy is not my area of expertise. Dr. Alessi: Sure. Dr. Brugge: So I haven’t tried to convince people, but I tend to fall back on sort of the public health community roots of my perspective. Dr. Alessi: Let me ask you another question. You know, you’re a department chairman, Doug, so you should be able to predict the future, right? That’s what you guys do, right? Dr. Brugge: Right. I didn’t see the current financial crisis coming, Tony. But anyway, go ahead. Dr. Alessi: Well, I mean, are we going to get confidence back? How’s that going to look? I mean, how does that look in the future in terms of when do you see that? How do you see that developing? Dr. Brugge: Yeah, my success in predicting the future has been almost zero, but let me give it a try anyway. I think we will get confidence back. I think that these things go through cycles for one thing. I also think there is a whole new generation of public health professionals. We’re training some of them and they’re going out into the world there. There are some people who are hesitant to go into public health right now. I think we’ll get past that, and I think public health is resilient. I hope, as I said earlier, I hope we make some corrections and improve our ability to relate to and communicate with the public, especially parts of the public that are not immediately in agreement with us. But I think we’ll get there. And I also, you know, working with community partners has given me a deep respect and faith in regular people. And I feel like most people, most of the time, if you approach them and talk on a, you’re not through the media, not through political politics, but you’re just having a conversation with them, they’re very reasonable, they’re very open-minded. They’ll listen to you. You can learn from them, they can learn from you. And I think we need a lot more of that, frankly. Dr. Alessi: Well, let’s hope this podcast helps us in that respect and we’ve reached some people with this and with the benefit of your knowledge. Doug, listen, thank you. Thank you for spending time with us today. I really appreciate you taking time for this. Dr. Brugge: It was a pleasure and I enjoyed the conversation, Tony. Thank you. Dr. Alessi: We’re going to be doing it again soon ’cause we didn’t even get into environmental stuff, which is your strong point. Dr. Brugge: I could talk to you for hours about that too. Dr. Alessi: Sounds good. Many thanks to my guest today, Dr. Doug Brugge, who is chair of the Department of Public Health Sciences here at the University of Connecticut. If you have questions or ideas for future programs, you could reach out to me at healthyrounds@uchc.edu. Jennifer Walker is executive producer of the Healthy Rounds podcast. Chris DeFrancesco is the studio producer for the Healthy Rounds podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy. Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to welcome as my guest today. Dr. Doug Brugge, who is professor and chair in the Department of Public Health Sciences here at the University of Connecticut. Doug, I really wanted to have you on the program today to talk a little bit about public health initiatives. You know, it’s been public health initiatives that have provided what are among the greatest contributions to humanity and medical sciences in general. When we think of sanitation, water purification, vaccines, these are all things that make people safe and healthy. And yet I don’t think a lot of people understand and appreciate that these are public health initiatives. Dr. Brugge: Yeah. Thank you for that. And I certainly agree with your introduction to public health. Public health is, I think frequently does not get the attention it deserves because the benefits are more invisible to people. If you have an illness, if you have a heart attack, or you have cancer and you go to a hospital, and you receive treatment, and you get good treatment and it makes you better, that is really tangible. You know that somebody has saved your life or improved your life. If you don’t get cancer or don’t have a heart attack because someone, as you said, regulated toxins in the drinking water, or in my field, the pollution in the air, it’s invisible. You just don’t know that it happens. And so, I think we in public health work in a bit of a obscurity and underrepresented the impact we have now. That said, we have a really nice department here at UConn Health. We’re a very, very vibrant and enthusiastic department within the medical school. We have over 30 faculty. We have over a hundred students in our graduate programs and we represent a very broad range of approaches to research and education, as well as topical foci, in terms of public health, including those you mentioned, but others, substance use, diet, and nutrition, many, many other things as well. And so, I’m proud of the department that I chair. I’m really privileged to sit here and be in this position. Dr. Alessi: Yeah. What’s interesting to me is actually your background and your background was in biology and chemistry. You got a PhD in biology and then went into industrial hygiene. Can you tell us about what pointed you in that direction personally, to go to industrial hygiene? Dr. Brugge: Yeah. From third grade onward, I wanted to be a biologist, basically. And in third grade I thought it was a naturalist, but I didn’t know the difference. But, and I pursued that all the way through college. And at some point in grad school, I began to realize that there were aspects of laboratory science that were not right for me. And the two main ones were one, that it was very far removed from real world impact. You’re doing basic science. Someday, somewhere down the road, someone might use it for good or even not for good. You don’t know. And I wanted to have a more direct impact on the world. The other thing was I found working in a laboratory socially isolating, and I preferred to interact with people. This department is great in that regard. There are all these wonderful people and I’m interacting with them all the time. But, so I had a choice to make. What was I going to do? And I did the degree, it’s a public health degree in industrial hygiene at Harvard School of Public Health in order to shift my emphasis over into public health and do something that was both science, and more directly impacting real world problems. And so that, so it solved a problem for me, and I wish sometimes that I had known about public health in third grade, but no one introduced it to me until much later in my life. So, you know, it’s worked out okay. Dr. Alessi: You mentioned before that, you know, people in public health are relatively anonymous and in the background, but that’s not the case anymore since COVID. Dr. Brugge: Right, yeah. Dr. Alessi: I mean, let’s face it. In the headlines today, right? Canada is going to lose their measles free designation, right? In 1998, they were a hotspot. In 2000, their cases were rare. COVID took away your veil of anonymity. Dr. Brugge: Yeah. Dr. Alessi: And now to the point where there are attacks, there are threats on public health professionals. Can you talk to us what it’s like from the public health side? I know what it’s like from the medical side looking at this, but from the public health side, is there fear? Do people not want to go into public health because of these changes? Dr. Brugge: Those are all very good questions, and probably the basis of several hours of conversation between us, Tony. Dr. Alessi: Absolutely. Dr. Brugge: But anyway, let me see if I can be brief. I agree with you that COVID was an inflection point for public health. Maybe before COVID we were somewhat obscure, but largely, more largely respected. Maybe people didn’t know how polluted the United States was in 1970. Maybe they didn’t appreciate how much public health measures led to clear skies and much better health. Again, to focus on my field of environmental health. But, they weren’t against it. They weren’t angry about it. They weren’t resisting it, I don’t think. COVID was a crisis, and it was a very intense national and global crisis. I remember the early months, it was very hard to tell what was happening, how great the risk was, and what to do. It was a very scary time in my opinion. I remember driving from Hartford to Boston, ’cause my wife and I have a place outside Boston, to hide away for the early month or two of COVID, and thinking how surreal it was that I was running away from this infection that was spreading wildly. So, I think one thing that gets lost in all of this, and some of it is exacerbated by the media and by politics, in my opinion. The media plays up the conflict. That’s what they want because it gets clicks and views. Dr. Alessi: Sure. Dr. Brugge: And politicians play up conflict and accusations in order to get elected and to pursue their agenda. And so, we have this really scary situation that’s exacerbated in the media and the political sphere. And I think it got really, instead of sort of a level-headed public health approach, it became something more than that. And I think public health image was tarnished in the process. Now, I think the biggest problem was the resistance to public health, the pushback, the politicization, the media exaggeration, and drama. But I also think the public health field fell short in communicating well in that context also. And, let me just speak for myself. I’m not speaking for anyone else. Dr. Alessi: Sure. Dr. Brugge: But, I do community-based participatory research where we bring the community in and we have them as partners in our research process. And what I think I’ve learned from that is that if you engage people, and you talk to them, and you respect where they’re coming from, and even if they disagree with you or they have misconceptions, you work with them over time, you can form a good relationship and mutual respect. And maybe it’s partly just things were happening at a national level and really fast, but I feel like public health failed to reach out and engage people who were scared, and then felt that they were being commanded to do things that they either didn’t understand or that they doubted were effective. And so I think that it’s the lesser of the evils, but I think public health could learn something from this experience and hopefully do better in the future if there, hopefully there isn’t another one of these, but if there is, I would hope we’d learn some lessons from the past experience. Dr. Alessi: You know, unfortunately, Doug, I think people don’t realize that as we’re kind of going through this process, people are dying. I mean, right now, I was reading where there are over a thousand state bills in this country addressing public health. Over 400 of them are designed to weaken our protections on vaccines. Right, fluoride, milk safety. Okay. Dr. Brugge: Yeah. Dr. Alessi: I mean, I think a lot of people are confusing ideology and science. And, how do we get past that? I know you’re talking about communication, but as we’re communicating and trying to reach out to these people, people are losing their lives. Dr. Brugge: You’re absolutely correct. And we should be pursuing evidence-based public health measures that are protective and that save lives or improve the quality of life, absolutely. I think where it becomes challenging is when the evidence is not fully convincing at a causal level. Now, in the COVID situation, it was almost impossible to come up with that because it was evolving and happening so fast. This is a question of science and evidence. It should be possible to discuss it. Dr. Alessi: Well, I think some of that comes from the sudden lack of scientists in the CDC in places such as that. And I think to have that health discussion, that’s where we get into politics, right? Dr. Brugge: Yeah. Well, maybe, and that is going to exacerbate it certainly. I feel like we in public health, we need to be more willing to engage with ideas that do not conform to our public health orthodoxy and to examine the evidence fairly and engage in discussion about these issues that are potentially politically and in the media controversial in a way that is transparent and informative rather than trying to shut them down. That’s my view. Dr. Alessi: Let me shift gears a little bit and give you a real world example that a pediatrician came to me with. And that was, had a student whose family did not want them to get the MMR vaccine or the second dose of the MMR vaccine. So, naturally, here in the state of Connecticut, they could not attend school. So, the family went and got a note. It was a stamped note from a doctor in Texas.  Dr. Brugge: Wow. Dr. Alessi: And, naturally, that was not accepted either. And so, the child was not able to attend preschool. And what was interesting, the pediatrician said, you know, I’ve been seeing more of this in certain ethnic communities where there’s more of a belief or whether it be rumor or whatever. How does that pediatrician get over that? Right? I mean, the parents are kind of locked in now because their neighbors, and members of their church, and members of their ethnic community are not, they’re all saying it’s bad for you, and yet, we’re going to have a problem. I mean, we’re having a problem now with taking measles. Dr. Brugge: Right. Dr. Alessi: So, how does a pediatrician, how does a doctor who’s listening to this podcast kind of get over that? How should they react or discuss this with a patient? Dr. Brugge: Yeah, so let’s be clear. MMR vaccination is not something that’s equivocal. The evidence is very strong. It’s something that children should all get, how to convince, and it’s a very, very unfortunate outcome of the COVID epidemic in again, in my opinion, that vaccine hesitancy and questioning of vaccines has spread to other vaccines beyond just specifically COVID. And I agree with you completely, that presents a substantial problem and an obstacle for us. I don’t know how, I’m not a clinician, so I don’t know how a pediatrician dealing with a specific family should approach this, but I would go back to my more public health roots, my approach to collaborating with communities and say that engaging, not necessarily on an in one-on-one basis, in a clinical setting, but in a broader community way, engaging the community in a mutually respectful conversation, in which they can ask questions, they can express their views, and we who have our knowledge and evidence can express ours. And people in public health who are behavioral experts, who are social scientists, can take what they’re hearing and think about how to address the concerns and fears and doubts that are out there. I think it’s more of a societal population approach than it is probably one-on-one because the one-on-one conversation, even if that pediatrician succeeds, it’s just one person. There’s still the rest of the community. So, that would be my thought. Now, vaccine hesitancy is not my area of expertise. Dr. Alessi: Sure. Dr. Brugge: So I haven’t tried to convince people, but I tend to fall back on sort of the public health community roots of my perspective. Dr. Alessi: Let me ask you another question. You know, you’re a department chairman, Doug, so you should be able to predict the future, right? That’s what you guys do, right? Dr. Brugge: Right. I didn’t see the current financial crisis coming, Tony. But anyway, go ahead. Dr. Alessi: Well, I mean, are we going to get confidence back? How’s that going to look? I mean, how does that look in the future in terms of when do you see that? How do you see that developing? Dr. Brugge: Yeah, my success in predicting the future has been almost zero, but let me give it a try anyway. I think we will get confidence back. I think that these things go through cycles for one thing. I also think there is a whole new generation of public health professionals. We’re training some of them and they’re going out into the world there. There are some people who are hesitant to go into public health right now. I think we’ll get past that, and I think public health is resilient. I hope, as I said earlier, I hope we make some corrections and improve our ability to relate to and communicate with the public, especially parts of the public that are not immediately in agreement with us. But I think we’ll get there. And I also, you know, working with community partners has given me a deep respect and faith in regular people. And I feel like most people, most of the time, if you approach them and talk on a, you’re not through the media, not through political politics, but you’re just having a conversation with them, they’re very reasonable, they’re very open-minded. They’ll listen to you. You can learn from them, they can learn from you. And I think we need a lot more of that, frankly. Dr. Alessi: Well, let’s hope this podcast helps us in that respect and we’ve reached some people with this and with the benefit of your knowledge. Doug, listen, thank you. Thank you for spending time with us today. I really appreciate you taking time for this. Dr. Brugge: It was a pleasure and I enjoyed the conversation, Tony. Thank you. Dr. Alessi: We’re going to be doing it again soon ’cause we didn’t even get into environmental stuff, which is your strong point. Dr. Brugge: I could talk to you for hours about that too. Dr. Alessi: Sounds good. Many thanks to my guest today, Dr. Doug Brugge, who is chair of the Department of Public Health Sciences here at the University of Connecticut. If you have questions or ideas for future programs, you could reach out to me at healthyrounds@uchc.edu. Jennifer Walker is executive producer of the Healthy Rounds podcast. Chris DeFrancesco is the studio producer for the Healthy Rounds podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

Bonus Episode: Quality, Patient Safety

This week we revisit the conversation with Dr. Scott Allen, UConn Health’s chief medical officer. Dr. Alessi digs deeper into what we mean by the terms “quality” and “patient safety,” exploring the patient experience as well as how to measure quality and how the increasing complexity of medicine makes safety such a priority. He also differentiates between internists and family medicine practitioners. Submit questions for Healthy Rounds: healthyrounds@uchc.edu [HealthyRounds@uchc.edu] Dr. Scott Allen: https://facultydirectory.uchc.edu/profile?profileId=Allen-Scott [https://facultydirectory.uchc.edu/profile?profileId=Allen-Scott]  UConn Today: Make It 10 Straight A’s for UConn Health’s Hospital Safety https://today.uconn.edu/2025/11/make-it-10-straight-as-for-uconn-healths-hospital-safety/ [https://today.uconn.edu/2025/11/make-it-10-straight-as-for-uconn-healths-hospital-safety/]  UConn Health Orthopedics and Sports Medicine https://www.uconnhealth.org/orthopedics-sports-medicine [https://www.uconnhealth.org/orthopedics-sports-medicine] UConn Health: https://www.uconnhealth.org [https://www.uconnhealth.org/] Grant support from Coverys: www.coverys.com [http://www.coverys.com/] Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it’s great to be with you to really dig deep into some of the topics we discussed last week with Dr. Scott Allen. As you’ll recall, Dr. Allen is the chief medical officer here at UConn Health. He is an internist and specializes in primary care internal medicine, and was he went over his personal history, we can see that he’s always had a passion for improving the quality of medical care, and it has really evolved as, that’s almost as a subspecialty of medicine has evolved. But what was also interesting, and I wanted to clear up some things, is that he is a specialist in primary care internal medicine, and that differs from primary care family physicians. There’s different training involved. So family physicians are primarily people who do general medical care, but includes things like obstetrics and gynecology, different subspecialties may be doing some minor surgeries and other areas, so it’s a more broad field and it’s truly family medicine because they also treat children, so they treat the entire family. And it came about really in people in rural communities as well as now we see more and more this has developed to folks in bigger cities as well, where it’s hard to get access to care. So there’s a difference between primary care family medicine and primary care internal medicine, whereas internists treat adults only, and also a broad range of treatments for those adults. And among the things he talked about and that I really got out of this was the approach to quality of care and patient safety. These are things that I wasn’t familiar with in terms of how they relate to the patient. And as you’ll recall, he talked about the first of the three phases being the patient experience, followed by the quality of care and followed by safety. As he explained it, for patients who come to receive medical care, they want to be treated well; they want high quality care, so they want to get better; and more importantly, they don’t want to be hurt. So let’s talk about the patient experience itself. That’s a lot to do with actual having contact with the patient, that initial contact. And there are a lot of things that I’ve learned over the years that help that contact. So even today when I see a patient, I’m asking things like, “Who sent you here?” “What do you like to do?” try to make things conversational. At the same time. I’m trying to identify the patient, speaking to the checklist that we talked about with Dr. Allen. Things like what side is being affected, right versus left, instead of asking again for their date of birth. Now people ask the date of birth a lot ‘cause that’s a big identifier, but I’ll ask the patient’s age. I’ll try to make this part of a conversation. But by the same token, I’m trying to improve their experience as well as identify the proper patient and why we’re there. One other trick I learned, and it’s not really a trick, it’s actually something that speaks quite well to being in contact with patients, is when I would make rounds with patients and go into their room, often you have all these doctors standing around the bedside, right? So when, when I was the attending, I would primarily be the lead physician. I’ll have residents with me in the whole group. I always made a point of sitting down, whether the patient was in a chair or in bed. I wanted to sit down somewhere so that it wasn’t always this feeling of I’m looking down at them. It also gives the impression that I’m spending more time. I spent enough time to sit down and ask my questions rather than having it seem like I’m on the run, getting ready to get out of this room and get going. So there are those things that affect the patient experience. When it comes to quality of care, there are a lot of different measures, right? We measure outcomes, frequency of infection rate, how often does a patient have to be readmitted after being discharged from the hospital? So those are the quality issues, but safety is another issue. And we talked somewhat about why is safety more of a problem now than it was in the past. And I think from my standpoint, it’s clear that medicine has become much more complex. It’s really like the difference between flying a small aircraft and flying some huge jet liner. So there are a lot of things that can go wrong and it’s important to stay on top of those. And that’s where we got into the checklist and that’s why I used the flight analogy, because you always have these checklists. Now obviously when you’re on a huge jet, the checklist becomes much longer. As opposed to flying a small two-seater plane, and I think that’s what has happened now in terms of the evolution of medicine and its complexity with regard to computers and so many other things that are going on with the patient at the time care is being delivered. One of the things I wanted to mention, we have a grant to do these podcasts from a company called Coverys.  Coverys is an insurance company that provides medical malpractice insurance to physicians, and they’ve been my insurer for many years. What’s interesting is that, you think that, well, it’s insurance, they get the lawyer, and now you go through a process. But at Coverys, they spend a lot of time trying to improve quality by continuing medical education and requiring that continued medical education of the physicians, physician assistants, nurse practitioners who are all their insureds. And some of the courses they take are so important and I’ve learned a great deal from them over the years. So we really appreciate having them on board to support this podcast as we move forward. With that, I want to thank again Dr. Allen for his time that he spent with us. It was really enlightening overall. Next week we’re going to be chatting with Dr. Douglas Brugge. Dr. Brugge professor and chair of the Department of Public Health Sciences here at the University of Connecticut, and we spent a lot of time talking about public health initiatives and the effects that these folks out there who are against science have now really impacted public health, and it’s something we all need to be mindful of. If you have any questions or ideas for future programs, you can reach out to me at Healthy rounds@uchc.edu. Jennifer Walker is the executive producer for Healthy Rounds. Chris DeFrancesco is our studio producer for the Healthy Rounds Podcast, and Tessa Rickert is in charge of our social media. Until next time, this is Dr. Anthony Alessi. Please stay healthy.