Expert faculty members in the University of Pittsburghs School of Medicine are at the helm of a new COVID-19 Medical Response Office, which will oversee the implementation of a virus monitoring program on all five Pitt campuses. The program will direct the Universitys COVID-19 testing, contact tracing, reporting procedures and isolation and quarantine protocols.

Tracking this virus will be vital to our response and return to campus in the fall, said Anantha Shekhar, senior vice chancellor for the health sciences and John and Gertrude Petersen Dean of theSchool of Medicine. Fortunately, Pitt is home to some of the best and brightest scholars in this fieldresearchers and clinicians from our world-renowned health sciences programand few universities are better equipped to support the well-being of its faculty, staff and students.

The COVID-19 Medical Response Office will report to Shekhar, who also chairs the Universitys Healthcare Advisory Groupa team of medical experts responsible for setting and monitoring campus health and safety guidelines during the pandemic.

John V. Williams, chief of the medical schools Division of Infectious Diseases, Henry L. Hillman Endowed Chair in Pediatric Immunology and professor of pediatrics, will direct the new office.

Williams is a member of the Universitys Healthcare Advisory Group and serves as the director of the Institute for Infection, Inflammation, and Immunity in Children. He is alsoa faculty member in the graduate program in Microbiology and Immunology and an affiliate in the Center for Vaccine Research.

Supporting Williams as the offices chief operating officer isChristopher P. O'Donnell,and faculty membersElise Martin and Joe Suyama.

ODonnell is a professor of medicine in the medical schools Division of Pulmonary, Allergy and Critical Care Medicine and executive vice chair of academic affairs in theDepartment of Medicine. He is also assistant vice chancellor for Special Projects in the Health Sciences and played a central role in developing School of Medicine guidelines for the restart of research operations in June.

Martin is an assistant professor in the Department of Medicine and Division of Infectious Diseasesand the associate medical director of infection prevention and hospital epidemiology for UPMC Presbyterian.

Suyama is an associate professor in the Department of Emergency Medicine and chief of emergency medicine services at Magee-Womens Hospital of UPMCs emergency department. He recently co-chaired the UPMC Pandemic Flu Task Force and assisted in its preparedness and response efforts to the 2009 H1N1 pandemic.

What we are doing, along with our teams, is taking the great work done by the Healthcare Advisory Group and others and translating it into practice across the University, Williams said.

For example, we know testing plays a crucial role in virus monitoring. The COVID-19 Medical Response Office is charged with looking at what testing is available, what the latest guidance says, what the best science says and determining who should be tested, when they should be tested and where those tests should be performed.

With the help of data analytics and administrative staff members, the office will develop and oversee implementation of the virus monitoring program, including strategies, protocols and methods for testing, symptom monitoring, contact tracing and quarantine and isolation on all five of the Universitys campuses.

While this office will implement virus monitoring protocols, the COVID Medical Response Office will not provide medical care or medical advice.

Symptomatic individuals and those with positive COVID-19 test results should call Pitts Student Health Service or employee health clinic, MyHealth@Work.

The University will continue posting information about COVID-19 on campus at coronavirus.pitt.edu.

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New COVID-19 Medical Response Office to Oversee University-wide Virus Monitoring and Testing - UPJ Athletics

Gabby Gilmer, a rising second-year medical student, said she believes racism is deeply ingrained in medicine, which is why an anti-racism curriculum is necessary for every future physician.

We as physicians in training need to be trained to understand our patients, because right now our curriculum trains us to be racist not directly, but with implicit biases, Gilmer said. Removing our blinders and forcing us to see this reality is one tiny baby step to improving.

This belief is what prompted Gilmer along with another 97 rising second-year medical students to sign up for a voluntary book club this summer and read Medical Apartheid by Harriet Washington. This book focuses on medical experimentation and other cruelties against Black people by health care providers and how this history impacts medical care today.

The book club is a continuation of an anti-racism curriculum change introduced last year in Clinical Experiences a required course for all medical students that runs from the beginning of spring semester of the first year through the fall semester of the second year. The anti-racism component was implemented for the first time in January 2020 with two mandatory lectures on health equity for all 147 medical students.

The course is taught by Andrew McCormick, an associate professor of pediatrics in the School of Medicine. McCormick developed this curriculum last fall alongside Dara Mendez, an assistant professor of epidemiology in the Graduate School of Public Health, and Jada Shirriel, the CEO of Healthy Start, a nonprofit focusing on improving maternal and child health.

This curriculum change was adopted months before a list of nearly 20 demands was drafted by medical students Casey Tompkins-Rhoades, Rachel Eleazu and Wheytnie Alexandre, as well as public health student Alexander Schuyler, in early June. The demands vary from scholarships for Black students to additional support staff to reforming school curriculum and policies.

Anantha Shekhar, the senior vice chancellor for health sciences and the schools dean, agreed to some of the demands, including creating four scholarships, reevaluating the role of the Schools Honor Council and enforcing serious consequences for racist behavior.

Mendez said this curriculum adjustment is only one component of the broader changes students are pushing for.

We have students who have demanded some really important things that should shift our culture, should shift our institution and what were doing in this class is a really small piece, Mendez said. Especially me as a Black faculty member, these are things weve been asking for a long time.

McCormick said while this curriculum revision is an important first step, it is not nearly enough. He said he hopes to make the book club mandatory next year, as well.

This is a starting conversation for a long, multiyear curriculum intervention, McCormick said. The ultimate goal is to have this be a springboard to larger curriculum changes to other courses in the School of Medicine and have it be not just a first-year intervention, but first-year, second-year, third- and fourth-year continuous dialogue.

In the American health care system today, Black patients health outcomes are markedly worse than white patients. Black people tend to receive lower-quality health services, including for cancer, H.I.V. and cardiovascular disease, as well as prenatal and preventative care. They are also more likely to have unnecessary limb amputations and have more than double the infant mortality rate.

Medical Apartheid touches on many of these statistics and how they originated. The first half of the book, which students have discussed thus far, focuses on some historical wrongdoings, including those of James Marion Sims, whos considered to be the father of modern gynecology, in which he conducted invasive experiments on enslaved Black women, often without anesthesia.

It also describes the Tuskegee syphilis experiment, a federally funded study where hundreds of Black men infected with syphilis were not given penicillin to cure the disease, so researchers could observe its natural course. Pitts Public Health building used to be named after Thomas Parran Jr., a former Pitt dean who presided over the Tuskegee and Guatemala syphilis experiments during his time as U.S. surgeon general. The building was renamed two years ago.

Gilmer said she was shocked upon learning this historical context, and is concerned about how many doctors before her never knew about this legacy of mistreatment.

I was appalled by this history, and I was further appalled by the fact that I am halfway through my pre-clinical experience and I had never heard of any of these things, Gilmer said. Thinking of all the doctors who have gone through medical school and likely have never heard any of this its imperative that everyone read it.

Arnab Ray, a rising second-year medical student who is also in the book club, said participating has been an eye-opening experience because it helped him recognize how injustices against Black patients were perpetuated in medicine and how to recognize these biases within himself.

The author mentions that surgeons didnt show empathy to Black bodies used for demonstrations in the surgical theater which got passed on to students, Ray said. Ive adopted a lot of views and attitudes about medicine from docs I respect, and with unconscious biases, sometimes you could inherit those values.

Ray added that the current medical school curriculum doesnt allow for self-introspection required to get rid of those biases, which is something he hopes will change.

Just because medicine isnt participating in what we would now completely condemn as horribly racist, it is more insidious in the forms it is creeping into medicine, Ray said. It should be mandatory because it directly plays into the oath we took at the beginning of medical school to learn how to be a supporter and advocate of every patient, no matter what kind of patient.

McCormick said these biases need to be examined because they impact medical care for many members of the Pittsburgh community and beyond.

This is foundational knowledge, just as much as learning anatomy and physiology, McCormick said. If we are physicians that care about the health of everyone in the community, we need to know how racism is impacting our ability to provide that care.

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'Foundational knowledge': School of Medicine reflects on anti-racist curriculum changes - University of Pittsburgh The Pitt News

Should children return to school this fall? Amid the COVID-19 pandemic, its a question physiciansmost notably pediatricians and those practicing family medicineare likely to hear with increasing frequency in the coming months from patients. And its not an easy one to answer.

"Like any issue related to COVID-19, you are going to find a lot of opinions about it, said John Andrews, MD, the AMAs vice president for graduate medical education innovations, who has been a practicing pediatrician for three decades. Parsing those opinions is not at all easy.

So how should physicians address parental concerns about a return to school? Dr. Andrews offers these thoughts.

In late June, the American Academy of Pediatrics (AAP) released a statement that, with a number of caveats, strongly advocated all policy considerations for the coming school year should start with a goal of having students physically present in school.

Andrews says data that indicates children appear less likely to contract the disease, and when they do, they tend to recover well. Further, spread of the disease from asymptomatic children to other children or adults is uncommon. Communicating that to worried parents and presenting the adverse outcomes from keeping children home may, in fact, outweigh those of sending them back to school.

Its clear that the remote learning that many schools went to at the conclusion of the school year last year was essentially no learning at all, Dr. Andrews said. Educational outcomes will suffer if kids arent in school come the fall.

When kids are at home there are risks to that, as well. There may be increases in behavioral health issues. And, the risk of maltreatment as their families face distress is higher.

While its important to consider sending children back to school, theres going to be a risk, which many parents will, naturally, point out. Pushing back on those concerns isnt the role Andrews believes a doctor should play in current circumstances.

Im a pediatrician, Dr. Andrews said. Im a source of advice. The decision-makers in the lives of children are their parents. My approach is to share the information objectively and when asked for my opinion offer it. But its important to recognize parents make independent decisions.

When things really are a judgment call, and this is a case where that is true, Ill present the evidence and offer my opinion, but Ill acknowledge there will be some parents who wont be comfortable sending their kids back to school and thats something well have to figure out how to manage.

Theres more debate surrounding how the disease presents and afflicts older children, so the AAP advocates for schools to mandate more preventative measuressuch as mask-wearing and physical distancingin facilities that host older children. Even still, at any level of education, certain children will be more at risk.

The risk profile of the child is important, Dr. Andrews said. There are kids who are unique cases. The benefits of a structured education have to be weighed against the risk of exposure to infection.

As far as reducing the risk of that exposure, it is likely going to fall on the school systems to be realistic about what they can and cannot do. The AAP calls for policies to be nimble and responsive to new information regarding the pandemic. It also calls for them to be practical, feasible, and appropriate for child and adolescent's developmental stage.

Physicians can offer their take on what that could look like.

Parents need some reassurance about their ability or the ability of the school system to manage the behavior of children in a way that will reduce the risk of infection, Dr. Andrews said. Parents and the school systems may have unreasonable expectations about the way children behave at school. Activities like meals and recesses that promote uncontrolled contact between children may need to be carefully evaluated. As a physician, to have some frank conversations about that will be helpful.

Stay current on theAMAs COVID-19 advocacy effortsand track the pandemic with theAMA's COVID-19 resource center, which offers resources fromJAMA Network, the Centers for Disease Control and Prevention, and the World Health Organization.

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Back to school: What physicians can say to parents weighing the decision - American Medical Association

BERGEN, Norway, July 20, 2020 /PRNewswire/ -- BerGenBio ASA (OSE: BGBIO), a clinical-stage biopharmaceutical company developing novel, selective AXL kinase inhibitors for severe unmet medical need, announces that the first patient has been dosed and continues on therapy in a trial assessing bemcentinib in recurrent glioblastoma (GBM). The trial is sponsored by Prof. Ichiro Nakano, MD, Professor in the Department of Neurosurgery and co-leader of the Neuro-Oncology Program at University of Alabama at Birmingham and funded by the National Cancer Institute (NCI).

This is an open label, multi-centre, intra-tumoral tissue pharmacokinetic (PK) study of bemcentinib in patients with recurrent glioblastoma for whom a surgical resection is medically indicated. The study will enrol up to 20 recurrent GBM patients, at up to 15 sites in the USA. 10 patients will be treated prior to surgery and 10 patients will have no pre-surgical treatment. However, all patients will receive treatment with bemcentinib following surgery. The endpoints of the study include an evaluation of bemcentinib's ability to cross the blood brain barrier, AXL expression, pharmacokinetics, safety and tolerability, as well as efficacy assessments including Progression Free Survival and Overall Survival. More information about the trial can be found at https://clinicaltrials.gov/ct2/show/NCT03965494

Increased expression of the receptor tyrosine kinase AXL is significantly correlated with poor prognosis in GBM patients and preclinical data has suggested that bemcentinib may be a promising therapeutic agent for GBM, particularly in post-irradiation mesenchymal-transformed GBM tumors[1]. A comprehensive translational research programme will run in parallel with the clinical trial, this will be conducted by Prof. Jeff Supko, Harvard Medical School and Director of the Clinical Pharmacology Laboratory, Massachusetts General Hospital (Boston, USA).

Prof. Burt Nabors MD, the Chairman of the trial and Director of Neuro-Oncology at University of Alabama at Birmingham (UAB) and Director of UAB's Centre for Clinical Translational Science's Clinical Research Unit, commented: "GBM is among the most lethal of adult cancers. The median survival of patients remains less than two years despite the current available therapies, including surgery, radiation, and chemotherapy; development of more effective therapies is urgently needed. We welcome the opportunity to offer patients access to the investigational AXL inhibitor bemcentinib in this pilot study and look forward to initiating additional trial sites across the Adult Brain Tumour Consortium in the USA later this year."

Richard Godfrey, Chief Executive Officer of BerGenBio, commented: "We congratulate Prof. Nakano and Prof. Nabors on the start of this exciting clinical study, which we believe will provide us with important data regarding the ability of bemcentinib to cross the blood-brain barrier and potentially treat GBM patients. This clinical trial is based on pioneering preclinical research carried out by our collaborators, conducted at high profile research hospitals in the USA and is funded by National Cancer Institute (NCI). We look forward to reporting the potential of bemcentinib to improve patient outcomes in this very aggressive cancer."

About BerGenBio ASA

BerGenBio is a clinical-stage biopharmaceutical company focused on developing transformative drugs targeting AXL as a potential cornerstone of therapy for aggressive diseases, including immune-evasive and therapy resistant cancers. The company's proprietary lead candidate, bemcentinib, is a potentially first-in-class selective AXL inhibitor in a broad Phase II oncology clinical development programme focused on combination and single agent therapy in lung cancer, leukaemia and COVID-19. A first-in-class functional blocking anti-AXL antibody, tilvestamab, is undergoing Phase I clinical testing. In parallel, BerGenBio is developing companion diagnostic tests to identify those patient populations most likely to benefit from bemcentinib or tilvestamab: this is expected to facilitate more efficient registration trials and support a precision medicine-based commercialisation strategy. For further information, please visit: http://www.bergenbio.com

About Investigator-Sponsored Trials

Investigator-sponsored clinical trials are clinical trials proposed by front-line patient-facing physicians who act as the regulatory sponsor and are supported by industry in bespoke clinical development partnerships. The industry partner does not assume the role of sponsor according to European or US regulatory guidelines but may offer support in a variety of different ways, such as providing investigational medicinal product at no cost.

About Glioblastoma

Glioblastoma (GBM) ranks among the deadliest of all human cancers with no curative options available[2]. It is the most aggressive of the gliomas, a collection of tumors arising from glia or their precursors within the central nervous system. Gliomas are divided into four grades, grade 4 or glioblastoma multiforme (GBM) is the most aggressive of these and is the most common in humans. Most patients with GBMs die of their disease in less than a year[3].

For more information, please contact

Richard GodfreyCEO, BerGenBio ASAmedia@bergenbio.com+47 917 86 304

International Media RelationsMary-Jane Elliott, Chris Welsh, Carina Jurs,Lucy Featherstone, Maya BennisonConsilium Strategic Communicationsbergenbio@consilium-comms.com+44 7780 600290

Forward looking statements

This announcement may contain forward-looking statements, which as such are not historical facts, but are based upon various assumptions, many of which are based, in turn, upon further assumptions. These assumptions are inherently subject to significant known and unknown risks, uncertainties, and other important factors. Such risks, uncertainties, contingencies and other important factors could cause actual events to differ materially from the expectations expressed or implied in this announcement by such forward-looking statements

This information is subject to the disclosure requirements pursuant to section 5-12 of the Norwegian Securities Trading Act.

[1] 3. Sadahiro H, Kang KD, Gibson JT, et al. Activation of the Receptor Tyrosine Kinase AXL Regulates the Immune Microenvironment in Glioblastoma. Cancer Res. 2018;78(11):3002-3013.

[2,3] 1. Cloughesy, T., Finocchiaro, G., Belda-Iniesta, C., et al. (2016). Randomized, Double-Blind, Placebo-Controlled, Multicenter Phase II Study of Onartuzumab plus Bevacizumab versus Placebo plus Bevacizumab in Patients with Recurrent Glioblastoma: Efficacy, Safety, and Hepatocyte Growth Factor and O6-Methylguanine-DNA Methyltransferase Biomarker Analyses. J Clin Oncol, JCO2015647685. Gilbert, M.R., Sulman, E.P., and Mehta, M.P. (2014). Bevacizumab for newly diagnosed glioblastoma. N Engl J Med 370, 2048-2049.

This information was brought to you by Cision http://news.cision.com

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SOURCE BerGenBio ASA

Company Codes: Bloomberg:BGBIO@NO, ISIN:NO0010650013, Oslo:BGBIO, RICS:BGBIO.OL

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Bergenbio Announces First Patient Dosed in Recurrent Glioblastoma Investigator Sponsored Phase I/II Study Assessing Selective AXL Inhibitor...

Malone Mukwende was in his first day of medical school when he noticed something odd. As he learned about diseases of the body, all of the diagnostics were grounded in white skin. Red bumps from rashes. Blue lips from oxygen deprivation. Such colors are masked by melanin, meaning these diagnostics dont work for much, even most, of the worlds population.

As a person who is of African origin, I knew that the symptoms we were seeing and being told about, on my own skin, they would not appear the same, and that was very problematic, Mukwende says. My first year of university, it was almost a curiosity. Second year, I thought the issue would get better. But there was no progress. So I said, Okay, I need to address this myself somehow.'

Teaming up with two of his professors, Mukwende has spent the past year and a half writing Mind the Gap. Its a richly photographed and annotated clinical handbook for diagnosing diseases on Black and Brown skin thats slated to be released at an unannounced time in the future. Mukwende hopes that it will become required reading in medical schools and hospitals around the world.

While he doesnt claim its the first publication to address racial diagnostic biasindeed, the last decade has brought multiple textbooks on this topicthe need for Mind the Gap is still pressing. Theres plenty of evidence that Black people have worse outcomes when facing the same diseases as white people.

There are all sorts of reasons for this. Genetics may play a role in some cases. But many issues are tied to systemic racism: One study found that diagnostic algorithms used in hospitals are racially biased and recommend treatment to Black people less often than white people for the same symptoms. Another study shows that African Americans and Hispanic people in the U.S. are less likely to have health insurance than white people, because in the United States, proper medical care is tied closely to economic advantage.

Structural racism in medical education goes beyond skin to nearly every field of medicine, says Andrew Ibrahim, an MD who is also assistant professor of surgery, architecture & urban planning at University of Michigan and a senior principal and chief medical officer at the architecture firm HOK. Ibrahim points out that the number of Black male doctors is going down rather than up. This sort of exclusion leads to poor practices across the board in healthcare. A new study flagged 10 common diagnostic tests, which software analyzes with different criteria depending on race. The same lab value may be interpreted as normal in a white patient, but abnormal for a Black patient because medical education has set the normal ranges differently by race, says Ibrahim. In making race an objective measurement rather than a social construct, we run the risk of accepting racial disparity as an immutable fact rather than an injustice that requires intervention.

Of course, treating everyone the exact same way is a problem, too. Mukwende points out that doctors are trained to spot diseases through just one racial lens. Textbooks are racially biased, sometimes to the point of flagrant racism, and as a result, the medical community is beginning to realize that Black people tend to get diagnosed and treated later for the same disease white people might have, at which point, the disease is harder to treat and often more deadly.

Mukwende gives examples of how bad training leads to poor health outcomes. With the rise of COVID-19, which has disproportionately killed Black people, doctors have seen an increase of Kawasaki disease, which is an inflammatory condition that involves swelling across parts of the body. One of its telltale signs on white skin is a bright red rash. But on Black skin this same rash appears without a clear color signifier; to the untrained eye, it might look like goosebumps.

Meningitis is another problem, Mukwende says. Meningitis is harder to spot in darker skin, he says. In this case, poor medical training hurts the Black community twice as much, because the disease may be more difficult to see due to melanin, and the doctor is looking for the wrong clues to spot it.

In some cases, these late diagnoses are literally a matter of life and death. [Take] lips turning blue . . . even with that point, what we describe as blue on white skin. On darker skin it would not be the same blue, says Mukwende. It would just not appear the same because of the melanin in the skin . . . [and] if you dont see that early enough, that person might literally have a lack of oxygen in their blood.

Mukwende has managed to finish the Mind the Gap while completing his second year of medical school, and thats largely thanks to his collaboration with two school lecturers who are helping with the book.

Speaking to others I didnt work withsome people who teach me time to timeat first the response was like, Surely thats common sense, or, Surely people learn how to just apply their knowledge,' says Mukwende. Unfortunately, this gray zone of assumption is whats leading to people ultimately losing their lives. People are just assuming everybody knows. But clearly people dont know.

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Medical textbooks are designed to diagnose white people. This student wants to change that - Fast Company

A Black medical student has created a handbook to help trainee doctors recognise conditions on darker skin.

Malone Mukwende, a second year student at St George's, University of London, had the idea after only being taught about clinical signs and symptoms on White skin.

The handbook is called Mind the Gap. It contains side-by-side images demonstrating how illnesses and diseases can present in light and dark skin.

He hopes the handbook will help future doctors spot and diagnose potentially life-threatening diseases on British Asian and Minority Ethnic (BAME) people.

It comes as nearly 200,000 people have signed a petition calling for medical schools to include BAME representation in clinical teaching.

It points to Kawasaki disease, a rare condition affecting young children. On white skin it appears as a red rash but on darker skin it shows up differently and is much harder to spot.

Medscape UK asked Malone Mukwende about the handbook.

Where did the idea comefrom for Mind the Gap?

On arrival at medical school I noticed the lack of teaching on darker skins. We were often being taught to look for symptoms such as red rashes. I was aware that this would not appear as described in my own skin. When flagging to tutors it was clear that they didnt know of any other way to describe these conditions and I knew that I had to make a change to that. After extensively asking peer tutors and also lecturers it was clear there was a major gap in the current medical education and a lot of the time I was being told to go and look for it myself.

Following on from that I undertook a staff-student partnership at my university with two members of staff who helped me to create Mind the Gap.

Who did youcollaborate with at St George's?

I worked with Margot Turner, a senior lecturer in diversity, and Dr Peter Tamony, a clinical lecturer. We were a dynamic team which had a common goal in mind.

When will the handbook be available?

We are currently working on the best way of disseminating the work to the public. There has been an incredible response since I posted it on my social media, with posts being seen over three million times as well as numerous press features. I am hoping to provide a further update on when the book will be out towards the end of July.

What do you think of the petition to medical schools to include moreteaching of the effects of illness and diseases on Black, Asian, and Minority Ethic people?

The petition closely ties in with the work that I am doing. It is clear that there is an urgent need to increase the medical education on darker skins so that the profession can serve the patient population. We saw in the recent COVID-19 pandemic that the worst affected group of people were from a BAME background.

There are a host of reasons as to why this may have been the case. However another factor may be that healthcare professionals weren't able to identify these signs and symptoms in time. Some of the coronavirus guidance from royal colleges stated information such as looking for patients to be 'blue around the lips'. This may have led to slower identification of coronavirus.

To see over 180,000 signatures on the petition was a positive step in the right direction. It is clear to see that this is a big issue. If we fail to act now that the issue has been identified, we run the risk of lives being lost.

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Medical Student Creates Handbook of Clinical Signs on Black and Brown Skin - Medscape

The Dallas Chapter of The Links, Incorporated is comprised of 50 women of color who have dedicated years to the Dallas community. One of their passions, in particular, is introducing girls to the world of STEAM (Science, Technology, Engineering, the Arts and Mathematics).

We aretrying to reach as many young ladies as we can who otherwise may have neverbeen introduced to these disciplines, member Tracey Nash-Huntley said. Onlyabout one in 10 employed in these fields right now are women of color. Oftentimes, they just need to be introduced.

The Dallas Chapter of The Links has spent the last eight years doing just that. Through their STEAM Academy, they provide programming for more than 400 seventh to 12th grade girls, emphasizing STEAM disciplines and career readiness.

The Dallas Chapter of The Links, Inc. hosts an event in conjunction with Texas Scottish Rite in early 2020 for girls in the STEAM Academy.

We know thatits important to augment their classroom learning with experiences whetherthey are educational excursions, mentoring sessions and actually STEM and STEAMhands-on experiments and projects to keep it top of mind for these girls, saidNash-Huntley.

The latest news from around North Texas.

Theorganization is hoping to create a pipeline to success for young girls ofcolor, while exposing them to the dynamic women of North Texas who are currentlyshining in those fields.

One of therecent graduates of the academy is Journie Crow, who said her time in theacademy provided her with so much more than a textbook ever could.

I was able to have more hands-on activities to figure out where I wanted to be in the STEAM field, Crow said. It was a better learning environment for me outside of the classroom. I also had the opportunity to go on amazing field trips and met some amazing people that I never would have thought I would have met before.

The Dallas Chapter of The Links, Inc. take STEAM Academy participants to event at Dallas Museum of Art in Feb 2020.

Crow said the encounter of a lifetime, through the STEAM Academy, was when she got to meet Michelle Obama.

Oh my gosh, I will never forget it. I even got her to sign my badge that day. I would have never been able to even talk to her if it wasnt for the program, Crow said.

Crow is also a budding artist. She will be attending the University of North Texas in the fall. Her hope is to graduate with honors and then go on to medical school. Her ultimate goal is to become a cardiologist and own her own practice. A dream she said became a goal after she started the STEAM Academy.

Like many organizations, the Dallas Chapter of The Links, Incorporated has had to pivot due to the pandemic, so their 2020 Women Who STEAM Awards Luncheon, to honor several women who are at the top of their fields around Texas, is now a virtual event. It is also their biggest fundraiser of the year to help provide continued support for the STEAM Academy.

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Local Non-Profit Introducing Girls of Color to STEAM Disciplines - NBC 5 Dallas-Fort Worth

Cover of Johan Zwaan's new book "WWII + VI: A Kid's Memories of War and Postwar"

SAN ANTONIO, Texas, July 20, 2020 (GLOBE NEWSWIRE) -- WWII + VI: A Kids Memories of War and Postwar by Johan Zwaan presents the authors riveting story of growing up as a small child in German-occupied Holland during World War II. The book also chronicles the heroic acts of his father who was a doctor and part of The Dutch Resistance that helped rescue and save many Jewish lives from the atrocities of the Nazis.

Zwaan recounts the struggles and losses his family suffered, as well as those around them in Gorinchem, Holland, while also providing historical facts of the major events that occurred during WWII. Zwaan was inspired to publish his familys experience to provide a keepsake for his children and grandchildren who would often ask him questions about WWII. He also hopes his memories will help educate readers on the events of the war and how they changed the world.

This book becomes a must-read for those seeking inspirational narratives, especially during these catastrophic times, about good triumphing evilUltimately, these writings leave readers with a clearer understanding of daily life during World War II, which makes this book a distinctive, informative text about the importance of family, duty, and sacrifice that can benefit all who read it in these moments of societal questioning. The U.S. Review of Books

WWII + VI demonstrates to readers through the acts of kindness and bravery of those during the war on the importance of helping others, keeping ones cool, and that sometimes it is a moral obligation to take risks for the betterment of all. To learn more, please visit http://www.johanzwaan.com.

WWII + VI: A Kids Memories of War and PostwarBy Johan ZwaanISBN: 978-1-7960-7598-4 (HC); 978-1-7960-7597-7 (SC) 978-1-7960-7596-0 (e)Available through Amazon, Barnes & Noble, and Xlibris

About the AuthorJohan Zwaan was born in Gorinchem, Holland in 1934 and lived there as a child during WWII and later attended the local classical high school, Gymnasium Camphusianum, which he completed at the age of 16. He then attended medical school in Amsterdam for a couple of years and was drafted into the Dutch Royal Army. After Zwaans discharge, he continued with medical school and received his M.D. in 1961 and Ph.D. in 1963. He had a career in Ophthalmology that took him around the world including three years in Saudi Arabia, 10 plus years at Harvard, and he eventually landed in San Antonio, Texas where he held a private practice until his retirement at the age of 82 and still currently resides.

Xlibris Publishing, an Author Solutions, LLC imprint, is a self-publishing services provider created in 1997 by authors, for authors. By focusing on the needs of creative writers and artists and adopting the latest print-on-demand publishing technology and strategies, we provide expert publishing services with direct and personal access to quality publication in hardcover, trade paperback, custom leather-bound and full-color formats. To date, Xlibris has helped to publish more than 60,000 titles. For more information, visit xlibris.com or call 1-888-795-4274 to receive a free publishing guide.

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Former Harvard Professor Presents Gripping Recollection of Growing up in German-Occupied Holland During World War II in New Book - GlobeNewswire

WASHINGTON For a while there, it looked possible that Dr. Anthony S. Fauci the nations top infectious disease expert and a Washington sacred cow if there ever was one might come away from the Trump White House unscathed. He was viewed as bipartisan (served six presidents!) and a savvy truth-teller able to skirt the reputational contagions that can accompany prolonged exposure to President Trump.

He dominated March and April as the coronavirus pandemic raged.

But then Hang Fauci signs started popping up at Reopen Now rallies, and #FireFauci hashtags started trending on Twitter. The president himself retweeted one. And now, well

That is a bit bizarre, Dr. Fauci said this week in describing his current predicament at the White House. He has come under sustained attack, from the Oval Office down, on the record and off, in presidential tweets and in an attack op-ed article in USA Today by Peter Navarro, Mr. Trumps top trade adviser, who declared that Dr. Fauci was wrong about everything.

(On Wednesday, the newspaper had second thoughts, as Bill Sternberg, the editorial page editor, said the article did not meet USA Todays fact-checking standards.)

You can trust respected medical authorities, Dr. Fauci said this week in a virtual forum at Georgetown University, almost plaintively at times. I believe Im one of them, so I think you can trust me.

He urged students to avoid the waste of time that can be an occupational hazard for anyone who tries to promote science research and public health in Washington. Dont get involved in any of the political nonsense, he pleaded from the center of exactly that.

These are treacherous times in the sacred cow business.

Dr. Fauci can vanquish pandemics, receive a Presidential Medal of Freedom (awarded by President George W. Bush) and have a talent for killer lab-coat news conferences and still require a security detail.

I think its outrageous whats happening to Dr. Fauci, I really do, said Gov. Larry Hogan, Republican of Maryland, a Trump critic who has worked closely with Dr. Fauci on Marylands response to the coronavirus. I have never seen anything like this in Washington, and Ive been around a long time.

Whats happening to Dr. Fauci has become an urgent topic around the capital these days, as well as in science and medical circles where he holds a solemn and almost revered status. The matter often gets raised with a level of resignation or with a hint of surprise that he has survived this long around Mr. Trump.

On some level, I guess Im despondent, said Dr. Ashish Jha, a professor of global health at Harvard Medical School. I suppose it was inevitable, though. Obviously the pandemic response is going extremely badly, and when things get so bad, people need a scapegoat. But when youre turning on Tony Fauci, youre really in big trouble.

The 45th president has a particular knack for going after figures once considered beyond reproach. Before he was even inaugurated, Mr. Trump went after a whole herd of presumed sacred cows Representative John Lewis, Meryl Streep, the cast of Hamilton and the pope, among others and lived to tell about it. Not only that, but his supporters seemed especially thrilled by Mr. Trumps willingness to fight with anyone, no matter how exalted or elite.

Washington in particular has always had a weakness for a few designated figures who enjoyed bipartisan national treasure status. Colin L. Powell after the gulf war or John McCain after he ran for president in 2000 or Alan Greenspan before people started blaming him for tanking the economy or Robert S. Mueller III, the special counsel in the Russia investigation (at least until Mr. Trump started attacking his witch hunt investigation and many of the presidents supporters followed suit).

Dr. Fauci has burnished his own credentials over more than a half-century in Washington. He packed all the right biographical details and hobbies. He hailed from Brooklyn, was trained by Jesuits (College of the Holy Cross, class of 1962), loved baseball (Go Nats), ran lots of miles and subsisted on only four or five hours of sleep a night and double shots of Illy espresso when he rose at or before dawn.

He checked all the right boxes of a particular kind of Washington icon who could transcend politics.

I have known Tony a long time, and Ive never heard him identify himself as a Democrat or Republican, said Dr. Margaret A. Hamburg, a former director of the Food and Drug Administration and a onetime assistant to Dr. Fauci. He has always taken great pride in that he has continued to run a lab and see patients.

Dr. Fauci joined the National Institutes of Health in 1968, was hailed for his pioneering AIDS research in the 1980s and was the inspiration for a dashing scientist protagonist in a best-selling 1991 novel, Happy Endings, by Sally Quinn, the longtime journalist, hostess and chronicler of Washingtons cultural anthropology.

He was especially adept at throwing himself into desperate situations, running up against prickly personalities and taming them into allies. Larry Kramer, the countrys best-known AIDS activist, would routinely rail against Dr. Fauci in the 1980s for what Mr. Kramer considered to be Dr. Faucis slow-walking of potential treatments against the deadly virus.

How did I meet Larry? He called me a murderer and an incompetent idiot on the front page of the San Francisco Examiner magazine, Dr. Fauci recalled to The New York Timess Donald G. McNeil Jr. after Mr. Kramers death in May. Mr. Kramer eventually apologized, and the two would go on to forge an extraordinary 33-year relationship, Dr. Fauci said. We loved each other.

No one doubts Dr. Faucis ego, or his skill in cultivating his public image. He is solicitous and responsive to the news media, and displays an impressive gallery of photographs of himself with presidents and other dignitaries in his office at the N.I.H. He joked in a CNN interview that he would like Brad Pitt to play him in a Saturday Night Live skit and then, a few weeks later, there was Brad Pitt playing Dr. Fauci in a Saturday Night Live skit.

In the early days of the pandemic, Mr. Trump would marvel at how big of a celebrity Dr. Fauci had become, as if he were just some obscure science nerd until Mr. Trump discovered him.

Dr. Fauci was ever mindful of managing up. He paid determined deference to the president, whom he would describe as the boss, even when he was strenuously recommending actions that ran directly counter to Mr. Trumps own example like wearing a mask.

For a while, Dr. Faucis avuncular, almost sheepish manner proved sufficiently disarming. Mr. Trump repeatedly referred to him as a nice guy.

He learned how to speak truth to power but to do so in a way that did not threaten these big political egos, said Dr. Howard Markel, a professor of the history of medicine at the University of Michigan Medical School.

Even in recent days, Dr. Faucis defense of himself against the White House attempts to undermine him have landed on the notion that this unseemly melodrama is hurting the president, as if Mr. Trump himself were just a passive victim of another random distraction that dropped from the sky.

I remember hearing Tony talk once about working with all these different presidents, said Dr. Jha, of Harvard Medical School. He said that he didnt spend a lot of time trying to figure out what their angles were.

In his own humble way, Dr. Jha added, he said, Im not smart enough to figure out what someones angle is. And usually that worked out just fine for him.

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Treacherous Times for Dr. Fauci in the Sacred Cow Business - The New York Times

(CNN) Daniel Green is still hobbled by the severe viral infection that struck him in March and left him coughing up blood.

Three months ago, the 28-year-old postdoctoral research associate from Newcastle, United Kingdom, was on the road with friends in a band as they toured venues in the French Alps.

He came down with Covid-19 symptoms, and like many coronavirus patients, spent weeks in bed.

Unlike other people, however, Greens life hasnt returned to normal.

Since then its been on and off with extreme tiredness and fatigue, he said.

Every day he has brain fog, difficulty concentrating and problems with short-term memory that make reading, writing and speaking harder.

Breathing has been very difficult, he said. I dont feel like I have my full breath capacity. If I go for a walk for one minute, Ill be really exhausted.

The profound mark the disease has made on Greens life isnt uncommon.

About 80% are going to experience a mild or asymptomatic version of Covid. Its the other 20% that were worried about, said Dr. Luis Ostrosky-Zeichner, a professor of medicine at the University of Texas McGovern Medical School.

One out of five patients are going to get a severe form of the disease.

As case counts among young people rise, Green and others in their 20s want to share stories of the wreckage Covid-19 has wrought in their lives.

Those patients can potentially experience permanent lung damage, including scarring and reduced lower respiratory capacity.

The thing that we dont yet fully appreciate is what happens when you get infected, and you get serious disease, and you recover? said Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, at the BIO International Convention in June.

We dont know the extent of full recovery or partial recovery, so theres a lot we need to learn, he said.

Young people, who are less likely to die from coronavirus than their grandparents, are an important target of those lessons.

Whether they contracted the virus among the snow-capped peaks of the Alps or in the heart of the outbreak in New York Citys borough of Queens, some 20-somethings are getting sick from Covid-19. And staying sick.

Their stories are a warning from millennials to millennials: Dont play the odds with coronavirus because this disease could permanently damage your body.

What I like to tell my students and patients is that this is a lottery you do not want to win, said Ostrosky-Zeichner.

At home in Newcastle, Green is in his fourth month of Covid-19 aftermath.

He has a doctors note saying that he shouldnt return to full-time work, but he picks up an occasional project when he can. There isnt much else to do resting in bed.

The symptoms are lingering, and theyre severe.

Two weeks ago I had a crushing sensation in my chest, he said. It felt like I couldnt breathe. That was the worst part.

Last week, while driving, he felt faint and had to pull over to the side of the road to call an ambulance to pick him up. Afraid of blacking out behind the wheel, he decided to take a break from driving.

He joined the Long Covid Support Group, where hes been sharing his experiences with more than 6,000 others from around the world afflicted with similar symptoms following Covid-19 infection.

His girlfriend, a nurse, lives in town, but aside from a few socially distanced walks, they havent seen each other in person in months.

When I feel ill, I wonder if its Covid, or is it me picking up every bug because my immune system is so low?

Hes caught in limbo somewhere between sickness and health. He has a disease the medical establishment is still struggling to define, and its unclear whether its safe for him or others to be in contact with each other.

You kind of feel like a leper, really, he said.

When Morgan Swank got sick around Christmas, she texted her friends, Im dying. Ive never felt like this before.

The Atlanta-based television writer has credits on Saturday Night Live, Late Night With Jimmy Fallon, and The Mindy Project, and she now runs a production company focusing on elevating projects from women and filmmakers of color.

Swank had a fever for three weeks and lost her sense of smell for nine days. While ill with what she thought was the flu, she passed out in an airport during an international trip, she said.

A nonsmoker who worked out three times a week, she wasnt used to struggling for air.

Swank eventually tested positive for Covid-19 antibodies in April, but her lungs are damaged from a month of hard coughing.

Shes back to working out, and in addition to boxing gloves, she now keeps Albuterol inhalers with her boxing gloves in her gym bag. The inhalers help her finish her workout.

I have to use an inhaler every couple minutes to reinvigorate my lungs, she said.

Even short conversations can be a struggle. I hear it in my voice just talking to you, she said in a phone interview. Im winded.

Getting sick again is her biggest worry, and she feels like her immune system is now compromised.

I really wish people would wear their masks all the time, she said. If I get another respiratory infection like the flu and my lungs get damaged from that, I may have to be hospitalized.

When Jordan Josey got Covid-19 the first time, he felt like he was suffocating. The disease partially collapsed one of his lungs.

Shortness of breath was my biggest problem, he said. Coronavirus takes your energy away completely. Youre always dazed and tired. I could sleep for 13 hours.

Josey, who works as a lawyer in Macon, Georgia, tested positive for coronavirus on April 1. He shared details of his 103-degree temperature and stabbing chest pains in his local paper.

He eventually started feeling a little better and tested positive for antibodies. He donated his blood plasma so that others might also benefit from his immunity.

But then in late June, that same shortness of breath and lightheadeness returned. He was winded just folding laundry. He tested positive again.

I just sat there and shook my head, he said. I didnt want to go through it all again. It was awful.

On July 1, he dropped that bomb in a text message to his family. With a mother whos immunocompromised and a grandfather undergoing chemotherapy for cancer, Joseys second Covid-19 diagnosis has the whole family nervous.

Nothing about my test indicated it was a second strain, he said. I thought, How is this possible? And really, no one knows. The doctors think it may have flared back up.

One of the things that irks him is a common belief that people will be fine after they contract the coronavirus and test positive for antibodies.

I dont buy that at all, he said. My doctor said I might even test positive a third time.

Like many in their 20s, Josey and his wife used to love meeting friends for dinner before heading to a concert, bar or club. With him testing positive twice and her testing positive once, they havent done that since February.

This thing is no joke. Im young and healthy, and it did all this to me, Josey said. Coronavirus is now a much bigger threat than it was when I got sick. And its all in conjunction with people going to bars and nightclubs and large parties.

Nearly 1,000 miles away in Queens, New York, Kevin Garcia is also grappling with long-term fallout from Covid-19. He desperately wants his peers to be safe as case numbers rise again.

The college student is currently furloughed from his job during the pandemic. But even if he wasnt, he doesnt feel fit to return to work. Hes functioning only at about 75%, and just walking up a flight of stairs is a major challenge.

Hes nowhere near his pre-pandemic days of going to work, school, the gym and bars all in one packed marathon day.

His symptoms began March 25 when he had to call an ambulance. I felt something foreign in my body.

Within a week and a half, it felt like his body was in an all-out war.

After more than two weeks of body aches, fatigue and gastrointestinal issues, he managed to survive. But his new life is different than the old one.

I saw doctors bringing out dead bodies every day. I heard ambulances probably 50 times a day, he said. Im glad that Im alive because a lot of people my age died.

He too wants to push against the conventional narrative that young people can get sick, get immune and return to their previous lives. And he wants the world to know that post-Covid symptoms arent imaginary.

You dont tell people with Covid they have anxiety, he explained. Were nervous. We have a disease you guys dont know enough about. We survived it, and now we have symptoms that are coming and going.

I hope that its not chronic and that I dont become bedridden, he said. I have a long life ahead of me.

Hell turn 25 in December, and didnt imagine hed celebrate a quarter century so humbled, and almost certainly without a party. But now forgoing parties is his highest priority for himself, and his generation.

After the Spanish flu, we had the Roaring 20s. That could be the case after coronavirus. This is temporary, he said. But dont risk your life. You can die from this.

His message for young people was that if you didnt want to hear it from public health officials, you could take it from him: Wear a mask. Avoid crowds. Wash your hands. Dont touch your face.

I dont think anybody should see someone die over one or two hours of fun, he added.

We can have days of fun when this is over. Sacrifice the time now.

The-CNN-Wire & 2020 Cable News Network, Inc., a WarnerMedia Company. All rights reserved.

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Young Survivors Of Coronavirus Offer Warnings About The Virus - CBS Pittsburgh

A longstanding failure of the U.S. health care system is that minority and vulnerable populations experience poorer health outcomes and higher death rates. The Covid-19 pandemic and other public health emergencies extend and deepen this failure.

Some see this as a symptom that the country needs more health professionals, especially in the context of looming shortages of primary care and other clinicians. But just adding more clinicians wont solve this vexing issue. What we need is a health care workforce that has been trained to not only understand that social determinants things like access to healthy food, a safe place to live, access to health services, and the like have important effects on health but are able to respond to them.

The impact of social and economic determinants on public health crises is not new. We saw it during Hurricane Katrina in August 2005 and the influenza A (H1N1) pandemic that began in January 2009. But the uncertainties about the transmission of Covid-19 and appropriate diagnostics and therapies present new challenges.

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To date, the best strategies to prevent or combat SARS-CoV-2, the virus that causes Covid-19, are influenced by structural inequalities. People in minority groups often live in more densely populated areas and have more people per household, making it difficult to follow social distancing recommendations. They also disproportionately work jobs currently considered essential, and without the luxury of working from home may be at higher risk of exposure to the virus.

How health professionals are educated reflects the investment our society places in improving public health and preventing societal injustices. Thats why educational institutions need to increase their capacity to convey the importance of addressing the social, physical, and environmental factors that determine health and how providers can use their expertise and influence to advance the health of individual patients and communities. It is vitally important that educators show trainees the proximity of these social inequalities and stress their capacity to improve them.

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Recognizing the relationship between homelessness and Covid-19, for example, does not explain the most effective method of reducing the transmission of Covid-19 among the homeless population. We know individuals experiencing homelessness and insecure housing cannot practice safety measures, but thats not enough. Health professionals should have the ability to advocate for a foreclosure and eviction moratorium for single family homeowners and offer mobile public health services to make sure health screening, education, and support services reach unsheltered individuals.

For years, medical schools have largely followed the same format for teaching students: two years of basic science curricula combined with an additional two years of rotations in clinical settings. This approach teaches individuals how to think and solve problems, but the emphasis is on individuals and disease states. While this is a foundational component of becoming a physician, it is not sufficient.

We need to offer future providers more training on how to manage the health of populations and the disparities that influence their health and well-being. We believe education must be rooted in the concept of social mission. There are undoubtedly many ways to do this. One we are familiar with is the Beyond Flexner Alliance, a national movement committed to social mission for which one of us (I.C.) is an unpaid volunteer board member. The alliance focuses on training health professionals as agents of more equitable health care. This movement takes us beyond old conventions and trains health professionals to build a system that is not only better, but fairer.

This could be illustrated by third-year year medical students being required to deliver treatment plans that include social determinants of health on the list of factors that affect the health of their patients. For vulnerable populations experiencing the Covid-19 pandemic, for example, asking standardized questions during a history and physical examination is not enough. You may be able to explain the nature of disease by asking these simple questions, but not what puts someone at risk of serious illness or death. Students should be taught how to broadentheir focus to include the patients values and social constructs, while using a team-based approach. The education of health professionals needs to allocate more resources that prepare them to understand and respond to the pandemic. This will not only provide immediate enhancement to students learning but prepare them to be better providers for future generations.

Before medical students graduate to residency programs, they take two medical licensing examinations that evaluate their ability to apply knowledge, concepts, and competencies that are important to the health of individuals and communities. But these examinations focus mainly on concepts of science basic to practice of medicine and offer little in the way of assessing students understanding of the root causes of socioeconomic determinants and their implications on health and cost. Board certifications and continuing medical education should be held accountable for their commitment of preparing providers that can adapt to the ever-changing society.

Modifications of medical curricula are largely influenced by oversight bodies and educators perceived value of including social inequalities in their curriculum is guided by these accrediting institutions. The Liaison Committee for Medical Education and its sponsoring organizations institute benchmarks based on peer assessments, with the ultimate goal of improving academic quality. Accreditation bodies remain a cornerstone for establishing the standards, at minimum for the priorities that the health care system measures. Yet accrediting organizations are not focusing on broader approaches that address social, economic, and environmental factors that influence health.

A number of educational institutions and organizations have committed to fortifying their contributions to health equity. A.T. Still University of Health Science, for example, partnered with the National Association of Community Health Centers to train physicians to help fill the anticipated needs for community health care providers. At the ATSU School of Osteopathic Medicine in Arizona, students spend their second through fourth years in one of 11 community campuses nationwide based in community health centers. Advances like these and others are promising but represent only a fraction of the commitment needed to address the scope of change.

The long-term solution will, of course, take multilevel efforts across all major health care institutions, not just the educational system. Nevertheless, the goal of all educational institutions should be to graduate competent providers who do not simply treat patients but recognize and address the barriers that hinder their patients ability to attain their full health potential.

How would our nation look now had its health care workforce been trained and empowered to address the individual and systemic inequalities that have obstructed its ability to provide high-quality care? Perhaps more physicians would have recognized that their patients drove buses or worked as cashiers in grocery stores, propelling them to navigate resources for obtaining personal protective equipment for them. Perhaps more physicians would have recognized that their patients occupation, ZIP code, and income level contributed to their being hospitalized for Covid-19, ultimately helping provide better preventive measures.

As public health emergencies continue to arise, the challenge for newer members of the healing professions becomes clearer: They must master the art of providing evidence-based care while understanding the complexities of social determinants and how they lead to health disparities and inhibit the quality of care. Yet they cannot accomplish this task without being equipped with the proper tools. We must provide students with the training, skills, and support they need to take this agenda forward.

The purpose of education is knowledge not merely of truths but also of values. There may be moments in our lifetime when we feel helpless to prevent the inequalities and injustice in our society, but there must never be a time when we fail to try to overcome them.

Jamar Slocum is a general preventive medicine fellow at the Johns Hopkins Bloomberg School of Public Health. Isabel Chen is an Instructor of health system science at Kaiser Permanente School of Medicine. Natalie Kirilichin is an assistant professor of emergency medicine at the George Washington University Department of Emergency Medicine.

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Med students need social mission education now more than ever - STAT

Even as the United States slowly opens back up with restrictions on nonessential businesses easing, coronavirus disease 2019 (COVID-19) has left an indelible mark on human history. The full impact of the lives lost and the disability caused by COVID-19 are only part of the picture.

Oncologists, just like their patients, are facing an unprecedented emotional burden from the COVID-19 pandemic. First-line responders are at especially high risk of experiencing psychological hardship from the burden of disease, death, and anxiety, whereas oncologists, in particular, are feeling the strain of worried patients, financial hardship, and uncertainty about the future.

Even during ordinary times, women physicians, resident physicians, and medical students face higher rates of depression than the general population.1,2 Every year, it is estimated that 400 physicians take their own lives, with women physicians facing a much higher risk of suicide than the general population.3 Increased emotional stress from these difficult times may increase the risk of depression in physicians. Sadly, the toll of COVID-19 has already resulted in the loss of one of our emergency department physician colleagues.4

Emotional Contagion Emotions, just like viruses, are contagious. Psychologist Steven Cohen, PsyD, notes that physicians, just like all others, are at risk of internalizing the negative feelings of the people around them. Physicians who work in a daily atmosphere of severe emotional distress, fear, and worry, must take special precautions to avoid being overwhelmed by these negative emotions.

According to Cohen, the first step to managing emotional distress is to simply acknowledge and examine our emotional reactions. Physicians often experience guilt, anxiety, or shame when powerful emotions like sadness or anger are experienced. This discomfort leads to the repression of feelings. Because unexamined emotions lead to distraction, inattention, irritability, emotional exhaustion, and burnout, Cohen says that it is essential to acknowledge and reflect on these feelings.5 This is especially important for oncologists who face emotions involved with patient death. Traditionally, grief in medical training has been considered weak or unprofessional, and doctors have been encouraged to suppress their feelings. Rather than openly expressing grief, physicians instead use the technique of compartmentalizationputting the painful emotions into a metaphorical sealed box.

Healthy coping mechanisms such as acknowledging feelings and accepting support from others are important to practice.

Physicians are often reluctant to share negative emotions with others. It is critically important to open up about feelings with a family member or trusted friend or colleague.

In some cases, reaching out to a professional to help cope with powerful emotions is important. Asking for help is not a sign of weakness. In fact, it takes more courage to ask for help than it does to suffer in silence.

One of the dangers to sudden traumatic events like the COVID-19 pandemic is that they can trigger sudden, intense feelings of helplessness and hopelessness, which can provoke suicidal thoughts even in people without any underlying mental conditions, says Cohen. He notes that receiving adequate mental health care at the time of the serious event may help physicians to have improved emotional and cognitive resilience to withstand the impact of the trauma.

To get the best result in managing depression symptoms, physicians must work with a trained clinician in a structured fashion. Avoid self- treatment or using friends or colleagues informally for medical care. Instead, ask a trusted colleague or your primary care physician for a recommendation to a psychologist.

Although physicians often worry that seeking psychological help may have an adverse effect on their career, there are ways to get help conf identially or even anonymously. For example, both the Collier County Medical Society and the Lee County Medical Society in southwest Florida provide free and completely confidential sessions for physicians in the community. Others, including the LifeBridge Physician Wellness Program, offer a free toolkit that helps organizations start confidential programs for doctors.6

Well-known factors associated with physician depression include lack of sleep, dealing with death, making mistakes, 24-hour responsibility, self-criticism, and difficult relationships with coworkers and patients.7

Physicians must acknowledge the need for self care.8 Take time to manage the physical needs for adequate sleep, nutrition, exercise, recreation, and social activities. Avoid turning to maladaptive techniques of self-care. Acknowledge that despite best efforts, failures can occur.

Although these are difficult times, look to others for support. Physicians are incredibly resilientcompleting medical school, internship, and residency takes incredible fortitude. Everyone just needs a little help from friends, family, each other, and perhaps, a good psychologist.

Rebekah Bernard, MD,is a family physician in Fort Myers, Florida, and the author of Physician Wellness: The Rock Star Doctors Guide.This article originally appeared in Medical Economics.

Reference:

1. Frank E, Dingle AD. Self-reported depression and suicide attempts among U.S. women physicians. Am J Psychiatry. 1999;156(12):18871894. doi:10.1176/ajp.156.12.1887

2. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354373. doi:10.1097/00001888-200604000-00009

3. Sargent DA, Jensen VW, Petty TA, Raskin H. Preventing physician suicide. The role of family, colleagues, and organized medicine. JAMA. 1977;237(2):143145. doi:10.1001/jama.237.2.143

4. Watkins A, Rothfield M, Rashbaum WK, Rosenthal BM. Top E.R. Doctor who treated virus patients dies by suicide. New York Times. Published April 27, 2020. Updated April 29, 2020. Accessed June 10, 2020. https://nyti. ms/2AAtxwu

5. Granek L, Tozer R, Mazzotta P, Ramjaun A, Krzyzanowska M. Nature and impact of grief over patient loss on oncologists personal and professional lives. Arch Intern Med. 2012;172(12):964-966. doi:10.1001/ archinternmed.2012.1426

6. LifeBridge Physician Wellness Program. Working to mitigate physician burnout. Accessed June 10, 2020. https://bit.ly/38yPI2R

7. Bright RP, Krahn L. Depression and suicide among physicians. Curr Psychiatry. 2011;10(4):16-30.

8. Bernard R. The 5 elements of physician self-care. Medical Economics. November 6, 2019. Accessed June 10, 2020. https://bit.ly/2CbEPrx

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Coping With Physician Depression in the Era of COVID-19 - Targeted Oncology