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Language: en
[Intro]: Welcome to 'COVID's Lasting
Impact: Caring for Immigrant, Migrant,
and Asylee Patients', a 10-episode mini-series
within Migrant Clinician Network's 'On The Move'
podcast, a podcast dedicated to providers
who work with vulnerable populations,
specifically migrant populations. In this
mini-series MCN provides clinical teams,
including community health care workers and
Primary Care clinicians, with up-to-date
information, expert guidance, resources,
and relatable case stories for identifying,
treating, and managing COVID and long covid
among US-based immigrant, migrant, asylee,
and limited English proficient patients in
the outpatient setting. MCN is a national
non-profit with extensive experience
providing timely, practical solutions,
at the intersection of vulnerability, migration,
and health. Each episode provides clinicians with
impactful tools and information for improving the
quality of COVID care for vulnerable populations.
if you want to hear future conversations on the
topic of Health Justice be sure to subscribe
to the 'On the Move' podcast. For resources
mentioned in today's podcast be sure to click
on the link in our episode notes to go to our
podcast page at migrantclination.org/podcasts.
[Music]
[Zuroweste]: Well welcome back to
another episode of our miniseries. I'm
Dr Ed Zuroweste. I'm the Founding Medical
Director of Migrant Clinicians Network,
and co-hosting again with us on this episode is
Dr Elena Rios. Dr Rios serves as the President
and CEO of the National Hispanic Medical
Association which represents 50,000 Hispanic
physicians in the United States. Dr Rios also
serves as President of NHMA's National Hispanic
Health Foundation to direct educational and
research activities. Welcome back Dr Rios!
[Rios]: Thank you Dr Zuroweste. I think it's a
great pleasure to be helpful in educating more
clinicians about our communities. So, thank you
for having me. Today we will be discussing how to
address COVID-19 in special populations with
underlying comorbidities, and I'm very happy
to have, today, with us Dr Susan Gaeta. Dr Gaeta
graduated from the University of California Davis,
School of Medicine in 1998 and she currently
works at the department of emergency medicine
at the University of Texas MD Anderson Cancer
Center where she does research in sepsis,
advanced care planning, emergency medicine, and
emergency medical care of cancer patients. She
is board certified in Internal Medicine and
is currently pursuing a master's in health
care transformation at UT Austin. She also has
been in two different leadership programs. I
think it's great to see you Dr Getta - she
was part of our National Hispanic Medical
Association Leadership Fellowship in 2022 and
also participated in the Center for the Study of
Latino Health and Cultures, accelerating latinx
leadership cohort of 2023. Dr Getta, welcome.
[Gaeta]: Thank you, thank you,
Dr Rios for that nice introduction.
And, nice to meet you Dr Zuroweste.
[Rios]: So, Dr Gaeta, we wanted to start with
asking you for some examples of day-to-day
activities working around patients with
COVID and infectious disease specifically.
[Gaeta]: So, as you mentioned, I work for MD
Anderson Cancer Center in the department of
emergency medicine. And for those who are
not aware, we predominantly take care of
all our cancer patients which, you know, they
are immunocompromised either because of their
cancer or their treatment. So, they're definitely
at risk for infection. So, well, most of you know,
the United States probably hasn't gone to masking
- we're still masking every time we go into work.
And then of course we're using our protective, you
know, protective clothing when we're seeing our
patients. And then, even within our institution
we're asking our employees and our visitors to
still wear a mask when they're in, you know,
mixing with different individuals. And then,
of course, you know, you don't want to be wearing
your mask all the time, so for our patients if
they're in their room by themselves we tell
them 'you can take your mask off so that way
you can breathe'. And then, of course, you know,
like any other hospital, you know, we wash our
hands before we see our patients, and after we
examine the patients, we always wash our hands
afterwards. And along with COVID, you know, for
us, because our patients are immunocompromised,
they're at risk for a lot of infections.
Particularly respiratory along with the flu and
the RSV. So, we're always kind of having that in a
high differential when we're seeing our patients.
[Zuroweste]: Well, that's a great
introduction. And we've got several
questions we'd like to ask you
today, Dr Gaeta. First of all,
can you review some of the symptoms of COVID
which have actually changed over time - you know,
we're now in like year three of COVID, and
some of the symptoms have changed - as well
as what the leading recommendations are
right now for prevention at this time?
[Gaeta]: Thank you Dr Zuroweste, that's a
great question. So if we go back, you know,
to 2021, people were coming in, you know, with
"I'm having diarrhea", "nausea", "vomiting",
"loss of taste or smell". Now if you
fast forward to now, to 2023 and 2024,
what we're seeing is some patients are just coming
in with a fever or sore throat. Occasionally
you'll see some coming in with shortness of
breath. And then I see patients that come in,
at least in my population, with fatigue. And,
you know, I examine them and then, you know,
we get our respiratory swab and they're positive
for COVID. And they're like 'what do you mean
I'm having COVID?". So you're seeing, in summary,
people with fever, short throat - but occasionally
I'll have someone come in with shortness
of breath - and cough, which is different
than before when it tended to be more multiple
symptoms when we initially started the pandemic.
[Rios]: So, Dr Gaeta, I have
another question too. What are
the comorbidities that might make a
person more likely to get COVID and
are some populations at higher risk
for having certain comorbidities?
[Gaeta]: Literature shows that if you're age 65
or greater, if you're immunocompromised - and
immunocompromised could be from cancer or there's
also other immunocompromised patients, you know,
if you have rheumatoid arthritis and you're on
treatments. And then, going back to the cancer
patients, which is what I focus on, if you have a
hematological cancer like leukemia versus a solid
tumor like a kidney disease, a kidney cancer,
you're more at risk with the ones that are
hematological cancers. And then, also, bringing
it just to an everyday - if you have diabetes
type one and type two that's a risk factor. And
then, unfortunately, obesity is a risk factor.
And the reason I say unfortunately is because
we're seeing data - I take care of only adults,
but my colleagues in the Pediatrics - our
kids are having obesity. So they definitely,
that is another risk factor for having COVID.
And I just want to stress that even though these
are risk factors - anybody could get COVID, but
what's important about these risk factors is these
individuals are more at risk for having a severe
illness and particularly being hospitalized.
[Zuroweste]: Great, so you've gone
over the comorbidities. So my next
question is what kinds of social and
environmental factors might lead to
higher rates of comorbidities, such as diabetes
and cancers, in immigrant and other populations?
[Gaeta]: So, we'll start with immigrant
populations. When we look at the initial
data, what they've noticed is when you're first
generation, you're coming into the United States,
you don't have as much risk for cancer, but as
you get, the longer you're in the United States, a
second generation - because, you know, they start
adopting our Western diets, maybe less exercise, -
they're developing more risk. And then, also, one
of the things that, you know, going back to COVID,
is, you know, some of the things how to prevent,
you know COVID is, you know, you want to mask,
you want to do hand hygiene, and then also
social distance. So, if some of the patients,
the community, are immigrants, and if they're
living, you know, multiple families in one house,
you know, you could think of that's not much space
that you could distance yourself. And then also,
where the individuals are working, you know, if
they're working in the customer service industry,
in the hotels, you know there's a lot of people
there. If they're working in the fields, you know,
there's a lot of people and it's kind of hard to
kind of distance. So those are all different risk
factors that put our community at risk for getting
COVID or getting worsening disease from COVID.
[Rios]: So, I have another question. You know,
we have a lot of immigrants and other
populations that are working, laborers in,
whether it's rural or urban. How might poverty and
health insurance access impact these communities?
[Gaeta]: So, that's a great question. So, we'll
start with poverty so do you think, you know, you
know, if you ever turn on the TV, there's always
these commercials with fast food that you can,
I think it's like, you can get a dollar, two
burgers for a dollar. But then if you go to the
grocery store and you try to get some vegetables
- in fact I was just at the store the other day
and it was like apples it was like $3 a pound
- and so when you're, you know, you're short
on money and you have to sit there and figure
like 'how am I going to feed a family of four?',
while you may not want to not eat healthy, it's
easier to go buy the dollar hamburger versus the,
you know, pay for the vegetables. And then some
communities you don't even have access to, you
know, healthy food. You know, the food deserts.
So that's also a risk or a concern that causes,
you know, patients - even though they want
to be healthy, they don't have access to
it. That's from a poverty perspective. And
then from a health insurance perspective,
you know, even with our Affordable Care
act, insurance, you know, where we have
the marketplace - if you look into that, I
mean, it's expensive to get it. And then it's,
you know, a high deductible. And then you
go, you know, if you're able to get it,
then you go to the hospital or the clinic and
they're like we don't take Marketplace. So what
happens is patients are not able to go to the
clinics and get, you know, the preventive care,
get the, you know, seen by a doctor, get screened.
And then they end up in the emergency room when
they're later advanced because they don't want to
go in. I mean I often talk to my patient like 'why
did you take 10 days?'... "Well, I was trying to
see if I could get better". So those are some of
the things that make it worse when you don't have
health insurance. And then, also, with poverty.
[Zuroweste]: Well great. Well stay staying
on the social aspects, our next question is:
Do you think structural racism and
its impacts like mistrust of the
system has impacted health outcomes
for people at higher risk for COVID?
[Gaeta]: So yes, if you think back and, you
know, both in the African-American and Latino
communities, you know, there is a lot of
structural racism a lot of mistrust in the
healthcare system, you know. There's been a lot
published on the concerns. And so now you have us,
you know, the clinicians. And, you know, we are
telling our patients, you know, come, you know,
get screened for COVID, get these vaccines, you
know, get tested for colon cancer - all these
different things. And if the trust is not there
they're not going to want to believe you because,
you know, then of course the media doesn't
help because it's like 'oh doctors are getting
rich' with, you know, prescribing vaccines,
prescribing this. So, it definitely has an effect,
if the trust is not there. So, we need
to build that trust with our patients.
[Rios]: So, you know, I think it's
important to build trust. And we do
know that doctors especially are very
trusted, especially for families that
do have access to health care. But how would
you recommend doctors talk to patients and
community members who are actually hesitant
to get the vaccine, and what role do you
feel community health workers have in this
process as another part of the strategy?
[Gaeta]: Thank you Dr Rios, that's a great
question. And I was sitting here reflecting,
I remember actually one of my co-workers - she
is one of our nurses aid - came to me and she's
like 'you know, Dr Gaeta, I know you're always
talking about COVID vaccine, how it's important'
,she goes, 'but I'm scared'. So what I would say
is listen to where the patients are at. And so I
asked her, I said, 'why are you scared/'. She
goes, 'well I've heard that if I get my COVID
vaccine I'm gonna die'. I said 'well, let's unpack
that'. So I think that's the main thing, and the
message I would say is listen to them and see
what their concerns are, why are they hesitant,
you know, what they've heard. And, you know,
taking that time to see where they're at. And
you don't want to just say 'I'm the doctor you
need to take the COVID vaccine'. That's not the
way you built the trust and that relationship. So
I think that's what I would recommend is listen to
them and ask them, you know, why they're hesitant.
And it might take a couple of visits, a couple of
conversations. And, you know, for my colleague,
she came back to me a couple months later she's
like "I took the vaccine". And I said "okay,
good". I said, "and you were okay, you didn't
die?", she's like "no". I said "so share that
with your colleagues and your friends". So I think
that's how we get our patients to listen to us.
And then, as far as the community health workers,
I mean I can't speak a lot about them. I mean
they are helpful, you know, they're out in the
community, and one of the things that I enjoy
about the community health workers is they're
there talking to the community and asking, you
know, what is it they're concerned about and then
they're taking that, you know, either to myself
or someone else. And saying 'you know, I spoke
to this group, this is what they're concerned
about'. And so, we talk to them. And then also
providing that information for the community
health workers. I mean they're our strongest
advocate. They're out there in the community
and saying 'you know, this is helpful for you".
[Zuroweste]: I'm glad you brought up the
community health worker,s because this
podcast goes out and is viewed by a lot
of community health workers and a lot of
frontline providers. So my next question
is, what are some treatments now that the
community health workers and other clinicians
should be aware of and they should be telling
their community members about when it's
in regard to testing and or actually if
they become positive for COVID? What are
some of those pearls we need to have our
community health workers know and our clinicians
know when they're talking to the community?
[Gaeta]: So, we'll start with testing. I think
my recommendation, and looking at the literature,
is, if you think you have COVID, get tested. I
know initially, you know, we were getting - the
government was sending - COVID samples, tests,
you know, to your house. And I know recently
they restarted again. So get tested if you're
concerned. And then of course people say well,
you know, I can't afford it. And so you're always
- the recommendation is to get tested - but if
you're not able to get tested, kind of separate
yourself for five days to try to get better if
you're not getting tested. So definitely get
tested, avoid large crowds as far as testing.
For treatment, it's divided in two groups - adults
and children. And so there's currently right now
three main treatments at the moment based on
the current variants of the COVID virus that's
out there. So the first one that is Plaxovid, and
this is recommended for adult and children of age
12 and older. One of the things about this drug
is there's a lot of drug-drug interactions. And
so while it helps to prevent worsening disease
of COVID, there's always, when the prescriber
is going to prescribe this medication to the
person, you want to make sure that you review
what medications they're on and make sure there's
no drug-drug interactions. And then see if there
is a drug-drug interaction, can you hold that
medication while you're giving the Plaxovid. So
that's the main recommended treatment. Now because
there is a lot of drug-drug interactions there is
a second agent. However, this is only recommended
for adults and it's called Molnupiravir and the
the brand name is Lagevrio. Again, this is,
both of these Plaxovid and Molnupiravir are
oral agents, and the recommendation is to give
these for patients who are high risk of getting
complications from COVID. So the patients that
we've been talking about that are at risk,
this is where you would treat it. Now if you're
not able to get these oral agents, or if the
patient is needing to come into the hospital,
then there is one or a IV agent called remdesivir.
There is some hospitals that are giving this as
an outpatient. You have to keep in mind that it's
three-day infusion so you would have to go into
the clinic to have it done on three separate days.
It is approved for adults and children. And
then of course if you come into the hospital,
and we sometimes we do hospitalize our patients,
and we give that as an IV formulation. Again,
all these three agents are only recommended
for patients who are at high risk.
[Rios]: So, I think, you know, we've heard a
lot about the importance of continuing to be on
the alert for clinicians and community workers
who are in contact with patients who are sick,
and to consider COVID-19 as still a virus that
is plaguing our communities, especially our
poor communities and undocumented communities and
immigrant communities who may not have the access
to health care. And you may see them in your
community clinics. And I think it's important
that we heard from Dr Gaeta the importance of
getting tested, the importance of being educated
about being separated from other people - not
being in crowds. And also the importance of that
there are treatments available now for people to
be aware of. And I think what's important also is
that there's so many different immunocompromised
patients out there that don't even realize that
they could get worsened COVID or long COVID. And
we all need as a medical community and community
health worker community to be aware of letting
others know about the importance of these patients
so that we can get care for them. And I know that
it's hard with without insurance but I think the
community health centers, especially in our rural
areas, the migrant clinician centers for example,
are a place to have access to care because
they take care of everyone that they can.
And I think Dr Zuroweste, you could tell us
more about the challenges. But I think there's
a real opportunity for educating more of our
clinicians and community health workers - not just
doctors - about the importance of educating people
about the importance of getting care. Especially
when you have comorbidities already, whether it's
cancer - like the patients that Dr Gaeta sees - or
other immunocompromised. And even being over the
age of 65 and having more chronic diseases that
you may not be aware you have, you know, can
substantially give you the chances of having
worse COVID. So I think that we learned a lot from
you today Dr Gaeta and I think it's important to,
you know, thank you for all your knowledge. And
good luck with all your continued education of
your patients and the community health workers
you work with. I know you're doing a great job.
[Zuroweste]: Yeah, I think Dr Rios just summarized
very well what this podcast was all about. And I
think as we're, you know, 2024 COVID will still
be with us. We were all hoping it was going to be
gone in a year or two but it's still with us
in 2024, so we need to be prepared for that.
And I think the emphasis to me is that we need
to work with those community health workers who
are the trusted messengers for the communities,
and make sure that they're educated so that when
they go out in the communities, they let the
community know that COVID is still an issue
but there are resources for them at community
migrant health centers all over the country.
Whether you're documented, undocumented, it
doesn't matter. Whether you can pay or not pay,
it doesn't matter. There's sliding fee scales
for community health centers so that there
should be access for testing and treatment for all
patients in the United States. And so with that,
I want to thank Dr Gaeta again. And there are
resources for this episode, including a recording
of the webinar on this topic, can be found through
the link in the notes section of the episode.
[Rios]: And I just wanted to mention that
the National Hispanic Medical Association
has resources also that you should be aware of
in English and in Spanish for our communities at
www.HispanicHealth.info. That's hispanichealth,
one word, .info. And we also partner with the
Centers for Disease Control and prevention in
our Vaccinate for All Campaign. We have another
website Vaccinateforall.org. And I'll just share
a couple things about our programs to help more
doctors out there, and others, who want to become
leaders. We have two programs right now. One is
the Hispanic Leadership Development Fellowship
funded by the Office of Minority Health. This
is for students in Master's programs, Master's
graduate degree programs, or graduates within
the last two years of your master's program. And
we've had one cohort already. We're about to have
three different cohorts. These are students that
are interested in coming to Washington DC to work
for nine months at the US Department of Health and
Human Services. We provide mentoring from Hispanic
employees at HHS. We also provide webinars
like this with speakers who are experienced
in leadership and also with public health and
we're very concerned about the importance of
having more leaders within HHS that are Hispanic,
especially. The second program we have is actually
our leadership Fellowship that Dr Gaeta was a
part of. We now have a program really focused on
California right for the moment - the California
Leadership Fellowship of our National Hispanic
Health Foundation. That program is we're looking
for 10 doctors who work in California interested
in learning more about public health in the state
and also at the national level to advance careers
so that we can develop more programs and policies
with migrant centers with community health centers
and with our public health in general to be able
to help our communities through not only webinars
like this but policy positions and programs
where they can get into public health and
help us make changes in our communities for the
good of all Americans. So thank you very much.
[Zuroweste]: And, we want to thank our listeners
for joining us today to speak with Dr Gaeta. And
we want to thank you Dr Gaeta for taking time -
I know you're very busy - out of your schedule
to come and speak with us today. Your knowledge
is very important to us, so thank you Dr Gaeta.
[Gaeta]: Thank you Dr Zuroweste for the invitation
and Dr Rios. I just wanted to say in closing I
know we've been focusing on COVID, but along
with COVID it's flu season, RSV. So please get
vaccinated for flu and RSV if you meet the
criteria so we can take care of everybody.
[Zuroweste]: That's great, that's a very good
recommendation. And thank you again Dr Rios
for co-hosting again this episode, we really
appreciate you taking your time - we know you're
very busy - out of your schedule to come and
help co-host this for us. Thank you very much.
[Rios]: No, and thank you Dr Zuroweste for
inviting me and Dr Gaeta for for being a
great speaker. Just to let you know, we actually
have, the National Hispanic Medical Association
website is nhma.org and our California Leadership
Fellowship that I mentioned is actually under our
National Hispanic Health Foundation. That website
is NHMAfoundation.org, and you can see more
resources and activities that we're involved with
the help of our communities. Thank you very much.
[Zuroweste]: And I think if you
want to get in touch with Dr Gaeta,
for those of you who are on now,
she's on LinkedIn at Susan Gaeta
that's Gaeta MD FACP. And you can
email her at susgaeta@gmail.com.
[Rios]: I'd also like to let everyone know that
I'm also available on social media, especially
with Twitter and Instagram and also Facebook
and LinkedIn. And it's Elena Rios MD. Thank you.
[Zuroweste]: And for all of these links will
be listed in our episode notes. For more expert
guidance and tools to improve the quality of
COVID care for vulnerable populations follow
our podcast 'On the Move with MCN' and come back
and listen again. So thank you very much everyone.
[Gaeta]: Thank you everybody.
[Rios]: Thank you. Thank you.
[Outro]: To access resources mentioned in
today's podcast click on the link in our
notes section to go to our podcast page
at migrantclinician.org/podcasts. Visit
migrantclinician.org/signup to join our email list
and subscribe to our blog to get updates on new
MCN podcasts, resources, and webinars. Migrant
Clinicians Network is a national non-profit
dedicated to providing practical solutions at
the intersection of vulnerability, migration,
and health. We offer technical assistance, health
provider capacity building, resource development,
research, and data and evaluation support, and
virtual case management for mobile populations,
and free resources and training. The
information in this podcast is for
trained healthcare professional education
only. Information should only be used in
combination with up-to-date national and
international guidelines. The information
is not to be used as healthcare
advice for the general public.
