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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.
[Dr. Zuroweste]:
Welcome to today's podcast it's titled 'COVID
Care After the COVID-19 Public Health Emergency:
Vaccines testing and treatment'. I'm Dr Ed
Zuroweste. I'm the Founding Medical Director
of Migrant Clinicians Network and today I am very
delighted to have my friend and colleague Esther
Rojas with me. She's the Project Coordinator
at migrant Clinicians Network who's been
heavily involved in our work with COVID. We'll be
discussing changes in COVID care after the end of
the Public Health Emergency and important guidance
on vaccines and care access that clinicians
should be aware of. Esther Rojas works as MCN's
Project Coordinator in the Eastern region office.
She received her BS in public health from
Salisbury University and a certificate in
community-based participatory research from
the University of Michigan in 2021. As the
project coordinator, her work has included
the coordination and management of various
COVID-19 projects focused on increasing vaccine
awareness in migrant and vulnerable populations in
the United States and Puerto Rico. Since March of
2022 Rojas has worked closely with community-based
organizations to provide technical assistance
and capacity building to community health
workers serving Latina, Latino, and Haitian
communities in her state. Welcome Esther!
[Rojas]: Hi Dr. Ed, thank
you so much for having me.
[Dr. Zuroweste]: On a personal note I've
worked a lot with Esther, we've done a lot
of webcasts together, we've done a lot of
learning collaborative sessions together,
and Esther's really been the one who's been
working day to day on the front lines with
community health workers and providers who were
doing the work of vaccinating individuals for
COVID and educating them about COVID. So,
Esther, why don't you just kind of give
us a snapshot of a day in the life of Esther
over the last year or two working on COVID.
[Rojas]: Yeah, absolutely. So like you said it
was, it was a lot of that capacity building,
a lot of that technical assistance for our
community health workers and also for the
community-based organizations that they work for.
So in my day-to-day I am able to coordinate a lot
of the efforts not just with Dr. Ed here, but
also with a lot of our teams, project managers.
And what MCN has essentially done is break down
the science for a lot of our community health
workers and community-based organizations. So,
these health agencies like CDC were putting out
suggestions, recommendations, and policies about
COVID-19 and we were able to take that, break it
down for the everyday individual, and also for
our migrant, immigrant and refugee communities,
in a way that made sense to them. So
my day-to-day includes some of that,
and then I also am able to work locally here with
the Lower Shore Vulnerable Populations Task Force
where we're addressing, again, COVID-19,
but also taking that holistic approach
and identifying the barriers. So, whether
it's food, whether it's housing, education,
and child care that might limit someone's
access to COVID-19 vaccines or treatment,
Etc. So, I'm a little bit all over the place, so
my day-to-day is a little bit hard to define, but
it includes a lot of a lot of great work with
a lot of great partners and contributors.
[Dr. Zuroweste]: Great, great. Well, we thought
we'd start out this session with just a little
bit of quick review. I'm just going to spend
a few minutes on reviewing COVID vaccines and
going to talk about why it's important
to stay up to date with your vaccines,
the risk and benefits of vaccines. And I thought
I'd start out with just a little historical
background. You remember that the first case of
COVID came into the United States in actually
January of 2020. We didn't have our first
death until about the end of February of 2020.
And then amazingly, by December of 2020, less
than a year after that first case came in,
we had the first FDA-approved vaccine.
And that was a monovalent vaccine,
that was just for the Delta strain of COVID that
we had at that time. And then we had our first
bivalent booster in September of 2022, and it
was bivalent in that that one had not only the
Delta but also the the Omicron strain. And then
in April of this year, 2023, it was approved
by the FDA and the CDC for certain high-risk
populations to get a second bivalent booster.
And now it looks like in the fall of 2023, this
year, we're probably going to have a monovalent
Omicron-only booster. And it looks like from
both the FDA... the FDA met in the middle of
June and they approved having a monovalent.
And so I think the most important thing is that
people should stay up-to-date on their vaccines.
especially if they're in those high-risk groups
of anyone over the age of 65 or anyone who's
immunocompromised. Those are the people who are
most likely to get COVID and have bad outcomes
from COVID. The other thing that's important to
remember about vaccines are that vaccines were
developed not necessarily to prevent infection,
they were developed to prevent the worst
side effects of getting COVID infection ,that of
hospitalization and deaths. So it's been shown
over and over again that the COVID vaccines
have prevented tremendous amounts, probably
70 to 90 percent, of hospitalization and deaths
from COVID, if a person is fully vaccinated.
There is no such thing as a vaccination
without side effects, there's always side
effects. The most significant side effect
from this vaccine... First of all I have to
say these are the safest vaccines we've ever had
in the world, they're extremely safe vaccines.
The only really significant side effect that
we've found was really the very rare myocarditis
in adolescent males. That was probably the
most significant side effect that came out
of this whole COVID vaccine situation, and it
must be pointed out that the actual myocarditis
that you get from COVID is much more severe.
So I think I'm going to stop at that point,
at this point in time. That's kind of a little
update on vaccines. And now I want to ask
Esther a bunch of questions. So, Esther my
first question to you is can you explain
why we need to continue to talk about COVID
after the end of the Public Health Emergency?
[Rojas]: Ed, I'm gonna lead
with my biggest takeaway here,
COVID isn't over. The only thing that
really ended was the way that our government
is responding to COVID-19 by no longer
providing that funding that we initially had.
So, this also affects the way that we monitor
and collect our data about COVID-19. But, we are
still seeing that deaths due to COVID, and also
infection rates, are still occurring nationally.
[Dr. Zuroweste]: All right, my next
question is, what services have ended
now that the National Public
Health Emergency is over and
how will this impact immigrant,
migrant, and refugee communities.
[Rojas]: So, one of one of the biggest changes
that is coming about, and probably one of the most
obvious for many of us, is that that funding is
no longer there for the free vaccines, free tests,
and also some of those treatments, which will
essentially impact the way that our communities,
the migrant, immigrant, and refugee communities,
are able to protect themselves, treat,
and also care for their families and their
households. Another aspect is the continuous
Medicaid re-enrollment which has been changing
on a state-to-state basis but throughout the
COVID-19 pandemic, essentially the last three
years, individuals were able to sign up one time
for Medicaid benefits and then that coverage
would continue on a year-to-year basis and
they wouldn't have to navigate this complex and
confusing system that is our Medicaid Program.
Another aspect is a reduction in funding to
community-based organizations and health agencies
that are aiming to increase the COVID-19 vaccine
in their communities. And also our SNAP benefits,
which many individuals know as food stamps,
has reduced significantly for many individuals,
and also, this affects the way that
they're able to feed not only themselves,
but also their children, which in in total,
it will affect our communities as a whole.
[Dr. Zuroweste]: How could these communities
still access health care coverage?
[Rojas]: Yeah, so like I mentioned, the end
of that continuous Medicaid re-enrollment,
because it is ending, many individuals will now
have to navigate that system which is, again,
it's very complex. So the best way, the best
thing that they can do, and the best way that
they can continue to be informed, is when they
receive a notice about the end of their continuous
enrollment, they can ensure that their contact
information is as up to date as possible. And
also, try to find any services which will provide
language access and also any assistance when it
comes to computer access, in order to re-enroll
again. For our refugee individuals, they're able
to access the refugee medical assistance for up
to 12 months after they arrive into the country.
Any individuals who are not eligible for either of
those, there's always employer health insurance,
or they can find health insurance through the
health insurance Marketplace. Which, again,
I don't feel like that is a sufficient answer
for many individuals. But we have our Federally
Qualified Health Centers, which of course are a
great avenue for individuals seeking vaccines,
tests, and care in general. For
many individuals who are uninsured,
or underinsured, our health departments are also
a great access point for many of these treatments,
not just COVID-19 but any other information.
And for our community-based organizations,
my recommendation would be to continue
mapping out where are these agencies,
or these free access points, for many of our
communities, in order to fill those gaps.
[Zuroweste]: And that's important. I think
it's important that everybody knows that
community health centers and public health clinics
don't turn anyone away. And if they have problems,
they will find a solution for those individuals.
There's a new federal program that I've just heard
about very recently and I want you to explain
a little bit about the new Federal Health and
Human Services Bridge Access Program for COVID-19
vaccines and treatment. We've been hearing
a lot about that over the last week or two.
[Rojas]: Yeah, so have I, I'm trying to learn
about as much as I can. And, really, what the
Administration, the current Administration,
has said is that this Bridge Access Program
is going to fill some of those gaps where the
funding left off from the Public Health Emergency.
So, I personally would say, I'm not sure what the
rollout is going to look like, so it might change,
but what we're hearing is that there's essentially
going to be three access points for individuals
seeking free COVID-19 vaccines. And this is set to
roll out in the fall of 2023, so quite soon now.
And the three access points will be: Number one,
are Health departments which the CDC denotes
as the local health agencies, and they will
essentially take and distribute from the CDC
these COVID-19 vaccines to their networks. Number
two is going to be our Federally Qualified Health
Centers, like you said, they don't turn away
anyone, regardless of their health coverage.
And then lastly our retail pharmacies, which
is an incredible I think feat for for us to be
able to say that our pharmacies are going to be
partnered with us in the fight against COVID-19.
But they're going to be covering for individuals
who are also insured, but their insurance does
not cover the whole cost of the COVID-19
vaccine. So, a lot of unknowns I would say.
[Zuroweste]: Right, that's really great. The
the Administration really understands that,
especially in the fall when these new vaccines
come out, that we're going to have to have access.
And the real concern is, last year also, what we
saw was because of all this anti-vaccine dogma
that's going on out there, and misinformation,
even the flu vaccine last year was not accepted
as well as it had been in the past. So hopefully,
with the retail pharmacies, and they're oftentimes
also trusted partners in the communities, for
them to partner I think will really be helpful.
[Rojas]: I would also add that we've
also seen kind of the tide change,
with not just our Administration but,
also with the vaccine manufacturers,
and this is something that I should add
Pfizer and Moderna have announced that
they are also in this movement to provide free
vaccines for individuals. So, what I think is
going to happen is that there might be some
interplay between what we know as the Bridge
Access Program through our federal government
and also these large vaccine manufacturers,
to continue providing free vaccines once the
vaccines go into the commercial market. So,
something else to keep an eye out for, and
and hopefully we'll see a smooth transition.
[Zuroweste]: All right, well you just
explained that you and I are having
trouble keeping up with all this, so how
can clinicians who are out there on the
front line doing a lot of other things, very
very busy every day, how are those clinicians
going to stay updated on the changes in
access to COVID care for their patients?
[Rojas]: So, I'm gonna do a shameless plug for
MCN, because we have this amazing resource which
is available in both English and Spanish, and that
is our Frequently Asked Questions blog 'COVID-19:
Migrant and Immigrant Food and Farm worker
Patients', which, like I said, is available in
two languages. We are able to gather a lot of
our latest questions, but also, we have a lot
of the basic questions, and questions specific to
our working communities, our migrant communities,
a lot of great information for clinicians. And
I will say that I use it personally. Sometimes
there are questions that I need answered,
and this is one of the best ways to have
those questions answered. We're able to pull
questions and and also comments from our local
community partners and national partners in order
to gather more information of 'what are we hearing
on the ground?', and then also have our amazing
clinicians on staff, like Dr. Ed and Dr. Laz,
who are able to break down some of that science
for us. I will also mention that there are amazing
videos that are tagged to those questions which
will also help increase the reach of our amazing
blog. So, I believe our link to that is going to
be added, but of course, always check with the CDC
websites, check what the FDA, CDC are saying with
any other additions to what's going on with COVID.
I know everything changes so rapidly, but we like
to be as up-to-date as those agencies are as well.
[Zuroweste]: Those are great resources. Any other
resources you could think of that we
need to add at this point in time?
[Rojas]: Yeah! MCN's amazing website. We
also have a great COVID-19 web page which
has a lot of printable social media
resources, easy to change and highly
editable for anyone who wants to share
with their community more about COVID-19.
[Zuroweste]: Great, and I should point
out that the resources for this episode,
including a recording of the MCN webinar
that Esther and I presented on this topic,
can be found through the link in
the notes section of this episode.
So, I think at this point in time I just want to
thank all the podcast listeners. I want to thank
you for joining us today and speaking with Esther
on this topic. I want to obviously thank Esther
for joining me today for this discussion, and
all of her great insight from literally the front
lines of what we've been doing at MCN. And you can
reach our staff anytime on our web page. I want to
thank the listeners, there's more expert guidance
and tools to improve the quality of code care for
their vulnerable populations by following
our other podcast 'On the Move with MCN',
and come back and listen to us again! So,
Esther do you have any closing remarks?
[Rojas]: I just want to say thank you to you,
and again, thank you to all of our listeners,
whether you're catching us in video on YouTube
or finding us on your streaming services.
I think this information, it's incredibly
important, and I'm so happy to be able
to do this work, not just with you Dr Ed, but
with our communities and our partners as well.
[Zuroweste]: Well, thank you again
Esther, great job. And everybody,
come back for our next podcast. Thanks
a lot, and we'll see you very soon!
[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.
