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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 MN 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]: I'd like to welcome you to MCN's
podcast. The title is "The Evolution of COVID-19:
Moving Treatment to the Primary
Care Setting". I'm Dr. Ed Zuroweste.
I'm the founding medical director
of Migrant Clinicians Network,
and I'm very pleased today to have
a co-host for this episode with me.
Dr Elena Rios is the President and CEO of
the National Hispanic Medical Association,
and President of the National Hispanic
Health Foundation. Welcome, Dr Rios!
[Dr. Rios]: Thank you Dr. Zuroweste,
it's a pleasure to be here with
Migrant Clinicians Network today.
[Dr. Zuroweste]: All right, if you won't mind,
if you would please introduce our speaker today.
[Dr. Rios]: Sure, so with us today as we cover
the topic of the treatment of COVID-19 being
moved towards the primary care setting, is Dr.
Trinidad Solis. Dr. Solis is a Deputy Health
Officer at the Fresno County Department of Public
Health in central California. Her duties include
guiding the County's response to disease outbreak
and assisting with health programs that promote
chronic disease prevention. She also coordinates
the Health Department's rural mobile health
program which aims to make health care access more
equitable for people living in Fresno County's
rural areas and for the Region's farm workers. Dr.
Solis is the proud daughter of Mexican, immigrant,
farm workers, with roots in the San Joaquin
Valley of California. She previously worked
as a Family Medicine Physician in Los Angeles
for several years where she treated a diverse
patient population. When the COVID-19 pandemic
began, Dr. Solis wanted to help the region where
she was raised and moved back to the Central
Valley to assist with local efforts directed
at mitigating the impact of COVID-19 on vulnerable
communities. Dr. Solis received her undergraduate
degree from Stanford University, yay Stanford, and
earned her medical degree from the University of
California San Francisco School of Medicine. She
completed her Family Medicine Residency at UCLA
Medical Center and obtained her Master of Public
Health degree from Johns Hopkins University.
Dr. Solis, welcome! And, Dr
Zuroweste, I know you're going to..
[Dr. Zuroweste]: Yes, Dr. Solis,
I would like to have you take the
opportunity now to say a few words
of greeting to our podcast audience.
[Dr. Solis]: Yes, well, I want to thank you
Dr. Zuroweste and Migrant Clinicians Network
for inviting me, it's really a pleasure
for me to be here with all of you today.
[Dr. Zuroweste]: That's great. Well,
if you wouldn't mind starting out by
just giving us kind of a snapshot of
a day in the life of you working as
a Health Officer at the Fresno County
Public Health as related to COVID-19.
[Dr. Solis]: So yes, I joined
our health department in 2020,
right at the beginning of the pandemic.
And, my duties at that time included,
for example, creating health advisories for our
providers in the region, updating them on the
latest with COVID, not only the COVID variants
but then eventually when the vaccines came out.
I'm also, I assist with outbreak so when
it was happening at different facilities,
providing guidance, and I also helped initiate
vaccination events at agricultural workplaces.
And, we were one of the first counties in the
country to really start doing that, where we
brought the vaccines to where farm workers were
working at, and we found because of our efforts
we were able to administer over 35,000 doses of
the COVID vaccine to farm workers. And currently,
in my duties now, a few years later after
the pandemic, as you mentioned, my duties do
include creating health advisories, but it's not
only on COVID, it's on other infectious diseases
that might be occurring in the community. Also,
promoting eating healthy, exercising, and also,
as well, like other outbreaks that may occur,
I provide guidance and I'm running the rural
mobile health program. As Dr. Rios mentioned,
we're similar, we're meeting the community
where they're at. And now besides offering the
COVID vaccines, we're offering other services
such as diabetes screening, blood pressure
checks, and other screenings, such as those.
[Dr. Zuroweste]: That's great, that's
great. Well, Dr. Rios and I have some
other questions we'd like to ask you so I'll
let Dr Rios start out with those questions.
[Dr. Rios]: Sure, the first question we
have is 'What are some of the outpatient
therapies and treatments for COVID-19, now,
that Primary Care clinicians should know about?'
[Dr. Solis]: Yes, and so before I begin, I
do want to clarify that I do not have any
potential conflicts of interest with any of the
medications that I will be discussing, and these
treatments that I'm going to be talking about are
really based off evidence-based guidelines that
the National Institutes of Health or NIH provides
for clinicians. And so, in regards to treatments,
really, the NIH, based off the effectiveness of
the treatments, ranks the current treatments that
are available for individuals, and the first
one on that list is the oral antiviral known
as Paxlovid. And this medication is close to 90
percent effective at preventing hospitalizations
and death. And what I really want to stress
for providers, is that these medications,
the oral antiviral Paxlovid, and also
the second one, an oral antiviral, is
Molnupiravir, is that these medications are
very good for individuals who are considered
high risk. So for any clinician, when they see
a patient in their clinics who are symptomatic,
have COVID symptoms, and they're
high risk, which means older age...
So, the CDC considers anyone over 50 years old as
older age. And the studies show the older you get,
such individuals are at higher risk of having to
be hospitalized, or have other severe outcomes,
due to getting infected with COVID. Also, having
chronic diseases. As a primary care doctor,
I see a lot of patients who have diabetes
- very common in the Hispanic community and
other communities of color. High blood pressure,
asthma... I know at this time there's a lot of
parts in the country where there's bad smoke, air
pollution, and that can contribute to worsening
of asthma. And if you get COVID on top of
that, it puts you at high risk. So, again,
if any of these patients come into your clinic are
high risk, as a primary care provider I think it's
good to have that discussion with your patients,
because a common barrier I see is that individuals
don't even know that these treatments exist. A
barrier for some providers with Paxlovid that
I hear from, when I speak with providers in in my
region, is that they're concerned about drug-drug
interactions. And they're worried "well I'm not
sure, can my patient take this?" So I do want
to highlight that there are drug-drug interaction
tools available - online, you can check with your
local health departments... Because, we don't
want that to be a barrier for our providers
to at least have that discussion with their
patients and and prescribe such treatments.
[Dr. Zuroweste]: Yeah, I have a second
question for you. Since you mentioned
that you've worked with migrant farm
workers in the past, my question is,
what are some of the possible negative impacts of
the treatment changing to the primary care setting
for those vulnerable communities such as migrant
farm workers, immigrants, and asylum patients.
[Dr. Solis]: Yes, well, from what I've seen with
the farm worker population out here in the Central
Valley, is that many patients, such as the farm
workers, have issues with access to care. So
either they don't have health insurance, or in our
region, there's a doctor shortage. So it can, even
if you do have health insurance, it could take
a while to get an appointment with your primary
care doctor. And with these treatments that we're
talking about today, it's really critical once a
patient has COVID symptoms, and they're testing
positive, and they're high risk, that they get
treatment within five days of getting these
symptoms. So that that could be a barrier,
Dr. Zuroweste, in that if someone wants access
to these treatments, and now that it's mainly
in the outpatient setting, it can be difficult to
access them. But there are solutions. I do want
to stress that, for example, in our County, now
that the COVID emergency has ended, we saw a lot
of COVID test and treat sites being scaled down,
not only here, but throughout the country. And so,
because of that, we have this rural mobile
health program where, again, we're meeting
the farm workers where they're at. We're not only
doing COVID vaccines, but also testing them - If
they have symptoms for COVID, treating them right
then and there. So that is one way we've developed
a safety net even though the COVID emergency
has ended. And we are sharing these lessons
with other counties. We've gotten inquiries from
other local and state health departments asking
about this program. So I do feel utilizing mobile
health services is one way to bridge that gap.
And also the telemedicine - what we've seen
during the pandemic, telemedicine is another
way to reach these vulnerable communities that
may take a while to get a clinic appointment.
And, you know, a lot of our patients nowadays have
a phone. And so even in our rural areas... so in
the county where I work, here in Fresno County,
there is a mixture of metropolitan and rural,
and so for some of my patients it's
difficult to make it to a clinic where,
you know, if it's in the metropolitan area...
and they don't have a car and transportation
issues.... but with telemedicine we
are able to bridge some of those gaps.
[Dr. Rios]: So I have another question, and this
is, I'm going to make it a little different than
what we've talked about, you already mentioned
Asthma as one way to triage your patients to know
that they're going to have more risk for COVID-19,
or higher risk. What other types of patients would
you recommend to clinicians to help prevent COVID
infections? What, and I'm thinking that you've
already mentioned farm workers, what about
perhaps other vulnerable communities that you see,
and what are solutions for them? And I'm thinking
perhaps Spanish speaking, needing interpreters,
or services, or perhaps those with other
chronic diseases that you've seen in Fresno.
[Dr. Solis]: Yes, that's a great question
and so in my specialty as a Primary Care
Family Medicine doctor, we deal with a lot of
chronic diseases, and so I've seen a lot of
patients who have diabetes. So even having
diabetes, that can affect an individual's
immune system if it's poorly controlled, So
that also places individuals at risk. The CDC
also lists people who have heart disease and
they also note high blood pressure. So again,
another disease where a lot of individuals have
high blood pressure and they don't necessarily
know that, that puts them at higher risk.
So as clinicians I think it's important,
again, when someone comes in your office and
they have COVID symptoms or are testing positive,
or if they're calling through a telemedicine
appointment, it's good to look at their problem
list, or if they're a new patient to ask. As you
were saying doctor Rios, asking about if there's
heart disease, or diabetes, or asthma, even
obesity. In my county, unfortunately, there's
high levels of obesity and that can also increase
one's risk of having issues, of being hospitalized
or dying. And you mentioned other communities such
as Spanish-speaking. And so, in my county there's
a lot of Spanish speakers, especially, as I
mentioned, with our farm workers, also monolingual
Spanish speakers. And so I think utilizing,
for example, in a clinic setting, having
translation services as well, to explain,
if the doctor is not bilingual, that way
they can assist with explaining. Out in the
community, from a public health standpoint,
we utilize community-based organizations where we
have community health workers that also come and
educate the public about 'hey, what to do... have
a plan if you have COVID, talk to your doctor."
And also, we noted that a lot of farm workers not
only speak Spanish but they also speak indigenous
languages. And so that was a learning lesson
for us, to not assume if they're monolingual
that it's Spanish, it could be indigenous. So we
do have a community-based organization that speaks
indigenous languages and they also do outreach and
help us out. So I think that's a great question.
So in the clinical setting using translation
services, as you mentioned, but also out in
public health we also work with our community
health workers, also known as promotoras.
[Dr. Zuroweste]: That's great. So you've given
some information about treatment for clinicians,
but where can other healthcare clinicians turn to
for additional guidance if they have
questions about COVID treatments,
and where can they find educational resources
about COVID treatments for their patients?
[Dr. Solis]: Yes, so I'm going to share some
resources that I find really helpful and that
I consider evidence-based. So, I referenced
the NIH. So, the NIH has a section about COVID
treatments. And they list it based off the
order of efficacy. And as we know with COVID,
the virus is constantly changing. Earlier on in
the pandemic there is monoclonal antibodies,
and we were talking about them, and unfortunately,
due to resistance and the virus changing,
those are no longer listed. And so that is
something I would like to share with our
providers that I have found useful. So that's
the NIH. Also, the CDC. There's a section for
healthcare providers that talks about, not only
the COVID treatments, but possible side effects
and also, as I mentioned, drug
interactions, what to look out for..
Those are two good resources that I look for. And
finally, I just want to say, you know our medical
providers can also turn to their local health
departments. We get a lot of, for example, from my
perspective, I see a lot of emails coming through
from providers having questions. Sometimes it's
medical ones about COVID treatments. And just
know you can always reach out to your local
providers at the health department, or even state
health departments have a team that can answer
questions. So hopefully that gives our medical
providers that are listening to this podcast
some resources to turn to. And know that I don't
want that to be a barrier about starting someone
on an antiviral, COVID antiviral, if they're not
sure, there's resources out there to guide them.
[Dr. Rios]: Yes, and from the National
Hispanic Medical Association our website
is NHMAmd.org. And we do have.. 'Vaccinate for
All' is our campaign to increase information
about vaccines for COVID-19. But we
also started a new website that had
been revised called hispanichealth.info, and
like Dr. Solis mentioned, we have resources
in English and Spanish for the provider and
for the patient. And there's links to CDC,
NIH too, but also links to others and other
medical societies that have information. We've
tried to collect information all in one
place. Hispanichhealth.info. And then of
course we have virtual briefings that we've
had for the last three years. They've all
been recorded. And those are on our YouTube
for National Hispanic Medical Association.
[Dr. Zuroweste]: That's great, and Migrant
Clinicians Network, just so you know,
the resources for this episode, this podcast,
including a recording of MCN's webinar with Dr.
Solis that she presented on this topic, can be
found through the link in the notes section of
this podcast. So just in recap, Dr. Solis, you've
given a great explanation of what we can do at the
primary care level, and I think it's important
that you've also mentioned how to do outreach
to populations that oftentimes aren't coming into
the primary care setting. I really appreciate all
the knowledge you've shared with us today and
I'll let Dr Rios give any final comments, also.
[Dr. Rios]: Well I think Dr. Solis you've done
a great job with also presenting a, you know,
a more holistic approach to our vulnerable
populations like farm workers, or like you
mentioned, Spanish-speaking who are monolingual,
or even indigenous language populations. And one
of the things that you mentioned that I think
providers don't think about is, many people
don't have insurance or don't have access, so
we have to go beyond just expecting patients to
come to us or come to the providers. We have to
reach out to the community-based organizations
as partners to let more people know how important
it is to come and to see your doctor when you have
symptoms of COVID-19, or to go to the local
clinic or local emergency room. And I think
that thinking about that as the responsibility
of our providers that are in our rural areas,
and certainly for the migrant clinicians, it's
so important to realize that not every patient is
just going to have the opportunity to just knock
on your door and come in and make an appointment.
So, thank you for all the public health
aspects that you brought into the primary
care provider's, you know, portfolio of
activities to do for our communities.
[Dr. Zuroweste]: Thank you. Dr Rios I'd
like to give you an opportunity now to
promote anything you've got coming
up on your agenda in the next few
weeks to this podcast audience who
may very much want to tune in to.
[Dr. Rios]: Sure, the National Hispanic
Medical Association is very proud of being
able to provide information to our providers
across the country and to those that are in
the rural areas too. We have an immunization
monthly Twitter chat. And, again, that's to
talk about the importance of immunizations
for our most vulnerable populations. That's
August the 1st at 1pm and we have our vaccinate
for all campaign briefing series August 30th,
And that's 7 p.m. And these are Eastern
time. The webinar topic will be called:
'Closing the Gap: Enhancing Routine Immunization
Rates Among the Immunocompromised Latino Adults'.
And you can find those events on the
event bar of our website nhmamd.org.
[Dr. Zuroweste]: All right.
[Dr. Rios]: Thank you.
[Dr. Zuroweste]: Great! Well, I'd like to thank
our audience for tuning in to this podcast,
and I'd like to particularly thank
Dr. Solis for her input today,
and give you any last final comments, Dr. Solis.
[Dr. Solis]: Yes, well, I really enjoyed speaking
with the both of you about this very important
topic. Right now, as Dr. Rios mentioned about the
immunocompromised, if there are any patients that
come across your clinic that are immunocompromised
either via because they're taking certain
medications or due to their condition, then it's
important to also initiate treatment with them,
or have those discussions, and also work with
their specialists. For example, there's some
patients who may be taking medications for cancer,
and sometimes the primary care doctor may need
to reach out with their specialists because
of those drug-drug interactions. So, just,
I wanted to reiterate the importance of
collaboration between a primary care doctor and a
specialist, if that's needed. But I think overall,
it's just very important as a primary care doctor
to have these discussions with our patients who
are considered high risk because we are at a
point with COVID where we have these great tools
available for us. Not only the vaccines to prevent
it, the severe illness, but also the treatment
to also prevent hospitalizations. So, I think
that's just a really big takeaway Dr. Zuroweste
that I wanted to share with our providers.
[Dr. Zuroweste]: Great. And I really want to
thank Dr. Rios for taking time out of your
very busy schedule to co-host this podcast
with us, and give you any final comments.
[Dr. Rios]: Well, thank you to Migrant Clinicians
Network for having us and Dr Zuroweste especially,
I think this is a collaboration that we need to
continue. And you know we have so many things in
common with our providers who take care of the
most vulnerable in our country. And I want to
tell everybody don't burn out please, and don't
retire, we need you - and Dr. Zuroweste, that's
for you too, and Dr Solis, who's a lot younger
than us. But, we definitely need more doctors.
[Dr. Zuroweste]: That's great. Well I just want to
tell our listeners that they can find our guests
online. You can reach Dr. Solis on Instagram at
@dr.trinidad.solis and on LinkedIn by searching
for Trinidad Solis MD MPH. And Dr. Rios and
others from the National Hispanic Medical
Association can be reached through Twitter
and Instagram using the handle @nhmamd.
And for more information about the National
Hispanic Medical Association you can visit
their website www.nhmamd.org. And these links will
be listed on our episode notes. So thank you very
much for all these 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, thank you!
[Dr. Rios]: Thank you.
[Dr. Solis]: 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.
