UCI Podcast: Practicing harm reduction to flatten the coronavirus curve – again

Society is opening back up from pandemic lockdowns, and many people are returning to social life. But at the same time, coronavirus cases are spiking here in Orange County and hospitals are filling with patients, prompting the question: Did we relax too soon? And should we have kept vigilant for longer?

Today, I’m speaking with Bernadette Boden-Albala, who’s the Dean of UCI’s Program in Public Health. She argues that we need to pursue harm reduction by remaining dedicated to the most effective methods of preventing the spread of the virus while also protecting our own mental health.

Dean Boden-Albala, thank you for joining me today on the UCI podcast.

It’s a pleasure to be here. Thanks so much, Aaron.

So coronavirus cases are on the rise again here in Orange County. When did this first start happening?

It’s interesting, right? So we’re sort of in our second rise. So remember that back in March, we were on that really bad trajectory, doubling every three days. And we did a great job and we flattened that curve and we were really flat. We were always the growing cases, but not at such a high rate and not so many cases. We were really sheltered in place, if you think about it for almost two months, and we’ve really had a nice flattening. But it was after Memorial day that we really start seeing this increase, this incremental increase. And if you watch, even from, I think the end of May, you see this increase in a little flattening, and then increase in a little flattening. Each time that the numbers increased, they increased by a lot. Now, at the same time, we were also ramping up our testing, but where it’s important is that we start to sort of see this edging up of the percentage of people positive.

If you’re doing a great job out there, then even if a lot of people get tested and the actual number of people is greater than that are positive, the percentage positive stays the same or decreases. And what we’ve now seen is that increase. So when you start seeing that increase coupled with real capacity filling in hospital beds, intensive care beds throughout the county, and some increase in death, although our death rates, thank goodness, they’re still not as bad as they could be. But, but I think that we we’ve seen this upward and I think it’s this relaxation of everybody saying, you know, enough is enough. I can’t handle this anymore.

So you think there’s a tie to people gathering for Memorial Day and Mother’s Day and Father’s Day and getting into groups again.

Right. And I think that’s absolutely what people have been doing. And I think that’s also tied. We all choose role models. We choose champions. We choose leadership from around the nation from globally. And when we’re getting a lot of mixed messages, it’s really, really difficult. I was so proud of Orange County and of course of the UCI community of holding in there and really being the leader in doing what was very difficult, which was staying at home. If you look at the curve, if you look at that flattening, it really was significant while everybody else was building, building. But sometimes when it doesn’t happen to you, there isn’t anyone you know, that’s gotten coronavirus, you almost say, well, is that real? Is that really going to happen now? Maybe not, maybe we were all doing this, and it’s silly and look at how terrible it hit our economy. I think that it’s unsustainable for us to just lock our doors and not come out. And I think that May showed that and, and Memorial Day weekend and July 4th weekend. And so harm reduction is a little bit different thinking. It’s how do I reduce, to the most that I can, my risk of exposure to COVID, but remain sane at the same time. It’s not easy for everybody to stay at home. Some people can’t. We have frontline workers, we have essential workers, we have healthcare workers. Some people are in bad situations at home, and there are people out there that are in those situations.

So, harm reduction. Maybe we’ll be less fatigued about harm reduction. And how do we think about that? And we can all do that. And that’s really acting responsibly and trying to mitigate exposure. And so the devil’s in the details with harm reduction. Because harm reduction is all about all the things, like I have to go out to the grocery store, but maybe I don’t have to go out on Saturday morning when everybody else out there. I’m going to go on an off time and I’m going to come back in my car and I’m going to go back to the first behaviors that we learned back in March. I’m going to take my mask off because I’ve had it on the whole time that I was in the store and I’m going to wash that mask. Because I know what we’ve all done, (we say) it’s only been to three or four grocery stores, I don’t need to wash it. I’m going to wash that mask. And I’m also going to bleach my hands. I’m going to use the wipes or I’m going to use hand sanitizer. When you get home, you need to just take everything off, throw it in the wash, wash down, change clothes and hang out in a new set of clothes. I mean, this is harm reduction. I’m going out there a little bit. But I’m doing it the right way for myself and for my community.

What about social situations. What are some of the tips for if you’re gathering with friends or family and to do that, if you can, in a safe way?

The best is not to interact with anybody, that’s the best. But that’s not always tenable or attainable at this point. But social situations are good. I think you have to choose, I’m going to call it, you can extend to a pod. So a pod is a family or friends. I have no family here. I have friends. So a couple of people no more, that you that you have expanded into your pod. So maybe you’re two, we’re two, Bruce and I, so now we’re going to go to four. Okay, or six the most. When they come over, I’ve been involved in these kinds of encounters now, and I think that they work. Everything is outside and where better than in California, six to eight to 10 feet away. Set all paper (materials), so everything gets thrown away. And then you sit at your own table. And so you’ve got this distancing because you’re eating and eating is a very much of an activity that people are spitting. They don’t mean to, but they’re spitting in eating at the same time. This is harm reduction. There’s been some suggestions to minimize wine. Although of course, in a situation like this, everyone wants their wine. But just because when you, when you drink and you’re feeling more relaxed, you are less likely to remain as vigilant about your distancing. Except for eating, you got to keep your mask on, keep the timing short, a couple of hours and really not a lot of in house. Everything should really be outside. And I think, again, we can do that. It’s the summer, it’s the time to do that.

And these recommendations and these precautions that you’re mentioning, these are all backed up by the research. This is what we’re finding from studies that are saying, these are the ways to keep the spread of the virus to a minimum.

That’s right. That’s right. And you know, the other really important thing for here for Orange County is that there were areas that had denser viral load because they were more densely populated. And so I would say in March and through April, there were areas that you knew that you were more likely to be exposed, and areas that you knew you were less likely, but if you see the numbers now in Orange County, this virus is disseminated throughout the county. And so there is no safe place. Your risk of exposure is great wherever you are. And it’s a pretty easily transmissible disease. And so that’s why I think it’s extra vigilance now.

So we flattened the curve back in March and this spring and now we need to really focus on harm reduction to prevent a huge spread. But what is the long-term strategy here? Are we pinning our hopes on a vaccine? And what if that takes a really long time to get here?

There’s really only two ways to handle this. One is where’s the vaccine. We need a vaccine. And that still takes time, even if there was an approved vaccine, we don’t know how good that vaccine is, and it takes time to just disseminate that vaccine. So the other way is that we have to sort of live with the virus and really try to take up what is sustainable and doable harm reduction strategies. I think this virus now is going to be around for a while. I think we’ve always talked about that. I think we just have to stay the course. We need to take our vacation days. We need to not schedule 14-hour Zoom days every single day. Guess what? We know you’re working. We know you’re working in a global pandemic. And we’re going to burn out and it’s not mentally healthy. So staying the course is the long run.

And talking about going on a vacation or taking some time off, not doing 14-hour days – mental health contributes to physical health.

I think at this point, everybody should be doing a check in with their health provider. Because most of us have some kind of health-related issues, anyway. It’s a check-in. You may not know that you’re this stressed. And so I think that that’s the second part of this. How do we maintain the course? We do it by being mentally healthy. Wellbeing and wellness, this is a critical time. You need to be outside and taking deep breaths and doing good, deep breathing and yoga and whatever are the other things that you’ve, you’ve been comfortable with in improving your quality of life. You need to be able to do that. You need to make sure that your hypertension and your diabetes and all of that, it’s under control.

We’ve moved from acute to chronic and this is the time to say help, or I need a respite, I need a break. And so everybody needs that. And I’ve heard of people doing some camping trips or just taking, we live in beautiful Southern California, take a ride during the week, not the weekends, but during the week, take a ride out someplace that you know not a lot of people are at. And just bring a picnic and just meditate. It’s been a lot. Give yourself some credit for having gone through this and sustaining it, and we’re still part of it. And don’t be too hard on yourself. And schedule yourself a bloody lunch on Zoom every day. You know, you have to do that. It’s, it’s really important because we still have a long way to go. Because back to the question of how long this is sustainable, if what we’re seeing now is an exposure or prevalence of somewhere, maybe around 5 to 8 percent, that means that we have a long way to go. That means that 90 percent of us haven’t had that exposure yet. And it means that we remain vulnerable to that. And so any time that we let our guard down, we can let us be exposed to the virus and that’s not what we want. So it’s a long run, not a short run. And I think we really need to be prepared for that.

So we’ve talked a lot about all these measures to reduce the spread of the virus. Why is it so important for everyone to do that, and for everyone to contribute? What happens when a few people choose not to?

We don’t know if we are the transmitters or the receivers at any point. So that’s the first thing. We’re in this together. The behavior of the folks across the street or the neighbors or the people in my pod affects me and my behavior affects them. And there’s nobody who believes in autonomy and independence more than I do. But this is a community event. This is a community virus. This is a community moment. And we need to do this for our community, not just for ourselves, because if we do everything we can to prevent harm to our community, then we will decrease harm to ourselves as well. We have to help everybody. The vulnerable, think about the, the older folks in communities, they’re isolated. So we need to make sure that they’re getting some social support, even if it’s virtual. So this is all about community.

Final question. Are we able to do this as a community?

Yes. But give yourself some breaks. Take some time. We are, absolutely. In fact, we did this already as a community. And we were the model community. People were calling from New York and the East Coast and saying, what’s going on in Orange County? Why are your numbers so low? It’s because we were such a great community and we are a great community. But we’re tired. We’re fatigued. I get it. Give yourself a break, reevaluate the situation, work to do what you can do. Harm reduction. You don’t have to just be alone. There were ways to figure out how to do it. It’s not time to throw parties. Unfortunately, it’s not time for big weddings. It’s not time for big events. But it certainly is time to support each other. Because I think together we can flatten this curve, again.

Thank you for joining me today on the UCI podcast, Dean Boden-Albala.

Thanks so much, Aaron.