This presentation covers how the coronavirus has impacted Black, Indigenous and other communities of color.
Richard O. White, M.D., a Mayo Clinic internist, and community members discuss immediate concerns, including obtaining PPE, testing and support needs, as well as other social determinants brought to light by the pandemic.
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Welcome to Mayo Clinic Cove in 19 expert insights and strategies. The following activity is supported in part by an independent medical education grant from Pfizer Inc and is in accordance with a C CMI guidelines. Welcome to the Cove in 19 expert Electra Siri's My Name is Richard White. I'm an assistant professor of internal medicine and pediatrics here at the Mayo Clinic Florida campus. I'm going to be joined today by Narine Stevenson, who is a program manager for the Center for Health Equity and Community Engagement Research, as well as Miss Gentle Williams, who is the associate clinical research coordinator in the center of Health, Equity and Community Engagement Research, 2020 has certainly been a difficult and unforgettable year for everyone from the first two now over seven million case of the novel SARS coronavirus infection. Kobe, 19, has captured and maintained national attention, impacting and disrupting the lives of us all. From the beginning of the pandemic, many experts who work in the space of health disparities and health equity began to sound the alarm of concern with regards to the potential disproportionate impact of the pandemic on minority populations or now as the vernacular has shifted towards use of the term black, indigenous and people of color or by pox. Most of this concern stemmed from the well documented social determinants of health, which are known to place many bipod communities at higher risk of poor health outcomes, disadvantaged access to quality care and less than ideal health care experiences. The social determinants of health can be more easily understood as the factors that influence where people live, work and play, how we access and navigate and often complex health care system, the types of interactions we have within that system and the health behaviors we learn and or adopt, all of which contribute to the downstream effect of one's vulnerability to disease and, ultimately, life expectancy. At the time of recording of the CMI event, we're well into the 10th month of the pandemic and to say the least, many across the country are weary from the struggle. Regardless, we must continue to disaggregate fact from myth, scientific evidence from politics, and continue working together as a nation to not Onley control the pandemic, but take its lessons and apply them towards true progress and health equity. We offer this segment of the program as an opportunity to take a deeper dive into the factors that created stark vulnerability for many bipod communities in the US But more importantly, toe learn from first hand accounts of individuals who's lived experience during the pandemic will provide timely insight upon which action can be built and a beacon of hope from which sustainable change can emerge. Join us as we take a closer look at the perceptions of Kobe 19 and minority groups value vulnerability and vernacular early in the pandemic. As we improved our transparency of racial and ethnic data as related to hospitalizations, hospital mortality complications it became quickly evident across the country that many bipod communities were being disproportionately impacted. Several chronic conditions, such as obesity, heart disease, diabetes, chronic kidney disease quickly emerged as independent risk factors. Ah, for for mortality and for complications from Kobe. 19. Many of these conditions already exist in higher prevalence among bipod communities. Regulus and others conducted a retrospective cohort study looking at adults hospitalized with Kobe, 19 from March 10th through May 1st 2020 they looked at a single large academic hospital system in New York City, really, at the peak of the Corona virus outbreak in New York. Their primary in point was odds of hospitalization. By race, their secondary in point was comparative and overall survival to discharge. What they found was that blacks had a twofold higher odds of hospitalization. In adjusted analyses, Hispanics and Asians also had to fold higher hazard of in hospital mortality. Since then, there have been multiple other reports looking at patient populations in other areas of the country, such as Texas, California, Illinois, Louisiana that have shown irrefutable evidence that the cove in 19 pandemic has disproportionately impacted communities of color. As we look at the differing landscape and wide variety of different communities across the U. S. And as we understand the fact that the coronavirus has no innate capability of distinguishing between people's power position, prestige has become even more clear that the social determinants of health are significant risk factor for poor health and for poor health outcomes. Data that was collected by the Pew Research Center has shown that based upon individuals, income individuals have disproportionate access to being able to tell the work. Other investigators have used the medical expenditure panel survey to look at the differential disproportionate representation of bipod communities in several industries, as well as in several contexts. For example, if we look at other essential workers who were unable to work from home, you can see that both black and Hispanic populations were overrepresented among those groups. Similarly, within the food industry again, blacks and Hispanics and Asians are overrepresented if you look at public safety and utility workers, which include police officers, firefighters, corrections workers, public transportation employees, postal workers and workers at funeral parlors and crematoriums. Again, we see that blacks are disproportionately represented among those among those workers. And similarly within the health care industry, where these workers, such as employees at hospitals, outpatient clinics, physician's offices, nursing homes and other residential treatment facilities, as well as home health care workers and ambulance drivers we see that both blacks, Hispanics and Asians are overrepresented in those groups. Compared to whites, these factors have influenced the fact that bipod communities have experienced increased occupational hazards that includes higher exposure, risk to the coronavirus, lower ability to shelter in place and lower capacity for working remotely. Now we have looked at the disproportionate impact of Kobe, 19, on hospitalization in hospital mortality rates as well as disproportionate occupational exposure risk among communities of color. But what about the actual experience of communities of color, their perceptions as they have lived, um, and navigated this pandemic across our country? Data from Canada suggested that 27% of visible minority participants reported feeling very, very or somewhat unsafe when walking alone in their neighborhood after dark, compared with 15% of participants who were not designated as visible minorities. Among the visible minority participants in this survey, more than one in three women felt unsafe when walking alone after dark compared to one in five men. No. They also looked and found that one in five or 21% of visible minorities perceive that harassment or attacks based upon race, ethnicity or skin color occurred sometimes or often in their neighborhood, which was double the proportion among the rest of the population. Finally, visible minorities in this survey were three times more likely than the rest of the population to perceive increases in the frequency of harassment or attacks based on race, ethnicity or skin color. During the early stages of the pandemic in the United States, Lou and her team also investigated, perceived discrimination and mental distress. Amid the Koven 19 pandemic, they conducted a probability based nationally representative sample of U. S adults greater than or equal to your 18 years of age and studied 3665 individuals. They conducted Kobe related online surveys that were completed in March in April of 2020. During the survey period, the absolute value for perceived discrimination increased significantly for Asians, for blacks and for individuals that wore masks during the early stages of the pandemic. Interestingly, perceived discrimination was significantly associate ID with mental distress. There have been several investigators across the country who have attempted to understand and to document the experience of individuals of color through the coded 19 pandemic in terms of their awareness in terms of their planned behavior and in terms of their attitude. Towards the Towards the outbreak, Wolf and others conducted a telephonic survey of 660 vulnerable adults with greater than or equal to one chronic condition. They conducted this survey, um, through seven different primary care sites, five of which were academic sites and two were federally qualified health centers, all of which had ongoing active N. I H studies. They assessed Kobe 19 awareness, knowledge, attitudes and related behaviors. They found that 24.6% of individuals felt very worried about the situation, but only 30% of them were able to accurately report uh, poor symptom or prevention. Uh, strategy recognition, 21.9% indicated that they felt they had that the cove in pandemic at that time was having little impact on their lives. Interestingly, they found that being black or living below the poverty level or having low levels of health literacy were significantly associated with reports of feeling less worried about the Kobe 19 outbreak. Reporting lower perceived risk, feeling less prepared for the pandemic and specifically among individuals with low health literacy, they reported greater confidence in the government's ability to respond to control the pandemic. Block and others were interested in investigating the public health or the self reported um adherence to public health recommendations. They surveyed 604 African American participants and asked them several questions. 72% of the individuals indicated that they always frequently wash their hands for at least 20 seconds. 67% stated that they always stayed at least 6 ft away from others when they were in public. Only 55% reported that they always avoided touching their eyes, nose or mouth with unwashed hands, and only 65% reported wearing a mask went outside on good and could potentially come in close contact with others. These data suggested that there was differential understanding of individual risks and perceptions of exposure to the to the pandemic to the virus that's causing the pandemic, as well as less than ideal rates of reported adherence to the public health recommendations. And finally, there's been significant disruptions and care delays across the country and across a variety of health health care systems. Sisler and others examined factors that were associated with temporary disruptions in routine and urgent medical care. Due to concerns over coded 19, they conducted a Web based survey during one week period of time. In June, they found that 41% of individuals who responded to their survey reported avoiding UH medical care during the pandemic. 12% specifically said they avoided urgent or emergent care, and 31.5% reported that they avoided routine care avoidance of urgent or emergent healthcare was significantly higher for the following groups for unpaid care givers for persons with two or more medical conditions. Interestingly, for the for the insured, they saw higher rates of medical care avoidance among blacks and among Hispanics, also among younger patients, compared to older patients and finally among individuals with disabilities. Now I would like to transition and invite you all to hear firsthand accounts from several individuals who volunteered their time and their energy to share with you their perceptions and their experiences with navigating the Cove in 19 Pandemic. I would like to present to you Mrs Rosa Nichols, who is a development fundraiser for the Clear White Mission. She'll be followed by Miss Brenda Ford, who is a community volunteer for AmeriCorps. Later we'll hear from Miss Barbara Sanchez, who is president of the Resident Advisory Council for the Jacksonville Housing Authority. And finally, we'll hear from Miss Mia Jones, who is thesis EEO of a Gap Community Health Center, which is a federally qualified health center here in Northeast Florida. You know, I think everyone was just extremely surprised, and they were wandering. Is this really, really can this really be happening here and, um Ah, lot of people were was like, What does this really mean? How is this going to impact our lives? Well, there were a lot of responses from the community as well as questions. And as you know, Newtown is a despair. The community. So transportation was very important. Groceries, obtaining groceries been ableto get medications not just for themselves but for the Children. Child care was a concern, um, schools and especially because some of the parents were not familiar or illiterate about the school work that their students were involved in in school. So you had a multitude of issues, and some of them were even concerned about their continuation of life. So there were a lot of personal concerns for the community. Initially, it was panic, uh, and not knowing what to do, not knowing what the protocol is. Not knowing much about, uh, code itself. That was the initial response to cove it and then paying attention to the news and the media to find out what to do, what not to do and to learn as much about the disease is possible and govern ourselves accordingly. When Cove it first started what we found Waas a lot of fear. Our staff would hear it from the We would also hear it from the staff. Um, just the fear of the unknown is really what seemed to be the biggest thing. And not having unlimited resource is to make sure that we had everything that we needed in order to make sure that everyone felt safe. Um was difficulty. Well, I wanted to learn more about it. Um, it seemed like that it was something that I needed to know. And I have Children of my own. And I wanted to know What was this going to mean? What did I need to relay back to them? Because they're not always listening to the news and always not up on what's going on. So I wanted to learn as much as I could so that I could dispense that information to my immediate family and my friends who may not know or heard what was happening. My immediate concern for the community was health care as well as being confined, because I know once you're you're confined after a period of time, those things become an issue because with the, uh, income being decreased, um, transportation and and some of the other things that were natural for the families that they had already adjusted to are now going to be discontinued. So my issue was that they would be confined and we would start seeing mawr spousal abuse, child abuse, some of the issues that had already been addressed that we're not really an issue. Come back to life making sure that those who are most vulnerable are taking care of that. They have what they need. Um, so pants sanitizers, uh, products to clean their homes to keep it is clean as possible. Um, speaking for myself, there was concern all over the place. I have to watch my packaging, my packages, my mail When I go to the grocery store, anything I touched, um, initially when they said blue light symptoms world, the common cold became suspect. You know, when somebody was sneezed or call for you just didn't think. Okay, they have something in their throat. You know, your mind or my mind I'm guilty of it. Went straight to you have symptoms of the cove, it 19 virus. So, like I said, my initial response to the cove in 19 with panic it was feeling, and then concern for my community what we saw. Waas patients may have made appointments to come in. They started to know show, um and when we would call them back, they were concerned that, um it may or may not be a safe environment for them to come into because they felt that you know, Cove it would be in the clinic because there would be patients that would be come into the clinic because of it. Um, we did not immediately start implementing citywide testing or anything like that, because we recognize that as we were attempting to get TPE, we were not able to guarantee when it would be shipped to us. How much would be shipped to us? Um, even though we may have had the money to pay for it, we were not, um, able to guarantee that we would have what we needed to have in place, uh, to be able to support whatever we may may have stood up at the time, and so we kind of held back before we jumped out there. We were not able to get tests, and so that was another issue for us and the patients. You know, we basically made it our business to know where testing was taking place, shared that information with our patients and made sure that they were able thio access that testing through other venues. Well, you know, I really didn't start wearing, um I've always stayed in the office working even when the city shut down and said people home, I was an essential employees, and so it was never really pushed that we needed to be wearing a mask. So it wasn't here to about a month and a half, maybe two months ago, that that directive came forth that everyone was mandated to where? The mass. So before in the early stages of this, I was not wearing a mask. Um, because I was not told that I needed to wear a mask. I did not realize how really important that it was to do so. At first it was a concern as to where do you go to get this? Because it wasn't being broadcast because ah, lot of places didn't have it. But one good thing that I I became involved with, and that was the coed program organization. And that was that community organization, active and disasters. And they had all of the city rescue Representative zone that call, and that call is operating three times a week. So once I got hooked up with the coed group, then getting if things that I needed and getting them out to the community did not become an issue. Um, initially it waas. But soon after that, then the mask came in. Um, but initially, it waas and it was I had to take care of my home first before I could venture out into the community to find out what their needs were. Um, of course we knew mask, but residents services, they eventually got us some mass to distribute to the resonance, um, to every were given a budget to have certain events. And one of the events is it's called eviction prevention. Where we the council purchases cleaning supplies, Um, you know, to help residents keep their place clean. Well, once that happened, the cove it happened. There was a restriction on how much bleach you didn't buy. I'm in a 328 community communities, So trying to buy in bulk became impossible because there was a freeze on how much you could buy S O. That was an issue and people weren't going. I know I wasn't. I wasn't going out that much. I wasn't. I was afraid. I had to make sure that I had gloves cleaning supplies to keep my place clean. And then I would, like I said, Venture out to see if mine the residents had what they need. But by them putting a freeze on how much alcohol, hand sanitizers, bleach, disinfectant, wipes that you could buy. It became really scarce. And I couldn't buy a ZMA much as I would have liked to, to get it to those residents who are the most vulnerable. Many of the providers, the larger medical supply chains, were stretched. They were strapped and they were having difficulty getting the P P p out to the, uh, customers that they had, and some of them were not able to get it in order to be able to Vince sell it to someone else. And so what? We found waas, um, some of the suppliers put a cap on how much you could get based on what you would normally get, and that just wasn't sufficient for what our needs were as a result of being able to look forward and provide the additional services that are patients needed. Yes, I am a B a veteran, and so again I knew what was happening. I just didn't know the extent as to what was happening. So when I would go to the VA clinic, it had basically shut down and they were meeting people in the parking lot and turning them away. I had other doctor appointments that was scheduled with civilian providers, and they were now doing temperature checks and asking people to stay in their vehicles. It was impacted not so much personally myself, because I thank God I have not had nor did I get covert. But I was exposed to people that were and when I say that we deliver dinners to the residents in the community and and my delivering dinners, one of the guys a residents, came out and received his mill and later that day called me at home and told me and he he had been tested positive for Cold Convent, which gave me just a small bit of alarm. But as I did go immediately and get myself tested to find out that. And I went Teoh one of the facilities that can give it to you within several hours. And in two hours, I knew that I was not affected by cove it. But I have been through my friends, my church members, some co workers. One of the fathers, one of the co workers that that will orders his father died with cove. It we just this week at one of our church members that were getting ready to bury um, that cove it Dr Jones Waas trying to introduce or not time, but he waas introducing telemedicine, which I thought was a great idea. Um, but at the time it hits, we didn't get as far as I'm sure he would have liked to setting up training in the homes of some residents, Um, or setting up training to show them how to use a computer or a device or their phones, uh, to do telemedicine. We didn't get that far. Uh, the introduction of it, we just got us faras introduction of it and how it could impact the community. Since I have ah desktop. It was easy for me to still go on with mine doctors visits because I'm familiar with Zoom or Ring Central things like that. So it really didn't I would have liked still like to have been able to go into my doctor's office, you know, because that's that's her relationship patient doctor relationship, which is also good. And it keeps me accountable of the things that I'm supposed to be doing that he has prescribed for me to do. Um, e will admit being at home and on the camera. It's kind of easy to, um, not do what you're supposed and not be account. So that's yes and no. It was easy for me to still keep in contact with them, but yeah, easy not to do what I was supposed todo. We have seen the patients really, um, come back even stronger than they were before. And one of the things that we have started to do is really toe focus on those patients that have chronic diseases and making sure that they understand that it's really critical for them to be adherent to the medical advice of their providers and to make sure that they're paying attention to those things that they may have taken for granted before. Um and so we are very pleased that our no show rate has improved. Our patients are coming in. We're implementing, um, different scenarios where we will reach out to those chronic patients and say to them, You know, you haven't been in in three three months or you haven't been in the six months. Um, but it's time for you to come in and let's make sure that we're taking care of the needs that you have because we know that with those chronic diseases comes, um, situations that result in them being, um challenged as it relates to cover it. Well, actually, there was a situation where someone close had popped positive for the virus. So we all went into a panic. Those that were notified. And, um, I reached out to the V A facility because that's where I go for all my medical care. And I wanted to find out. Hey, can I get a test? It wasn't as easy as I thought that it was going to be. I kept getting directions as to other locations, and I was told that the time to wait or for those tests were sometimes up to two and three hours. Um, I eventually circle back around to the va, and after weeks, I was able to get that test. Yes. Waas. I did go through that through that. The testing itself wasn't as bad as I thought it would have been. In fact, it was It was comfortable. They made me comfortable. And I was very happy that they were able to get, um, my bro test my test results back. It was at ever senior. Of course, you pay a small fee for that convenience, but I was willing to do that because it was close and convenient. Yes, I a tested a matter of fact, quite a few. If not all of the Jacksonville housing communities did get tested. I'm not sure some of them I do have a question about because I believe they ran out of test. But, uh, Brentwood was one of the sites where if the residents wanted to get tested, they could, And, uh, that was an easy I was unfamiliar with it. So I was a little skeptical at first having something inserted in my nose. Yeah, I was skeptical because I didn't know if it was painful or not, or I wasn't sure if it was painful or not. But after going through it, I've had myself tested Fountain two other times because I had come in contact with someone who had been in contact with someone who possibly had Covic. So just to, you know, make sure that I'm being responsible and about getting tested. You know, I had myself tested two other times, so getting tested wasn't really a problem. There were other sides that I could drive to. I know I could drive to if I wanted to. But for the other residents who are don't have cars, I can see that being a problem because they couldn't They can't get to the testing sites and it's a drive through. I'm not sure if their doctors offices uh, uh, do the testing in their office. I'm speaking on the places that I know that we're doing testing and all, you know, and there was no problem, no co pay or anything. We started doing limited testing, probably about mid June early July, and that would be and event. We would stand up an event and do testing. Um, we did that every two weeks at our various locations around the city for about a month, month and a half. And then we were in a better position to get more PPE to make sure that we had multiple testing and lab providers that would be able to support the needs that we would create. Well, I don't think that it's as easy still to get the test as people believe that it iss um, I know that we were in the height of this, which I think we're still in the height of this. There were locations that were throughout this area where people could go so they could find easy locations that were close to them. I don't see those locations anymore right across the street from us. They were doing it. They're no longer there. They were at the stadium. They're no longer there. I'm not really sure exactly where the locations are. My default will always be trying to contact the VA. I think people don't know exactly where they can go. I don't think they know whether or not they can go to their own providers. I believe that there are some providers that will that are allowed to give the test so you don't have to stay in those long lines. Um, I think people still don't understand the importance of wearing the mask. And while we do so So I think there's a lot of education. Um, that needs to be done because I don't think that people really fully understand about Covic information. People need information. You won't believe how many people I talked to giving them information. And they said, Oh, I didn't know that. Oh, I wasn't aware of the old Is that a part of so information is, no matter how small or how large it is, it's always needed, and people it despaired. It'll help eliminate Ah, lot of the questions and distrust and uncertainties that people face because of lack of information. This could have been handled so much better if we had better leadership. If we had yes, better leadership. Um, mhm. I think the death toll didn't have to be as high as it is if everybody was told the truth. One of the things I wish, um, that could have happened is that the medical community, no matter what hospital you're in, could have gone on television and said the same thing in unison And where your mass. This is what you have to do. A, B and C to minimize you know, your possibility for infection. Talk to our governing officials. This is not the time to open this city back up. You're putting more people at risk. I wish there was some kind of way that the medical field or the science field could have over written what the government wanted to do. I just wish we had smarter people in place. I wish we had smarter people in place because at 200,000 people who lost their lives, that number should not have been that high. That number should not have been that high. And from what I understand, it's in communities like mine. That's the sad part about it. It's in communities that are, um, like not I mean, nobody people dying unnecessarily is problematic. But the studies show it's in communities like and I wish there were people who we're smarter, who had made a better choice, made better choices when it comes to support, being able to have that back up. We all have our traditional partnerships and relationships that we may have in place. And so what I found and what I've shared with my staff is that it's really important that we not just depend on that one supplier that we would normally use. We did that because, uh, you get better pricing when you have larger orders. So you would try not to spread those orders out over multiple vendors in normal situations. Because if you're buying in bulk, then you would be able to get a better price. Well, I've shared with them that it's really important for us to have multiple relationships because we don't know where our supplier will be. We don't know what our supplier will have, and we have to be able to make sure that we can get what we need to get. And so we have established some new relationships that we hadn't had in the past, and we are building on those relationships. So we will request orders from them so that if our larger provider says to us, well, you know, you have a limit on how much you can get. We can have, uh, that next person lined up and ready to go. Since the pandemic, we have opened up to additional clinics and so what we were doing prior to the pandemic is different than what we're doing now. And so we need to make sure that we have what we need, that we're able to provide our patients with the proper care and the quality of care that they deserve, and that takes a lot of planning. It requires us to make sure that we're paying attention to some things that might have slipped through the cracks before. But we will definitely be paying attention to more of those things as we're going for. I think that it has brought to light the health disparities that we have within our communities. Um, for those that I really think that there's probably been people that have been extremely sick and maybe some of them have survived it, some of them may not have, but I really think that it brought to light that health care is a critical issue and not everyone is privy to have good health care. I also think that in the the low lying communities with the the lower income, I think they were the hardest hit because maybe they didn't have adequate healthcare or the means of transportation to get to the some of these locations. And I think that that has been truly, um it's been horrible the way it's impacted the community as a whole. I laugh on the time of myself because now everybody is equal. So equality, you know, there are no more rich people there no more. I mean, you know, when I say that, I mean this disease has affected everybody, and it has put us all on an equal level off sickness as well as vulnerability. It has brought that part of it to light as well, that people are just vulnerable. They they're now feeling that it can attack anybody. It doesn't matter your status high or low, whatever. But it's been one disease that has made us humble because now we feel empathy and sympathy for other people that you may not have thought of thought to feel that for before that death Israel, when someone tells you that there is a deadly disease out there and it will kill you, um, you need to be prepared these air steps that you have to take, um, and give you the steps that you need to take to minimize your exposure. Uh, hope and pray that people will listen. I will listen to science. I will listen to the people in the medical field the people who have expertise in this in this field, I will listen. Life is short. You think you're you're healthy, but there's some communicable, you know, some diseases that will just take you out and way have to be aware of it. I see why they have. I'm not sure if it's if I'm pronouncing it right, but there's ah, branch. Um Where, uh, the president has these group of scientists that study, you know, these diseases. I understand that now I understand that now, totally, while the why those people are in place because who knew this this would have happened. Who knew Ebola would have had you know who knew the other place that have had. And I'm grateful to those people who study it. I'm I'm grateful that there is appealed like that where people can study it and prevent it, uh, from happening, forgetting if it's going to happen, it's going to happen but minimizing uh, the deaths instead of it getting. And I understand the United States have has the largest amount of the EU tallit ease. United States has the largest amount of fatalities, and it didn't even originate here. I think for those patients we have a lot of patients that smoke. Um, we have really started to push Even Mawr are smoking sensation program and we know that cove it is, ah, the long disease. And it's one that those that have COPD or asthma are impacted greater. And so we try to make sure that they understand, Um, what types of things, preventive things they can do and what types of things that they need to be considering. Um number one stop smoking, being able to make sure that they're in environments that are safe for them. Some people can't make those changes, and so we try to refer them out to organizations that can provide them with that assistance. We know a lot of people have lost their jobs during this time and as a result than they have housing challenges. And so when you have chronic diseases and you're homeless than you are in even Mawr, um, difficult position and so all of those things start to play a part in what our patients are facing. We have increased some of our partnerships in the area of food, recognizing that many of our patients live in food deserts, and we have begun to do food distributions and partnerships with some of the other nonprofit organizations within our community. And those food distributions on any given Saturday may be able to positively impact anywhere from 250 to 300 families. And so we make sure that our patients are aware that on this day we're gonna be at this location and providing these services. And so as we look forward, we know that we have to b'more than just the health care provider. We have to be a conduit for our patients and being able to connect them with services and re sources that are available within the community. Thank you very much, ladies, for your poignant for your heartfelt and for your candid discussion of your perceptions and of your experience through the Kobe 19 pandemic, our team here wishes you continue to health and safety. As we all continue to navigate through this, I think that we should think about solutions in terms of both immediate short term and long term responses to the experiences of iPod community members as they have navigated through the pandemic. Certainly as we continue to emerge from the pandemic, I think that it is really important that we continue to improve risk communication strategies that target populations that are known or suspected to be an increased risk of the infection. We should also continue to engender greater collaboration across sectors including health care, housing, labor and transportation to inform and better educate individuals about risk and risk mitigation strategies. In the short term, we need to continue to ensure that our patients are have access to culturally congruent and language concordant point of care, particularly using approaches that consider subgroup variation in contextual factors. In the long term, we, as a nation continue need to continue to address the social determinants of health that underpin experiences of discrimination and contribute to poor health outcomes for bipod communities. And finally, we need to continue to improve collaboration between academic and community health clinics to address and implement strategies toe ultimately eliminate health inequities in our nation here in Mayo Clinic and across our institutions across our institution and enterprise we were able in the early stages of the pandemic to rapidly mobilize and to implement methodologies for addressing the immediate needs of our bipod communities surrounding our various locations across the country. We were fortunate to work and collaborate with several of our community partners to yeah, implement several Kobe 19 town halls where we engaged with communities via zoom to answer people question people's questions about the pandemic. We were also able to support and implement a Hispanic virtual health conference where we specifically responded to the community's concerns and their questions about Kobe. 19. One of the things that we realized early in the stages of the pandemic was that many of the communities of color surrounding our our clinics were experiencing exacerbation of already known food and security. So one of the things that we were able to do in response to that was to support and collaborate with our community partners to stand up several food distribution drives and distribute food, Um, in collaboration with several community organizations. We did this for both are African American as well as our Hispanic communities that we have the privilege to work with with relation with regards to our Hispanic Virtual Health Conference. We were able to leverage several existing community academic partnerships and deliver to our community a an in depth Hispanic health conference that focused on several Hispanic health disparities but also included a day completely dedicated to discussions about Kobe. 19. We offered our community a live call in Q and a session where people able to call in and have discussions with our experts about Kobe 19 and get specific recommendations for how they could successfully navigate the pandemic. And finally, our institution has made significant investments into supporting, um, several Kobe 19 testing facilities in our communities, um, to ensure that the vulnerable community members had access to accurate and to timely Kobe testing. We hope that you have enjoyed this segment. I hope that you've been able to gain some insight into the perspectives of communities of color and how they have navigated and experience the Kobe 19 pandemic as well as gain some understanding and insight into some evidence based strategies for engaging with communities. If you're interested in additional information, we would welcome you to visit our website with particular emphasis on our community engagement strategies. Um has put forth that are through our Center for Health Equity and community engagement Research. Thank you for your time and attention. And we wish you well as we continue to emerge from this pandemic hopefully stronger as a nation. Thank you.