Jason Salemi
To make a very long story short, I got contacted by the National COVID tracking project. They loved what I was doing in the efforts I was making. And you know, fast forward nine months or so I’ve now got a very comprehensive dashboard of Health
Gregg Masters
PopHealth Week is brought to you by Health Innovation Media. Health Innovation Media brings your brand narrative alive via original or value-added digitally curated content for omni channel distribution and engagement. Connect with us at www.popupstudio.productions and welcome everyone. I’m Gregg Masters, Managing Director of Health Innovation Media and the producer and co host of PopHealth Week. Joining me in the virtual studio is my partner, colleague and lead co host of PopHealth Week Fred Goldstein president of accountable health, LLC. On today’s show, our guest is Jason l. Salemi, PhD, MPH, associate professor of epidemiology at the University of South Florida College of Public Health. Dr. Salemi is a tenured Associate Professor with joint appointments at the University of South Florida College of Public Health and the Morsani College of Medicine. He also maintains adjunct faculty status at the Baylor College of Medicine. Dr. Salemi has a demonstrated record of collaborative research, scholarly publication, teaching and advising and participation in public health organizations and professional associations. with that introduction, Fred, over to you help us get more familiar with Dr. Salemi.
Fred Goldstein
Thanks so much, Gregg. And Jason, welcome to PopHealth Week.
Jason Salemi
Thanks so much for having me, Fred.
Fred Goldstein
Yeah, it’s really great that I just happen to have been watching your website for a while seeing your posts up there and said, I got to reach out to this guy and get him on the show. So I’m really glad you joined us. Why don’t we start give our audience a little sense of your background and the work you do?
Jason Salemi
Yeah, absolutely. I’m actually a native of Tampa, Florida, I lived here all my life before I transitioned over to Houston for my first academic position. So I’ve gotten my undergraduate degree, my master’s degree and my PhD all from the same institution at the University of South Florida in Tampa. And I am trained as a maternal and child health epidemiologist. And obviously, that, you know, comes with a nice infrastructure of skill sets and tools that you learn along the way. I’m really a data expert, I think, you know, if I could really pinpoint anything that’s helped me specifically in the COVID-19 pandemic, it’s my ability to interact, manipulate, work with data, visualize it, and help other people, regardless of the stakeholder group, try and understand what the data are telling them. And so that that is kind of how I’m trained my passion. Ultimately, I know it kind of sounds cliche, but I got into this business because I wanted to impact people’s lives. And I’ve never felt that more so than I have in the past year, obviously, public health professionals who are often seen in the backdrop, you don’t know what they’re doing for you. They’ve been cast into the limelight now, and I’m very proud of how we’ve answered the call to service.
Fred Goldstein
Yeah, really amazing. So before we get into the COVID stuff, let’s talk a little bit about Maternal and Child Health and some of your work there. What areas do you focus on?
Jason Salemi
So yeah, my area of interest and area of expertise really has been everything in the reproductive and perinatal realm. I’ve done a lot of different research and a lot of domains, but it’s primarily been birth defects. This is how I got my start. When I was a master’s student, I got a field experience working with the Florida birth defects registry, this was way back in 2005. And I’ve actually maintained some contacts, some work with that group, all the way through right now the present time. And so we research a lot of the risk factors for birth defects, we investigate how to do better surveillance of birth defects and understand the different methodologies by which we understand birth defects in the United States and worldwide. And, you know, I work pretty extensively with the National birth defects prevention network, one of the largest nonprofit organizations for birth defects in the United States, as well as our federal partners at the CDC. And of course, all of the different state based birth defects, you know, surveillance programs, not just Florida, but around the country. And so that’s really where I would say I spend at least 60% of my time in the Maternal and Child Health realm. It’s trying to understand birth defects.
Fred Goldstein
And where are we as a nation with birth defects?
Jason Salemi
Yeah, you know, I think we just came across the quite scary Zika pandemic, a very different pandemic from COVID-19. But certainly that was something new in terms of the ability for birth defects surveillance programs, to respond rapidly to an issue, we’re very good at collecting information. And unfortunately, we we very frequently have to report that we don’t know what causes 70% of all birth defects. And we’ve had some real home runs with things like folic acid supplementation, that reduces the risk of neural tube defects like spina bifida by about 70%. And so we’ve got a lot of homeruns that we’ve hit, we’ve got a lot of, you know, remaining questions that need to be answered, but never have we had to respond so rapidly as programs to try and understand how this Zika virus was impacting pregnancies, and babies being born with congenital Zika syndrome. And so, you know, that was something that was kind of eye opening. And and I think it’s really strengthened birth defects surveillance programs around the country, and how we’re able to respond not only to issues like infections, but also more recently, even though it’s not a birth defect, maternal opioid use disorder and how that’s impacted children who are born with neonatal abstinence syndrome, I think we’ve done a much better job at being able to have the infrastructure to respond rapidly to those kind of emerging events.
Fred Goldstein
And obviously, you put this data together and these data and you’re showing what’s going on in these areas. Do we see in birth defects, similar things in terms of disparities of outcomes based on racial disparities or community disparities that we see with other say chronic diseases in the United States?
Jason Salemi
We absolutely do. I think it’s one that’s almost universal, that anytime you look at any sort of health outcome, you tend to see disparities. It’s not always racial, ethnic, it’s sometimes across just socioeconomic status lines, but we absolutely do. The challenge with birth defects is it’s inappropriate to consider them as a single conglomerate, right? There are a bunch of different very heterogeneous conditions. And so the extent to which you see disparities, and sometimes those disparities are in the likelihood of having a child born with a birth defect. But sometimes it’s once these children are born with a birth defect, the disparity is how well they do, are they getting access to the care that they need? Are they getting the appropriate surgical interventions, if that’s appropriate, and especially I’ll give you a good example. The constellation of birth defects that impacts the most morbidity and mortality for people is congenital heart defects. And so we see some pretty substantial disparities, even though children with heart defects are thankfully living longer into life, how these children do, how they transition from childhood to adulthood, and receive that the care that they need in adulthood. That’s a recent study that I published with some researchers from Texas Children’s Hospital, showing disparities throughout the lifetime. And so yes, the short answer is these disparities do exist. But the message might be different depending on which birth defects we’re talking about.
Fred Goldstein
Right. And it’s fascinating, as you talked about this, because it’s not really an area I’ve explored much been more on the area of preterm delivery and things like that one, some of the work we did. But this issue of, as you said, what happens after the birth and and it’s really about access to services and financial means and the ability to get that that that you’re demonstrating through some of these studies?
Jason Salemi
It absolutely is, you know, so often in epidemiology, we focus on trying to have primary prevention. So it’s very common for people to publish studies on risk factors associated with the likelihood of having a child born with a particular birth defect. But so often, we call it consequential epidemiology, when somebody is born with a condition because no matter how well we do, we’re still going to have children who are born with birth defects. an equally important line of research is what then happens to them, what do their outcomes look like? What are the expectations for either survival or morbidity? And how can we improve access to health care? So we can make sure that everybody has an equal opportunity to have a long and fruitful life, even though they’re born with different types of birth defects?
Fred Goldstein
And you’ve obviously Jason done a lot of thinking and work in this area, published a lot of studies in this, what made you suddenly decide to switch to COVID?
Jason Salemi
You’re absolutely right. Well, actually, you know, it does sort of fit my initial push in this direction was, although my passion for my practice is represented in a lot of different topic areas. My first instinct with COVID-19 was how is this new Coronavirus affecting pregnant women and children? That’s always the initial question I’m going to ask. And even though the early information coming out of Wuhan, China was that children were at less risk of much lower risk of severe morbidity and mortality. And that’s proven to be true throughout the pandemic. Nonetheless, there are still 74 million children in the United States. And so we knew if this, you know, virus ran in an unmitigated fashion, there would still be a lot of children affected, and a lot of children needlessly suffering from severe illness and death, even though again, they’re at lower absolute risk of those events happening. And so we ended up starting to compile information, we published our paper in the Journal of Public Health Management in Practice. And our goal in this paper was just to provide some evidence based estimates of the number of children who at the time, this was back in April of 2020, who were actually infected with the novel Coronavirus in the United States. And we also offered some projected cumulative numbers of severely ill pediatric patients and the possibility of mortality in a number of different scenarios. And so through the course of that, I tried to compile information and my colleagues did as well. And we noticed, I always felt frustrated, like, and this is, you know, it’s a lions task, you know, lion’s share of the task for State Department’s of health to put this information together and compile it early on in the pandemic, but I always felt like I was asking for more. And so thankfully, I’ll give the Florida Department of Health, an immense amount of credit, they make a lot of information publicly available, you just need to have some know how with compiling all of these disparate data sources in a meaningful fashion, and so I was selfishly doing that for myself. But where I really got engaged in this is I think, like all of us this should resonate with anybody listening is the level of misinformation and disinformation that was being circulated around COVID-19. And so in an effort to combat that with just my friends and family, mainly on social media, I started to use some of these visualizations, I was preparing. And they said, Oh, my God, this is fantastic. You should make this available to the general public. And so at the time, I think only had like five or six different visualizations. I made it publicly available. To make a very long story short, I got contacted by the National COVID tracking project. They loved what I was doing in the effort. As I was making and you know, fast forward nine months or so, I’ve now got a very comprehensive dashboard that, you know, builds in publicly available information from the state some information from the CDC, and from the Department of Health and Human Services. And I actually did a tally, just for this podcast, I now have 93 different visualizations that you know, goes over cases and testing and hospitalizations, and mortality and variants, and vaccinations and excess mortality, like all of these different metrics that hopefully help people to stay in tune. And then, you know, I do my best to try and supplement that by talking to the media and trying to convey just factual information on what we’re seeing.
Fred Goldstein
And one of the things I really like about your website is these visual aids visualizations. Can you talk about, you know, and I know, we discussed this earlier, the importance of putting this out in ways that people can better absorb it and understand the information.
Jason Salemi
Yeah, so thankfully, I’ve considered myself a long standing partner of the Department of Health. And so I took this on in order to not replicate or duplicate or anything like that with what they’re trying to put out there with their official dashboard. But to go further. So what I really tried to do is two major things with my dashboard that I didn’t feel was being done. One is the ability to drill down deeper, right, if I wanted to know, among the 20 to 49 year old age group in Hillsborough County, now what’s going on with, you know, infection rates in the past two weeks, you know, you can now drill down to that level. And again, it’s because the Department of Health makes this information available in a very granular format. And so I’m able to then display that and allow that drill down capability. The other thing was, I didn’t want a bunch of just static images. I wanted it so that when people look at a visualization and hover over it, they get a lot of additional information. So one good example of that is your traditional epidemic curve. How many new cases are we seeing in a particular area every day of the pandemic? And it looks like a curve? Well, when you hover over that on my dashboard, you get not only the number of cases on that day, but what are the seven day trends? How many cumulative cases to date, what’s the actual rate, the age adjusted rate? How have the rates changed in the past one week, the past two weeks. So again, it gives people a lot of information. So they don’t have to make those calculations themselves. I didn’t want people to feel like they had to do a lot of hard work to understand and provide some answers to the questions that they had. So I think it’s immensely important because I think people should be given the opportunity to digest the information in an easy way and make informed decisions based on that.
Fred Goldstein
And there’s been a lot of talk about, what’s the real data, you know, is, are all the cases being reported? You look at this as a scientist, how do you deal with that?
Jason Salemi
It this has probably been the biggest challenge. I know, a lot of people have tried to coin it as the second pandemic. But yeah, it’s almost like we’ve been doing the reverse scientific method. You know, as a scientist, usually I start from what we call the null hypothesis. And we say, we assume that there’s no association between an exposure and an outcome. So that is, the burden of proof is on the scientists to show that something exists. And I feel like, unfortunately, we’ve had certain narratives that even without complete evidence, so for example, you know, maybe the state of Florida is hiding certain pieces of information or not reporting accurately on deaths. That’s not necessarily substantiated by the evidence. But you know, a lot of people when they’re investigating data, and some of these are sciences, some, but most of them are not there. There may be armchair epidemiologist, they’re looking at the data. And they’re starting from a standpoint of believing that there’s something nefarious going on. And that’s just a bad way to go about science, because then as soon as they find something that corroborates that now we’ve got a confirmation bias. And and it’s become kind of lazy, I think. And you’re starting to see stories emerge that don’t provide full context. And again, some of that is because a lot of people who are trying to digest this information are not scientists, they’re not used to it. But I don’t think that some people do their due diligence and really think about what are the data actually saying, what is the evidence base, not what do I really feel is going on. And so that’s been a big challenge, because as soon as you say something that might be counter to a narrative, whether that narrative is coming from the quote, unquote, right, or the quote, unquote, left, you somehow now become an enemy of that opinion. And that’s been the big challenge. I said, from day one. You know, I have political opinions like everybody else, but it does not enter into my science. I’m going to look at the data, do my due diligence and come up with it. My own honest, you know, I hope is an expert interpretation of what I’m seeing. I may be wrong, but I’m going to always try and say what the data say regardless of, you know, popular opinion from either political aisle, and I think that’s why a lot of people you know, from both sides of the aisle, do at least value that they know that that’s my effort. I’m trying to convey just what the data say nothing more, nothing less.
Fred Goldstein
And given, given that approach, have you personally experienced people coming at you from either side? Because of what the you put up on the website?
Jason Salemi
Yes. But I would say my experience has not been nearly as egregious in particular, some of the things that I’ve seen happen to female scientists, during this pandemic has been atrocious. But I would say, yeah, you know, you have to learn to let things slide off your back. So when I was on social media, and frequently tweeting out information, you would have what they term, you know, your trolls coming on board. And, you know, I think a good example of this is, I’m really a nobody in this space, maybe I’ve got a little bit of recognition locally for my dashboard. But early on in this pandemic, you know, I’m really a nobody in the COVID-19 science world. And so back in July, I appeared on CNN, you know, national news, but it was in the middle of the day on a Friday. And by that evening, people were already posting, you know, false news that I was affiliated with Nazis and just trying to discredit me trying to muddy the waters so that people trying to convey scientific communication are seen as maybe untrustworthy. And and that’s been a challenge just because you know, you never want anybody to spread mistruths about you. But at the same time, like I said, it’s, it’s pretty easy to go ahead and just let that deflect off your back, try and keep doing what you’re doing. And know that you know, most people have a genuine desire to know what the truth is, but but it’s a problem. And again, I’ve seen it so agree just with certain, you know, high profile individuals, and again, especially for a lot of female scientists, I’ve seen it really just I don’t know, is it’s astonishing, the depths to which people will go, especially when they’re protected by anonymity on social media,
Gregg Masters
And if you’re just tuning into PopHealth Week, our guest is Jason l. Salemi, PhD, MPH Associate Professor of epidemiology at the University of South Florida College of Public Health
Fred Goldstein
right, unbelievable. And I really appreciate you getting into that a little bit in discussing it. Because really, what you’re trying to do is say, here’s the data, here’s different ways to visualize it, and to look at it. And hopefully you can then take that and better understand it, make some decisions on that for yourself and for others, etc. So it’s really, at its truest point, it’s just really about non political. This is what this is, as I see it, when I look at epidemiological data, obviously, you have to say, here are the reasons why maybe we’re missing, we may be missing some data. We’re not quite sure of this. But But you know, and then place those into the conversation. But other than that, it’s really just getting it up there. And you have two sites, right? You have a site, that’s the Florida site, and then you have a kid side as well.
Jason Salemi
Yeah, you’re absolutely right. I’m very proud about this, because many people really do know me for my Florida specific dashboard. But I’m equally proud of the Coronavirus and Kids Tracking and Education Project. We call it the COVKID project for short. This is an initiative that’s led by Beth Pathak. She’s a an outstanding epidemiologist with 30 years of experience. She’s a personal mentor of mine, and also Dr. Janelle Menard. She’s an equally terrific medical anthropologist and an epidemiologist, I’m just really fortunate to be a part of this very small but mighty team, we’ve compiled national and state data going to each state’s dashboard, collecting all of this information on cumulative cases, intensive care, hospitalizations, and deaths, specifically in children and teens. And one of the big things you actually alluded to, you know, trying to say what the data say and the limitations of the data. Well, we’ve been trying to call for standardized reporting of all important COVID-19 metrics by age, sex, race, and ethnicity. Otherwise, you know, it really becomes immensely difficult to make sense of all of the data and the differences across reporting jurisdiction. So we’ve really tried to better understand again, we’re fortunate that children seem to be impacted less, but they are impacted. There’s plenty of families that have absolutely been traumatized by COVID-19. And what’s happening to people in the pediatric age range. And so been very proud of that initiative, that dashboard that’s available and this team of people for the COVKID project. I’ve consulted locally with a couple of school boards, and the cove kid team has consulted with the National Education Association, to try and improve evidence based decision making around what’s going on with kids understanding that the decisions to go back to school. So I’m just I’m super proud of the work that we’ve accomplished. And again, we’re unfunded, and we’re small, but we are a mighty team that’s very passionate about the work that we do.
Fred Goldstein
Yeah, it’s fantastic if people want to go to that site, that one is COVKIDproject.org that was done by Beth ,Janelle and you Jason’s rits eally fantastic to have found that and be reporting on the kids. And I think as you pointed out, it’s important to recognize that although children are less impacted by this disease, the impact is not zero. We do have obviously deaths and people with other issues post COVID.
Jason Salemi
Yeah, you’re absolutely right. I mean, I think you know, not only what’s happening with children, but so often I hear this narrative and it’s, it’s human nature to want to make comparisons. And I live in Florida and everybody wants to compare how is Florida doing on cases and deaths and hospitalizations to other states? And to me, we’re missing the picture. Even if we fall middle of the pack, or at the bottom of the pack on things, it’s what decisions can we make to prevent as much morbidity and mortality from this virus as humanly possible, while also keeping in mind the, the fact that we have to keep a functioning economy going on. So you know, I don’t envy the decision makers who have to make these immensely difficult decisions. But to me, you know, don’t don’t try and think how am I doing compared to others just, you know, look at the evidence, unbiased evidence, make decisions that are best in the best interest of people in, in your state, in your county, in your local communities? That’s what we should be striving for.
Fred Goldstein
Well put, well put for sure, Jason. So as you’ve looked at this, we’ve been through a couple of waves. Now, you’re an epidemiologist, where do you think we’re going now with this race, sort of between the vaccine and the variance?
Jason Salemi
Yeah, it’s it’s exactly that, isn’t it? I think we’re making you know, pretty incredible progress for for people like me who’ve studied clinical trials for such a long time. And we know how long these trials can really take to get through phase three and rollout it’s, it’s been astonishing that we can roll out these vaccines that are both safe and effective for people. And it’s great that we’re, you know, continuing to get doses in arms. My age group was actually called this Monday in Florida. And so I’ll be getting my vaccine on Friday, at least the first dose of the Pfizer vaccine. And so I’m really excited. And we’re starting to even see in the numbers in Florida, the unfortunate side is that we are having an uptick in cases. But if you look at the uptick, or at least if you look at the cases over the past two weeks by age group, you’re really starting to see that pronounced effect of the vaccine. We learned earlier this week from the CDC that not only are the vaccines, effective at preventing severe illness and death, but they’re also pretty darn efficacious at preventing you from getting infected in the first place. And that’s why I think we’re continuing to see declines or at least flattening in our senior population, just in terms of the number of cases. But the bad news is, you know, we are starting to have an uptick in cases and pretty pronounced in some of our major metropolitan areas in Florida, in Tampa and in Miami, in Orlando. And why that is a cause for concern is because two things mainly right. First of all, we’ve proven time and again, in the United States, certainly in Florida that it We can’t just let people get the virus and go about their business who are quote unquote, low risk, this virus is very good at finding vulnerable populations. And right now in Florida, we still have 1.3 million seniors who have yet to get any dose of a vaccine. And we’ve got another 1 million seniors who are not fully vaccinated. So still, even just by age, there are plenty of vulnerable people in our communities who can get infected. And again, if community transmission gets high enough, it will find those individuals and again cause unnecessary hospitalizations and deaths from the virus. But the other reason is, when you give a virus a chance to replicate, you give the virus a chance to mutate. And we’ve got some concerning variants that right now seem to be just more transmissible. It seems like our vaccines are still very effective against these strains, but they are passing to more and more people in our population. And the concern is that if we keep community transmission high, we just get the virus and increased opportunity to have another dominant variant that emerges and maybe this variant is more virulent, maybe this variant is is more likely to evade our vaccine and the efficacy, efficacy goes down, you know, a ton. So I’m concerned about that. Let’s not give the virus an opportunity, especially when we’re this close to getting enough people vaccinated. To starting to get back to some semblance of a normal of normalcy. Let’s not give the virus an opportunity to affect vulnerable people needlessly, and not let’s not give it a chance to have other variants that emerge that are more troublesome and and that will really delay our ability to get back to normal.
Fred Goldstein
Absolutely, Jason, and I look at it now. And what I’m sort of hearing in the various communities and the organizations that we’re working with around COVID is there’s sort of now this whole thing, well, the vaccines are here, everybody’s taking a nice breath, it’s all going to be better. And we’ve sort of loosened up quite a bit, it seems like and I find that a bit concerning given, we really sort of potentially have two paths as I see it. One is you see what’s happening in Europe. And the other is you see what’s happening in Israel. And and we’re sort of at that inflection point where we could potentially, you know, become more like Israel with really having the vaccines having a major impact and bringing the disease down. And hospitalizations down to you see, like Europe suddenly it just takes off because of the variance. So it’s been interesting to watch.
Jason Salemi
And, Fred, you’re you’re absolutely right, we really are at a critical point. You know, one of the things I try and do as often as I can, because I don’t think it’s done enough, especially by scientists like myself is, I know that this has been immensely challenging for everybody. And we’re often telling people what to do, and continue to wear masks and socially distance and do things outside. And while it is for the betterment of our entire community, and getting us back to normal soon, it’s not easy to do these things. And so I want to thank all of the people out there who, for such a long period of time, have tried to do their best to prevent the spread of this virus. But there’s more work to be done. Because I promise you, if we continue to relax things, this virus is happy to take hold and do exactly what it’s doing in Europe and again, set us back from all the progress that we’ve made, and ultimately, just have unneedlessly more people getting extremely ill and dying from this virus. We are getting close, we’ve got something that is a game changer. These vaccines are absolutely game changers. But let’s keep community spread low enough, allow the vaccines to do their job. And we’ll be in a much better place. And you know, the steps are honestly very simple, you know, wearing a mask, socially distancing, these things are not challenging. They’re proven to work at bringing down community transmission. We’ve seen it in Florida, we’ve seen it in the United States. And so I know everybody has COVID fatigue, we all deserve to get back to our normal lives. But we just have to, you know, get some grit and do this for just a little bit longer. Because again, I think, you know, we’re very close to getting most of our population vaccinated and getting back to normal.
Fred Goldstein
Fantastic. Well, I think that’ll have to do it for the end of today’s show. Jason, I’d love to get you back on to talk about some of the other areas you’re working on. So thank you so much for joining us on pop Health Week.
Jason Salemi
Fred, thanks so much for having me. It’s been a pleasure.
Fred Goldstein
Back to you, Gregg.
Gregg Masters 28:14
And thank you for that as the last word for today’s broadcast. I want to thank Jason l Salemi, PhD, MPH Associate Professor of epidemiology in the College of Public Health at the University of South Florida for his time and insights today, for more information on Jason’s work, go to www.JasonSalemi.com. That’s jasonsalemi.com