W
elcome to the winter 2022 issue of Health Magazine, published by the Southwest Utah Public Health Foundation and distributed to most residences in our five-county district. We also welcome those of you who have recently relocated here. Southwest Utah offers incredible natural scenery and open spaces along with towns and cities where you’ll find strong values of community and service. Our district is home to over 250,000 people, with continuing rapid growth. Washington, Iron, Kane, Beaver, and Garfield counties are each unique in their own way. What our residents have in common is the desire to live long, healthy lives. One of our goals is to provide use-
ful and reliable health information to help you - and your family– enjoy wellness and prevent illness and injury. I am grateful for the dedicated work of my staff, as well as the efforts of our local hospitals, Becoming familiar with businesses, schools, and volunteers during the remarkable science a pandemic that is reaching its two-year behind the battle against mark. We have rethis virus can help you mained focused on maintaining a steady make your decisions with course during times of conflicting policies confidence. and opinions. COVID-19 may be around for a while, with some variants more contagious than others. With most of our counties still having high transmission rates, it’s a matter of time before we’ll all be exposed or in-
HEALTH MAGAZINE | WINTER 2022
fected. Since we have no way of knowing exactly how our individual immune systems will respond, being unvaccinated could leave you open to more serious illness or “long-hauler” effects. We continue to advocate for wise precautions that protect you and those around you. Widespread vaccination against COVID-19 remains critical in protecting our residents from severe illness, hospitalization, and death. Articles in this issue will give you insight on how the vaccines work; it’s why I got vaccinated and encourage others to do the same. Becoming familiar with the remarkable science behind the battle against this virus can help you make your decisions with confidence. Also included in this issue are articles about rabies, first aid preparedness, sugar consumption, used oil hazards, and a big-picture view of public health efforts. We hope you enjoy your reading! Sincerely,
David W. Blodgett, MD, MPH Southwest Utah Public Health Department (SWUPHD) Director & Health Officer
SWUHEALTH.ORG | PAGE 3
IN THIS ISSUE The design for this issue of HEALTH pays tribute to the ranchers who have ranged throughout Southwest Utah since the mid-1800s. Their lifestyle survives to this day and has influenced our culture and traditions in many ways. The photography features local winter scenes, reminding us that, as winter arrives and settles in, we can still venture outdoors and enjoy the fresh air. This is our second winter under the shadow of a pandemic, but we hope for good health and quick recoveries for all.
“If we had no winter, the spring would not be so pleasant: if we did not sometimes taste of adversity, prosperity would not be so welcome.” — Anne Bradstreet
INSIDE 6. PUBLIC HEALTH PAST & PRESENT By David Heaton
10. SUGAR HABIT By Naomi Martinez
12. PANDEMIC UPDATE 14. COVID-19 mRNA VACCINE FACTS 16. PANDEMIC TO ENDemic By Zubin Damania, MD
20. CHECK YOUR SOURCES By David Blodgett, MD, MPH
24. USED OIL Q&A By George Kayser
26. LET'S TALK RABIES
By Danielle G. Timothy RN, BSN
28. MEDICAL PREPAREDNESS FOR FAMILIES By Mike Gale, AEMT
30. LOVE
By Kindal Ridd
HEALTH MAGAZINE | WINTER 2022
SWUPHD LOCATIONS (Southwest Utah Public Health Department)
B E AV E R
75 W 1175 N Beaver, Utah 84713 435-438-2482
GARFIELD
601 E Center Panguitch, Utah 84759 435-676-8800
IRON
HEALTH MAGAZINE DIRECTOR/HEALTH OFFICER:
David W. Blodgett MD, MPH
PUBLISHING DIRECTOR: Jeff Shumway
EDITOR:
David Heaton
260 E DL Sargent DR. Cedar City, Utah 84721 435-586-2437
KANE
445 North Main Kanab, Utah 84741 435-644-2537
WA S H I N G TO N
620 S 400 E St. George, Utah 84770 435-673-3528
DESIGN & ARTWORK:
Kindal Ridd
QUESTIONS OR COMMENTS INFO@SWUHEALTH.ORG The entire contents of this publication are Copyright ©2022 HEALTH (the magazine of the Southwest Utah Public Health Foundation) with all rights reserved and shall not be reproduced or transmitted in any manner, either in whole or in part, without prior written permission of the publisher. Health magazine hereby disclaims all liability and is not responsible for any damage suffered as the result of claims or representations made in this publication. Printed by Hudson Printing Company / Salt Lake City, Utah / hudsonprinting.com
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P ublic H ealth
PAST & PRESENT
By David Heaton Managing Editor SWUPHD Public Information Officer The Poison Pump In 1831, England was hit for the first time by a wave of cholera, one of the most dreaded diseases of the time. A bacterial infection of the intestines, cholera causes profuse diarrhea and vomiting and has up to a 60% mortality rate if left untreated, sometimes causing death within hours after symptoms begin. Cholera killed millions of people in the 1800s as it spread from India to Russia, Europe, and North America. Most medical practitioners at the time believed that diseases like cholera spread through a poisonous mist in the air called "miasma". John Snow, a British physician, was skeptical of this theory and challenged it in an 1849 essay. A few years later, London was in the grip of another series of cholera outbreaks. On August 31, 1854 the worst outbreak hit the Soho district, causing most residents to flee
and killing over 600 people over the course of a few weeks. With the aid of a local reverend, Dr. Snow took to the streets of Soho as the outbreak raged in an effort to track down the source. Going door to door to identify where the victims lived and what they had in common, he created a map that helped him narrow his search to a specific area surrounding a water pump on Broad Street. Dr. Snow wrote: "On proceeding to the spot, I found that nearly all the deaths had taken place within a short distance of the pump. There were only ten deaths in houses situated decidedly nearer to another street pump. In five of these cases the families of the deceased persons informed me that they always sent to the pump in Broad-street, as they preferred the water to that of the pumps which were nearer. In three other cases the deceased were children who went
HEALTH MAGAZINE | WINTER 2022
to school near the pump in Broad-street. Two of air, was responsible for the spread of cholera, and them were known to drink the water, and the par- he traced the source of disease to nearby cesspools ents of the third think it probable that it did so… and sewage-polluted water from the Thames river, which was being piped directly to the pumps. With regard to the deaths occurring in the locality belonging to the pump, there were 61 instances in Dr. Snow's use of statistics and investigation along which I was informed that the deceased persons with the simple removal of a pump handle marked used to drink the pump water from Broad-street, the founding of epidemiology, or the science of either constantly or occasionally… studying patterns of health and disease at the population level. A new element of public health had The result of this inquiry, then, is that there has emerged. been no particular outbreak or prevalence of cholera in this part of London except among the per- Protecting the Public sons who were in the habit of drinking the water of Renowned bacteriologist C.E.A. Winslow defined the above-mentioned pump-well. public health as "the science and art of preventdisease, prolonging life and promoting health I had an interview with the Board of Guardians of ing through the organized efforts and informed choicSt. James's parish, on the evening of the 7th (of es of society, organizations...communities and September), and represented the above circum- individuals." Public health has been practiced in stances to them. In consequence of what I said, the various ways throughout history. The Chinese handle of the pump was removed on the following employed an early form of immunization against day." smallpox 3,000 years ago. In the Roman era, meaSource: Snow, John. Med. Times and Gazette, n. s. sures were taken to divert human waste in cities. Quarantine was used in medieval times to fight the vol. 9, Sept. 23, 1854, pp. 321-322. spread of contagious illnesses. The 19th centuDr. John Snow's detective work helped end what ry saw the development of sewers, garbage colhe later called "the most terrible outbreak of chol- lection, and landfills in industrialized countries era which ever occurred in the United Kingdom". where higher populations in urban areas increased He was able to show that contaminated water, not the risk of disease. By the arrival of the 20th cencontinued on next page...
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HEALTH MAGAZINE | WINTER 2022
tury, germ theory had been accepted and vaccines were being developed. World War I became the first major conflict where disease caused fewer casualties than combat. Science was making amazing strides against smallpox, diphtheria, yellow fever, syphilis, typhoid, and bubonic plague. Tetanus and meningitis were largely conquered with antitoxins. Feared diseases that once took a high toll from the population were being subdued in the United States and other developed nations. In the 1950s, Jonas Salk and Albert Sabin introduced vaccines for polio, which has now been eradicated throughout most of the world. Smallpox, which once destroyed entire civilizations and killed millions annually until just a few decades ago, became the first disease to be completely eradicated as of 1979. Advances in public health have reduced infant mortality and have increased life expectancy to over 78 years for Americans. Traditional public health has usually included clean water, immunization, safe food, rule enforcement, passive surveillance, and some clinical programs. More recently, public health practice has entered new frontiers in technology, emergency preparedness, community involvement, and personal empowerment. Good public health practice protects the community's health by promoting wellness and preventing health problems from occurring in the first place. Doing More With Less The task of shouldering the responsibility of public health in society has largely fallen to government entities, since the emphasis is on populations and broad-based solutions. The Department of Health and Human Services (HHS) oversees public health on the federal level and includes the Surgeon General, Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH). The Utah Department of Health (UDOH) addresses public health issues on the state level, and finally the work on the ground in Utah is done by independent local health departments. These county-level organizations are charged with providing direct services to their communities, and do so today with increasing expectations and decreasing resources. Today the United States spends about $11,582 annually per person on health care, usually for treatment after we become ill. It is estimated that an investment of $1,000 per person (as recommended by the CDC) for public health activities would actually cut what we spend on healthcare in half. Traditionally, we in Utah have funded public health at one of the lowest rates in the nation, and so we're forced to do
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a lot with very little. Utah’s 13 local health departments get the majority of their budget from federal grants, which are obtained and distributed by the Utah Department of Health. Currently, the five counties covered by the Southwest Utah Public Health Department (SWUPHD) get $30 annually per person for public health, including $6.75 per head from county taxes. Funding public health has been a "backburner" issue for years, and increasing funding to prevent future problems is a tough sell for many people, especially in today's economy. The profession is also losing knowledge and wisdom as experienced members of the public health workforce retire. They, and others who leave for different employment, may not be replaced due to tightening budgets. Local health departments are charged with the responsibility of preventing disease, promoting wellness, and protecting the health of the population. Answering to a Board of Health composed of county commissioners and appointed citizens, the SWUPHD employs 85 staff and offers over 80 programs to promote and protect the health of the 257,390 residents of southwestern Utah, which includes Washington, Iron, Kane, Beaver, and Garfield counties. “These services make the most impact at the local level and our health department will continue to do our best to offer science-based, effective programs to our communities," states Dr. David Blodgett, SWUPHD Director and Health Officer. "Much of what we do is preventive and unnoticed. Yet in reality, the difference between a third world country and a developed nation is a good public health system."
sugar
HABIT
By Naomi Martinez Health Educator
S
ugar is something each of us is born with an instinctive taste for - in fact, newborns are born with a natural affinity for sugars, usually found in mothers’ breast milk. But what has this innate fondness turned into for most of us? A three p.m. craving for cookies, candy, soda, and other sweets. This kind of sugar, or “added sugar”, is a whole new sweet passion that most of us don’t think twice about. Much of my experience with sugar is similar to yours, but was forever changed when I spent a year living in Central America right next to a sugar plantation. Besides the social issues created by these tall fields of sugar cane, I saw the direct health effects it had on a sugar-dependent community. Today, however, we’ll focus on the individual and how sugar can be an obvious, silent, or not-so-secret love affair that we each experience. Sugar History Sugar, like the white or brown crystals seen next to your bowl of oatmeal at a restaurant or by the coffee station at work, has been around for centuries. It became a commonly used item in the 16th century when the processing of sugar cane or sugar
HEALTH MAGAZINE | WINTER 2022
beets was found to produce a sweet syrup which could then be crystalized. This sweet treat quickly caught on in European countries as an essential ingredient for a good cup of tea. Later on, consumption and the cost of taxes on sugar spurred events like the Boston Tea Party of 1773, which led to the American Revolution. Sugar also played a role in shaping the North American slave trade, with thousands of individuals forced to cut sugar cane in plantations across the continent. Today, sugar is a subsidized product in the United States and an industry that grossed over $97.2 billion in 2017. Something that has been around for so long must be a good thing - or is it? What is “Added Sugar”? Sugar, in scientific terms, could refer to any simple carbohydrate. A carbohydrate is a quick and easy source of energy for your body. These kinds of sugars are found naturally in almost everything you consume: fruits, vegetables, dairy products, and grains, which are all important to your health. You’ve probably tasted this kind of natural sugar when you’ve enjoyed fresh strawberries or a plump peach. “Added sugar” is what we’re referring to when we discuss the sugar processed from sugar cane, sugar beets, corn, and other sources which are added to foods for flavor, texture, or preservation. Added sugars can go by many names: sugar, brown sugar, honey, high fructose corn syrup, sucrose, dextrose, maltose, lactose, and others. Foods like
cereals, ketchup, breads, salad dressings, and pasta sauces may contain natural sugars from some of their ingredients, but odds are they likely have sugar that has been added as well. The truth is, we are each consuming more added sugars than we might imagine - approximately 165 pounds of sugar per person per year in America. Much of the added sugar we consume in Utah is found in soda and candy, with our candy purchase rate being almost double the U.S. average in 2015.
ception here; however, we can more specifically reduce added sugars in our diet in order to decrease our risk of many chronic diseases. The American Heart Association recommends that women consume no more than 6 teaspoons (24 grams) a day of added sugar, while men should consume no more than 9 teaspoons (36 grams). Nutrition labels reveal just how “sugared-up” packaged and processed foods can be. Under the “Total Carbohydrate” section, there is a sub-section labeled “Total Sugars”. “Added Sugars” are often listed there in grams, alHealth Effects Chichigalpa, the Central lowing you to see how much a American town I mentioned serving takes up of your daily earlier, is home to people who added sugar allowance. were remarkably kind and welcoming, but I was saddened by The good news is that we have to be subject to their health conditions related don’t these imposed sugar amounts to high added sugar intake. In from pre-packaged We addition to dealing with sever- can compare labels foods. at the sual third-world crises, their rates permarket to ensure we’re of obesity, diabetes, and kid- getting the least added sugars ney failure were astronomical. necessary to still enjoy our Individuals with missing teeth, food. We can choose to have open wounds, and amputated plain water and milk, rather limbs were not the exception in than flavored milks, sugared this population- they were the fruit juices, or full-sugar soda. rule. These diseases and con- Making our food from scratch ditions have been scientifically can greatly reduce added linked to an increased added sugars; try making your own sugar intake; in fact, those who granola, pasta sauce, or condiexceed the daily recommended ments to stay in control of the amount often find themselves ingredients used and in what at an increased risk of oral dis- amounts. More great tips on ease, cardiovascular disease, reducing your overall sugar obesity, and type 2 diabetes. intake can be found at eatSo, how can we actively work right.org. You can consult to prevent these same health your doctor or a registered dioutcomes in our lives? etician on specific ways to improve your diet. Overall, we Reducing Added can make positive changes to Sugar Intake help reduce our overall daily Diet and exercise seem to be the added sugar intake and save answer to many of our health the super sweet stuff for spequestions, and there is no ex- cial occasions.
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pandemic update for
SOUTHWEST UTAH This data is subject to change frequently. Visit swuhealth.org/covid for the most current information (updated every Thursday)
S
outhwest Utah’s first locally diagnosed COVID-19 case was reported on March 21, 2020. On March 27, we lost our first resident to the disease (Utah’s second death). Many of the district’s initial cases were travel related, but community-spread illness soon took hold in a summer surge of cases. Beaver County reported its first case on June 15, 2020, making it one of the last counties in the nation to be affected by COVID-19. Following an autumn lull, we experienced a winter surge which strained hospital resources and impacted many families and businesses. Vaccines had begun to arrive in December, and by February 2021 clinics were administering thousands of shots to priority groups according to occupation, age, and risk. Another lull in the summer was only temporary; by October another surge, likely fueled by the delta variant of COVID-19, reached its peak. As we head into December, cases remain similar to where they were this time last year. Another winter surge is possible, along with the return of seasonal influenza, which was almost a no-show last season partly due to large-scale infection control practices against COVID-19. We encourage Southwest Utah residents to take advantage of vaccines and boosters, along with social distancing (or masking in public when distancing is impractical), and staying home when sick.
Vaccination (as of 11/24/21) • Total eligible local residents fully vaccinated: 114,165 (about 50%) • % of local residents fully vaccinated age 70+: 83% • % of recent Utah cases + deaths who were unvaccinated: 93% • % of recent Utah cases + deaths who were vaccinated (“breakthrough”): 7% Vaccines are available for all residents age 5+. Boosters are available to residents age 18+ (6 months after 1st Moderna or Pfizer series, 2 months after Johnson & Johnson). Boosters can be any brand. To get vaccinated visit swuhealth.org/covid or contact your local pharmacy
HEALTH MAGAZINE | WINTER 2022
Local Pandemic Trends Southwest Utah Public Health Department Area Specific Numbers (April 2020 - November 2021) 200 people
|Deaths |Hospitalizations |Cases
100 people
| April
| May
|u J ne
|u J ly
| August | Sept.
| Oct.
| Nov.
| Dec.
2020
|a J n.
| Feb.
| March | April
| May
|u J ne
|u J ly
| August | Sept.
2021
CURRENT TOTAL TOTAL TOTAL TRANSMISSION RATE CASES HOSPITALIZED DEATHS
Beaver
high
1170
66
14
Garfield
high
701
50
12
Iron
high
9804
402
63
Kane
low
983
56
13
Washington
high
30500 1764
331
Unspecified
132
5
Southwest Utah
43290 2343
← ← ← ← ←
COUNTY (as of 11/24/21)
5
←
= trending down over past 2 weeks
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438
| Oct.
|Nov.
COVID-19
m RNA
VACCINE FACTS Source: cdc.gov/coronavirus/2019-ncov/vaccines
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C
OVID-19 vaccines have been rapidly developed While many vaccines put a weakened or inactivated and distributed to help fight the pandemic, although germ into our bodies to trigger an immune response, viresearchers have been working with messenger RNA ral vector vaccines (like Johnson & Johnson COVID-19 vaccines for decades. mRNA vaccines have been stud- version) use a modified, harmless version of a different ied before for flu, Zika, rabies, and cytomegalovirus. virus (a vector) to deliver important instructions to our As soon as the neccells to produce a essary information spike protein. Hundreds of millions of people in the United about the virus that vaccines causes COVID-19 States have received COVID-19 vaccines under the mRNA (like Moderna and was available, scimost intense safety monitoring in U.S. history. Pfizer) use mRNA entists began decreated in a laborasigning the mRNA instructions for cells to build the unique spike protein tory. Once injected into the arm, the mRNA enters the muscle cells and instructs them to produce a harmless into an mRNA vaccine. piece of spike protein that is found on the surface of the Vaccines developed in the United States usually go virus that causes COVID-19. After the protein piece is through three phases of clinical trials to make sure they made, our cells break down the mRNA and remove it. are safe and effective. For COVID-19 vaccines, these The mRNA never enters the nucleus of the cell where phases overlapped to speed up the process so the vac- our DNA is located, so it cannot change or influence our cines could be used as quickly as possible to control the genes. pandemic. No trial phases have been skipped. Next, our immune system recognizes that the protein The clinical trials for COVID-19 vaccines have in- doesn’t belong there. This triggers our immune system volved tens of thousands of volunteers of different ages, to produce antibodies and activate other immune cells races, and ethnicities. Because COVID-19 continues to to fight off what it thinks is an infection. That immune be widespread, the vaccine clinical trials have been con- response, which produces antibodies, is what protects ducted more quickly us from getting inthan if the disease fected if the real were less common. Vaccine technology will continue to advance public COVID-19 virus enhealth’s ongoing mission to promote longer life ters our bodies. The The trials showed no serious safety spike proteins, like and reduced suffering in the world. concerns within 8 the injected mRNA, weeks following don’t last long in the vaccination. This is an important milestone, as it is un- body and are estimated to be gone after a few weeks. usual for adverse effects caused by vaccines to appear At the end of the process, our bodies have learned how after this amount of time. to protect against future infection from COVID-19 Results also determined that three COVID-19 vaccines and its long term consequences. Clinical trials showed (Moderna, Pfizer, Johnson & Johnson) met the FDA’s 95% effectiveness of Moderna and Pfizer vaccines in safety and effectiveness standards and granted those preventing COVID-19 infection in fully vaccinated (2 vaccines Emergency Use Authorizations (EUAs), which shots) people. Since protection may wane after several allowed the vaccines to be quickly distributed for use months, an additional booster shot is recommended after while maintaining the same high safety standards re- 6 months of completing your first shots. The booster can quired for all vaccines. The FDA has since granted full be any brand. approval for Pfizer’s vaccine for people aged 16 and Even if you experience a breakthrough infection after older. being vaccinated or immunity against infection wanes, Hundreds of millions of people in the United States COVID-19 vaccines have shown to stay remarkably have received COVID-19 vaccines under the most effective in continuing to help prevent serious illness, intense safety monitoring in U.S. history. The CDC hospitalization, and death. and FDA use several monitoring systems - like the Vaccine Adverse Event Reporting System (VAERS), Future mRNA vaccine technology may allow for one Vaccine Safety Datalink (VSD), and the v-safe app vaccine to provide protection against multiple diseases, - and alert the public about health problems that are thus decreasing the number of shots needed for proreported after vaccination. Some people have no tection against common vaccine-preventable diseasside effects. Many people have reported common es. Beyond vaccines, cancer research has used mRNA side effects after COVID-19 vaccination, like pain to trigger the immune system to target specific cancer or swelling at the injection site, a headache, chills, cells. Vaccine technology will continue to advance pubor fever. These reactions are common and are nor- lic health’s ongoing mission to promote longer life and mal signs that your body is building protection. reduced suffering in the world. Source: cdc.gov/coronavirus/2019-ncov/vaccines
SWUHEALTH.ORG | PAGE 15
pandemic to
ENDemic By Zubin Damania, MD Guest Columnist
Eyes on the future
S
o, people have been freaking out because the COVID-19 vaccines don’t seem to prevent reinfections, sometimes. And they’re thinking the pandemic’s just going to go on forever, especially when we’re back with masks and some countries have lockdowns. Let’s do some science on this, because it turns out it’s very likely, which is something we’ve been saying from the beginning, that this pandemic of SARS-CoV-2 is ultimately going to turn into an endemic, meaning a virus that lives with us seasonally and is no different than the common cold in the severity of disease it causes. When you look at the endemic cold viruses, everybody’s been infected at some point. Elders are protected from severe disease through multiple reinfections every cold season or so. The only new primary infections are in young kids and babies who innately blow it off, partially because they may have a lower concentration of ACE receptors, or - in the case of infants - antibodies from their mother. The seasonal cold “auto-vaccinates” us, that’s why
we don’t have a vaccine against the common cold, honestly. There are four endemic human coronaviruses that cause common cold-type symptoms around the world in a seasonal fashion. These have been with us for hundreds or thousands of years. Then we have three kinds of newschool coronaviruses: SARS-CoV-1, MERS, and SARS-CoV-2 (which causes COVID-19). MERS and SARSCoV-1 never achieved pandemic status because they were infectious only when you were having symptoms, so they were easier to contain; you could just identify, test, and isolate symptomatic people. SARS-CoV-2 is different, because asymptomatic people could infect others, and that’s why control and containment became pretty much impossible after it got out of the bag. When we consider antibody studies in the human population against those original four coronaviruses, we find there are two types of antibodies produced; one is IgM, which mounts an immediate response immediately after you're first infected, and the other is continued on next page...
HEALTH MAGAZINE | WINTER 2022
SWUHEALTH.ORG | PAGE 17
IgG, which takes longer to produce and are usually still protected from severe can mount a memory response if you’re disease and death. reinfected. IgM positivity really only The third aspect of immune protection is happens in kids. transmissibility. So how much So at some point, nearly every kid up does your immunity prevent you from until age 15 gets infected with these en- transmitting? It’s pretty clear - and the demic coronaviruses and mounts an IgM CDC has looked at this - that the vaccines response that then evolves into an IgG still allow you, if reinfected, to transmit response. After 15, there is almost no SARS-CoV-2. But how much? The maIgM response; they generate immunity jority of vaccinated and previously infectthrough the IgG response that persists ed people may still get infected and even into adulthood, but that immunity does get symptoms, but the duration of their not prevent reinfection. These studies transmissibility is narrowed. They clear came up with three aspects of immunity the virus faster, which means there’s less you ought to think about when discuss- transmission overall. It looks like that’s ing how a virus goes from pandemic to what happens with endemic coronavirus endemic. - our common colds - as well. Can you see how these dynamics of susceptibility, One is immune resistance to infection in severe disease, and transmissibility can the first place. How susceptible modify how you think about a pandemic? are you, and how much does your immunity help? When you get naturally Let’s put this together into a picture infected or vaccicomparing SARSnated (they’re realCoV-2 and MERS ly kind of the same (Middle Eastern thing) against a dis- Here's the punchline: Respiratory Synease like measles, the early part of the drome). Both of you get sterilizing them are coronavipandemic is over. immunity. You are ruses, but MERS is no longer suscepmore fatal, particuStop panicking. tible to infection. larly in young peoBut infection from It's going to be okay... ple and old people. coronaviruses (and MERS kills kids. vaccination against If it became a panSARS-CoV-2) gendemic, you would erates immunity that wanes over time, so lock down early, protect as many people that you can get reinfected. as you can, mask everybody, be very cautious, and aggressively work on a vacThe second aspect of immunity is cine. At that point, you would vaccinate protection against severe everybody, including little babies, and it disease. While protection against would become a routine childhood vacciinfection by SARS-CoV-2 from vacci- nation once MERS became endemic. nation looks like it wanes fast, protection against severe disease does not seem to SARS, however, affects an age gradiwane quickly. Natural infection probably ent that gets worse as you get older, or does the same thing to some degree. Re- it attacks comorbidities like obesity, diducing severe disease is a feature of pro- abetes, and other risk factors. Kids gentection that matters, especially for peo- erally don’t die from it. If you vaccinate ple who are older or have compromised against SARS-CoV-2 - or you get natuimmune systems because those are the rally infected - your immunity will likepeople that fill up our hospitals. Nobody ly prevent severe disease, particularly in cares about getting a cold; we care about the most vulnerable people. Reinfection people dying in hospitals on ventilators. will still occur, particularly in youngOverflowing hospitals mean we can’t er groups that then generate a broader do elective procedures and prevent can- disease protection over some period of cer with screenings. It turns out, if you time, probably years. But this process study a vaccinated (or naturally infected) can be sped up by increased transmission breakthrough case who gets a rip-roaring through repeated reinfection or revaccireinfection with a high viral load, they nation (boosters). HEALTH MAGAZINE | WINTER 2022
So, with a disease like SARS-CoV-2, you start out by bending the curve early on when you don’t have a vaccine to protect targeted populations like the elderly and people at risk. There has been a lot of controversy about how to do that when it comes to masking and shutting down businesses. Are we driving our children crazy? Are we creating mental illness? Are we hurting the economy? Are we harming poor people? These are all the things we’ve been talking about over the entire pandemic, and that’s up to debate because people are still at risk. You have to weigh costs and benefits. But when you get a vaccine, you now have a bypass switch where the vaccine’s going to behave like natural infection in terms of preventing severe disease. You start vaccinating as many people as you can, beginning with people at high risk, and get the jump on turning the pandemic to endemic.
hospitals get busier because some breakthroughs will lead to some disease that requires hospitalization, but Iceland’s severe disease and deaths are very low, and they have a jumpstart on endemicity. Here’s the punchline: the early part of the pandemic is over. Stop panicking. It’s going to be okay, but we have to get through this phase where people are at risk. That means get vaccinated. Kids and young adults may get naturally infected anyway, but you can also vaccinate as many as you can. Boost for people who are at higher risk and anyone else who wants one. Maybe you’re one of those people who has diabetes, hypertension, or kidney disease, and you’re at higher risk for breakthrough infection and severe disease. If you’ve been previously infected, get a jump on that extra immunity against severe disease by getting a vaccine.
Now, the thing is, this may take a little Classic herd imwhile. It may take munity is tough ...but we have to get multiple re-expoto achieve when through this phase sures, which is why, you can get reinwhen mixed with fected. It may take where people are at boosters and natural multiple exposures infection, the Delrisk. That means to turn this virus ta variant may be a safe long-term, but get vaccinated. blessing to people we’re creating imwho are vaccinatmunity against seed, because it could vere disease in the make this thing enprocess. We have a real-world case example of this with demic for them quicker. Iceland. They did a great job early in the After completing a residency as an internist at pandemic. Iceland has a small population Stanford University School of Medicine, Dr. Zubin with integrated healthcare. They geno- Damania spent ten years as a hospitalist at the typed and tested everybody with a high- Palo Alto Medical Foundation while he began provideos under the the pseudonym “ZDoggtech kind of approach to it, and it worked ducing MD” that have since gone viral among healthcare really well without a very aggressive professionals and general viewers alike. lockdown. They reached an 80% vacciThis article was condensed from a transcript of nation rate. Now we’re seeing their cases reach the highest rate they’ve ever been in the pandemic. Anti-vaxxers are using Iceland as an example of “look, the vaccines don’t work, right?” So what happened? They opened up, they travelled, the mask requirements were gone, and the very contagious Delta variant of SARS-CoV-2 emerged, which is so contagious that if you haven’t been vaccinated or naturally infected, it’s going to get you. But it’s Delta in the setting of an 80% vaccination rate, meaning cases may be high and
the video Pandemic to Endemic (ZDoggMD, August 17, 2021, YouTube) Used with permission.
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watch the video using this link
U.S. P reventive S ervices T ask F orce
CHECK YOUR SOURCES
By David Blodgett, MD, MPH SWUPHD Director and Health Officer
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t is bewildering to consider the onslaught of information that we are exposed to in today’s world. As more is understood about any given topic, it becomes even clearer that there is much that we do not know. It’s also exciting to live in a time when vast amounts of information are available and readily accessible to almost anyone. The internet in particular has opened these doors so that all may learn the secrets of the ages. However, not all sources of information are equal. The modern day miracle of the internet has a downside. With very little investment in experience, education, forethought or finances, anyone can rep-
resent themselves as an expert on any issue. What people used to say about the news is now said about the internet; the joke now goes, “I found it online, so it must be true!” Even people who seem to have legitimate credentials, such as celebrity doctors, are often maintaining large financial operations and can be influenced by paid advertisers and product endorsements. We can be easily manipulated by emotion and criticism, therefore a well-based online article may not be able to compete with the frequently anonymous tirades that follow it. A study published in the Journal of Computer-Mediated Communication (Feb-
HEALTH MAGAZINE | WINTER 2022
ruary 2013) found that inflammatory statements arise from over-testing and over-promising. Their made in online comment sections can influence recommendations can be found online at usprereaders on the topic more than the article itself! ventiveservicestaskforce.org. Here you will find evidence-based evaluations of many The difficulty of navigating the information su- popular preventive screenings and medical interperhighway is compounded by the complexity of ventions, gathered from thorough investigations some issues. The media tends to explain issues and reviews of medical literature. The USPSTF in one-liners and sound-bites and we tend to wel- makes recommendations on the following basis: come oversimplified explanations. This is the path Grades A & B: to misunderstanding, division, inconsistency, and Recommended for everyone often downright bad information. Nowhere is this more apparent than in politics, but a close second Grade C: would have to be the medical world. Recommended only for selected individuals You don’t have to look far to see examples of this Grade D: every day: coconut oil is bad for you/coconut oil is Not recommended healthy. Whole wheat is nutritious/whole wheat is Grade I: poisonous. Do statins (medications for high choInsufficient evidence to recommend either way lesterol) help or hinder? “Use this one weird trick to (insert whatever health problem is being exploit- These recommendations are supported by extened)”. sive research and documentation of the process the task force used to arrive at their conclusion. Who can you trust? There are several organizations that have been set Some of the recommendations of the task force up to specifically avoid the effects of politics and may surprise you. For example, screening for money on medical and public health decision mak- prostate cancer using a prostate specific antigen ing. These groups become the most credible simply (PSA) test received a D grade (not recommended) because their charge is to examine and interpret all in 2012 after the task force found that studies on of the scientific data instead of advancing an agen- prostate screening could not find any benefits as far da. Often their recommendations are controversial as men saved from dying of prostate cancer. That because they are made outside of the political and grade was upgraded to a C in 2018 after ongoing research showed that “screening offers a small social environment. potential benefit of reducing the chance of death Among the best of these organizations is the United from prostate cancer in some men.” The test is still States Preventive Services Task Force (USPSTF). only recommended for select individuals based on Here’s a description from their website: family history, race, and other risk factors, since men will experience potential harms of “Created in 1984, the U.S. Preventive Services “many screening, including false-positive results that reTask Force is an independent, volunteer panel of quire additional and possible prostate biopnational experts in prevention and evidence-based sy; overdiagnosistesting and overtreatment; treatment medicine. The Task Force works to improve the complications, such as incontinenceand and erectile health of all Americans by making evidence-based dysfunction.” PSAs are still not recommended for recommendations about clinical preventive ser- men aged 70 and older. vices such as screenings, counseling services, and preventive medications. Other preventive tests and interventions that don’t Task Force members come from the fields of pre- make the cut: ventive medicine and primary care, including in- • Screening for carotid artery stenosis: D ternal medicine, family medicine, pediatrics, be- • Ovarian cancer screening for most women: D havioral health, obstetrics and gynecology, and • Testicular cancer screening: D nursing. Their recommendations are based on a • Combined estrogen and progestin for the pririgorous review of existing peer-reviewed evidence mary prevention of chronic conditions in postand are intended to help primary care clinicians menopausal women: D and patients decide together whether a preventive The USPSTF caused some controversy when it service is right for a patient's needs.” found that the best use of mammograms for womThe USPSTF serves as a watchdog over health en at average risk is at ages 50-74, then every other practices and helps protect against harm that may year (grade B). The American Cancer society had continued on next page... SWUHEALTH.ORG | PAGE 21
'check your sources' continued...
recommended mammograms every year after age 40, but has since increased the age to 45 with alternating annual tests starting at age 55.
Here are some recommended tests and interventions from the task force: •Colonoscopies for everyone ages 50-75: A •Folic acid supplements for women of childbearing age: A •Screening for gestational diabetes in pregnant women after second trimester: B •Blood pressure screening for all adults: A The USPSTF has also released an app called ePSS that will display all of the recommended screenings for you, based on your age and risk factors. The app will also leave out screenings that have been shown to be unnecessary or potentially harmful, based on the data you enter. The USPSTF serves as a trusted resource that does all the heavy lifting to provide reliable information on which to base your health decisions. Scan this QR code on your device to download the ePSS app:
HEALTH MAGAZINE | WINTER 2022
iPhone
Android
How to be a healthy skeptic Ask yourself these basic questions when evaluating information you find online or anywhere else, especially when it affects your health: •Does the claim fall in line with what you know about the world and common sense? •Is the claim advocating an extreme regimen, behavior, or quantity of something? “Moderation in all things” is more than a nice phrase, and “more is better” has its limits. •Is this an effort to sell you something or does someone’s livelihood benefit from the decision you make about the claim? Look for indications of a “paid advertisement”. •Is the source a lone expert? In general, sources that are supported by recognizable groups of authorities in an area of expertise are more reliable than a single individual. This guideline is not foolproof, but larger professional organizations often have a process in place that helps weed out bad information. •Are there any underlying agendas? Sources that do not have a financial or political stake in the issue are more credible. The role of governmental organizations (such as the Centers for Disease Control & Prevention or your local health department) should be to put science ahead of politics, so that the public benefits from accurate, unbiased information.
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Q&A
USED OIL
By George Kayser SWUPHD Environmental Health Scientist
A
bout 1.35 billion gallons of used oil are generated in the United States annually. Used oil includes used engine oil, hydraulic oil, and transmission fluid used in millions of cars and machines in Utah alone. With use over time, oil loses some of its original properties, which is why it needs to be replaced. Used oil is actually far from useless and can be re-refined, recycled, and reused in many ways. Although used oil is not managed as a ‘hazardous waste’ under the Utah Administrative Code, it can have harmful effects on the environment. The Environmental Protection Agency estimates that 50% of Americans change their own oil on their vehicles, but only about 35% of that oil is recycled correctly, leaving around 2 million gallons of used oil improperly disposed of. Since 1993, it has been unlawful in Utah to dump used oil in landfills, rivers, lakes, sewers, and storm
drains or to use oil as a weed or dust suppressant. Unlawfully and improperly disposing of used oil in any way poses dangers to the environment and is difficult and costly to clean up. Our precious water supply could easily be contaminated by used oil. Putting used oil down the drain causes a massive strain on water treatment facilities and sewer systems, costing significant amounts of time and money to fix. Just one gallon of used oil can potentially contaminate 1 million gallons of freshwater, rendering it unsafe to drink. One way to ensure that used oil is correctly handled and recycled is through Used Oil Collection Centers (UOCCs), which follow Utah rules and laws regarding safe procedures for dealing with used oil. A UOCC can accept up to 5 gallons of used oil from a single person, and some UOCCs accept used oil filters as well. Many local auto parts dealers
HEALTH MAGAZINE | WINTER 2022
and repair shops are approved collection centers. To find one near you, call the Utah Department of Environmental Quality at (800) 458-0145, or go online to swuhealth.org/oil for a list of UOCCs by county. All the UOCCs accept non-contaminated and non-hazardous used oil free of charge. It is important to know if used oil has been contaminated with hazardous substances such as antifreeze, refrigerants, or halogens so it can be treated appropriately, which is usually by chemical treatment or incineration. It may not always be evident that used oil is contaminated, although discoloration or separated layers are likely indicators that the oil contains other material. Both the person dropping off the oil and the oil collection center must determine and disclose the presence of contaminated oil. Residents can dispose of contaminated oil during Hazardous Waste Days which are usually hosted twice a year at Washington County Landfill. Visit wcsw.org/household-hazardous-waste for more information. The Southwest Utah Public Health Department conducts bi-annual inspections of UOCCs. The inspector looks for any spills, ensures proper records are being kept, and that an approved used oil transporter is being used, among other items on the inspection checklist. The inspector can also advise collection centers on regulations, best practices, and contamination issues regarding used oil. The disposal of used oil is a significant environmental concern which do-it-yourself oil changers can help with by taking their used oil to a nearby UOCC instead of dumping it in the trash, on the ground, or in the water supply. Proper disposal makes a difference in preserving our beautiful Southwest Utah environment.
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lets talk
RABIES
By Danielle G. Timothy RN, BSN SWUPHD Epidemiologist
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t was in France, July 1885 when 9-year-old Joseph Meister was bit by a rabid dog and brought to a physician for care. The doctor realized he would not be able to save little Joseph and sent the patient and his family to a local scientist, the famous Louis Pasteur, who had previously discovered how to make vaccines for cholera and anthrax. A rabies vaccine had been tested on dogs with great success, but had not yet been used on humans. In consultation with three other doctors in the area, Louis Pasteur and his team decided that if they did nothing, the boy would die, and therefore it would be best to attempt to save his life by trying the vaccine. The 9-year old was then injected with dried-out rabies virus from the spinal fluid of a rabid rabbit. Pasteur’s theory was that if someone was exposed to a weakened version of a disease, the body would build up a defense mechanism to fight off the real thing. The child was given 13 more rabies injections over the next ten days. Three months later, Louis Pasteur announced that the child’s life was no longer in danger. By 1886, he had successfully treated 350 rabies patients. Due to Pasteur’s discovery and advances in medicine over the past century, average rabies deaths in the United States have decreased from over 100 to two, annually. According to Utah Division of Wildlife Resources (DWR), Utah has had 59 instances of a person being exposed to a confirmed rabid animal since 2016, with one fatality in 2018. In that same time period, 98% of wild animals testing positive for rabies by the Utah Public Health Lab were bats, followed by an occasional fox or skunk. HEALTH MAGAZINE | WINTER 2022
There are two forms of rabies. One form is referred to as “dumb rabies”, where animals behave wounded, dazed, or tamed. The other form is “furious rabies”, where animals behave aggressively, exhibit unusually excited behavior, and salivate more than usual. Behaviors, however, are not used exclusively to diagnose rabies. Definitive diagnosis requires testing of brain matter. Rabies can be transmitted to humans through the saliva (usually a bite) of an infected animal. It is nearly 100% fatal once symptoms begin to show, which is why contacting your State or Local Health Department for treatment recommendations as soon as possible after a suspected exposure is so important. If you have contact with a wild animal - especially if you were bitten or scratched - call your local Animal Control or Department of Wildlife Resources for capture of the animal, along with the Health Department for investigation (see page 4 for contact information). If it’s not able to be captured for testing, it may be presumed that you have had contact with a rabid animal, depending on the situation and the animal you were exposed to. Rabies post-exposure prophylaxis (disease prevention) for humans includes four rabies vaccinations on days 0, 3, 7, and 14, as well as human rabies immune globulin (HRIG) injected into and around the wound as much as possible. Here in Southwest Utah, post-exposure prophylaxis is only given in the emergency room. If a pet comes into contact with a wild animal, you should contact Animal Control or DWR for capture. If the animal tests positive, the next steps depend on your pet’s rabies vaccination status. Again, it will be presumed your pet has been exposed to rabies if there is no animal to test, depending on the animal. Dogs, cats, and ferrets that have been scratched or bitten by a rabid animal and are not vaccinated with rabies will be required to be euthanized immediately. If the pet is up to date on rabies vaccinations, they will be required to receive a booster rabies vaccine and a strict 45day home quarantine in partnership with Animal Control. Preventive measures include: • Keep your pet’s rabies vaccinations up to date (required for dogs, cats, and ferrets) • Do not handle wild, stray, or sick animals • Do not handle dead animals • Cover your garbage cans • Do not keep wild animals as pets • Do not handle bats (scratches or bites are so small, they may go unnoticed) For more information relating to rabies, please visit cdc.gov/rabies. Rabies kills around 59,000 people every year worldwide, mostly due to rabid dog bites. Rabies has the highest mortality rate (99.9%) of any disease on earth. Symptoms in humans include fever, confusion, insomnia, hydrophobia (fear of water), excessive salivation, hallucinations, paralysis, and coma. India has the most rabies fatalities (20,000 annually) in the world. Australia & New Zealand are rabies-free.
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medical preparedness for
FAMILIES By Mike Gale, AEMT SWUPHD Emergency Preparedness Director
HEALTH MAGAZINE | WINTER 2022
I
n emergency situations, we rely heavily upon trained professionals such as law enforcement, emergency medical technicians, and firefighters to have the right equipment and knowledge to handle the situation. In a previous role working as an EMT, I experienced first hand that the term “first responder” is a bit of a misnomer. In fact, rarely was there a time when we were called to a scene where “bystanders” weren’t the first to render aid; many times this included family members.
take with you on outings. There are many different types of first aid kits with varying levels of quality. Band-aids will likely be the most frequently used items, but consider getting “Stop the Bleed” supplies that include a quality tourniquet, pressure bandage, medical shears, gauze, gloves, and an emergency blanket. If there are rescue medications such as epi pens or inhalers prescribed to a family member make sure everyone knows where they are located and how to use them.
The first responder is YOU!
Some people may be hesitant to jump in and help because they do not have professional experience, but with a little training and a good first aid kit, bystanders and family members can provide lifesaving care and comfort until help arrives. Family members are also an important source of information for the professional responder because they can share critical medical history and background on the patient. There are many ways that family medical preparedness can improve what could be the worst day of someone's life. Here are some ideas and resources to consider. Have a Plan Sit down with your family and talk about what medical risks your family could face. Talk about what health conditions members of your family have and what to do if they experience a medical emergency. Talk with your kids about when to call 911 and what information they will need to provide (such as your address or location). Make sure everyone knows where your first aid kit is, how to use it, and how to get help. Get a Kit Having a quality first aid kit on hand wherever you are is an important part of emergency preparedness. We recommend you have a kit that stays in your home, one in each vehicle, and a small portable kit that you can
Be Informed There are many training courses that introduce the basics of emergency medical care and can be taken online or through local providers. Here are a few to start with: First Aid and CPR: A great course that covers many emergency medical situations and how to handle them. Courses are certified through American Heart Association, Red Cross, and National Safety Council. Locally, Dixie Tech has regular classes available at dixietech.edu.
You Are the Help Until Help Arrives: Online FEMA course that teaches 5 simple steps to save a life. community.fema.gov/until-help-arrives
Stop the Bleed: A one-hour class on how to recognize and stop life threatening bleeding by using direct pressure, wound packing, and tourniquets. There are in-person classes as well as a hybrid course with an online portion followed by in-person skills training. To find a course and get a kit go to stopthebleed.org.
Narcan/naloxone: Training on how to administer Narcan/naloxone to suspected opioid overdose patients. To learn about how to get a kit and training visit utahnaloxone.org
With a little time and effort you can increase your family's preparedness to deal with medical emergencies.
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L♥VE = HEALTH By Kindal Ridd SWUPHD Art & Design
I
n 1938, Harvard Medical School began a study that showed truly fascinating results. They investigated the biological and behavioral factors that account for the health benefits of connecting with others. For example, they determined that a happy relationship relieves harmful levels of stress, which can adversely affect coronary arteries, gut function, insulin regulation, and the immune system. Caring behaviors also trigger the release of stress-reducing hormones. "Nobody cared about researching empathy or attachment,” said the Harvard investigators, but their groundbreaking study, which continues to this day, has been able to report that "the key to healthy aging is relationships, relationships, relationships." To support this claim, researchers at Carnegie Mellon University found that people in loving relationships have reduced stress, anxiety, and depression. People engaging in supportive, positive relationships produce more oxytocin and are therefore less likely to get sick after exposure to cold or flu viruses. “Generally, we see patients with strong social support having better recoveries,” said Benjamin A. Steinberg, MD, assistant professor of medicine in the cardiovascular division of University of Utah Healthcare. “That can be from friends or family, or even support from an animal partnership, like a pet.” Steinberg attributes improved recovery to lower levels of stress hormones, like cortisol. Let's talk about a healthy relationship. According to Stephen Covey, author of ‘The 7 Habits of Highly
Effective People’, the reason why most relationships fail is because we focus on changing our superficial behaviors and attitudes before addressing the way we perceive the relationship itself. We focus on changing the leaves of our relationship tree instead of the roots. Here's one suggestion for focusing on the root. There is a concept in psychology called 'self-signaling’; it's the idea that our actions determine who we are - and not the other way around. If you act generously, you will become generous. If you constantly express your gratitude towards others, it starts becoming part of your personality, and you truly begin to feel it. A real-life example of this concept, comes from my favorite book, ‘The Hiding Place’. This is the triumphant true story of Corrie ten Boom, a World War II concentration camp survivor. In the book she says, “It was astonishing, really, the quality of life she was able to lead in that crippled body, and watching her during the three years of her paralysis, I made another discovery about love. Mama’s love had always been the kind that acted itself out with soup pot and sewing basket. But now that these things were taken away, the love seemed as whole as before. She sat in her chair at the window and loved us. She loved the people she saw in the street—and beyond: her love took in the city, the land of Holland, the world. And so I learned that love is larger than the walls that shut it in." We could all use more of this medicine called love, so here's an idea for sharing it…
HEALTH MAGAZINE | WINTER 2022
←
Take a moment to consider…who is someone you know who needs to 'feel better soon'? Now all you have to do is cut out this postcard, right here...( ) Take a few minutes to write a message to someone who needs a loving connection. You could start by saying, "Thank you for..." and see where that takes you. Let's allow giving love to turn us into loving people who are healthier and happier as a result. Happy Holidays!
Feel Better Soon!
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