Annc: This Studio Sacramento episode is supported by UC Davis Health where doctors, nurses, and researchers share a passion for advancing health.

Learn more about their latest medical innovations at health.ucdavis.edu.

♪♪ Scott: Sacramento County Public Health Officer Dr. Olivia Kasirye was recently called indispensable in the region's fight against COVID-19.

Dr. Kasirye, the 2021 recipient of the Mort Freedman Award for Leadership joins us today to discuss her observations on the pandemic and the role of public health in our community.

Dr. Kasirye, congratulations on winning the 2021 Friedman Award.

Olivia: Thank you, Scott.

And thank you for having me on the show.

Scott: Tell us, where do we stand in our continuing fight against the pandemic at this moment?

Olivia: Well, since June 15th, California did open up and, uh, so a lot of businesses are back and, um, a lot of people are out enjoying themselves, enjoying the streets.

And, uh, we just had the 4th of July celebration.

But what we have continued to tell people is yes, there is a light at the end of the tunnel because of the availability of the vaccine.

But we're not out of the woods yet.

And unfortunately, right now we are seeing a little bit of an uptick in our numbers, which is a bit concerning, but it does remind us that we still have work ahead of us.

So, we're still real busy trying to get the vaccine out, especially to the underserved communities.

Scott: The most recent information that we're aware of is that over 684,000 people locally have been fully vaccinated.

Who's left that are among the unvaccinated?

Olivia: So, when we look at the numbers, um, we usually look at it by age and then by geography as well.

And what we see is, uh, when you look by age for people over the age of, uh, 50, we have a 70%, uh, vaccination of at least one dose.

But, uh, people younger than 50, we're not doing so well, especially for the teenagers where our vaccination rate is about 37%.

So, we still have a lot of work, um, especially when it comes to, uh, vaccinating the younger people.

And then when you look by geography, some of the zip codes have over 90% vaccination, and then we still have others that are below 50%, and these tend to be the underserved communities.

And so, um, that's why we-- our focus right now is on the pop-up clinics, uh, where we're taking the vaccine to the people, because what we've found in many of these areas is that, um, oftentimes either there's a lack of information or a lot of barriers to being able to get to the vaccination sites or, uh, not-- people who are not willing to go to places that they're not familiar with or to places where the services are provided by people that they are not accustomed to working with.

So, working with community-based agencies and trying to see how we can, um, get the services there.

And of course, there are also disparities when we look by race, ethnicity.

We find for the people of color that, um, there is a disparity, and that actually started right from the start.

So, um, it's something that we're working on as well.

Scott: Let's go through a couple of those... and... and... and put some context around it.

Give us an example of a zip code or neighborhood that has this extremely high penetration of way over 70%, you said 90%, and one that is extremely low.

Just so that people can kind of get a sense of a community where some of these things are happening.

Olivia: So, some of the areas that have high, um, vaccination rates include Rancho Cordova and then also Folsom and some areas in Elk Grove as well.

And for the low vaccination rates, we have places like South Sacramento and also, uh, North Highlands and Del Paso Heights.

So those are the areas that we are focusing on.

Scott: There are-- there's a lot of information out there and sometimes it... it-- there's so much that it seems a bit overwhelming.

For instance, you... you referenced teenagers.

Can you help us get clear on who should be getting vaccinated and who shouldn't be?

Because on the one hand you referenced teenagers and on the other hand, uh, it... it's our understanding that still children are not to be vaccinated at this time.

But I'm not sure that the public really understands the demarcation line between the two.

Can you help us out?

Olivia: Sure.

And of course, we have to remember that the, um, information has changed over time.

So, it's understandable if people are a little unclear on what the guide-- present guidance is.

But right now, for anybody over the age of 12, they can get vaccinated.

For those 12 to 17, they have to... to use the, uh, Pfizer vaccine.

But for anybody else, we do have two additional, the Moderna and the Johnson and Johnson vaccine that they can have as well as the Pfizer.

Scott: Okay.

That's helpful.

And it's understandable that the guidance has been evolving over time.

With the emergence of the delta virus, does that change at all any of the guidance or where it is that you and other public health officials are putting their emphasis?

Olivia: That is an area of concern because now we're seeing with more and more of the cases that the delta... the delta variant is becoming the predominant variant, you know, or strain, that is circulating.

And of course, as we know, it is, uh, more contagious and it can affect people who are younger.

Um, so it does put pressure on us to make sure that we get to those areas where we know that, um, there's, uh, people are either disadvantaged or they're not accessing the vaccine so that we can get to them because we know that the vaccine is our best protection against this, uh, variant as well.

Scott: Even with all of the public health outreach that's being done, there are continuing news reports that talk about that people, um, of different ethnicity-- ethnicities, for instance, African Americans, some within the African American community because of a historical, uh, distrust over, uh, bad interactions with the healthcare system are-- have had varying levels of resistance to getting vaccinated.

Sometimes people from different political persuasions have different points of view on getting vaccinated.

And some people just generally are anti-vaccinations in general.

How do you and your colleagues change hearts and minds on moving people to being willing to embrace, uh, the benefits of being vaccinated?

Olivia: So, I think the important thing is to find out why people have that vaccine hesitancy and also to find out the levels and to find out where those pockets of people are.

And what we find is that oftentimes, um... actually that one is that the vaccine hesitancy is not a static number.

And so being able to talk to people, answer their questions is really important.

So being able to identify those people is important.

And one of the factors we've found is one, is that people tend to want to hear information from people that they trust.

And so, being able to use, and you've probably heard this term being used, of a trusted messenger.

And so being able to go into the communities with community-based agencies that have already been providing services there.

Also, um, working with churches.

In fact, I recall one story where we were talking in a group and we asked this lady if she would be willing to get vaccinated and what she said is, "If my pastor tells me that I should get vaccinated, I will."

So that reminds us of how important those messengers are.

And of course, it's also important for us to acknowledge some of the, um, mistrust that people have and work towards, um, building that trust.

And so that's one of the things we're doing in public health is just being out there, being with the people, getting to know them, developing that relationship.

Another, uh... uh, factor is also being able to work with, uh, doctors because people tend to trust their doctors.

And so, uh, being able to have, uh, this vaccine in doctor's offices will also be important.

Scott: You know, you... you reference, uh, public health and, uh, while, um, most recently, uh, you and your colleagues have been associated with the fight on COVID-19.

Tell us for a moment, what exactly does our county's Public Health Officer do?

Olivia: Wow.

Well, that's, uh... uh, there's a lot.

Um, but in general, the way I look at it and the way I describe it to people is of course they know what a doctor does in a clinic.

If it's your doctor, you go there, they check you out.

Or if you're sick, you go there, and they'll make you get better.

So, for the Health Officer, my patient is actually the entire community.

And the way that I monitor the health of the community is by the data that I get, the death data comes to us... us, uh, birth data, or sometimes we do surveys.

So, that gives us the information that we need.

And then the way that we provide our care is, um, through different programs that we have.

So, um, as in my position, as Health Officer, I also oversee a whole list of, uh, different programs of right-- all the way from birth up to old age.

Scott: Right.

You know, we-- w-- we're talking about the work in public health, and you referenced earlier the June 15th reopening of the state.

From a public health perspective, what concerns you most about the public's conduct in how they're going about their everyday interactions, uh, post June 15 and continuing concerns related to the pandemic?

Olivia: I think what concerns me most is, um, there are two groups of people.

They're the group of people that from the beginning have, um, insisted that COVID is not an issue and that they don't need to do anything.

Um, because their actions, unfortunately put them at risk and put their relatives and their loved ones at risk by not following the guidance that we provide.

But then we also have the other group of people who think that this is over, especially because, um, California has opened up.

And so, they're out just living their lives and, um, have not even bothered to get vaccinated because they think that they don't need to.

And, um, I think again, for those people as well, I get concerned that we're not out of the woods yet and, um, we could see something that's happening in countries like Europe.

Scott: Do you think that, uh, the... the June 15th reopening was premature?

Olivia: No, I think that we set goals and we reached those goals.

And of course, there'’s-- when-- in public health, one of the things is that you're always having to balance between the measures that you take, as well as, uh, the impact.

And so, knowing the impact that this has had and people having to remain isolated and businesses having to close, I think these are all considerations that the governor was taking.

Um, and when it came to the point, especially with the availability of the vaccine, um, he felt that it was safe enough, but it still remains on us to continue doing the work of, uh, vaccinating those that are not vaccinated.

Scott: W-- when you talk about impact, um, and you talk about balancing those needs, one of the things that, uh, that some have criticized the healthcare community and inclusive of the public health world, is that there... there's been a concern that the healthcare community has, you know, initiated lockdowns and policies with little regard to the impact on small businesses, workers, the economy, and that they've seemed arbitrary and inconsistent.

How do you respond to that?

Olivia: I think one thing to remember is that this is the, uh, largest pandemic that we have had since the 1918 flu pandemic.

And if you read the history of what happened during that time and how they looked back and... and said, you know, "We should have taken these actions to protect the people."

That's something that we think about.

That's, uh, paramount in the decisions that we make is we want to be able to protect lives, to save lives.

Um, but of course we also acknowledge that there, you know, there are the... the... im-- there is the impact that... that, um, that's there for people who in businesses that have to close.

But of course, our hope is that once we get through the crisis, that then we will be able to rebuild together.

And that's what we're hoping to do.

Especially with the money that has been provided at the state and federal level, is that now that we are able to start reopening is let's see how we can help one another and as public health we want to be there.

So, we are hoping to be able to continue working with the communities towards that.

Scott: I think a lot of what people are looking for is practical advice.

And, uh, because as you say, this is the biggest, uh, pandemic we've had since the one at the beginning of the last century.

There was a lot to learn on the fly.

I'll...

I'll ask you for some advice on one particular, uh, issue that comes up on an ongoing basis.

There are people who have decided not to be vaccinated, uh, for whatever reason.

And then there are people that are vaccinated.

Right now, people share common spaces without, uh, any sort of restriction between vaccinated and unvaccinated.

What is it that everyone should be doing to keep ourselves and our loved ones safe based on the fact that we don't know who we're interacting with at any given time?

Olivia: So, one good thing we know that the vaccines that we have are very effective even against this variant.

So, those that have vaccinated, I think they've done the best thing that they can to protect themselves and their families.

But then we also do need to remember that, for example, uh, children, uh, below the age of 12 cannot be vaccinated, so they are vulnerable.

And so, being careful about, um, the places that we go to and how we conduct ourselves.

For people who have symptoms, they need to stay home.

And then, um, if you're not vaccinated, you are still required to be wearing a mask when you're out in the public.

So those are still things that people, uh, should be doing right now.

And for those that are not vaccinated, I think to be able to look back at that and find out where you can actually get a vaccine and... and, uh, do that, get vaccinated.

Scott: Based on your recent experience and all that's happened in the wake of the pandemic, how well are we prepared as a society now for another... another major public health outbreak?

Olivia: I think there are a lot of lessons learned through this experience, but, um...

I think it's important for us to be able to reflect and especially look for where we need to make changes.

Um, for example, how do we do our messaging?

How do we reach out to people, especially through social media and make sure that we have accurate information out?

And I think there's still a lot that we're going to learn.

I think we need the resources.

Cause that's one thing we talked about in public health, is we did need the resources in order to be able to respond.

So those are all things that we're still working on.

And of course, we depend on the experts to be able to tell us what's going on and learn to respect and also to follow the recommendations that we're given.

Scott: Hmm.

It's my understanding the new state budget includes significant increases for public health and in addition that the counties poised to receive significant new funding through the American Rescue Act.

What's been identified out of all that funding that's going to go to improve our public health infrastructure in the future?

Olivia: We're still working on that.

But I think two major areas that I can look at is, um, being able to increase the workforce because of course, during the budget cuts in 2009, we did lose quite a number of staff, especially in the nursing units and with the pandemic we needed them in order to be able to do the testing, to do the vaccination.

So being able to increase, uh, staffing.

And then the other area is being able to work with community-based agencies, which we are dependent on right now for our outreach efforts.

And that of course make-- takes resources as well.

So, our hope is that those are two areas that we'll be able to work on and, um, continue to have resources for.

Scott: When you look back over the last year, what has been the most difficult part of your job?

Olivia: I think it's the communication.

Um... because one, things were changing so fast at times, and two, also being able to keep up with what was happening on the social media.

But what I found is that I'm making myself available for numerous interviews and also making myself available to the different communities really helped in being able to explain to them what we were seeing and, um, being able to get them to understand what needed to be done.

So, I think communication is really key to being able to, um, get the message across.

Scott: Communication, um, is obviously one part of the equation.

The other is there's a question on decision -making.

Now, it's been well reported in the papers that you had some challenges with county leadership last year, and that, um, there are some who've written that in fact, some of the decisions that ultimately came down, uh, reflected power and income differences within the community.

As an example, on the shutdowns, things like golf courses, largely remained open during the pandemic where, um, other types of activities like basketball courts that are typically heavily utilized in low-income areas were shut down.

Uh, one, uh, is that a fair charge and two, how will things improve to make sure that, um, not only is the communication better, but the decision-making processes are inclusive and reflective of all of the concerns in the community?

Olivia: I think one of the challenges that we had-- we faced, um, during this, um, response was especially with making decisions on which businesses needed to close, because it is so difficult to put businesses into different compartments.

And also, to be able to make an assessment of what their risk is for people who are working there or for the clients who access those services.

And so, we worked real closely with other health offices to be able to make those decisions.

And then also the state, uh, came in with, uh, the blueprint which really helped to, um, take the decision-making to that level where we weren't trying to go business by business trying to make decisions, but it was, um, the state at the state level where they were able to make those decisions.

So, I think that really helped.

Um, it's hard.

I...

I hear the... the criticism and, um, I think those are still the lessons that we need to look at and see how to improve if we ever have to go through this again.

But I think especially being able to have a centralized place where those decisions are made and then, at the state level, and then, uh, we at the county level are able to implement, I think helps a lot.

Scott: Once we move past the pandemic, and by the way, one question that I know is on everyone's mind is, do you have any prediction, or your colleagues have any prediction on when all of this will be over?

Olivia: It's hard to say, especially with this most, uh, recent uptick in numbers.

Um, at least from what we're hearing from all the experts is that, uh, we can expect that COVID will be around with us for a long time, but we need to get to the point where we get the numbers down low enough that we can continue with our normal lives.

I'm thinking that, uh, probably next year might be an easier time to think of of actually getting to the point where we're closer to normal.

But it, uh, as, uh, Dr. Fauci has said, I think it's the, um, the virus that's going to dictate.

So, we just do the best we can right now, and hope that we're able to control it.

Scott: Given the tremendous focus for everyone on the pandemic and con-- and confronting the virus and its impacts, what public health challenges have been pushed to the side that you'd be focusing on right now?

And that we all should be focusing on if we weren't dealing with the pandemic?

Olivia: I think going back to some of the, um, the i-- initiatives that we were working on before will be important.

Um, mental health, behavioral health is really important.

That's an issue that's important to a lot of people that was actually maybe even exacerbated, especially with some of the isolation.

And then also things like, um, the... the drug overdose problem.

Uh, we know that anecdotally from reports that we're hearing, it seems like there might have been an increase during this period of time.

So, being able to get back to that and being able to help people.

But I think, one of the major things that has been brought to light through this pandemic, is how vulnerable some of our communities are because they, uh, were not able to isolate when they, uh, when they got the virus.

For example, when, uh, certain families, um, members got the virus it just spread really quickly to all the family members, because they were not able to isolate.

They're not able to take time off from work.

And so, all of those are factors we need to look at and make sure that for people who are vulnerable, that we provide the resources for them.

So that if a... a Situation like this presents itself, that they're able to recover just as quickly as other communities can.

Scott: And I think that we will leave it there.

Thank you very much, Dr. Kasirye and good luck on your work.

We're all depending on you.

Olivia: Thank you.

Scott: And that's our show.

Thanks to our guest and thanks to you for watching Studio Sacramento.

I'm Scott Syphax.

See you next time right here on KVIE.

♪♪ ♪♪ Scott Syphax: All episodes of Studio Sacramento, along with other KVIE programs, are available to watch online at kvie.org/video.

Annc: This Studio Sacramento episode is supported by UC Davis Health where doctors, nurses, and researchers share a passion for advancing health.

Learn more about their latest medical innovations at health.ucdavis.edu.