Dr. James Hildreth on continued masking, long COVID and a pandemic silver lining

The number of COVID-19 cases in Nashville have dropped considerably after reaching an all-time high in January, and local and national health restrictions have largely disappeared. But, this doesn’t mean we’re in the clear yet, as local case numbers are still slowly ticking back up.

More: Checking in with Middle Tennesseans about the COVID-19 pandemic

Dr. James Hildreth, president of Meharry Medical College and a member of the Biden Administration’s COVID-19 Health Equity Task Force, joined This Is Nashville on Wednesday to answer listeners’ questions and concerns about the pandemic and how the community can better keep vulnerable people safe. Listen to the full episode here.

Here are some of the key takeaways:

QUESTION: What’s the best guidance when it comes to vaccines and boosters? How do we approach folks who are hesitant to get theirs?

Dr. James Hildreth: I think we first have to be reminded that vaccines are the best tool we have to control the spread of the virus and to put this behind us. (We need to) be reminded that they were subjected to a rigorous, large-scale evaluation. They’re very safe. There are always going to be a minor number of side effects that happen in some individuals, but by and large, the vaccines are the best hope we have for putting this behind us.

QUESTION: Would the current vaccines be effective against a new variant? 

JH: That depends on how different the new variant is from the original strain that the vaccines were based on. It’s one of our continual concerns that the virus will mutate to the point that the vaccine antibodies that we made will not be as effective against the new variants as they were against the the original viruses we got exposed to. I believe the vaccine producers are now working on modified vaccines to more closely match the variants that are circulating.

QUESTION: How do you foresee the way we’ve been approaching disease prevention in general changing as a result of this pandemic?

JH: One of the great outcomes of the pandemic is that there’s an increased awareness of how diseases are spread, especially viral diseases. And I suspect that a number of people with that awareness will now wear a mask when they go into new environments. Masks work when they’re appropriately used, and it’s why people in health care use them to protect the patients and themselves.

I also think dropping the mask mandates on public transportation, in my humble opinion, was a mistake. Public transportation represents ideal conditions for viruses to be transmitted. You’re in a closed space with limited circulation most of the time, especially on busses…I would continue to wear a mask unless you know all the persons in the vehicle with you.

QUESTION: A lot more people have been doing things like washing their hands more regularly. Do you see something like that keeping up?

JH: One of the observations that was made about a year into the pandemic was that other infectious diseases that we all would be concerned about were drastically reduced. As a matter of fact, I think flu virtually disappeared from the planet…We now know that SARS-CoV-2 is not so much transmitted from surfaces like other respiratory viruses, but the washing of hands and the other things that people were doing — sterilizing surfaces — limited the transmission of those other viral pathogens that we are concerned about. So I think that we should all keep those habits going.

QUESTION: How can all of us work to help protect the most vulnerable going forward?

JH: The best way to protect children who are not yet vaccinated is for the adults to do what they need to do, which is to get vaccinated and boosted, to wear a mask in crowded places. The bottom line is that we should not bring the virus home to those who are not yet protected, and that includes children, young children. That includes elderly parents and grandparents. That includes immunocompromised individuals.

QUESTION: The pandemic has had a horrific effect on Black and brown people. So how are we going to create equity within our public health plan?

JH: Some of the statistics are quite shocking. At one point in some of the major cities in the United States, the death rate from COVID-19 among African Americans was almost 10 times higher than it was for white Americans in those same cities. That’s because COVID-19 is especially challenging for those with underlying conditions — asthma, heart disease, those who smoke, those who are obese, cancer — and all of those things have a much higher prevalence in minority communities than in white communities. So there is a disproportionate burden of disease and death.

One of the the big issues is to make sure that we manage chronic conditions better, which means we have to have access to health care for all individuals in our society.

QUESTION: What do we know at this point about long COVID?

JH: Well, it’s a medical puzzle at the moment, but one of the things that’s quite perplexing about it is that it can involve multiple systems in the body — GI tract, nervous system, circulatory system…The estimates are between 20 and 45% globally of people who had COVID-19 will have long COVID. One of the things that I’m concerned about is that some of the symptoms associated with long COVID are amorphous and not measured by objective tests that you can do in a lab. Sometimes when people present to physicians with those kinds of conditions, they may not be necessarily taken seriously or they just may not have the adequate knowledge or insights to know what to do about it. We have got to make sure we do an all out effort to make physicians, especially primary care physicians, aware of what it is, how to diagnose it, and to make sure that people are not dropped out of care because we don’t understand this.