The 10,000 volunteers who are participating in the study are made up of adults of all ages from across the country. However, researchers are slightly oversampling in geographical areas and in populations that have been most affected by the virus.

“We are trying to get a snapshot of what is happening in the population in general, as well as the populations that appear to be most at risk,” said Eric Ford, Ph.D., one of the lead researchers and a professor at the UAB School of Public Health.

Each participant, after confirming they have not been diagnosed with COVID-19, are healthy and do not have any symptoms, will be sent a test kit that contains a finger stick to provide a blood sample. The sample will be sent back to the NIH, where it will be processed to find out if that individual has antibodies to SARS-CoV-2, the virus that causes COVID-19.

The data from the study will also help researchers understand herd immunity.

“We are trying to understand where there are antibodies even when people are not aware that they have had COVID-19,” said Jennifer Croker, Ph.D., one of the study’s lead researchers and assistant professor of medicine at UAB. “We would like to do future samplings to find out more about who has the antibodies. This is the first step in understanding herd immunity.

“Absent a vaccine, we want to reach herd immunity. For most diseases, 50 percent of the population needs to have been exposed; but with the infection rate of COVID-19, 65 to 70 percent of the population needs to be exposed to build up herd immunity,” Ford explained.

Kimberly says the study came together within a matter of weeks and is a result of the partnerships between the Center for Clinical and Translational Science, the School of Public Health, and the School of Medicine.

“I have never seen a study go from concept to grant to full written approval in this amount of time,” Kimberly said. “The rapidity with which we were able to get it together and get the formal proposal to the NIH, while also receiving all internal approvals, represented multiple facets of the university’s coming together and working as a team.”

Researchers hope to have a better understanding of the number of people who have been infected without knowing it by the end of the summer.

(Courtesy of UAB)

“Because we know that COVID-19 can be spread even by people who aren’t feeling sick, and because we’ve only tested about 2.7 percent of Alabamians, there are probably far more cases that we don’t know about,” Judd said. “Approximately how many? Well, studies conducted in Florida, New York and California suggest that the actual number of cases is probably six times the number of documented cases.”

That means, in Alabama, there might be approximately 41,200 COVID-19 positive infections. While that is less than 1 percent of the total population in Alabama, it means there are plenty of people who could spread the virus. This means that many more people could become sick in the upcoming months.

Since COVID-19 is still out there, how will we work to prevent people from getting the virus once businesses begin to reopen?

There are many strategies that can help you stay healthy while COVID-19 is still circulating:

• Wash your hands before you eat, wipe your eyes, blow your nose, bite your nails — basically wash your hands before you touch your face.
• Do not touch your face. When you leave home, keep your hands off your face.
• Try to maintain at least 6 feet of distance between yourself and others where possible. Respect others’ space so that, if they or you do accidentally sneeze or cough, there will be less risk of spreading the virus.
• Wear a face mask while in public. It is important for you to wear a face mask at all times in case you are a silent carrier. Silent carriers are people who have the virus that causes COVID-19, but do not know they are sick. Because you do not know who is sick, you have to assume everyone is sick, and live life accordingly.
• If you are sick, stay home. Even if you think it is just a cold, it could be COVID-19 because some of the symptoms are the same. Work with your employer to develop a plan so that you do not have to come into your workplace. If that is not possible, be sure you wear a face mask whenever you are feeling unwell.
• If you have been contacted by a health department official saying someone near you recently had COVID-19, stay home for 14 days. If it is not possible to stay home for 14 days, be sure to wear a face mask when you go out, and pay attention to how you feel over the next 14 days.

Is it OK to see family and friends in person now?

According to Hidalgo, it is best not to do so, especially if friends and family fall into high risk categories for COVID-19.

“We recognize that people are eager to see their friends and family. Our infection and death counts have not decreased, which means that our risk for infection and infecting others remains as high as it was before stay-at-home orders went into effect,” Hidalgo said. “If you have family members who are considered high risk, it is very important to continue physical distancing.”

People with higher risk for severe COVID-19 infections are those who have:

• Asthma
• Chronic lung disease
• Diabetes
• Serious heart conditions
• Kidney disease and on dialysis
• Severe obesity
• People age 65 years old and older
• People in nursing homes or long-term care facilities
• Compromised immune systems
• Liver disease

More information about high-risk groups can be found on the CDC website.

Will guidelines be different depending on if you live in a rural or urban area?

Whether you live in an urban or rural area, public health recommendations continue to be to maintain a distance of 6 feet whenever possible, covering your face when in public and frequent handwashing.

“Maintaining a 6-foot distance between you and others may be challenging in certain locations within urban areas simply because there are more people. However, just because there are fewer people in rural areas does not mean that COVID-19 will not spread in all areas. It is important to be very careful, no matter where you live. Physical distancing is especially important to consider in the context of gatherings, and especially in enclosed spaces. Close interactions with others is how the virus spreads most easily.” Hidalgo explained.

What is contact tracing?

Contact tracing is the process that health departments use to identify who has been exposed to an infectious disease like COVID-19.

“This is a vital part of our public health system and is routinely done during outbreaks of dangerous infectious diseases like measles or the novel coronavirus,” Judd said.

How will I know if I can trust the information if someone calls or texts me to say I have been in contact with someone with COVID-19?

An employee or volunteer from the health department will interview a person who has tested positive for COVID-19 and ask them where they have been in the past 10 to 14 days and with whom they have had contact. The health department staff member will then call, text or write to each of those people who have had contact with the person with COVID-19. The purpose of this is to let the person know they may have been exposed so they can self-quarantine for 14 days.

“According to the Alabama Department of Health, investigators will never ask for social security numbers or money, or try to sell products, which is what many scammers will do,” Hidalgo said. “If patients live in Jefferson County or Mobile County, they will be contacted by someone from

those health departments, and not the ADPH.”

This means that you will likely be contacted by someone from your local health department.

Hidalgo adds that you should never give someone your social security number, send money, or buy any products if you get a call related to COVID-19.

“When someone you do not know calls and begins to ask you questions about where you have been and tells you that you may have been exposed to a virus, it can be scary,” Hidalgo said.

Follow these steps to make sure you are receiving accurate information:

• Ask the person to provide identification about who they are and why they are calling.
• You can also ask to be provided with official documentation about who they are and why they are calling you.
• When in doubt, call the health department directly and ask if the person who called you is working for them as a contact tracer.

What do I do if I have been contacted by a contact tracer?

If you have been contacted by a health department official saying someone near you recently had COVID-19, you will be advised to stay home for 14 days. If it is not possible to stay home for 14 days, be sure to wear a face mask when you go out, and pay attention to how you feel over the next 14 days. If you become ill, seek a COVID-19 test. You should also consider reporting your symptoms in the UAB COVID-19 symptom tracker.

For more information about the novel coronavirus, visit uab.edu/coronavirus.

(Courtesy of UAB)

Before you go to the store

The most important thing to do before you go to the store is evaluate whether you even have to make the trip.

“You should go to the store only for essential items that you cannot live without in the moment,” Kempf said.

If you are considered high-risk due to your age or if you are immunocompromised, Kempf recommends having your groceries delivered or asking a family member or neighbor to pick up your groceries for you on their next trip to the store.

If those options are not available but you still need to buy groceries, try going during special hours set aside for senior citizens and those who are immunocompromised.

For people who are not high-risk but still need to buy groceries, making a list beforehand is an important step.

“You should try to minimize your time in a grocery store. One way to do this is to make a list so you know what you want. This will reduce the time that you are walking around looking for various items.”

Kempf adds that you should plan to buy the groceries you need for the next two weeks to limit the number of trips you make to the store.

Protect yourself and others while grocery shopping

Once you arrive at the store, grab a wipe, if it is available, or use your own to wipe down the cart or basket, especially around the handles.

Some stores are allowing only a certain number of people inside at a time; but even if your store is not doing this, it is important to practice physical distancing from other customers.

“Be patient, and give others their space. If someone else is in front of the product you want, wait for them to leave, and make sure you are staying 6 feet away from others.”

Grocery Shopping in the Time of COVID-19

• When you shop, please do not hoard. Shop for food thinking about what you need for the next week or, at most, two.
• Buy fresh meats that you can eat over the next few days. If you have a good amount of freezer space, use it.
• Buy protein sources that last when you do not have fresh meat. Cheese, eggs, canned and pouch tuna, and salmon are all great complete, high-quality proteins. Starchy beans when paired with rice also make a high-quality protein. Peanut butter is also a great protein that when paired with a grain (a peanut butter sandwich) is a complete, high-quality protein.
• Some fresh vegetables and fruits last a lot longer than others. Grapes, apples, carrots and potatoes stay fresher longer than lettuce and berries.
• Buy frozen and canned fruits and vegetables for when you run out of fresh.

When checking out, put your credit card or money in a pocket or somewhere that is easily accessible so that you do not have to search in your purse and touch other items.

If you have to use a touchpad or pen or accept change, use hand sanitizer or a wipe to clean your hands after putting those items away.

As for reusable bags, Kempf says it is safe to keep using them, as long as you wipe the bags down, especially on the outside, after each use.

Once you get home from the store

When you get home from the store, the first step is to wash your hands after you bring your groceries in, but before you unpack them.

Kempf recommends setting up a sanitation station somewhere in your house, where you can wipe down the groceries with anti-bacterial wipes. It is important to do this before you put your groceries away.

“After you’ve washed your hands, wiped off your groceries and put them away, wash your hands again,” Kempf added.

If you wore a facemask to the store, make sure to wash your hands after taking it off, and do not touch your face until you have clean hands.

For produce, you should continue to wash items before you eat, as you would do on a regular basis. Kempf says you do not need to wash your produce before you put it in the refrigerator.

For more information about protecting yourself and your family from the novel coronavirus, visit UAB’s coronavirus website.

(Courtesy of UAB)

According to Green, the study found that the amount of virus decreased rapidly over time on each of those surfaces, which means the risk of infection would likely decrease over time as well.

In the air, the half-life of the virus is about one hour; but in a three-hour period, researchers could still measure viable virus in the air.

“There are several factors that would determine whether or not the timeframes in the study are accurate in a given situation,” Green explained. “Humidity and temperature are some factors that would impact the viability of the virus. Also, if you are outside or if you are walking, factors like wind and other forces could cause the virus to fall to the ground or on a surface.”

Green says the amount of time the virus is viable will increase or decrease based on the quantity of the virus and the temperature and humidity levels it is exposed to.

“The higher the temperature and humidity level, the less viable the virus will be over time,” Green said. “However, precise studies with those variables remain to be done.”

While people are less likely to become infected by touching a contaminated surface than they are by being exposed to someone with the virus, it is important to practice preventive measures.

“Packages will be coming from a number of hands, and you might not know the symptom status of everyone who touched it along the way,” said Jodie Dionne-Odom, M.D., assistant professor in UAB’s Division of Infectious Diseases. “Wash your hands after opening and handling the package. That will kill the germs.”

You should also clean and disinfect frequently touched items and surfaces with isopropyl alcohol, avoid touching your face with unwashed hands, and cover your mouth with a tissue or a sleeve when you cough or sneeze.

For more information about the novel coronavirus, visit www.uab.edu/coronavirus.

(Courtesy of UAB)

Until now, there was no such thing as culturally based protocol for patients with serious illness or for end of life care, until this team of community members developed one for rural southern African Americans and another for Whites,” said Ronit Elk, Ph.D., a researcher in the Division of Gerontology, Geriatrics and Palliative Care at the University of Alabama at Birmingham.

For three and a half years, Elk and her colleagues worked with teams of White and African American community advisory board members to create this culturally based protocol. It was determined after focus groups held with community members who had been a caregiver to a loved one who had recently died.

“I started with the focus group six weeks after my husband passed away,” said Jonnie Grant, a member of the group. “I was a newly widowed person who was not knowing where to go or what to do.”

Gardenia Simmons-White, a member of the community advisory board, said working with the advisory group and learning of each other’s beliefs helped them create the protocol and form a mutual respect for each other’s cultures.

“When you take care of people, you care for people of all different nationalities and beliefs. You have to understand that everyone has different beliefs,” Simmons-White said. “You have to understand that everyone’s culture is different, and it is especially true of how African Americans and Caucasians react to end of life diagnoses. We need to know each other’s cultures in order to ask questions and not have stereotypical beliefs. And we need to understand our history in order to have respect.”

This unusual gathering was part of a training program conducted by the community members to prepare the palliative care physicians for a randomized clinical trial in which the efficacy of this community-developed and culturally based protocol will be tested. This trial, funded by the National Institutes of Health and co-led by Elk and Marie Bakitas, DNSc, of the UAB School of Nursing, will compare the culturally based palliative care consult program provided through telehealth, in addition to regular care. They will compare the findings to patients receiving regular care to see if it helps reduce patient suffering, increases the quality of life for the patient and family, and reduces the burden of care for caregivers.

The study began patient recruitment in January and will take place in three rural hospitals in Alabama, Mississippi and South Carolina.

The training program

The training program by the community members of the four palliative care physicians, Rodney Tucker, M.D., and Susan McCammon, M.D., from UAB, Josh Hauser, M.D., from Northwestern University in Chicago, and Jacob Graham, M.D., from Forrest General Hospital in Hattiesburg, Mississippi, included an in-depth review by the community advisory board members of the ethnic-group specific protocol, with an explanation of the cultural values underlying each of these.

“When you talk about life-threatening issues, it is good to include the pastor in the conversation,” said Pastor Michael Williams, a community advisory board member, referring to African American patients. “It’s because of faith, because of prayer and the pastor being there, that things will get better.”

Role play, a commonly used teaching strategy, was also a part of the training program. But this time, it was the community members who critiqued the physicians, telling them how they felt after they were spoken to about their goals of care conversations, or one about a serious and/or terminal prognosis.

“Patients and their families are really our most generous teachers. We think of ourselves as teachers, but when I think of the work that I get to do as a doctor, it is the patient and the family members that do the teaching,” Hauser said. “I always tell my residents and fellows that the most important teachers we have are the patients, the caregivers and people like you on the community advisory group.”

Visiting historic sites

In addition to the training program, the group visited two historic sites in South Carolina, each of which had an important historical meaning to each ethnic group. Old Sheldon Church Ruins, a famous red-stone church, twice burned down, the first time during the Civil War. Now a relic, it sits among green lawns and palm trees, with a scattering of 50 graves, some of which were used as an operating table during that war.

The next stop was to the Penn Center on Saint Helena’s Island, the site of the nation’s first school for formerly enslaved people. Simmons-White led the tour, and the group learned that it was the first school in the South for freed slaves and the center’s role in the civil rights movement.

“Our history was not written into the history books,” Simmons-White explained. “We need to know the significance of what we brought to our culture here. It is always good to know each other’s history because then you can respect them more.”

These visits provided meaningful insight for the clinicians, too.

“I can say visiting the Penn Center has continued to open my eyes to the cultural journey of the individuals for which I care for,” Tucker said. “It is important for me to understand their history, to understand their values, and their lived experience as we move forward with their care.”

“It would be too easy to focus on the nuts and bolts of the training for the protocol itself, but I think going to the Sheldon Church and the Penn Center, was incredibly rich, but the richness extends to the fact that you and this group acknowledge how important that historical context is,” McCammon said. “Everything we are doing now grew out of that history – the good and the bad and what we need to do today to make it better and better serve our patients.”

Impressions of the training

The physicians’ time and respect were the most meaningful part of the experience to several of the community members.

“I think it was important for the physicians to see how the local members of the community advisory group have embraced the concept of palliative care and that all as former caregivers, they had a personal experience of dealing with a very ill loved one,” said Cynthia Coburn-Smith, one of the community advisory group members. “It was wonderful to see the physicians get involved in role playing in the retreat. We went over the cultural training protocol we developed with Dr. Elk with the physicians, and we answered their questions on why these issues were important to us.”

One concern was unrealized by one of the members.

“One of my fears was that the doctors were going to come in with their attitudes, and they didn’t,” Grant said. “I hope that your memories, and I know that mine, will be cherished and, hopefully, we will be able to continue this relationship that we started and be able to do this in the future.”

To the doctors, it was just as worthwhile.

“It is validating for the things that we know, and how we can improve. You started it, and we will continue the next steps,” Tucker said. “If we gather together in another 10 years, I hope there are thousands of physicians outside of us that begin to realize culturally appropriate conversations are so important and not just for end of life or serious illness, but from the very start.”

“We’ve been at it for so many years,” Elk said. “When I think about how everybody came to all of the meetings, everybody still has their books, everyone has been committed to it through all of these years writing the protocol. For me, what we’ve accomplished is beyond a fantasy.”

This story originally appeared on the University of Alabama at Birmingham’s UAB News website.

(Courtesy of Alabama NewsCenter)

“Older adults should receive safe, high-quality health care that centers around their unique needs. By incorporating the Age-Friendly Initiatives into our system, UAB is training health care providers on evidence-based strategies for caring for older adults,” said Emily Simmons, MSN, nursing professional development specialist for UAB’s Nurses Improving Care for Health System Elders program. “Many of these health care providers later transition to new sites of care throughout Alabama, which means we are impacting care at UAB and throughout the state.”

The Age-Friendly Health Systems initiative is based on a series of practices focused on addressing four elements of care for older patients:

• What Matters: Know and align care with each older adult’s specific health outcome goals and care preferences, including, but not limited to, end-of-life care, and across settings of care.
• Medication: If medication is necessary, use Age-Friendly medications that do not interfere with what matters to the older adult, mobility or mentation across settings of care.
• Mentation: Prevent, identify, treat and manage dementia, depression and delirium across settings of care.
• Mobility: Ensure that older adults move safely every day in order to maintain function and do what matters.

The Division of Gerontology, Geriatrics and Palliative Care in the UAB School of Medicine created Alabama’s first Acute Care for Elders Unit, which is a model of inpatient geriatric care. The ACE Unit focuses on maintaining patient function by utilizing an interdisciplinary care team trained in geriatrics to aggressively manage geriatric syndromes while a hospitalist physician manages each patient’s acute medical diagnosis. The unit is at UAB Highlands; however, the ACE method is being implemented in other areas of the health system through various geriatric-specific initiatives.

UAB is also home to the Comprehensive Center for Healthy Aging, which is a university-wide interdisciplinary center. Its mission is to promote the health and well-being of older adults and their families through research, education and outreach initiatives.

The goal of the initiative is to make 20% of hospitals and health systems in the United States age-friendly by 2020. For more information, visit the Institute for Healthcare Improvement website.

This story originally appeared on the University of Alabama at Birmingham’s UAB News website.

(Courtesy of Alabama NewsCenter)

“The purpose of this study is to understand whether living in the rural South equates to more health-related issues,” said Shauntice Allen, Ph.D., co-principal investigator of the study and an assistant professor in the Department of Environmental Health Sciences at the UAB School of Public Health. “The rural South matters to the entire country. When the rural South hurts, the entire country does. It’s important to understand the reasons and potential causes of chronic health issues in rural areas.”

With funding from the National Heart, Lung and Blood Institute, part of the National Institutes of Health, this six-year, $21.4 million multisite prospective cohort study will include 50 investigators from 15 other institutions.

To better understand why certain factors amplify risk in some rural counties and what renders some communities more resilient, the researchers will be recruiting and studying 4,000 multi-ethnic participants from 10 of the most economically disadvantaged rural counties in the South.

“The truly exciting thing about this research is we are working with multiple investigators from across the Southeast to develop and maintain community engagement in addition to participant engagement,” said Suzanna Judd, co-principal investigator of the study and a professor in the Department of Biostatistics at the UAB School of Public Health. “We are looking to go beyond a simple epidemiological study to do more than simply observe a population.”

To accomplish this, researchers will build a mobile clinic to provide the medical exams on study participants in their counties. Familial, lifestyle and behavioral factors, along with medical history including risk for heart, lung, blood and sleep disorders, will be recorded. Environmental and economic factors will also be studied. UAB will be in charge of building the mobile clinic.

“This clinic will bring technology to rural communities that might not have ready access to specific types of diagnostic tests,” Judd said. “This is an engineering challenge, a community engagement challenge and a disease prevention challenge, which makes it incredibly exciting.”

“UAB is a major stakeholder in the state of Alabama,” Allen explained. “Access to quality care, educational opportunities and employment are all things anyone would want their family to have. Access is a significant issue in rural communities. Bringing accessible health screenings to rural areas is important.”

In addition to UAB, investigators from the University of Louisville, Louisiana State University’s Pennington Biomedical Research Center and University of Mississippi Medical Center will play a central role in participant recruitment, retention, follow-up, data return, return of results, community engagement and education. The study’s coordinating center is Boston University School of Medicine.

Recruitment in Alabama will begin next year. For more information, visit the RURAL Study website.

(Courtesy of Alabama NewsCenter)

Based on nationwide data from the UAB School of Public Health, the study was published Oct. 2 in the Journal of the American Medical Association.

Lead author George Howard, doctor of Public Health and professor of biostatistics, said the most significant part of the study is it identifies lifestyle changes that can be made to reduce the higher risk of hypertension in African-Americans. Hypertension is the main reason they are at higher risk of stroke and heart attacks, and one of the main reasons African-Americans have a shorter life expectancy.

“Hypertension is the single biggest contributor to racial disparities in cardiovascular disease,” Howard said. “Preventing hypertension is a critical piece of reducing health disparities in cardiovascular disease. This work identifies factors contributing to the development of high blood pressure and how they differ between African-Americans and white Americans.”

Cardiovascular disease, including stroke, is the largest contributor to the mortality difference between the black and white populations of the United States, accounting for 34 percent of the difference in years of life lost, according to data from the National Health Interview Survey.

“Life expectancy is about four years shorter in African-Americans compared to whites, and a driving force of life expectancy differences is cardiovascular diseases,” Howard said. “The higher risk of hypertension in African-Americans plays a central role in this problem. Not only does hypertension have a direct impact on racial disparities, it also drives the disparities in stroke and heart-related conditions.”

The researchers analyzed 6,897 participants from across the nation over a period of nearly 9.5 years; 1,807 were black and 5,090 were white. The participants are all part of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study, a federally funded effort based at UAB. The participants were interviewed by telephone, and then a health professional went to their homes and took measurements, including blood pressure, weight, height and waist. The participants answered questions about their health and completed questionnaires measuring their diets.

Twelve potential factors were studied for their relationship with the development of hypertension in blacks compared to whites. For both men and women, the biggest factor explaining the difference in the risk of developing high blood pressure between African-Americans and whites was eating a Southern-style diet. This is a dietary pattern high in fried foods, including fried fish, chicken and potatoes. It also contains sweetened beverages and processed foods. Suzanne Judd, Ph.D., a nutritional epidemiologist in UAB’s School of Public Health, is one of the investigators who first identified this eating pattern.

“This diet likely contributes to excess hypertension due to higher sodium intake, but it is impossible to guess at which component of this dietary pattern is the ‘silver bullet,’” Judd said. “Likely it could be all of the foods eaten together. The combination of a high-sodium diet with excess calories from fat and sugar and limited beneficial foods containing anti-oxidants, vitamins and minerals probably creates the perfect storm to make this diet less healthy.”

The study found there are similar and varying factors for men and women.

“The other important factors for both men and women are salt intake and education,” Howard said. “For women, the other factors are obesity and larger waist size. We know obesity is related to the development of hypertension in both men and women, but we didn’t know that it contributed differently in men and women to the racial difference in hypertension. We now know that obesity helps to explain the racial disparities between black and white women.”

Howard hopes the findings will help guide efforts to reduce the “extra” risk of hypertension in African-Americans, and this may help to reduce the extra risk of stroke and heart attack, and to reduce the shorter life expectancy in African-Americans.

“The best way to treat high blood pressure is to prevent it,” Howard said. “This study points to lifestyle changes that can be made to reduce the black-white difference in hypertension, which will in turn reduce the racial disparities in cardiovascular disease.”

The study was supported by the National Institute of Neurological Disorders and Stroke, which is part of the National Institutes of Health. The other study authors are Suzanne Oparil, M.D., Paul Muntner, Ph.D., Virginia G. Wadley, Ph.D., Leann Long, Ph.D., and Virginia Howard, Ph.D, all from UAB; as well as Mary Cushman, M.D., University of Vermont School of Medicine; Claudia S. Moy, Ph.D., National Institute of Neurological Disorders and Stroke, National Institutes of Health; Daniel T. Lackland, Medical University of South Carolina; Jennifer J. Manly, Ph.D., Columbia University; and Matthew L. Flaherty, M.D., University of Cincinnati Academic Health Center.

(Courtesy of Alabama NewsCenter)