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Public Health and the Dairy Cow in the Room

Public Health and the Dairy Cow in the Room

Released Tuesday, 26th November 2024
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Public Health and the Dairy Cow in the Room

Public Health and the Dairy Cow in the Room

Public Health and the Dairy Cow in the Room

Public Health and the Dairy Cow in the Room

Tuesday, 26th November 2024
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Episode Transcript

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0:01

I'm Karen Anthony. I'm a health reporter. For

0:04

years I've been looking into the deaths of

0:06

two black men in Sykes in Missouri. They

0:08

were killed nearly 80 years apart by a public

0:10

health threat of their time. Cleo

0:13

Wright was lynched. They did

0:15

not want to talk about that except that's

0:17

a hush hush. Denzel Taylor was

0:19

killed by police. Go

0:21

Miss Monique! Through their

0:23

stories, we're exploring what it means to

0:25

live with racism and violence and the

0:27

toll it takes on our health. Heart

0:30

disease, cancer, all these

0:32

other ailments. Telling

0:35

these stories uncovered secrets in my

0:37

own family. I think

0:39

there's something in our DNA that

0:42

still makes us scared to talk about it.

0:45

From World Channel and KFF Health News,

0:47

this is Silence in Sykes Den, the

0:49

podcast about finding the words to say

0:51

the things that go unsaid. Listen

0:54

to all episodes now, wherever you

0:56

get your podcast. Things

1:24

might have changed by the time you hear this. So

1:26

here we go. Today

1:38

I am thrilled to be joined

1:40

here in our KFF studios by

1:42

some of the staff of KFF

1:44

Health News' newest project, HealthBeat, which

1:46

we've created with another non-profit, civic

1:48

news company to cover public health

1:50

in America. Here with us

1:52

today are HealthBeat editor-in-chief Charlene Pissenty.

1:55

Hello. Amy Maxbin, KFF Health

1:57

News Public Health correspondent and HealthBeats national

1:59

report. Hi. And

2:01

Eliza Fawcett, New York City reporter. Hi

2:03

there. Hello everyone and thank you so

2:05

much for being here. Charlene, I want

2:07

to start with you. What exactly is

2:09

HealthBeat and why do we need it?

2:12

Now more than ever, I would say, HealthBeat

2:15

was created in the wake of

2:17

COVID when it became very apparent

2:19

that people needed a deeper understanding of

2:21

what public health is. The kind of

2:23

invisible shield that keeps us all

2:25

safe. And we also needed

2:28

more news coverage that centers reliable, science-based

2:30

information so that people could make good

2:32

decisions about the health of their families

2:34

themselves and the people around them. So

2:36

we thought part of that coverage should be rooted

2:39

in communities. It's been shown

2:41

that no matter their politics or how they

2:43

feel about the federal government, people do trust

2:45

their local public health leaders. And we think

2:47

that by elevating those voices on timely issues,

2:49

we can start to win back people's trust,

2:52

not only in journalism, but in science. That

2:54

sounds like a very uphill battle. Yes,

2:56

as you mentioned. But we are part

2:58

of Civic News Company, which you mentioned,

3:00

whose model has been developed over the

3:02

past 10 years covering schools with ChalkBeat.

3:05

And so we're trying to leverage the

3:07

success they've had with a local plus

3:10

national reporting. So for HealthBeat, we're partnering

3:12

with KFF Health News, which has a

3:14

long tradition of excellent health reporting to

3:16

handle national coverage. And then we've opened

3:18

two local bureaus to start. We're in

3:20

New York and Atlanta with a third

3:22

location to come next year. Cool.

3:25

So, Amy, you're our public health expert at

3:27

the table. How is public health different from

3:29

what we think of as regular

3:32

health care or medical care in general? I'm

3:35

excited to answer that question because I'm really

3:37

into public health. So whereas

3:40

you think about health care as

3:42

what happens in a clinic, an

3:44

individual is sick, and they're treated

3:46

within a hospital system, public health

3:48

really focuses on preventing illness and

3:50

improving health at a population level

3:52

through population level interventions. So for

3:55

example, infectious disease outbreaks are often a big

3:57

component of public health, and that's because they

3:59

spread. in communities. So even though a person

4:01

is treated in a hospital, say

4:05

if you have a, somebody who has

4:07

measles, now the person's treated for measles in

4:09

a hospital, but public health officers actually go

4:11

into communities, they figure out how the virus

4:13

is spreading, they might go to schools or

4:15

to hospitals or to a shopping mall, wherever

4:17

that person was. Similarly, like

4:20

if a person is shot, they

4:22

go to an emergency room and they get healthcare

4:24

in that emergency department. But public health is going

4:26

to look at the surrounding issues. How

4:28

does gun violence affect the whole neighborhood? What does

4:30

it mean to grow up with stress? Does it

4:32

mean you can exercise as much if the neighborhood's

4:34

dangerous? So that's sort of why

4:37

also a big component of public health is about

4:39

collecting a lot of data and analyzing that data.

4:41

I feel like people kind of misunderstand this

4:44

a lot. They think of public health, they

4:46

think of healthcare as something that's between a

4:48

health practitioner and you, the patient, whereas public

4:50

health is bigger than

4:52

that and you are not the focus

4:54

of public health, right? It's everybody

4:57

around you. Yep, that's the public

4:59

part. Yeah. And

5:02

it's fun because it's out there in the

5:04

world. But why do people, I feel like

5:06

people really misunderstand that and I feel like

5:08

that's the source of a lot of the

5:10

frustration that people get with public health. It's

5:12

like, well, that might not be good for

5:14

me. Yeah,

5:17

that's the tricky thing because I think that

5:19

is true. You have to believe in kind

5:21

of societal goods. You have to believe that

5:23

having a cleaner neighborhood is good for everyone

5:25

and not just because you have to take

5:27

out your trash or not. I don't know

5:29

if that's the best comparison. Eliza,

5:32

how did you get into public health? I

5:35

started as a reporter at the Hartford Courant

5:37

during the start of the COVID

5:39

pandemic. I became really interested in covering

5:41

health and also mental health during that

5:43

time. And I grew up

5:45

in New York and it's been really exciting to be the

5:48

first New York reporter for Health Beat, really

5:50

getting into community health issues

5:52

and understanding the sprawling

5:54

New York City Health Department, which is one

5:56

of the biggest in the country. And since

6:00

up in New York, it's been really exciting to

6:02

be doing this work. Certainly. What kinds of

6:04

stories is health beat pursuing? Well,

6:06

as you can imagine, public health is very

6:09

broad and we're just getting started. We just

6:11

officially launched August 30th. So we've just had

6:13

the last of our reporters come aboard for

6:15

right now. So we're trying to narrow it

6:17

down a little bit. And we're kind of

6:19

focusing on three key buckets for our coverage.

6:22

One is infectious diseases, which Amy's doing such

6:24

a great job on bird flu right now.

6:26

But also we're looking at that locally too.

6:28

What are the flu numbers right now? We're

6:30

going into flu season? What are the COVID

6:33

numbers? How's RSV ramping up and those sorts

6:35

of things? And the community's preparedness to deal

6:37

with outbreaks. Accountability is

6:39

another really big thing that we're focused on.

6:43

What many people may not realize is

6:45

that public health funding, even

6:47

at the local level, comes from Washington. It's

6:49

coming from CDC, it's coming from HHS. And

6:51

so we're looking at how those dollars flow

6:53

down to the local communities and how they

6:56

are spent. And also just, you

6:58

know, officials who are in charge of

7:00

public health policy. In Georgia already,

7:03

we've seen some pretty good impact in our

7:05

reporting, just by showing up, frankly. Our,

7:08

our first Atlanta reporter, Rebecca

7:10

Grapevine, she got on the job like the

7:12

first week and realized that the Board of

7:14

Public Health in Georgia had not held a

7:16

public meeting in like five months. So

7:19

we brought about that. And the story

7:21

got a lot of attention. And by

7:23

golly, in November, they had a meeting.

7:25

So that was really great. And then

7:27

the third thing is really community. We

7:29

really want to center our coverage on

7:31

the people on the ground who are

7:33

working on public health from many aspects.

7:35

It can be social workers. It can

7:37

be your local epidemiologist at the Health

7:39

Department. It can be volunteers at a

7:41

house of worship who has a ministry

7:43

trying to help with homelessness or maternal

7:46

mortality or any of those things. We're

7:48

really trying to be a platform and

7:50

a voice for those people. At

7:52

Civic News Company, we call people like that Civic Catalyst.

7:54

They're out there doing the work and we really want

7:56

to shine a light on them. So

7:58

Amy, what are the other Obviously, we're going to talk about

8:01

bird flu separately in a few

8:03

minutes. What are the other public health,

8:05

big national public health stories that you're

8:07

watching right now? I mean, I

8:09

think we'll keep an eye on vaccination

8:12

rates. You can expect those to unfortunately

8:14

drop and I'm not talking about just

8:16

the COVID vaccine, but childhood vaccination rates.

8:19

It's important to keep in mind the majority of adults,

8:21

around 70% still say that

8:23

childhood vaccines are really important. But

8:26

remember, going back to what's public health,

8:28

the power of vaccines is in kind

8:30

of herd immunity effect. So children

8:33

are being protected with say a measles

8:35

vaccine, but we want to have high

8:38

rates above 90% of vaccinations

8:40

so that teachers who are immunocompromised,

8:42

children who are immunocompromised, infants

8:45

too young to be vaccinated so that

8:47

they're all protected too. And

8:49

what we're going to see, if we see RFK Jr.

8:53

as the head of HHS,

8:56

there's some rumors

8:58

floating that Joseph Ladapo might

9:01

have a role in the administration as well. He's

9:04

the Florida Surgeon General who we've talked

9:06

about a lot on the podcast, who

9:08

himself is kind of vaccine agnostic. Yeah,

9:11

exactly. And so we're seeing a lot

9:13

of signs that we're going to hear

9:15

a lot of terms like choice and

9:17

consent when it comes to vaccines and

9:19

those sound like great words. But what

9:21

it ultimately means is that we'll

9:24

see a loosening of mandates around having

9:27

children be vaccinated before they go to public

9:29

school. And that combined with

9:31

misinformation, so we'll probably see lower vaccine

9:33

rates among children. So that's something to

9:36

watch because it means more outbreaks. Outbreaks

9:38

are costly to contain in money

9:41

and in life's last. So that's definitely

9:43

one story. There are certainly

9:46

others besides even the bird flu, which I'll

9:48

talk about. I write

9:50

a lot about occupational health. So there's lots

9:52

of health care workers who lost their lives

9:54

in COVID, but also have covered how

9:57

many are facing long COVID and PTSD because

9:59

they weren't. aren't very well protected when they

10:01

were at work during the

10:03

pandemic, during the peak of the pandemic. I've

10:06

written about how farm workers and

10:08

construction workers and landscapers have

10:10

had heat-related illness and injuries. There

10:13

was a law that the

10:16

Occupational Safety and Health Administration has

10:18

been working on, but it will

10:21

almost certainly stall under a Trump administration, so

10:23

we're not going to have national regulations on

10:25

heat. So those are some of the other

10:27

things I'll be thinking about. What

10:29

are the big stories in New York, Eliza? Well,

10:32

a lot of them are the same as what Amy

10:34

mentioned, and we're trying to

10:36

see how the big changes

10:38

coming down the pike with the second

10:40

Trump administration will impact us locally. Obviously,

10:44

that is in big part about

10:46

funding, and whether CDC funding stays

10:48

the same, is reduced,

10:50

et cetera. Same

10:52

for NIH and other federal agencies that deal

10:54

with health issues, the way

10:56

that local health departments

10:58

work, even really big ones like New York

11:01

City, is that they do get a lot

11:03

of money from the federal government, obviously, and

11:05

so any small changes could have a really

11:07

big impact on work on the ground, whether

11:09

that's making sure that kids can get vaccines.

11:12

The Vaccines for Children's Program

11:15

is responsible for making

11:17

sure that many, many, many children in the United States

11:19

get vaccinated. I'm of course so old

11:22

that I covered the Vaccines for Children program when it

11:24

began in the 1990s. But

11:27

yes, that is how most

11:29

kids get vaccinated now, is through the Federal

11:31

Government's Vaccines for Children program. One

11:34

thing that obviously we are looking towards

11:36

the possibility with Republicans backing control of

11:38

the Congress and the White House is

11:41

healthcare budget cuts. I mean, I assume

11:43

New York is assuming that there will

11:45

be less money in a Trump administration.

11:48

Yeah, I think it's a real concern for

11:50

public health leadership in the city, and it's

11:53

been interesting to see what the response has

11:55

been from city and state officials after the

11:58

election. They've kind of... made

12:00

this point of saying that New Yorkers

12:02

will be protected, whether that's reproductive

12:05

rights or vaccinations.

12:08

And there's this feeling of kind of pulling up the

12:10

drawbridge that New York has

12:12

a pretty robust public health infrastructure. And

12:14

so whatever happens on the federal level

12:16

will be okay. But obviously,

12:18

things are a lot more complicated and

12:20

intertwined than that. The city does get

12:22

a lot of its funding from... Or

12:25

the New York City Public Health Department does get a

12:27

lot of its funding from the city and from the

12:30

state, but also from the federal government. And

12:33

so if there are major changes

12:35

there, that could have a big impact

12:38

on the kinds of community-led programs that

12:40

do good public health work in the

12:42

city. And even

12:45

on vaccinations, that's an interesting question

12:47

too, because while

12:50

the CDC provides recommendations, they

12:52

don't actually provide mandates. That's

12:54

a state's issue. If the

12:56

CDC starts

13:00

changing its messaging around vaccinations, particularly if

13:02

RFK Junior is running HHS, which is

13:04

a big concern, that can still have

13:07

a trickle down impact on what

13:09

New Yorkers think about getting vaccinated in

13:11

general, which has already been a big

13:13

concern for folks. So I think it's

13:15

been interesting to see this dynamic

13:18

starting to play out in the city where

13:20

on the one hand, there's this strong progressive

13:22

leadership that is vowing to keep up the

13:24

good fight, but we'll see the extent to

13:27

which they can really protect themselves from any

13:29

large changes that are going to happen. Let's

13:31

talk about bird flu because it's sort of

13:34

the elephant or the dairy cow in the

13:36

room. We've been sort

13:38

of watching all year and I guess

13:40

health authorities have been watching with some

13:42

alarm as we're seeing bird

13:45

flu spreading in dairy cattle herds and

13:47

then occasionally to people, to dairy workers

13:49

and now to some people who are

13:52

apparently not dairy workers. What is your

13:55

feeling about where we are with bird flu

13:58

and what has the Biden administration done in

14:00

about it, and what do you anticipate that

14:02

the incoming Trump administration might do differently? Yeah,

14:05

so I think, you know, the past, looking

14:07

back on the past year with bird flu,

14:09

the huge disappointment appalling if you talk to

14:12

researchers, sort of frustrating if you talk to

14:14

public health officials, is we

14:17

failed to contain it when the bird flu

14:19

outbreak was confined to just a handful of

14:21

states. That would be when it was smaller,

14:23

it's like putting out a fire when it's

14:25

small versus, you know, once there's a huge

14:27

forest fire, it's harder to put out. So

14:31

now it's in at least 15 states,

14:33

and the number might be higher because a lot

14:35

of farms, maybe the majority of farms, haven't

14:38

tested at different periods

14:40

during the year. There's 52 cases

14:42

among people in the U.S., mainly

14:44

among farm workers. But yeah, as you

14:46

just mentioned from the case in California,

14:48

there's a few cases that have been

14:50

mysterious, people who have no contact, no

14:52

known contact with farm animals. These

14:55

unknowns are actually kind of what's a

14:57

staggering, is also the growth of the

14:59

epidemic. We're just, we've sort of

15:01

lost track of what's going on. So

15:04

what this means is, you know, I've talked to

15:06

so many experts at this point, and nobody

15:09

thinks we're going to eliminate this on dairy

15:11

farms. And to be clear, bird flu has

15:13

been around for 30 years, both the bird

15:15

flu and cattle spreading among mammals, that's new,

15:18

and that's in the U.S. So

15:20

what does this mean? This means, you

15:22

know, best case scenario, millions, not

15:24

billions of dollars in losses for the dairy and

15:26

poultry industry. It means farm

15:29

workers are going to continue to get the

15:31

bird flu, which is not comfortable. And

15:33

then it also means we just have this kind of

15:35

ominous, constant threat that maybe

15:38

the virus will evolve in a

15:40

way where it spreads between people

15:42

easily. And that's when you could

15:44

get a pandemic. That's

15:46

been the big fear about a pandemic. I

15:48

mean, but that was a fear even before

15:50

the COVID-19 pandemic, what everybody was afraid of

15:53

was a bird flu pandemic, was an avian

15:55

flu that mutated to pass from person to

15:57

person. Exactly. It's been on, you know, because

16:00

humans don't have a lot of experience with the

16:02

bird flu. It's novel, we may or may not

16:04

have some partial immunity to it. So it could

16:07

be very bad. So there's a chance

16:09

it will never mutate in a way that

16:12

has it spread easily between people. But

16:14

if it does, it could be horrible, like on

16:16

the scale of what we saw during COVID. And

16:19

so that's why everyone I talked to, I guess

16:21

the big question is, why are we taking a

16:24

gamble on this? But

16:26

that's what we've done this past year,

16:28

essentially, intentional, not intentional. I've

16:30

reported a lot on why this is, but

16:32

that's where we're at. I mean,

16:34

some of this I know comes back to

16:36

the whole trust issue, which is that the

16:38

CDC couldn't get on to some of the

16:40

dairy farms to test, because

16:43

the dairy farmers didn't trust the government.

16:45

I mean, what has the Biden administration

16:47

been able to accomplish in terms of

16:49

dealing with the bird flu? Well,

16:53

yeah, so on a

16:55

local level, this has really left to

16:57

local public health departments a lot

17:00

of the time. So that's really

17:02

who's doing the work here. Sometimes

17:04

it's state health departments. But on

17:06

the ground, we're talking about veterinarians,

17:08

farmers, and local health officials. And

17:11

I actually foyered a lot of health

17:13

departments and some agriculture departments to kind

17:15

of learn what's even happening. The system

17:18

of surveillance is a voluntary system. So

17:21

when there's mistrust, there are also just fears,

17:23

right? So farmers would be afraid of if

17:26

they say they have the bird flu of

17:28

losing their entire milk market, which is

17:30

a big one, cuz then they lose the whole farm. So

17:32

there's a lot of concerns sort of about

17:34

their own privacy. So basically,

17:36

a lot of the cooperation has kind of fallen

17:38

apart with that. What could the CDC do? I

17:41

think there's a lot of disappointment for the CDC and the

17:45

USDA from the experts that I speak

17:47

with. Because although, yes, they do, they

17:49

can't just storm onto farms. They

17:52

haven't actually been using sort

17:54

of the bully pulpit to say, this

17:57

is what's going wrong, we're really concerned, this is

17:59

how we can do it. do it better. This

18:01

is how we can get around some of these

18:03

problems like farmers being afraid of losing their milk

18:05

market or farm workers being afraid of losing their

18:07

job. They haven't really been very

18:10

open about the problems and

18:13

they also haven't acted with

18:15

urgency. So the

18:18

response on the high level has

18:20

seemed slow and uncoordinated. They'll announce

18:22

that they will be doing outreach

18:25

to farm workers, but then there

18:27

will be months past with

18:29

no outreach. They'll say that they're going

18:31

to be working on having other groups

18:33

be able to test for the bird

18:36

flu virus, but we still don't see any

18:38

group besides the CDC having that ability. So

18:43

there's a lot of

18:45

people who are aggravated

18:47

with the response under

18:49

the Biden administration. And

18:52

some of it's not just because of

18:54

leadership. There's kind of internal issues within

18:56

the U.S. We have a voluntary system

18:58

in a lot of ways. So for

19:02

better or worse, this might be the way

19:04

it is. And what would you expect from

19:06

an incoming Trump administration even? I mean, we

19:08

obviously don't know a lot about what to

19:11

expect from an incoming Trump administration, but based

19:13

on their handling of COVID, what would you

19:15

expect? Exactly. So based on their handling of

19:17

COVID, one is I

19:19

can say, you know, time-wise,

19:22

okay, so it's on our side. The plus

19:25

is as outbreaks continue, people

19:27

often get better at figuring out what to do.

19:29

So on the plus side, maybe

19:31

farmers will start to have a little bit more trust

19:34

that they're not going to have huge losses and that

19:36

therefore they'll be a little bit more open. Maybe vets

19:38

will get a better handle on how to control this.

19:40

So that's the plus side. The

19:42

downside is also pretty huge. So

19:45

during COVID, the

19:47

CDC basically stopped holding press briefings. So

19:49

right now, at least there are press

19:51

briefings. The hero is critical of the

19:53

CDC, but I might completely

19:56

lose all contact with them under

19:58

a Trump administration. has

24:00

been, I think, of everything, of all

24:02

of the sort of parts of American

24:04

society where the public has lost

24:06

trust, public health is way up towards the top,

24:08

and also it's way up towards the top in

24:11

terms of the misinformation that's been spread. So how

24:13

do you combat those two things? It's something that

24:16

we talk about all the time on the podcast,

24:18

and I don't know how to fix it. It's

24:21

really tough. I think that one

24:23

way that we really look at it is elevating

24:25

local voices. To your

24:27

point about immigrants and immigration status

24:29

as a social determinant of health,

24:32

we had a report just yesterday that came

24:34

out in Georgia that laid out all the

24:36

things that Amy and Eliza were just talking

24:38

about in Georgia as well, the stigma, the

24:40

not asking for help because

24:44

you fear about getting involved with

24:46

the authorities in some negative way.

24:48

But there are a lot

24:50

of community organizations that are a safe

24:52

space that do work to

24:54

provide culturally sensitive

24:56

care and speak the language and

25:00

offer the help to people so that they're not

25:02

threatened. So I think by highlighting those resources, that's

25:04

one thing that we can do. And

25:06

another one is just highlighting people who

25:08

know what they're talking about, scientific experts

25:11

in the community, particularly local ones.

25:14

One really exciting thing that we're doing

25:17

in New York is we're kind of

25:19

combining two of those concepts through a

25:21

partnership with your local epidemiologist. This

25:24

is a newsletter that is run by Caitlin

25:26

Jettalina who back in 2020

25:28

started an email. She was teaching at

25:30

the University of Texas. She's an epidemiologist

25:32

and she was just writing an email

25:35

to her students and her family and

25:37

friends to explain the science behind what

25:39

was going on with COVID. And

25:41

it has snowballed and four years later,

25:43

it's really huge. So we have partnered

25:45

with her to bring that

25:48

concept to health beat readers in New York.

25:50

So every week we have our own epidemiologist.

25:52

Her name is Marissa Donnelly and

25:54

she does an email newsletter every week that

25:56

kind of breaks down what we call the

25:58

community health forecast. And

26:01

it's all kinds of really great science-driven

26:04

information with nice little charts that

26:06

just lays it all out for

26:08

you. It's like the weather forecast,

26:10

but for health. Exactly. So

26:12

I think that's one way. Just lay it out

26:14

for people, give them the rationale behind it, the

26:17

science behind it. And I think

26:19

that work like that over time hopefully will

26:21

help regain some trust. Well, I

26:23

want to thank the panel. This has been

26:25

really inspiring. I'm

26:28

hoping that we can come back to you periodically

26:31

to see how public health in general and

26:33

health beat in specific are doing. So thanks

26:35

for joining us. Okay, that is

26:37

this week's show. As always, if you enjoy the

26:39

podcast, you can subscribe wherever you get your podcasts.

26:41

We'd appreciate it if you left us a review.

26:44

That helps other people find us too. Special

26:46

thanks this week to our producer, Taylor

26:48

Cook, our editor, Emory Hutterman, and KFF

26:51

Health News Enterprise editor, Kelly Johnson. As

26:53

always, you can email us your

26:56

comments or questions. Remember what the

26:58

health, all one word at kff.org,

27:00

or you can still find me

27:02

at X at J. Robner and

27:04

increasingly at BlueSky at JulieRobner.BlueSky.social. Do

27:07

you hang around on social media any place,

27:09

Amy? You know, I've just started,

27:12

I've joined the BlueSky trend. I just

27:14

sort of came over there. There's a

27:16

lot of, there's kind of one

27:18

of those moments where there's a lot

27:20

of journalists and health people and researchers.

27:22

So it's, yeah, I've... Do

27:25

you have a handle? My

27:27

handle is AmyMaxman.BlueSky.social. Excellent.

27:30

Charlene. I'm most active on

27:32

LinkedIn where all the health people are. There

27:34

you go. Eliza. I'm

27:36

also on BlueSky newly under my name,

27:38

Eliza Fawcett, and still kind of lurking

27:41

on Twitter. There you go. We'll

27:43

be back in your feed next week. Until then,

27:45

have a very happy holiday weekend and be healthy.

28:00

you

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