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#72: Opiates and COVID-19

April 7, 2021 | 1 hour 10 seconds

​In this episode of The Accidental Safety Pro Podcast, series host Jill James interviews Eric Persaud. Eric is a doctoral candidate in public health at the Department of Environmental and Occupational Health Sciences, at the State University of New York, Downstate Health Sciences University, and Eric will soon be defending his dissertation. Eric has a lot of insight on ways the pandemic has affected us in ways that might otherwise go unseen to the general public, like the rise in opiate overdose deaths.

Links and Show Notes

Persaud Mitchell 2021 NS_Needlestick Injury among Healthcare workers COVID vaccinations

Transcript

Jill:

This is the Accidental Safety Pro brought to you by HSI. This episode was recorded April 2, 2021. My name is Jill James, HSI's chief safety officer, and today I'm joined by Eric Persaud. Eric is a doctoral candidate in public health at the Department of Environmental and Occupational Health Sciences, State University of New York, Downstate Health Sciences University, and Eric will soon be defending his dissertation.

Eric focuses on evaluating and researching training programs related to preparing workers for emergencies and disasters in hazardous workplaces. He's been involved in evaluation and research associated with fentanyl and first responders, opiates in the workplace, and protecting workers from COVID-19. And he's also a contracted training program evaluator with the NIEHS or the National Institute of Environmental Health Sciences worker training program. Eric joins us today from his home in New York. Eric, welcome to the show.

Eric:

Glad to be here Jill.

Jill:

Well, I would like to know how a guy who started out as a geologist, because you've told me that before and I don't know the story yet, but first of all, I guess, how'd you become a geologist? And then second, what's the leap into health and safety?

Eric:

That's probably the one question most people will ask me when it comes to what I'm doing now. They are like, wait a second, where and how did that happen? Back in college, I had gotten in for engineering, and I remember the first thing I was going to do was not do engineering. I just looked at it and I saw labs, and I saw lack of communication, and lack of touch and feel with the world, and geology grew to me, the earth sciences grew to me because I've always been into these environmental issues in these sciences and the world as itself in a whole. And when I switched over to geology and finished up my Bachelor's, I was planning to do a Master's in geology as well, but then my mom unfortunately got very sick and I decided it was probably best to stay home, and get a job, and maybe do the Masters online or something. So I did my Master's online through North Carolina State University. And-

Jill:

Mm-hmm (affirmative) You finished it in geology.

Eric:

And I ended up doing it in environmental assessment.

Jill:

Mm-hmm (affirmative) Okay.

Eric:

Yes. So the environmental assessment is like one of these funny things where it's looking at exposures to chemicals or things within the environment.

Jill:

Mm-hmm (affirmative).

Eric:

And that combination and starting to work as a geologist for this construction company, gave me, I think, my first opportunity to start learning and start applying myself. And when it came to the work itself, we were doing environmental remediation. So it was like tanks, and groundwater, and contamination, and it went well with the Masters.

Jill:

Mm-hmm (affirmative).

Eric:

The Masters was about contamination and it went hand in hand, went nicely together. And I remember one day I'm in the office getting ready to go out into the field, and our Vice President in the company, this is a small little construction company in Queens full of plumbers, and one or two electricians here and there, a couple of laborers, it's a small base, half union, half not union.

Jill:

Mm-hmm (affirmative).

Eric:

And I heard the VP talking to the owner, the President, and they were chatting about cleaning these tanks, these chemical tanks.

Jill:

Mm-hmm (affirmative).

Eric:

And the guy is like, "Hey, why don't we just drop this chemical in here and it'll neutralize everything," because the chemical was this corrosive sodium hypochlorite or bleach.

Jill:

Mm-hmm (affirmative) Okay.

Eric:

And I stopped, and I looked at him, and I called him stupid.

Jill:

That's bold.

Eric:

Yes, he looked at me and was like, where did that come from? Because I'm a pretty generally quiet guy when it comes to work.

Jill:

Uh-huh (affirmative).

Eric:

I was like, you're going to kill somebody. You're going to drop something in there and it's going to blow it up.

Jill:

Mm-hmm (affirmative).

Eric:

And he's like, "You know about this stuff?" I was like, "Well I know enough about that." He's like, "Okay, can you take care of it?" And that was how I was thrust randomly into chemicals, and randomly into hazardous materials, and within the next one week I was out with a few other guys and we went out to clean these chemical tanks.

Jill:

Mm-hmm (affirmative).

Eric:

So the geologists was out there, inside of a tank with a power washer, and a vacuum truck vacuuming out those sodium hypochlorite, bleach, with power washing water. And the reason I had to go in was because the other two guys, as you know in confined space you typically have three folks.

Jill:

Mm-hmm (affirmative) Right.

Eric:

One that was a pretty big guy, so he wasn't getting in the hole.

Jill:

You're the one who fit in the hole [crosstalk 00:05:35] so that's why you went.

Eric:

I'm the one that fit in the hole, yes. The other guy had hurt his leg recently, so I don't know if I believe him, maybe that was a little far fetched to not get into the hole and I was the young guy.

Jill:

Yes.

Eric:

And there I was cleaning tanks day in day out, doing the safety on the side for it as well. Representing-

Jill:

Yes, I mean, did you even know anything about confined space entry or any of that before you got in that tank?

Eric:

I knew as much as we knew from the regular HAZMAT training, which if you're familiar with, and I'm sure you are, but to our viewers that may be less than familiar with it, it's a 40 hour class where you sit in a room and you listen to someone tell you stuff, but you don't actually go out and enter these spaces, right?

Jill:

Sure.

Eric:

Well, for this instance, some of them are more practical and hands on.

Jill:

Mm-hmm (affirmative).

Eric:

So no, I had never been in a confined space before, I entered that confined space for the first time. I had never worn level B HAZMAT suit, the stuff that looks like sci-fi movie material.

Jill:

Uh-huh (affirmative).

Eric:

But here I was jumping in a tank, and at the same time looking up the health and safety related to it, because our workplace being a small location didn't have a health and safety person really, right. It was basically the employer, and the employer was like, sure, go ahead, take care of it.

Jill:

Mm-hmm (affirmative).

Eric:

So I was managing health and safety unofficially, kept this title of geologists even though, realistically, I had no longer done anything with geology, and was doing these hazardous material jobs throughout the city. And I decided I saw so many folks going into these tanks and doing these chemical works in a dangerous manner.

Jill:

Mm-hmm (affirmative).

Eric:

A lot of people, not just me, were unsure of how to go about doing that work.

Jill:

Yes.

Eric:

I had folks mention to me, "It looks like water." And they just jump right in with a regular suit, when sodium hypochlorite can look a little bit, if you look at bleach when you pour it out, from a distance, maybe in a dark space, it looks like water.

Jill:

Yes.

Eric:

And stories like that, people wearing the wrong kinds of PPE and getting burnt, it inspired me to actually make my Master's thesis about chemical tank cleaners, and about the risk perceptions that they were facing.

Jill:

Interesting.

Eric:

And that was my transition from being so heavy into the environmental sciences, to pairing it with the Occupational Health Sciences, and looking at it through the lens of a worker and through the people who have to deal with these situations.

Jill:

Mm-hmm (affirmative) And it all wrapped around your first hand experience with it.

Eric:

Yes. Yes. And I think having that experience at the same time while doing the academics of it, helped me greatly because when I spoke about the health and safety to other folks that I worked with and those that are in the academic setting, I had lived it too, right.

Jill:

Mm-hmm (affirmative).

Eric:

So you're not going to challenge me in the sense that, hey, you're this young guy who doesn't know what you're talking about. I've lived through it.

Jill:

Yes.

Eric:

I've had the accidents, and the injuries, and things like that.

Jill:

Yes. So you came in with street cred right away even though you were a recent college grad.

Eric:

Yes, the hard knocks.

Jill:

Yes. That's awesome. So how long did you continue cleaning tanks, and then what happened next? Or are you still doing that?

Eric:

So, when I finished up the Master's degree, I decided to give the Doctorate a chance, right.

Jill:

Mm-hmm (affirmative).

Eric:

My advisor in my Masters program, bless her heart, reached out to me and was like, "Hey I think you should consider it." So I applied to a few vaguely public health programs throughout New York City and throughout parts of the country, and they all rejected me. I lacked academic background, right. I had a lot of work experience, but I think for just the sake of academics, it was a bit limited because it came from these environmental sciences, and I was applying for these public health programs.

Jill:

Mm-hmm (affirmative).

Eric:

So I had almost given up on it, I was like, man, I'm just going to clean tanks. And my advisor really pushed me one more time and she was like, "You know what, try for this one university downstate." And I was like, "Okay, you know what, I'll send out one more application, one last attempt." And I had gotten in, I got an email from downstate and I was about to accept it, unfortunately, the very next day my mother passed from cancer.

Jill:

Oh, man.

Eric:

Yes. And it was a difficult time to make a decision of doing a degree and these other responsibilities, and I had to make a decision quickly. And I sat on it, and I sat on it, and I looked at it and I was like, I've spent my whole life caring about these issues. I've cared about them for as long as I can remember, sciences, and health, and the environment, and I felt so deeply passionate to address these issues, to care about these issues. And to see so many workers being put into working conditions that were so dangerous and unsafe, I couldn't turn it down.

So eventually, I decided to take the program. I got in conditionally, because once again, my background was in public health. But it's turned out very well.

Jill:

Mm-hmm (affirmative).

And I continued to clean tanks and do that chemical work throughout the early part of the doctorate. So about, I would say, the first two years of it, about year four, I was getting up at five o'clock in the morning, heading out to a city job, going into tanks, cleaning them, sweating from head to toe, deconing around two o'clock or someone will hose me down, decon me. And I'd jump in my car, drive to Brooklyn, take a class from ... I would actually take a shower right before class, change off, so I wasn't too much of a mess.

Jill:

Yes.

Eric:

And I would go into class half awake, go for a few hours, these are very discretionary based classes. The doctorate I think was a great opportunity to talk to other people who are like minded and passionate about these issues, maybe slightly different things, but at the end of the day, passionate about what they were passionate about and we would have deep discussion, so you had to be awake. You had to be [crosstalk 00:13:03] participatory.

Jill:

You couldn't coast in this.

Eric:

You couldn't coast.

Jill:

Mm-hmm (affirmative).

Eric:

And I would finish around, get home around eight, nine o'clock, eat some dinner, but then I have to do the schoolwork or I have to do whatever was required. So I'd be up till midnight, one o'clock still doing it, get a few hours of sleep and repeat over and over for years.

Jill:

My gosh Eric. Do you think anybody else in your Doctoral program had that kind of a schedule going on? I mean, it seems like this would be a unique situation.

Eric:

I think one of the challenges for many folks who want to do higher academics is that your day to day life doesn't stop, right. When you're an undergrad maybe you could say, hey, I'm just going to spend, some people are very fortunate and in a great position where they can take those four years to just focus on school, right, that's your life.

Jill:

Mm-hmm (affirmative) Yes.

Eric:

I was not in such a position, but the beautiful thing about downstate was that they understood, the staff and the students also understood that we were professionals, we had our own responsibilities, and we were coming from day jobs, right, or families and other things.

Jill:

Mm-hmm (affirmative).

Eric:

So there was an understanding, and I think other students also had a high burden of stress, and work, and they were working as well. My situation was, I think, a bit unique of course, like everybody else's situation, but it was definitely a difficult, difficult journey, but at the same time, a very important journey, because I learned from those experiences.

I'm over there talking about work, but I work, right. And I think that perspective and the challenges really helped me understand and relate later on to people when they discussed the stress or the challenges that they would face, managing Life and work, managing families, or responsibilities, or other things in their day to day life that may create that stressful environment. And understanding, from my own perspective, that stressful environment as well as the working conditions on and off the job, has helped me greatly in being able to relate and care about these issues, not just as a statistic, but as a person.

Jill:

Right, and what those stresses put on a worker that increases risk as well, [crosstalk 00:15:44] it gives you a different lens.

Eric:

Mm-hmm (affirmative).

Jill:

Well, I mean, we're recording in April of 2021, you're within weeks of defending your dissertation, is that it?

Eric:

Yes, I'm going to defend most likely May 6th, wish me luck everybody who is listening. And I was able to finish, I think, a lot sooner because around December of 2018, after about two years of that workload, I was like, I need to really focus, I need to really take this risk and truly commit to this. Is this a hobby or is this something that I'm trying to really care about and bring real change?

Jill:

Mm-hmm (affirmative).

Eric:

And I ended up taking a huge risk, and I quit my job in a very peaceful, loving way, my employer is a great guy and I respect those folks. But I let them understood that I needed to take this risk, I needed to truly commit to this. And I left with no job in sight. Average folks take a couple more years to finish, and it was a day to day just looking at my bank account go down week by week.

Jill:

Mm-hmm (affirmative).

Eric:

And I had one research opportunity at the time, and it was to look at the risk perceptions of first responders to fentanyl exposure. Fentanyl is this opioid, it's a drug that is used legally in the hospital to reduce pain, for example, for folks who may have cancer as patches, but it can also be used illegally and illicitly as a misuse substance to get high and relief pain in that manner. And when I was looking at this issue is because at the time, there was a lot of misinformation, a lot of mis-confusion ... excuse me, I'll repeat that, a lot of confusion as it relates to how dangerous fentanyl was.

Jill:

Mm-hmm (affirmative).

Eric:

And I did a survey with the Christian Regenhard Center for Emergency Response Studies at John Jay College, and me and the principal investigator we published a study, a survey, of about 200 folks or so who are first responders in New York State, and we found that there was a number of issues, including many first responders believed that you could use hand sanitizer to clean off the fentanyl when in reality that led to more absorption. So many of them felt that briefly just touching it can kill them, when in fact, that wasn't the case. And there was a need to bring about training, bring about better education for first responders as it relates to this issue to reduce the panic and concerns that were misguided in that community.

Jill:

Mm-hmm (affirmative).

Eric:

And our study was basically the first of the kind, at least to my knowledge, to do that. And I had done the study for a couple hundred dollars. It was nothing, I needed a field experience for university as well as an issue that I was really concerned about, and it was a combination of just get it done, right.

Jill:

Yes. As you're watching your bank account go down you chose a passion project that means a lot for a couple hundred dollars, okay.

Eric:

Yes.

Jill:

Mm-hmm (affirmative).

Eric:

And of course the account was dwindling, week by week I couldn't sleep. And by chance, I think, the director of the worker training program that you had mentioned before the National Institute of Health Worker training program, Chip Hughes, had read that paper and heard about me through my advisor. And we started talking, because at the same time, they were doing work related to fentanyl and first responders. And little to my understanding at the time, I was using their information to train myself, they have training tools online, to train myself on the subject and prepare myself to deal with this issue. So, connecting the dots without even realizing I had connected dots.

Jill:

Mm-hmm (affirmative).

Eric:

We had started talking little by little over the phone in these group conversations, and they were planning on doing and opioids in the workplace prevention and response training program.

Jill:

Mm-hmm (affirmative).

Eric:

So in the summer of 2019, Chip and the NIH had offered me to do an internship or a fellowship or so to go ahead and, as once again part of that field experience that I needed through the doctorate, valuate that training program. So we went around the country and delivered a training, I believe a former person on your podcast, Jonathan Rosen, was the instructor of that program.

Jill:

Yes, okay.

Eric:

And I evaluated the program to find what was working, what was not working, how we were addressing stigma and addiction.

Jill:

Mm-hmm (affirmative).

Eric:

And it started off a little rocky. I remember the first session we had was with the Department of Energy, it was down in Hanford, Washington.

Jill:

Yes.

Eric:

And a beautiful place, wonderful people. And we were having a little bit of a rocky presentation because at the end of it, some folks had built up some anger towards the idea that opioid use disorder is not a disease, it is that they felt that it was a lack of willpower.

Jill:

Sure.

Eric:

Which in fact, opioid use disorder is a disease, and it's not a lack of willpower.

Jill:

Like any addiction.

Eric:

Yes, like any addiction. And the connection between work and opioid use and a misuse was challenged in that meeting. It was the first one, it was the first pilot training, and we had left a little shaken. We had left a little a little beaten down because-

Jill:

Yes, people were challenging you.

Eric:

They were challenging it, they were having a hard time changing their preconceived notions to stigma and addiction in a six hour class. It was unlikely, right, to change these inherit beliefs that had already come in, in a simple awareness course.

We made some adjustments, we emphasized it further, and in later courses, we saw that folks were getting it, they were understanding the addiction and how stigma, as well as opioid use disorder as a disease, and one challenge had a lot to do with the fact that the Department of Energy had a very punitive policy, very zero tolerance statement, because it's federal government. And even though some of those members in the class, who had privately come up to me and told me that they were dealing with addiction, they couldn't say it publicly because they would lose their job, they would lose their security clearance and therefore, in a sense, their job.

Jill:

Yes.

Eric:

And they weren't in any position to take any actions to do anything from the training to deal with the crisis at hand because of that restriction.

Jill:

Mm-hmm (affirmative) Yes, so I mean, that really leaves you in a precarious position, right? I mean, people are confessing essentially to you, and maybe it's the first time they've told anybody and they need help. And so what do you do?

Eric:

Yes, it's really something to have that happen. And we tried to create that environment where to be comfortable talking about the uncomfortable.

Jill:

Sounds like you did.

Eric:

And later on, we started to see more and more success, we adjusted it. And I was still going to school, I had republished a report on that, excuse me, on that program.

Jill:

Mm-hmm (affirmative).

Eric:

And around the same time, even though this was going on and I was learning so much and really feeling truly connected to these issues, I had dwindled down to about $100. So I was like, I want to keep doing this, I want to keep being here, but-

Jill:

I need some money.

Eric:

I have to think about lunch every once in a while, right?

Jill:

Yes, and paying the mortgage and all the other things.

Eric:

Yes. So I had been thinking about leaving it at that. Once this internship work was done, I'd have to probably go back and do some other, right. And I don't know where I got a Fellowship Award from downstate, it was a couple grand for, I guess, good grades and some work. And it was the first time they had ever given the award out. And it came the same day that I had to pay a bill with the only $100 that I had left.

Jill:

Oh, my gosh.

Eric:

And it saved me. It saved for a couple more weeks or so that I needed to keep going. And around that same-

Jill:

The universe came together.

Eric:

Yes, the universe, once in a while it happens I suppose.

Jill:

Yes.

Eric:

Once in a while a star aligns here and there.

Jill:

Yes.

Eric:

And around the same time, Chip WTP had offered me to continue working with them to fund my dissertation.

Jill:

Yes.

Eric:

And at that time, I didn't even have a dissertation, I didn't even know how to spell the ... I still don't really know how to spell the work to be honest. And they wanted me to continue evaluating that program. They organized and instructor course to improve the confidence of those who would go back from the training to deliver training themselves, as well as a leadership program. So the leadership program was to help those who were already in a position of leadership, to implement policies and programs as it relates to opioid use in the workplace, because that pilot program that we ran in the summer of 2019 was focused mainly on rank and file workers, those that may not have been really much in a position to do such actions, and it was geared more on awareness level.

So I continued working with them, now funding my dissertation and now I could have lunch once every while and pay the bills and such. And I continue doing work with them, I evaluated their training program, and still doing it to now, up to this day, looking at the follow up and seeing what actions folks took from the training, as well as how it's been working. And lo and behold, this thing happened, it's called COVID-19, I don't know if you've heard about it.

Jill:

Yes, right.

Eric:

It has happened in the middle of us getting ready to launch the instructor and the leadership course.

Jill:

I was just going to say, did you get a chance? Okay, so yes, please continue.

Eric:

Yes. And we had meant to do it in person, right. We had meant to do these trainings and evaluations in person. And like much of the world, we had to shift rapidly to an online format, wearing shorts and a nice shirt on your zoom calls.

Jill:

Mm-hmm (affirmative).

Eric:

And we continue to deliver the training online. Of course, we've met a lot of challenges, a lot of folks were not Zoom competent yet.

Jill:

Sure.

Eric:

I don't even know if I'm really still Zoom competent.

Jill:

I know. I mean, I think it's just because we switch between so many platforms every day is a new, oh, which one am I on? Yes, and I mean, it sounds like this training that you were doing, I mean, it deals with some pretty intimate topics, right. And so how you get that intimacy over Zoom when you haven't met people before, it sounds like a challenge.

Eric:

Yes, in the beginning, that was a real troubling concern, how are we going to have such an intimate discussions, about such personal topics, in an environment where you could zone out, right? You could click off your little screen, you can have your TV in the background or something.

Jill:

Right.

Eric:

But what we found was, when we created this environment to have such discussion that many folks, if not all folks, were in some way, shape, or form, being touched by addiction. And it may not have been just them, it could have been their son, their daughter, their wife, their friend, their co-worker, someone in their community, and we were trying to change a lot of hearts there, and I think we've really succeeded in getting to that, especially Jonathan as the instructor. And we brought in folks who had that lived experience, who could talk about it, who could talk from that place that they were in and may still be in, and that allowed us to have those conversations.

And when we had an environment that was allowing us to talk in such a way, even though it was via Zoom, even though at the time there was such a lack of social connectedness and a need to adapt our methods under social distancing, we were able to relate, we were able to have these difficult discussions, and I think we went a long way. Now they don't know the results of the six month follow up because I just finished it. But-

Jill:

Okay, is this breaking news?

Eric:

Yes, this is breaking news via podcast. And clearly, the pandemic had a lot to do with hurting folks' his ability to go out and take some actions, because there was a lack of resources and such a focus on that.

Jill:

Yes.

Eric:

But many folks were able to go back and do training. Many people were able to take some organizational level actions, those in leadership positions. So we found some success that the training program has helped contribute to programs around the country as well as increasing policies and programs related to opioid use and injury prevention.

Jill:

Well done. Wow.

Eric:

Yes.

Jill:

So, Eric, COVID upended things, did you have to stop? I mean, obviously you continued what you were doing, you were just explaining that, but at what point did you have to shift gears and then focus on COVID? I mean, what if you kept going with what you were doing with opioid work with Jonathan?

Eric:

Yes, so we're continuing to this day, still doing [crosstalk 00:31:50] the opioid program. We never let off and during the time when everything first happened back in March 2020, I was pretty much voluntold by NIH and Chip to evaluate their COVID program, the initial results, those early program results, the training that I know that you and Vivid HSI run.

Jill:

Yes.

Eric:

And I looked at the two main questions that were asked, those evaluation questions as it relates to the confidence in the program and increasing knowledge, and it was some early results, and I think it had me involved in the COVID discussion, involved in addressing COVID from a training point level and getting that support to developing, and implementing, and disseminating these Occupational Safety and Health and Infection control worker training programs.

Jill:

Yes.

Eric:

But it was on a voluntold basis.

Jill:

Mm-hmm (affirmative).

Eric:

It was Chip and NIH knowing that they needed to put together an assembly of an army of public health and occupational health science folks to address these issues at a time they're trying to conduct training under a time of crisis, right.

Jill:

Right. I mean, which is what they specialize in but not in the way that it's ever been done before because you couldn't deploy the trainers.

Eric:

Yes. And I've heard them regale stories of how they've addressed these issues in the past, 911 jumping on the pile, hurricane Katrina going down there and the recovery efforts. So, in the past, it's been so much more hands on, and now being deployed, it was in a different format, it's on your phone and on the computer, and finding ways to address these issues when you're not in physical touch.

Jill:

Do you think that made your evaluation easier or harder?

Eric:

I think it's difficult to compare because it's never happened, right. It's never been in that situation and that's also the thing with evaluating under these disastrous circumstances, is that there is no playbook.

Jill:

Yes.

Eric:

There is no, you know what, I'm just going to take this and shave off the title and put a new title, and that's it. No, it's an emerging, rapidly evolving situation that changes day to day, and it needed that flexibility not just from the response, but the responders, on how we evaluate and put together training.

Jill:

Mm-hmm (affirmative). Yes, go ahead.

Eric:

No, continue.

Jill:

I was just thinking that even your evaluation of the opioid training that you did, I mean, you started in person and your continuing in a virtual space.

Eric:

Mm-hmm (affirmative).

Jill:

So that's must have impacted the way that you evaluate too, like the before and during, and just the delivery, right?

Eric:

Yes, it was really important that we also look at the delivery of these trainings, right. So from the opioid perspective, part of the evaluation is looking at how that training was delivered, and making sure that the process of which we delivered a training is effective. And generally, we found that it was. The questions that we asked to probe those kind of inquiries, found that it was effective, with the limitation that Zoom was not people's favorite option.

Jill:

Yes Mm-hmm (affirmative).

Eric:

And now that I am working with the NIH as their program evaluator for COVID-19, we are continuing in that same vein. We're using online methods to look at these program directors, as well as institutional and cohort, excuse me, I'll repeat that, consortium leaders on how they've addressed COVID-19 and how they've put together training programs, and how they've looked at addressing not just their own organization, but as well as the community.

Jill:

Mm-hmm (affirmative).

Eric:

And as evaluation, I hope can help us understand what lessons we can learn and how we can improve going forward. The COVID-19 training program was based heavily on the Ebola training program.

Jill:

Mm-hmm (affirmative).

Eric:

And having that infectious disease response training situation and program as well as infrastructure, gave the worker training program, I think, the capacity to rapidly respond to COVID-19. Now from what I'm hoping is that we use these lessons that we're learning now, we use these lessons that we are faced right now and the mistakes that people have made throughout this response, so that the next time something happens, the next time, because there will be a next time, right, there will always be some issue, not just a pandemic, but there's always a disaster, there's always some crisis, and knowing that we have the ability to produce training under those situations of crisis, can help us fight that good fight.

Jill:

Yes. Yes. I mean it really was amazing to be just a part of it as I was in the last year to see how people pull together and how all these experts pull together as everything is changing in real time and everything has to be adjusted message wise on a week to week, month to month basis. Eric, what do you think is next in terms of training with COVID-19, or do you have a sense of that? I mean, we're not done with this pandemic yet, and we keep learning new things every day, what do you feel is the next iteration of training that we're going to see.

Eric:

So I have, in my opinion, two major focuses I believe that will come from COVID-19 ongoing. First off, after response is the recovery, right. And when you look at the connection between substance misuse as well as COVID-19, you can see that there are a lot of people right now who are still suffering from substance use, we're still seeing these upticks in overdose deaths. I don't remember the exact numbers, but I believe back in 2017 it was nearly 130 people a day were dying from these opioid related overdoses. And that number may have only been going up and up, right, only been up ticking because of the stress and the pain that our folks are enduring right now.

Jill:

Right.

Eric:

And I believe we need to focus on people's mental health, and the way that stress and our resiliency to coping with stress is paramount, not just now, but going on. People are going to need to recover, people have gone through a difficult time, and it's our responsibility to be there for them, to understand that this is important to everybody, that there should be no stigma in addressing people's mental health.

Jill:

Mm-hmm (affirmative) So true. As we're looking at what we hope is the nearing of the finish line of the pandemic, we hope, I have talked to so many people just in my personal life in the last couple of weeks, who are having anxiety about what's next. Anxiety in the sense of returning to whatever is our new normal, and walking back into pieces and parts of life that was. And just the anxiety of that, which I don't think we maybe could have anticipated, because it would just be like, oh, goody, everything is back. But I'm hearing from people who have great interpretation about it.

Eric:

Yes, there's going to be a lasting impact on so many people's mental health and the way they just look at the world, right. The way you look at the world has changed, the way we look at a workplace has changed, right. So look at how many people will no longer see their offices, and is that a good thing? Is that really a good thing? I don't know. Sometimes I wonder, you get to stay home, but being home, is that really the right thing for you? Maybe in some situations I understand that it could be very helpful, but for a lot of people, work is part of a big part of your life and your community.

Jill:

Yes.

Eric:

Work is where you see people most of the time during the day, where you talk to people most of the time during the day, where you learn from other people, where you get a perspective on so much more. And to see more and more people are going to continue to be based from home, I'm not sure if that's the right thing. And then we look at so many people who weren't home, who were essential, and not them being essential, but their work was essential. And because they did a central work, their work was taken as the predominantly important thing rather than the health of the worker themselves. It almost seemed like we sacrificed worker health for the broader public health.

Jill:

Yes, for the output. Mm-hmm (affirmative).

Eric:

Mm-hmm (affirmative). For the meat packer wasn't the main issue, it was the meat. The grocery store worker wasn't the main issue, it was the groceries on the shelf.

Jill:

That's right. Yes.

Eric:

How do we go back or really, well, we can't really go back, but how do we go forward remembering that these are people?

Jill:

That's right.

Eric:

How do we go forward not labeling work as just the output and not the person? I don't know.

Jill:

I really hope there's been some kind of an awareness to the contribution of human work, and what that means. I hope that people are thinking about that in a way that maybe they didn't, because they couldn't or didn't have access to it or it just never crossed their mind. You brought up meatpacking and it's an industry that I've worked in, and it's an industry that, when I was with OSHA, I investigated many, many times, and just having been in those facilities, I've never picked up a package of any kind of protein and not thought about the number of hands that had to touch it to get into my hands.

Eric:

Mm-hmm (affirmative).

Jill:

I mean, the luxury of picking up skinless, boneless chicken breast is really a luxury when you ... because I can see in my head the number of people, and the hands, and the machinery that made that possible and how many people had to touch that and do that work, to be able to be privileged enough to pick that up and take it home.

Eric:

I agree.

Jill:

And they've been doing this work the whole time.

Eric:

Yes. And what this situation has really brought forward is that these issues existed before, right. They didn't just pop up. Oh, shocks, Eric, I didn't realize this happened. No, we've known many times that we are not prepared for an infectious disease event. We've known that we are not handling substance use the right way. We've known that there are racial inequalities, there are food insecurities, there are housing disparities throughout this country, that isn't a new figure or fact, it's just now that you can't hide from it, it's in your face. Once it was not in your face and you could avoid it, but the awareness level is on a level that if you don't know by now, you're never going to know.

Jill:

That's right. I mean, because you're literally stepping over it, you can't really close your eyes to this, it's everywhere. Yes. Yes. Wow. So you see the future of focus and more training on recovery, like you said, with mental health and resiliency, do you see other things coming up, I mean, in your opinion? Let's respond to COVID-19.

Eric:

Recently myself and a fellow worker that I work with ... Actually, I'll repeat that. Myself and Dr. Amber Mitchell, we were concerned about needlestick injuries, and someone very dear to me had told me, and she's a nurse, had told me that once she had a needlestick injury, this was some time ago, and she [inaudible 00:46:46] all the pain, all the uncertainty, and the fear that she endured when that happened to her, right.

Jill:

Yes.

Eric:

What to do, the risk to her health, and that pain, I could hear it. And when I hear and know that we are about to launch, and we are in the midst of, excuse me, launching such mass vaccinations, and we're continuingly steadying up our vaccination efforts throughout the country, and expanding away from these traditional hospital settings into non-hospital settings, churches and community centers, are the people who are going to give you these injections and these vaccinations, how well are they trained? How safe are they to go about doing this?

Jill:

Yes.

Eric:

And we need to not just train the people who are going through this, but give them the safe working conditions to do it, right. It isn't just for just one moment, one time, we should address their safety, we need to address it all the time. We need underlying health and safety actions like safe staffing, right.

Jill:

[crosstalk 00:48:17] Yes, right, and we don't ignore the safety piece because we're in an emergency and we need to get as many shots in arms as possible, because the casualties will be these people who are doing the vaccinations.

Eric:

Mm-hmm (affirmative).

Jill:

And to your point, we are doing emergency training to train people to be these emergency vaccinators. I've been lucky enough to have one vaccine so far a few weeks ago, and it was at a pharmacy, and the person who gave me my shot, I said, "So are you here as a contractor working with the pharmacy or is this your regular job?" And she said, "This is where I've always worked. I've worked at this pharmacy for seven years." She said, "But I'm a pharmacy tech. And I've I've never given a shot before until I agreed to have this training to do it." And I said, "Well, how many do you think you've given?" And she said, "I think I've probably done 500 so far." And then I said, "Tell me about your training," because this is my job, right, Eric, so I'm asking questions.

And so she tells me about the training she has and then I don't tell her what my background is at all, and she goes, and I ha- ... because I'm like, first of all, you don't do that when you're in the safety field when somebody is about to stick a needle in you [inaudible 00:49:42] nervous, right.

Eric:

Yes.

Jill:

And she said, "And I have blood borne pathogen training." I'm like, okay. Okay, well that's a data point of good news. And then yesterday, in my life, I volunteered at a massive vaccination site for my county, and I wasn't doing anything medical related, I was helping shuffle people through the system. And they're doing in Carside. And I was just watching all those vaccinators, in all of that unpredictable environment, right. Cars of every shape and size, with numbers of different kinds of people coming through, where the vaccinators are putting their bodies in different positions to be able to reach people. I saw so many people bringing their dogs with them, the dog is in the back of the car, and all I'm thinking is, gosh, this is an unpredictable hazard where a dog might decide to jump and you've got a needle in your hand.

And I absolutely see, just from the sheer volume, that this is a risk, but then this unpredictable environment that makes it even a greater risk. And I'm wondering, what are all these organizations doing to protect people from needle sticks? And do they even have exposure control programs in place, post exposure control programs in place, when somebody does get a stick?

Eric:

Yes. And I think regardless of how robust a workplace health and safety program may be, workers will still get injured if the policies lead to those hazardous conditions, right. And if we want to, I think, achieve safer conditions, one thing we can use, and one thing we do in our paper that we address our call to action, is to emphasize the hierarchy of controls.

Jill:

Mm-hmm (affirmative).

Eric:

And as you know, the hierarchy of control start off with, this sounds like a test right now I'm saying it out loud, but eliminating and substituting the injury, I mean, excuse me, the hazard to begin with. And for COVID-19, we can't exactly substitute COVID-19 out, right, it's there, it's part of the situation in the site, other than eliminating it through vaccines itself. But to protect a worker, we want these engineered controls, we want these administrative controls, more focused than relying on PPE, personal protective equipment. There's been such an emphasis on, I want the right mask, rather than, I shouldn't be in the situation where the mask is my last line of defense.

Jill:

That's right.

Eric:

Excuse me, I'll repeat this. And what we've done is to emphasize something we call institutional controls. And institutional controls, we believe, sit on top of the hierarchy in controls, and it is a way of having full faculty engagement. Getting that leadership and management together, as well as the staff workers or even the union representation, and having everyone share responsibility rather than focus on placing accountability.

Jill:

Mm-hmm (affirmative).

Eric:

And I believe a full fledge effort of everyone working together can allow those in positions that can make the working conditions safe, aware of unsafe conditions.

Jill:

Mm-hmm (affirmative).

Eric:

Of course, not every employer listens, and not every employer agrees. I remember, a couple of days ago, I was getting my hair cut, and the barber was telling me about, "Yes, I've opened up a pharmacy with my wife." And I was like, "Oh, that's great."

Jill:

What!

Eric:

And I was like, "That's wonderful." And he was like, "Yes, but we're giving these vaccinations and the government just wants to take advantage. I don't even think this stuff is real."

Jill:

The virus?

Eric:

Yes, the virus. The pharmacy owners were telling me that they don't even think it's real. Excuse me, I'll repeat that. If they're not aware of the issue, or they lacking the empathy to protect the workers and employees, how can we know that those employees and those workers are going to be safe?

Jill:

Yes.

Eric:

And at a time right now where our country was seeing such a decline in unionization, one lasting mechanism that I know can really work is getting unions back, getting workers organized, collectively bargaining so that we aren't hit with another disaster and we're wondering, will people do the right thing? We know that the right thing will be done because workers have organized together for the safety and the standards that they deserve.

Jill:

Mm-hmm (affirmative). We can hope for more of those days.

Eric:

Or we can to hope for that emergency standard from OSHA, fingers crossed.

Jill:

Oh my gosh, right. I don't think my eyes have ever been glued to a website as hard as they have been since March waiting for that emergency temporary standard to come out, and I hope we're not waiting too much longer because we need it. We need it. I've talked to health and safety professionals from around the country who, as mask mandates are being lifted by governors, it was as their profession, the only hope that they had to leverage for safety and health in some work settings.

I mean, many, many employers are doing their best, they're trying their hardest with the information that they have, and they have their people in mind and they come from a place of caring, and then there are some that don't.

Eric:

Mm-hmm (affirmative).

Jill:

And the ones that don't, those health and safety professionals really need that law. And all of us, frankly, could use a roadmap, right. And I hope that emergency temporary standard provides that, we get it soon.

Eric:

Yes, I think it's important to have leadership.

Jill:

That's right.

Eric:

We've had a couple of years where scientific and worker health leadership was either non existent in some vacuums, or so beaten down and attacked that gave us a watered down version of what it truly should be. And I hope going forward, that all the situations that we described in this hour or so, highlight to people just how important it is that we move forward in a safer way, because it's not just for the polar bear in Alaska or wherever polar bears are, I don't know, Coca Cola bottles, but for-

Jill:

That's not your study.

Eric:

But for the future of the way we live and work, it's important. It's important that public health not get attacked, but supported.

Jill:

That's right. That's right. That's right. So the paper or the article rather that you authored for this journal is titled, Needlestick Injuries among Healthcare Workers Administering COVID-19 Vaccinations in the United States. And Eric, if you'd like we can include it in the show notes.

Eric:

Yes, that'd be great.

Jill:

So people can access it. Yes, okay. We'll do that. We'll make sure that it's included in the show notes for people who are listening today if they want to read about that as well.

Eric:

Mm-hmm (affirmative).

Jill:

Yes. Well, I have really enjoyed talking with you this past hour. Are there other things that you'd like to leave our audience with, other thoughts, before we close on our time?

Eric:

I would just want to say that, you're going to hear and you've been hearing so many statistics, so many numbers on paper, every day on your TV screen you see, whatever it may be, how many people got vaccinated today, how many people have unfortunately passed away or tested positive. You may hear about, so and so many people have, unfortunately, succumb to an overdose. You may hear, as we go forward, different kinds of issues arise, needlesticks, etc. And I hope that less and less people view those as numbers, as statistics, and remember that those are people.

Jill:

Mm-hmm (affirmative).

Eric:

That those are people who, for every single one of them is a story, for every single one of them it's their lives and it's not just a number, it's a person, and I hope we can continue to think about the way we look at public health in that vein.

Jill:

Mm-hmm (affirmative) Beautifully said Eric. Beautifully said. Thank you.

Eric:

Thank you Jill.

Jill:

Thank you so much. Mm-hmm (affirmative). Soon to be Dr. Eric Persaud, good luck with your dissertation.

Eric:

Thank you. Thank you. Fingers crossed. Fingers crossed.

Jill:

Mm-hmm (affirmative). And thank you all for spending your time listening today. And more importantly, thank you for your contribution toward the common good. Making sure your workers, including your temporary workers, make it home safe every day. If you'd like to join the conversation about this episode or any of our previous episodes, you can follow our page and join the Accidental Safety Pro community group on Facebook.

If you aren't subscribed yet and want to hear past and future episodes, you can subscribe in iTunes, the Apple podcast app, or any other podcast player you'd like. We'd love it if you could leave a rating and review us on iTunes, it really helps us connect the show with more and more professionals like Eric and I. Special thanks to will Moss, our podcast producer. And until next time, thanks for listening.