Over-the-counter hearing aids; taking up running; lessons from the pandemic: Upstate Medical University's HealthLink on Air for Sunday, Oct. 9, 2022

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air":

An audiologist gives advice about over-the-counter hearing aids.

Erin Bagley: ... I always tell patients, treat your devices just like you would your cellphone So, you wouldn't take your cellphone in the pool or the shower. You don't want to do that with your hearing aids, either. ...

Host Amber Smith: A doctor who enjoys running offers advice for people who want to follow in her footsteps.

Emily Albert, MD: ... The biggest thing is just squeezing it in when you can and being flexible, especially people who have jobs and have kids. ...

Host Amber Smith: And a public health professor shares lessons learned from the pandemic.

Chris Morley, PhD: ... We actually have learned a great deal more about how messaging rolls out and how not to roll it out, frankly, how contentious things can be. ...

Host Amber Smith: All that, and a visit from The Healing Muse, right after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, running advice from a doctor who's a devoted runner. Then, what did COVID teach us about public health? But first, what you need to know about over-the-counter hearing aids

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." The Food and Drug Administration has made hearing aids available without a prescription or medical exam. So soon, people with hearing loss will be seeing hearing aids in stores. Before making a purchase, there are some important things to consider, and I'm going over them with audiologist Dr. Erin Bagley from Upstate Medical University. Thank you for being here, Dr. Bagley.

Erin Bagley: Thank you for having me.

Host Amber Smith: First of all, let's talk about the scope of the issue of hearing loss. How many Americans are having trouble hearing?

About one in eight Americans, age 12 and up. So it's about 30 million people have some degree of hearing loss. As we age, can we expect that our hearing is not going to be as sharp as it was?

Erin Bagley: Yes. As we age, I think statistics are just about one in three people between the ages of 65 to 74 have some degree of hearing loss. And that number goes up after 75 to about half of Americans have some degree of hearing loss. So it is more common as we age.

Host Amber Smith: Does it always affect both ears equally? Or might people lose hearing in only one ear?

Erin Bagley: So typically, if we're talking about age-related hearing loss, we expect that that's going to be affecting both ears pretty equally. Anytime a person has hearing loss in just one ear, that does raise some red flags for us. And we actually do want to do a workup with that patient and find out what the underlying cause might be and what might be causing that hearing loss to affect one ear and not the other.

Host Amber Smith: Well, what would typically happen at a visit with an audiologist?

Erin Bagley: The first thing we always do is we take a thorough history to find out whether the person has any pain in their ears, whether they have ringing or tinnitus in their ears, if they have any balance concerns because hearing and balance are related in many cases. We also want to know have they worked around loud noises and things like that that might have had an impact on their hearing. Then, we of course look in their ears to make sure there's no wax or debris in their ear canals. We check their eardrums to see how their eardrums are moving and make sure that there's not fluid or some sort of stiffness of their eardrums that could be impacting their hearing. And then we do a hearing test, kind of like what you think about back when you were in elementary school, where you put on headphones, and let the audiologist know when you hear the beeps. We also measure word understanding as well, so some recordings of speech and have the patient repeat the words to see how clear speech is for them too.

Host Amber Smith: So, are you able, at the end of the exam to quantify how much hearing loss there is?

Erin Bagley: Yes. And also what type of hearing loss it is. Because there are different causes of hearing loss. So we just want to make sure that we know where it's coming from as well.

Host Amber Smith: We're going to be talking a lot about hearing aids, but are there other things that people may be recommended to try?

Erin Bagley: That would really be dependent upon what the audiologist finds. There are definitely some medical conditions that could be treated in other ways, either through surgery, perhaps the person needs some sort of medical intervention. And an audiologist is a great first person to look at that and decide if they, perhaps, need to follow up with a specialist, an ear, nose and throat specialist, to have that medical concern addressed, or if it's a matter of more of an age-related type of hearing loss that would be best suited by getting hearing aids.

Host Amber Smith: Is there a hearing aid out there for everyone, or are there some types of hearing loss that won't be helped by a hearing aid?

Erin Bagley: So in my practice, I see quite a range. There are patients for whom their hearing loss is so significant that hearing aids are no longer the best course of action for them. And the good news is, there is a continuum of care. We have cochlear implants for patients whose hearing loss is beyond what a hearing aid can provide for them. And I work with those patients as well, to help them on that journey and be able to hear better that way.

Host Amber Smith: So that's good to know. This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with audiologist Dr. Erin Bagley from Upstate Medical University about what's important to know about hearing aids, now that they'll be available over the counter without a prescription.

So, how long have hearing aids been on the market available with a prescription?

Erin Bagley: The very first hearing aids with the invention of the vacuum tube, go way back to the early 1900s, like around the 1930s. And those weren't necessarily worn on the ear. They were something that was like a box that someone would put in their pocket that had wires to run up to their ear. After World War II, a lot of veterans came home with hearing loss, and that's when the field of audiology really came into its own, to help all those veterans returning. And also the technology used in World War II helped lead to smaller and smaller electronic devices, which help lead us to where we are now, where hearing aids can be very small, and some aren't even very noticeable anymore.

Host Amber Smith: So how does a hearing aid work?

Erin Bagley: There are microphones on the outside of the device that pick up sounds in the person's environment. Then there's a little tiny computer chip inside, a microchip, that processes those sounds. It might give more emphasis to certain sounds at certain pitches where that individual needs more help. It may help filter out sudden loud sounds or other types of noises, like fan noises or wind noise. And then there's a speaker, and that filtered sound gets played through the speaker, into the person's ear.

Host Amber Smith: What is the price range for hearing aids?

Erin Bagley: Hearing aids, I want to separate a little bit prescription hearing aids versus over the counter hearing aids that will be coming out soon. So for prescription hearing aids, like you would get from an audiologist typically, they typically start around $1,000 apiece and up from there, depending on the technology involved.

Host Amber Smith: And when you say $1,000 apiece, do you need two of them, one for each ear? Or do they come in a set?

Erin Bagley: It depends on the person's needs and their hearing loss. So typically most people, again, we typically expect hearing loss to affect both ears pretty equally. So the majority of people do benefit the most from two hearing aids, but there are cases where that may not be the most appropriate treatment.

Host Amber Smith: In your experience, have you seen health insurance plans that cover the cost of hearing aids?

Erin Bagley: There are some health insurances that do cover the cost of hearing aids, or at least pay a portion of the cost. Unfortunately, a lot of them don't, unfortunately, including Medicare, which is obviously a big insurance carrier for a large majority of the population we're talking about, 65 and older. So, unfortunately, they don't, but there may be supplemental plans or secondary insurances that may offer some assistance.

Host Amber Smith: Do they generally pay for a hearing exam with an audiologist? Is that usually covered?

Erin Bagley: Yes. Usually the exam is covered.

Host Amber Smith: Now, I've heard that it's sometimes tricky to find a hearing aid that works, that's comfortable, because everyone's ears and their hearing abilities are all different. So how would you guide people who might be purchasing from store shelves or online? How can they pick something that's going to work?

Erin Bagley: Currently, we don't know exactly how the labeling is going to work on over-the-counter hearing aids. Our professional organizations, the American Speech Hearing Association and the American Academy of Audiology, have been working with the FDA, to give suggestions on labeling. Hearing aids purchased through an audiologist in New York state have a 45-day trial period. So the patient can return the hearing aids within 45 days to get a refund. We don't know yet exactly how return policies will work with over-the-counter hearing aids, so one thing I would caution people about is to make sure anything you do buy over the counter does have some sort of clearly stated return policy in case it doesn't work out for you.

Also, I'm a big believer in things like online reviews. Get as much information as you can about the product you're buying because we don't know yet which manufacturers or which companies may be starting to produce their own devices and enter the market. So, even audiologists, we're not sure yet what kind of devices we might be seeing in the stores.

Ears come in all different shapes and sizes. And that's where, as a professional, it's important to make sure that our patients' hearing aids fit well. So So that is a concern that we have with over-the-counter hearing aids, is just making sure people are able to get something that fits well for them. You know, I'm anticipating they're going to come with some different size tips that go on the part that goes into the ear, and finding a size that is a good fit for the ear so that it stays in place well is going to be important.

Host Amber Smith: Are there standardized sizes among all of the different hearing aid styles?

Erin Bagley: There are not, so there can be quite a wide range. Even among the prescription hearing aids that are on the market currently, through audiologists, there is quite a wide range. It kind of depends: What types of features are in the hearing aids? What size battery? If they're rechargeable? Things like that can all impact the size and shapes of devices. And some devices are custom made, so they'll fit the person's ear. And I'm anticipating that over-the-counter hearing aids will be the same. You know, I'm anticipating some will look kind of more like a Bluetooth headset kind of device, and some are going to look more like a traditional hearing aid, so I think we're going to see a range of sizes and styles.

Host Amber Smith: So they're all powered by some type of battery, is that right?

Erin Bagley: Yes. Some are rechargeable, and I'm anticipating over the counter will be the same, that some will be rechargeable and some will take small disposable batteries.

Host Amber Smith: And are all of the hearing aids adjustable? If you get them, do you have to do some adjusting to get the volume comfortable?

Erin Bagley: Prescription hearing aids through an audiologist are fit, like a prescription. So they are fit to the person's hearing loss. There's measurements that can be taken with a small microphone in the ear while the patient's wearing the hearing aid to make sure that the output of the hearing aid is doing what we think it's doing and meeting their needs.

With over-the-counter hearing aids, I think there's going to be a range of the recommendations from our professional organizations. Of course, we want there to be a volume control so that the person can adjust the hearing aids and have some control. Some of them, I think, are, it sounds like, are going to have some adjustments you can make perhaps through an app on your phone. So for the over-the-counter hearing aids, I do think that the adjustments will be more limited. But I think that there will be some degree of adaptability.

Host Amber Smith: Can people swim or shower with their hearing aids in?

Erin Bagley: I always tell patients, treat your devices just like you would your cellphone so you wouldn't take your cellphone in the pool or the shower. You don't want to do that with your hearing aids, either. They are electronic devices, so they are susceptible to damage from water.

Host Amber Smith: Are they generally Bluetooth compatible so that someone can answer their phone with the hearing aid in place?

Erin Bagley: The large majority of the prescription hearing aids on the market are. I don't know yet about over the counter. I'm anticipating that some of them will have that function as well. But a lot of prescription hearing aids have the ability to answer the phone, to stream music. Most of them have an app where you can make some adjustments to settings or volume.

Host Amber Smith: About how long should hearing aids last?

Erin Bagley: Hearing aids on average last about six years. Because they're little electronic devices, they do wear out. And they are exposed to sweat and ear wax and things like that. So they do wear out over time.

Host Amber Smith: In your experience with patients, how long does it take someone to get used to using hearing aids? Once they find something that works, does it take time to get used to it?

Erin Bagley: It can. I think in my experience, the longer someone has been struggling with their hearing, sometimes the longer it takes for them to get used to hearing differently through the hearing aids and hearing sounds around them again, and kind of relearn what all those different little noises in their home environment are. But every person is different and has a different experience. I find people that are really motivated and wear their hearing aids consistently do adapt more quickly than people who are not quite ready to wear them all the time.

Host Amber Smith: Well, as an audiologist who, your career has been spent with prescription hearing aids, do you have any concerns about them becoming available over the counter?

Erin Bagley: My biggest concerns are some of the marketing has been, "now available without needing a hearing test." I do think it's still really important if you have concerns about your hearing to get a hearing test. Hearing loss is one of those things that can come on very gradually over time. So, it's not always clear what degree of hearing loss you may have. Over-the-counter hearing aids are really intended for people with a mild to moderate hearing loss. But if you haven't had a hearing test, you may not know if you fall in that category. Also, I think it's very important to make sure that we're ruling out other causes of hearing loss that might be treatable in another way. So, Istill think it's really important to at least get a baseline hearing test so that we can make sure that we're seeing the big picture and treating a medical issue before it becomes more problematic.

Host Amber Smith: So if someone gets a hearing aid over the counter, what are some things they need to be aware of? Are there any warning signs that they need to have checked out?

Erin Bagley: If a person has any drainage coming from their ears, that's definitely something you want to go see a physician about. Or if a person has a sudden drop in hearing or a sudden change in hearing, especially if it's only in one ear, it's very important to get that checked out and make sure that there's not another underlying medical condition. Also, if a person has dizziness or if they have any pain in their ears, it's really important to see a physician about that, just to check on the health of your ears.

Host Amber Smith: Well, I appreciate you making time for this interview, Dr. Bagley.

Erin Bagley: Thank you.

Host Amber Smith: My guest has been Dr. Erin Bagley. She's an audiologist at Upstate Medical University. I'm Amber Smith for Upstate's "HealthLink on Air".

A doctor who runs tell us why she loves the sport -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Dr. Emily Albert was one of almost 2,000 runners who competed in the Syracuse Workforce Run this year, and she placed third in the women's race. Dr. Albert is an assistant professor of medicine at Upstate, and she agreed to talk with me about running.

Welcome to "HealthLink on Air," Dr. Albert.

Emily Albert, MD: Thank you very much for inviting me.

Host Amber Smith: The Workforce Run is a 5K, which is 3.1 miles. And you finished in 21 minutes, 25 seconds, which means your pace was just under a seven-minute mile. How did you do it?

Emily Albert, MD: So, I didn't really train specifically for that particular 5K. I have been a runner for most of my life, probably since I was like 12 or 13. More recently, I've actually done more cross training in the past few years than I probably ever have since we got a Peloton (exercise bicycle). We actually got ours pre-COVID but definitely used it a lot more during COVID with all the kids home and that type of thing. So for the Workforce Run, I knew about this run, and a 5K is a pretty manageable distance. I tend to run about five miles, probably, when I run. So it was a distance I probably was already training for and didn't do anything really particular for it. But I think the atmosphere of the Workforce Run and being with other runners, running in a group, there's a lot of camaradarie but also a competitive spirit, so I think that pushes you to do a little better than you certainly do running the residential streets in your neighborhood.

Host Amber Smith: So your training leading up to this was the Peloton bike, the bicycle workouts, and weightlifting and running as well?

Emily Albert, MD: Yeah, I would say now I probably run like, like, three times a week and then do the Peloton twice a week on average, which is the bike. There is a treadmill as well, which we don't have, but I think that cross training actually helps with a shorter race like a 5K. I think that cross training probably gives you a little more speed, when you don't need as much endurance for, like, a 15K or a half marathon or a little longer distance race. So I think that combination is probably really good for 5K, even though I wasn't specifically ... I think I signed up pretty late, actually, for the Workforce Run, so I wasn't specifically thinking of that, but that was just kind of my normal routine, which I think happens to be good, if you're looking at a race that distance.

Host Amber Smith: So do you have a race-day routine, or how do you prepare for a race? Once you know that you're going to be doing it, do you have any good-luck charms, or do you have any routine that you do every time?

Emily Albert, MD: You know, I really do not. I think when I was, like, younger and really competing in races, we did have some rituals, or when I was on teams, there were certain like handshakes that we would do before race. But I think since I've gotten older, and I have kids, I'm usually, like, last minute getting things ready for them as I'm running out the door to even get to the race. Like, this race, we had to catch a shuttle to get there, so I wasn't even like thinking about pre-race rituals or anything like that. One thing I do try to do and think about during the day, in general, is staying hydrated, for sure. I think the older I get, the more painful it is to get dehydrated. So, I'm a little more cognizant of that with races. But I don't have anything particular I eat. I've done the Mountain Goat (10-mile run) here and have done a marathon and some halves. And there's this whole philosophy of, like, carb loading two nights before. So I'll sometimes do that if I'm doing a longer race, but for the 5K I don't have any good, exciting pre-race rituals. Just get there on time -- which I did.

Host Amber Smith: Now you mentioned that you've been running since you were, like, 12 or 13. So were you an athlete in high school or college? Did you run track?

Emily Albert, MD: I did. I think I ran track when I was probably in, like, eighth grade, I started that spring and kind of did it throughout. I played other sports as well, which I think was maybe good. I know especially around here, there's pretty strong cross-country teams and people who are hard-core runners year round, but I think it helped me actually keep my enjoyment for running to do other things in other seasons. And I think that's true, even now, of cross training. And, I discovered doing triathlons since I've been older. And I actually think that also probably helps prevent injury that a lot of strictly runners do get as well. I think there's some evidence for that, too. So yeah, I think playing other sports potentially made me a better runner and vice versa. Staying in shape year round hopefully helped for those other sports as well. But definitely running was, I discovered it early and have run for many different reasons throughout my life. But I think at that time being an athlete was a big part of what motivated me to stick with it and work hard at it, I guess.

Host Amber Smith: During medical school at Upstate, and also while you were working on your master's of public health, did you find time for running or other types of exercise?

Emily Albert, MD: I did. I think until we got the Peloton a few years ago, I actually ran... I think I've become a weaker runner, like as far as my resilience to weather and that type of thing, because of the Peloton, but I used to run outside, you know, in Syracuse winters and pretty much anything. I had those, what do they call them? Like crampons, or the traction cleats, I think they call them, to get outside and run in the winter. So, I think as I got older and in medical school and when I was getting my MPH, I think it was a stress relief as well. So I kind of found time to squeeze it in. Probably the hardest time, even more so than medical school or residency, was when I started my first job. I was getting my master's. I had my first daughter. Somehow I would find ways to just squeeze it in, the morning, the end of the day, sometimes the middle of the day, if that's what worked out. But I think because of I know those endogenous endorphins or the endocannabinoids, whatever it is that you release, I think that helps keep me going through those times. And also having a husband who appreciates exercise and running as well. So he would come home and hold a baby, so I could get out there even if it was 30 minutes, or I've run with a lot of strollers throughout my life. I've had a single, and a double, and a dog strapped to my waist. So any way to get out there and get it in, I think there's no simple schedule. I think for most people, life is pretty complicated these days.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Upstate internist Dr. Emily Albert about running for fitness.

So why running? What do you like so much about running?

Emily Albert, MD: I think what got me initially and probably what's kept me with it is it's so versatile. I mean, I can remember running in so many cities and states and on vacations. All you really need is a decent pair of sneakers. They really don't have to be fancy, in my opinion. And you know, you can kind of do it anywhere. It's something you can do with other people. You can do it for a cause. You can train for a goal or just do it just to stay fit, or release stress or whatever kind of drives you to do it. But I think probably the versatility of it, the minimal equipment.

I mean, I think of getting all of our family skiing in these past few winters and the amount of effort and equipment and money. I mean, we love it, but the amount of work that goes into a ski season, compared to be able to go out for a run, it's really a fraction of that. So I think that's one of the things that has made it very doable over, across many different transition periods in life and locations. It's worked out.

Host Amber Smith: I was going to ask for advice that you would have for someone who wants to start running. Now, you mentioned shoes, or the sneakers. How do you go about choosing the right sneaker?

Emily Albert, MD: I think there is a lot of research and probably money put in from different companies to try to get, convince people of certain aspects of a good running shoe. I actually think Fleet Feet (shoe store) here in Syracuse -- I don't know if I can give a shout out to them -- but I think they do a pretty good job of kind of assessing people without going too overboard in technicalities. Honestly, I've run in so many different brands of shoes. I've really never had any serious injuries in all these years of running, no matter which shoes I've worn. So I think, you know, finding something that's comfortable, unless you have a specific overuse injury or some indication to look for something specific, I actually think there have been studies that show if you spend, I don't know, over $150 or $200 in shoes, you're more likely to have running related injuries. Now that potentially could be those people run more or whatever. They're higher risk for, a lot of confounders there. But I think it just goes to show you don't have to spend $200 to get a decent sneaker.

Host Amber Smith: What about other gadgets? Do you have any other items that you run with? Some people use water belts. Some people rely on watches because they're trying to time themselves.

Emily Albert, MD: I do use an Apple watch, and I will clock my run and kind of see what my time is. And I've probably had one for five years. And all the years before that, I think, I mean, I didn't really have anything fancy. I could gauge the amount of miles I ran just based on time and what it felt like. I do run with my phone, and I actually will listen to podcasts and sometimes music when I'm running. I think if you live in an urban area, that's pretty dangerous, but where we are with all sidewalks, and I often run in Green Lakes (State Park). I think it's, as long as you're aware of your surroundings, there's certainly dangers anywhere, but I think it's doable.

Host Amber Smith: But I can remember running with a Discman (portable CD player) like way back in the day, that I had to, like, hold steady, so it wouldn't skip when I was running. And so nowadays there's lots of things. If you need something for a little entertainment, just with a little caveat of knowing your surroundings, I would often run with, like, one headphone in and one out, so I can hear traffic, or if I had a stroller or something. Are there any common injuries that you would caution runners about?

Emily Albert, MD: So there's probably two things I think of. One is plantar fasciitis. I think that is such a common running injury, and I've had it myself. I've done one marathon, and after that marathon, I had horrendous plantar fasciitis. The plantar fascia is a thick, white tissue on the bottom of the foot that connects the heel to the toes. And usually it is from an overuse of that. It can be affected by form. But when that becomes inflamed, it can become very painful along the bottom of the foot and is one of probably the most common running injuries, especially when you're first starting out. I think just being aware of that, and there's a lot of different stretches and massage techniques. And certainly if you can take NSAIDs -- which are like ibuprofen and Advil -- that's the best and most simple pain medicine for that. And sometimes rest and ice -- that old "RICE" saying -- compression, elevation. Those things, you know, for a lot of running injuries, those are pretty beneficial. And just kind of listening to your body, being aware of those things, especially early on, when you're starting out. And if things don't get better with those kind of simple measures, seeking advice. There's a lot that physical therapy can do nowadays as well.

The other injury that comes to mind are tight IT (iliotibial tract) bands, especially in female runners. The IT bands run kind of down the side of your thigh and comes around the lateral aspect of the knee joint and can cause knee pain. And I actually had that as well. And that's another common injury. I think I've been lucky to get through them both fairly quickly, but that injury, I thought I had deranged my knee for sure. I was in college at the time, at Clarkson, and went to the trainer for the hockey team. And he did some special tests for my knee, assessing the ligaments and the meniscus, and diagnosed that, and taught me some stretching and some strength training for the muscles around the joint, which is a common treatment for a lot of injuries -- for runners, it's usually ankles and knees -- strengthening those muscles around the joint made a huge difference, and I've not had a problem with it since, really. And that was 20 years ago, to date myself.

Host Amber Smith: What advice do you have for experienced runners who would like to be more competitive in races like the Workforce Run?

Emily Albert, MD: I think the biggest thing is just squeezing it in when you can and being flexible, especially people who have jobs and have kids. I think a lot of us type A personalities like a schedule, but I think you've got to be flexible and squeeze it in. Sometimes it's the morning, sometimes it's not.

And also, I think there's a lot of resources now. I mean, I always just kind of ran and honestly guesstimated how many miles I should put in to train for a marathon or whatever. But there's a lot of schedules out there now that are easily accessible through the internet that give training schedules if you have three months to train or six months to train, depending on how long of a race you're wanting to do, and trying to kind of follow one of those schedules. And again, with a little bit of flexibility and knowing it might not, you might not be doing the exact schedule every day, but I think sticking to one of those can be really helpful. There's a program called Couch to 5K, which is kind of a good program. My sister was telling me about that, too, because she did that when she initially started running. And I think that's a good way to just kind of get into it. And once you're there, and you find this running community, and it's one of those things, you can always find a race to enter if you want, if you want to do it on your own or with people in your neighborhood or whatever, it's a pretty versatile in that way, too. But there's a lot of resources and training schedules out there.

Host Amber Smith: Do you think that a crowd of runners at one of these events, do you think that helps, or does it hurt your performance?

Emily Albert, MD: Personally, I think it helps a lot. I think most runners when they do a race, at least for me, for sure. My time is a lot faster than a training race. I think running is one of those sports where as competitive as it is, as you are with each other out there, there's so much camaraderie and especially in a race when you're pushing yourself and there's like a little bit of pain and suffering -- not to say running is always painful and suffering involved -- but certainly in a race, it can be like that, and it's kind of fun, and that camaraderie and you push each other. So I think personally, I think it helps a lot, and it gives you that little bit of extra push in making it fun and kind of making you look forward to the next one.

Host Amber Smith: Well, Dr. Albert, I really appreciate you making time for this interview.

Emily Albert, MD: Thanks very much for inviting me.

Host Amber Smith: My guest has been Dr. Emily Albert. She's an internist and an assistant professor of medicine at Upstate, and a really fast runner. I'm Amber Smith for Upstate's " HealthLink on Air."

Next on Upstate's "HealthLink on Air" -- public health lessons learned from the pandemic.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

As we enter the third fall season with COVID-19 circulating, epidemiologists and public health experts are reflecting on what lessons they've learned from the pandemic. Here with me to share his thoughts is professor Chris Morley, the chair of the department of public health and preventive medicine at Upstate.

Welcome back to "HealthLink on Air," Dr. Morley.

Chris Morley, PhD: Thanks for having me back, Amber, it's always a pleasure to be with you.

Host Amber Smith: People working in public health already knew that creating an effective vaccine and convincing everyone to take it were two different challenges. You already knew how to project how many people could die and the impact on hospitals and the healthcare system. And we have already had the ability to do things virtually, but the pandemic accelerated the use of telemedicine. So, did we learn anything else beyond that?

Chris Morley, PhD: I think you raised three good points about what we've learned, and I could expand upon each of those briefly.

So you said we knew how to produce vaccines and that we knew it was different to produce good vaccines and then communicate about their use. But we actually have learned a great deal more about how messaging rolls out and how not to roll it out, frankly, and how contentious things can be. When I say we've learned, I think there are a lot of us who have ideas. I don't know that we're doing better as a society, because we still have people who are unvaccinated. So I think there's still more to learn about how to communicate about things like new technologies in general, especially when around contentious issues.

We also -- when you said we learned how to predict how many people would die -- we actually found out that our old models, like the SEIR (susceptible exposed infectious recovered) model, that was often used by infectious disease epidemiologists, actually have some holes in them, especially when you've got something that's so acutely and rapidly changing, like this pandemic has illustrated. We had very rapid mutation. Often when you do a model like that, you assume people, once they're susceptible, if they get infected or they get vaccinated, then they move to a recovered pool and they're no longer susceptible. But what we found is the virus mutates and as immunity wanes, people end up being susceptible again. And so we were both overestimated, as we learned how to use non-pharmaceutical interventions, we overestimated how rapidly people would distance and mask up and short circuit a surge. But we also learned how quickly our assumptions about susceptibility would change. So we've learned new subtle and sometimes not-so-subtle ways to use old tools and refine them. So it's been a learning curve on that as well, that we've learned to use existing tools.

We also are in a technological phase of education and work where it's been possible to, to teach, to learn, to work remotely for quite a while now. But we weren't doing it actively, and there were still some bumps and still some assumptions and cultural mores against doing things distally, if you could do them in person. And I think we've gotten over a lot of those things. And we've learned how to teach a lot better. I know, as a person who runs the department that runs a master of public health program, we pivoted and learned a lot about teaching remotely and do it a lot more effectively, for example. And a lot of clinics learned how to use telemedicine -- which existed before the pandemic -- to use that a lot more effectively, and they learned what was really important to do in person and what could be moved to a virtual session. So we've learned to use the tools we had at hand in better ways.

Host Amber Smith: Did we have the ability to track viruses in wastewater before this pandemic?

Chris Morley, PhD: Yeah, we actually did. And that was another tool that got adapted to use in the pandemic. So, there were people who were using wastewater testing, but it was often done in highly infectious environments, often in places where an entire village might, for example, might use a single water source. So basically people were employing wastewater monitoring in places like Africa, where we have had a number of infectious diseases emerge including Ebola, and people would use wastewater testing to monitor when you had other means of laboratory testing not as readily available. But it turns out that yeah, you can search wastewater for all sorts of things. For example, not only is it now being used in many places, including Onondaga County to look for COVID-19 producing viruses, the SARS COV-2 virus, but it also is being used to look for polio. For example, the polio case that emerged in Rockland County was quickly followed up with wastewater testing, and they found there is quite a bit of polio in the water. We are, as I understand it, beginning to look for monkeypox as well. And when you have a dearth of testing capacity or if you know you've got cases out there that aren't coming in for testing, for whatever reason, or that you're going to miss cases if you wait for people to show up in a clinic and get a clinical test, then monitoring wastewater in the community turns out to be a pretty effective way to get a picture of where things are going in the absence of robust clinical testing.

It also is available for use in more confined settings. For example, you could monitor a dorm or an office building or residential complex, and really even more refinedly use wastewater testing to see if something is popping up in a particular location. So there's a number of uses. It was used beforehand, but again, it's being adapted because it suddenly was necessary, and so it's come into its own.

Host Amber Smith: I know infectious disease people knew how easily germs transfer in regular daily life. But do you think that this experience with the pandemic, for the general public, has helped them learn the importance of washing hands and not breathing other people's air?

Chris Morley, PhD: Well, I hope so. We have seen other epidemics produce new societal practices. For example, after a number of rounds with aerosolized or airborne viruses or easily transmittable viruses, respiratory viruses like SARS 1 or MERS, or the H1N1 flu that swept through Asia.

In many parts of Asia, people regularly mask. If you have any symptoms at all, the current social more is that you don't walk around without a mask if you are expressing anything that looks like a respiratory virus or infection. I don't know if we're there yet. I do know we're combating two things. People know a lot more about hygiene in the presence of an infectious disease epidemic or outbreak. We certainly have taught a lot more people about that. But we also see, I guess, its ugly fraternal twin, and that's fatigue. And so, whereas people know what to do, they're also fatigued, and they're confused by what's been several years of often conflicting or complex recommendations, coupled with simply people not wanting to do this anymore and not wanting to do it 24/7.

And I think people know what to do. They understand things. But then they've heard information like, "Hey, maybe masks don't work." Well, no, masks certainly do work, but people don't like wearing them. And that's a conflict. How we're going to resolve remains to be seen. I hope people have learned more from this and that over the long term, we are able to adapt better when we have especially respiratory outbreaks.

Host Amber Smith: This is Upstate's "HealthLink on Air." I'm your host, Amber Smith talking with Chris Morley, who leads the department of public health and preventive medicine at Upstate, about lessons learned during the pandemic.

Do people working in public health have a new appreciation for the effects of isolation and loneliness in the population?

Chris Morley, PhD: Oh, absolutely. But I think, to be fair, we've always understood those things. We always understood that everything that we've done for the past almost -- unfortunately we're coming closer to three years now, or in two and a half years along -- that the things we were doing would have ramifications, and it's always a trade-off. Everything's been a trade off. So when we restricted activity, it wasn't lost in us that there would be financial outcomes that were deleterious. We were hoping we would see more rallying of the whole society to support businesses when we asked them to shut down. And unfortunately what we did was just open up very quickly, in some cases. We understand that when we ask people to mask or work distally or learn distally, that there was going to be issues with isolation, that mental health issues were going to be exacerbated, that things like crime, like drug use, suicidality were all going to increase as we place these emotional, financial and social pressures on people. We've always understood that. And the issue has always been counterbalancing and trying to counteract those effects while still looking out for the safety of the public.

So all of these things are equally important. We don't want people to die or get very sick and have long-term complications from COVID-19. We also don't want people in financial ruin or suffering deleterious mental health effects, or any of the other sequela that result. So, I think we've always known, we've had to balance these things, and the fact that we had to lean into some of some urgent measures over the past several years really underscores how quickly the virus spread, how quickly it almost overwhelmed our hospital system and how dangerous the situation was.

Host Amber Smith: What do you think it means that during the pandemic, visits dramatically increased to state and national parks and other outdoorsy venues?

Chris Morley, PhD: Well, I certainly jumped onto that bandwagon and started doing a lot more outdoor activities. I think people did several things. First of all, I think people understood much more quickly than the science was able to document that being outdoors was probably safer than being in a cramped indoor environment, especially with poor ventilation. I think you could even do more outside in terms of gathering than you could if you gathered people indoors. So people understood that outdoor activity was preferable.

I also think that what we were just speaking about in terms of the mental health consequences and the existential fears that people had throughout the pandemic really were amenable to more reflective and meditative activities like exposure to green space and forest bathing can have. There are documented impacts of exposure to green space that reduce stress and anxiety. My team actually had a paper on that several years ago, on the impact of increased exposure to green space on stress and anxiety.

So for those two reasons -- the basic fact that outdoor activity probably still is safer than indoor activity, and the need for reflection and meditation in the face of an existential threat -- probably combined toincrease the usages of parks, natural trails. And I've got to say, we have really lovely places here in Central New York, and I would encourage people to explore those. It is a relatively much safer activity, and we've got just awe-inspiring beauty, all around us. It has good mental health impacts as well.

Host Amber Smith: Some people are saying the way we live now, with more people than ever doing their jobs from home, is altering our cities. And I wonder what impact that is having, or may have, on public health.

Chris Morley, PhD: I think we're just beginning to realize what's going to happen. But I think we're already starting to see a transformation. I mean, there are all these stories about people moving and telecommuting or working part-time. For example, people have cleared out of New York City. They've been moving farther into the Hudson Valley and commuting a couple times a week and working more remotely. And that was before the pandemic. And I think that's increased. What will that mean for public health? Well, as populations become decentralized, how we measure all sorts of things, not just infectious diseases, but societal risksfor all sorts of things like rates of things like drug use or violence will probably be altered. And we will have different approaches to surveillance across the population if cities empty out or people become more dispersed.

As a public health professional and scientist, we understand that there will be social upheaval, some potentially for the better, but some potentially for the worse. As society changes, there are always winners and losers, and we will be looking out for the social determinants of health to be playing out as cities change and city scapes change and become less a center of of work and more center of commerce or play, or simply, as buildings empty out, you will see socioeconomic changes within those communities. And with socioeconomic change often comes changes in the health status of communities in a variety of indicators. So we're going to have to keep an eye on that.

We're also going to have to keep an eye on isolation that results when people disperse. Obviously people love working from home, but if over time they realize they become more socially isolated -- there are many societies grappling with epidemics of loneliness, for example; that was quite a concept in Britain a few years ago. I don't think that has gone away, and I think that's a real issue that as we negotiate our daily existence with technology and how we interact with one another in person versus technologically mediated interactions, we will learn what the ramifications are over time. As public health, as a field, we'll have to learn to watch for those sequelae from those societal changes.

Host Amber Smith: Well, Dr. Morley, I want to thank you for making time to talk with me about this.

Chris Morley, PhD: It's always my pleasure, Amber. It's always nice to speak with you, and thank you for having me back.

Host Amber Smith: My guest has been Dr. Christopher Morley. He leads the department of public health and preventive medicine at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from urologic oncologist Dr. Joe Jacob, from Upstate Medical University. What are symptoms of bladder cancer that a man or woman should not ignore?

Joseph Jacob, MD: The main thing that you have to understand is that seeing blood in the urine is not normal. So if you have blood in the urine, you should tell your doctor, and likely you need to see a urologist. Now, sometimes you'll have a bad urinary tract infection with blood, but if you're having what we call asymptomatic blood in the urine -- so you're not having any symptoms, and you're seeing blood in the urine -- then you really, really need to see a urologist. And that's one thing. The other thing is, you have to see your primary care doctor, and your primary care doctor will check your urine and check for microscopic blood as well. So this would be something you may not necessarily see with your own eyes, but they'll see this when they look under the microscope, and if there's blood microscopically, then you need to see a urologist as well.

Host Amber Smith: You've been listening to urologic oncologist Dr. Joe Jacob from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Jillian Barnet is a physical therapist, masseuse and a poet. She sent us a poem that starts off cataloguing the many indignities that cancer can mean for a body. Yet she ends with a beautiful reminder that love can push those moments aside.

Here is "You Don't Need a Nose and Other Things I've Learned":

You don't need a nose, but can do

with something resembling

melted fudge, just don't look

in the mirror. If you make a joke

about your prosthesis on Monday,

it doesn't mean you won't try to kill yourself

by Wednesday. Two eyes are unnecessary

for driving, but your 5-year-old may ask

you to put your second one in

before taking him to school. Men

most often get melanoma

on the back, women

on the leg. Sunscreen

is next to worthless. According

to accountants, it should take

no more than eight

minutes to tell a patient

he's dying. An ear

can be lopped off and

you'll hear fine through the unadorned

hole in your head. It's a very bad

idea to remove your own

melanoma with a kitchen knife. You can get

melanoma where the sun

doesn't shine. If you have

your eye radiated, or removed, you

have equal chances

of survival, but the fake eye will

seem more organic than

the blind one. Polymer

eyeballs bounce and easily

end up in the toilet. If you hated God before

you got stage IV melanoma, you won't

be around long enough to repair

the relationship. Melanoma likes

best to travel to the liver, lungs,

and brain. There are thousands of clinical

trials and no proven treatment. A wedge

of your head can be

removed like a slice of pie with

your cheek and eye in it, and your

husband will still adore you

as he watches you sleep

in your hospital bed. The mind

believes what it must. We are not

our bodies, but longings

individual as clouds.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air": why vision problems caused by vitamin A deficiency are on the rise.

If you missed any of today's show or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org. Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Stephen Shaw. This is your host, Amber Smith, thanking you for listening.