Houston Medical Times

Serving Harris, Brazoria, Fort Bend and Montgomery Counties

HOUSTON

Volume 10 | Issue 7

Inside This Issue

July Edition 2020

Everyday Heroes in Scrubs

By Tom Florence, Executive Vice President, Merritt Hawkins

S Texas’s First Moms’ Maternal Mental Wellness Program See pg. 10

INDEX Legal Matters ...................... pg.3 Oncology Research......... pg.5 Mental Health...................... pg.6 Healthy Heart....................... pg.8

Houston Methodist and UnitedHealthcare Renew Network Relationship See pg. 11

ince the first case of the coronavirus was confirmed in the United States in late January, healthcare professionals have been risking their own safety and health in order to treat and care for patients who have contracted the unfamiliar disease.

The countless doctors, nurses, and additional healthcare workers who continue to fight this global pandemic while the majority of the rest of the nation is encouraged to stay home are each dealing with the unexpected situation in different ways. Though there are more unique stories and heroic frontline workers than we will ever know, it is inspirational to hear their own insights and perspectives regarding what they face on a daily basis.

Barbara Edwards, a registered nurse in Gainesville, Florida, is one of the many healthcare professionals who volunteered to drop everything and travel to New York City last month to help with the rising COVID-19 cases. Edwards actually had to resign from her position in Florida in order to leave to New York, but she knew that it was something that she had to do.

“What it came down to was watching the numbers every day and seeing what was going on [there]—

thousands of people dying every day,” Edwards told Ellen Degeneres via video chat on her show, Ellen.

Edwards also told Ellen that

help every patient who comes in, but there are still so many unknowns.”

At the end of March, Dr. Craig Spencer, an Ebola survivor and the director of global health in emergency medicine at NewYork-Presbyterian/ Columbia University Medical Center, posted on Twitter a detailed description of a typical day in the life of an ER doctor and encouraged his followers to retweet so that others would realize what medical professionals are facing each day during this global pandemic.

“Walk in for your 8 a.m. shift: Immediately struck by how the calm of the early morning city streets is immediately transformed,” Spencer wrote. “The bright fluorescent lights of the ER reflect off everyone’s protective goggles. There is a cacophony of coughing. You stop. Mask up. Walk in.”

He describes seeing patient after patient suffering from the coronavirus and having to call and notify their families that the patients are now on life support. He notes that doctors and nurses are so busy taking care of others that they sometimes forget to take

I’m not afraid of contracting the virus or even of dying ...

What scares me most is how many people keep getting it and the lack of treatment and prevention we have for it. the response from residents in New York City has been uplifting and encouraging, and she and her coworkers feel a tremendous amount of love and appreciation from the entire city.

A Dallas-based nurse who requested not to be mentioned by name said that it has been rather overwhelming to go to work each day and see the number of coronavirus patients continue to rise. It is not her own health that concerns her, though.

“I’m not afraid of contracting the virus or even of dying,” she said.

“What scares me most is how many people keep getting it and the lack of treatment and prevention we have for it. We’re doing everything we can to

see Heroes... page 14

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Legal Matters Covid-19 Emergency Exception Under TCPA

By Iliana L. Peters, JD, Polsinelli, PC

I

n 1991, the Telephone Consumer Protection Act (“TCPA”) was enacted to address unwanted telephone calls and faxes for marketing. The Federal Communications Commission (“FCC”) Enforcement Bureau expanded the provisions of TCPA to include limits for the use of automated text messages. Specifically, the FCC has stated that the restrictions on making “autodialed” calls to cell phones include both voice calls and texts. As such, automated calls and text messages to cell phones are subject to the requirements of TCPA. Generally, entities can send automated text messages without the prior express, written consent of the recipient only in emergency circumstances, or if such text messages are directly related to

urgent and crucial matters of health care treatment for an individual.

The TCPA prohibits autodialed calls or text messages, as well as prerecorded calls, unless the caller has previously obtained the prior express consent of the recipient, or unless the calls or text messages are made for emergency purposes or subject to an FCC exemption. In most cases, “express” consent must be written.

Callers have the burden of proving that they obtained express, written consent, and recipients must be able to revoke consent.

First, the TCPA requirements include an exception to express consent for “exigent” messages related to health care for an individual, specifically with regard to “treatment” for the individual. Any messages relying on this exception must be “exigent” for treatment purposes; in other words, the messages must be urgent and crucial, must have a health care treatment purpose, and must comply with HIPAA (e.g., must not be of such a sensitive or personal nature that it

would violate an individual’s privacy if another person received the message).

Communications regarding billing, for example, are not considered “exigent” by the FCC. These messages must be “free-to-end-user;” there should be no charge to the recipient; the caller must honor opt-out requests immediately, and the caller may initiate only one message per day or three per week.

Second, prior express, written consent is not required under TCPA for messages related to “emergency purposes.”

Calls or messages for “emergency purposes,” under TCPA, are those “necessary in any situation affecting the health and safety of consumers.”

FCC recently issued a Declaratory Ruling regarding the COVID-19

pandemic, noting that it constitutes an “emergency” under the TCPA. In the Declaratory Ruling, the FCC stated that, for purposes of messages for “emergency purposes” related to COVID-19, two elements must particularly be considered: the identity of the caller; and the content of the call or message. Specifically, according to the FCC: • First, the caller must be from a hospital, or be a health care provider, state or local health official, or other government official as well as a person under the express direction of such an organization and acting on its behalf. see Legal Matters...page 14

Opening Summer

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July 2020

Houston Medical Times

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Towards COVID-19 Treatments UH Researchers Exploring Options

N

ot since the mid 20th century, amid the polio epidemic, have vaccines or drug treatment been so widely anticipated as those for COVID-19. In 1955, when the polio vaccine was licensed, the health outlook for millions of children improved and normal life resumed.

Still, not all pandemics have found such resolution. Since the 1980’s over 70 million people have been infected with the HIV virus, 35 million have died from AIDS, and still no vaccine exists, though a daily drug combination can reduce a person’s HIV viral load to an undetectable level.

Across the world, efforts continue to develop medicines to put the coronavirus to rest, including at the University of Houston. Two researchers are working on vaccines, and another is working on a drug to block the virus.

Gomika Udugamasooriya, finding

July 2020

a drug to block entry To create a drug that could prevent coronavirus, Gomika Udugamasooriya, associate professor of pharmacological and pharmaceutical sciences, first unravels how the virus enters the human body.

“The human entry of coronaviruses depends on first binding of the viral spike proteins to human cellular receptors that basically offer a cellular doorknob,” said Udugamasooriya.

“The virus latches onto the specific human cellular receptor, ACE2, and sneaks inside to replicate itself within the cell to spread throughout the body.”

Following that line, treatments that can block the ACE2 receptor could stop virus entry into the body.

“Our approach physically “guards” the entry point - the door – so the virus cannot enter,” he said.

Udugamasooriya and collaborator Bin Guo, associate professor of

pharmaceutics, are applying their unique cell-screening technology to identify specific synthetic chemical drug leads called peptoids that can bind to ACE2 receptor.

“Peptoids are easier to make, compatible with biological systems and economical to produce,” said Udugamasooriya. The project is currently at the initial screening levels and identified drug-lead validations will be performed in the future.

Navin Varadarajan, testing inhalation vaccines Navin Varadarajan, M.D. Anderson Associate Professor of chemical and biomolecular

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engineering is testing inhalation vaccines.

Think FluMist for COVID-19.

“For airborne pathogens, the nasal mucosa is the first point of defense that needs to be breached,” said Varadarajan. “Mucosal immunity and vaccines are fundamentally important for a wide range of pathogens including influenza, severe acute respiratory syndrome coronavirus (SARS-CoV) and the current SARS-CoV-2.” Still, he said, nasopharyngeal immunity is see Treatment...page 14

Houston Medical Times

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Oncology Research Covid-19 And Cancer: Three Ways To Protect Your Health

By Branden Hsu, M.D., Texas Oncology Houston Memorial City

A

s physicians, researchers, and health officials learn more about COVID-19 and its impacts, those with compromised immune systems, including many cancer patients, are learning how to protect their health in a changing world. Texas and other states have eased stay-at-home orders and many businesses are re-opening. If you’re a cancer patient or care for a cancer patient, you may be wondering how COVID-19 will continue to impact the cancer journey.

Cancer patients receiving active treatment are especially vulnerable and must remain vigilant about their health.

You, your caregivers, and other close contacts can take proactive measures to protect yourselves and those around you from COVID-19 and other illnesses.

Establish a ‘safety first’ mentality.

Following safety guidelines from the Centers for Disease Control and Prevention (CDC) is paramount. This includes washing your hands often, practicing social distancing, avoiding contact with those who are sick, and wearing face coverings. Recent studies cited by the CDC provide evidence that wearing face coverings, such as non-surgical masks and cloth face coverings, can slow the spread of the virus in public settings and further reduce community spread.

As a cancer patient, safety precautions aren’t enough if those around you aren’t doing the same. The people who are important to you and want to spend time around you must also follow safety guidelines. Their safety helps maintain your safety. The same principle applies to home repairs, deliveries, and other interactions with people: anyone entering your home should adhere to safety guidelines, including wearing a face covering. And remember, call your physician if you feel sick or have new or

Celebrating

unusual symptoms.

Communicate openly and often.

Open and honest communication is essential for coping, healing, and caring for your emotional health – especially with the added stresses brought on by the COVID-19 health crisis. For example, your physician doesn’t know how you may be struggling with treatment unless you talk about it. Your loved ones may not understand why they can’t come visit you unless you talk to them about the importance of maintaining distance during treatment. Open conversations help get to the heart of the matter and let others know how they can best support you.

Find new ways to cope with stress.

The COVID-19 pandemic has caused immense changes to our

lifestyles, which may trigger strong feelings including stress, anxiety, and fear of the unknown. When we might typically turn to loved ones for support, social distancing hinders the ability to connect in person. But there are ways to pull your support system together without putting anyone at risk. Connect by phone or video call regularly, and explore new ways to spend quality time, such as virtual family dinners, starting a book club, or joining a virtual support group for cancer patients.

Just as every cancer patient’s journey is unique, there isn’t a one-size-fits-all approach to fighting cancer amid COVID-19. Focus on what see Oncology Research...page 12

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Mental Health Watch Out for Signs Of Mental Illness In Teens As A Result Of Current Events

By Laura Frnka-Davis UT Physicians

T

he coronavirus pandemic, coupled with recent headlines of injustice, riots, racial tension, and protests, has surfaced feelings of anxiety and depression in adults, but young people are no doubt feeling the impact as well.

“Mental illnesses are on the rise across the board,” said Amalia Guardiola, MD, associate professor in the Department of Pediatrics at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and a pediatrician with UT Physicians.

“While it’s normal for teenagers to express themselves emotionally right now with so many stressful events happening at once, it’s important to keep tabs on the situation and consult with the teen’s pediatrician if you observe different or abnormal behaviors in your adolescent.”

The American Academy of Pediatrics recently issued a report indicating that visits to emergency

rooms have increased substantially between 2007 and 2016, which included a 68% increase for teens between the ages of 15 and 17.

There are certain signs parents can look for which may indicate an adolescent has an issue that needs to be addressed. Things, like yelling or storming out without a specific reason, a decrease in patience, and regressing in behavior, are all indications that a young person may be suffering from something beyond typical teenage moodiness. Other clues are spending too much time alone and drastic changes from being cheerful one moment to losing hope and being sad the next.

Denise Ramos, LCSW, a pediatric psychotherapist with UT Physicians, also says that mental disorders can manifest in other ways, including sleep difficulties, headaches, and stomachaches. Among the mental health issues seen during this time is the rise of xenophobia – or the dislike or prejudice against people from other countries.

“Because the coronavirus originated in China, Asians have become somewhat of a scapegoat, and as a result, Asians are more subject to attacks, discrimination, and possible bullying,” said Ramos. “The stigma is creating more fear toward the Asian population than the virus itself.”

Young Asian people and those who are African American may especially be feeling the impact of recent events mentally. Young people have a natural response to protect themselves and may socially isolate, which can lead to depression, increased levels of distress, and risk of self-harm.

“As much as parents want to

ensure their children’s mental health needs are being met, they themselves are processing this distress and may not be able to properly address these mental health issues we are seeing right now,” said Ramos. “We work with a multidisciplinary team consisting of a psychiatrist, psychotherapist, psychologist, social workers, and nurses who are ready to help.”

Ramos and Guardiola both suggest calling your pediatrician right away if you think your teen may be suffering from a mental health disorder.

In-person and telehealth appointments see Mental Health...page 12

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Healthy Heart Analysis of EMS And Hospital Data Indicates Low COVID Infection Risk From Bystander CPR

By The American Heart Association

A

nalysis of Seattle emergency medical services (EMS) and hospital data from January 1 to April 15, 2020, indicates bystander CPR is a lifesaving endeavor whose benefits outweigh the risks of COVID-19 infection, according to a new article published June 4, 2020, in the American Heart Association’s flagship journal Circulation.

Resuscitation of patients in out-of-hospital cardiac arrest (OHCA) depends on rapid, coordinated efforts involving laypersons, telecommunicators, prehospital professionals, and hospital providers. However, during the pandemic, experts have questioned whether chest compressions are a high-risk “aerosolizing” procedure that could increase the risk of COVID-19 infection, especially since bystander CPR is typically provided for only a few minutes.

InaResearchLettertitled“Prevalence of COVID-19 in Out-of-Hospital Cardiac Arrest: Implications for Bystander CPR,” University of Washington EMS physicians and researchers in Seattle and King County, Washington, analyzed EMS

July 2020

and hospital treatment data, and death certificates of all OHCAs to estimate the frequency of COVID-19 infection among the total out-of-hospital cardiac arrest population served.

From January 1 to April 15, EMS responded to 1,067 out-of-hospital cardiac arrests of which 478 were treated by EMS with CPR. During the active period of COVID-19 (February 26-April 15), EMS responded to 537 (50.3%) out-of-hospital cardiac arrests, of which 230 (48.1%) were EMS treated with CPR. The researchers note, as of April 15: • The community had 15 deaths per 100,000 population from COVID-19, higher than 42 other states at that time.

• COVID-19 was diagnosed in less than 10% of out-of-hospital cardiac arrests.

• Assuming the risk of transmission to bystanders performing hands-only CPR without PPE [personal protective equipment] is 10%, treating 100 patients could result in 1 bystander infection (10% with COVID-19 x 10% transmission).

• Given a 1% mortality for COVID-19,

approximately 1 rescuer might die in 10,000 bystander CPR events.

• By comparison, bystander CPR saves more than 300 additional lives among 10,000 patients with out-of-hospital cardiac arrest.

“We believe the current findings support telecommunicators and bystanders maintaining the most efficient approach that prioritizes rapid identification of cardiac arrest and immediately proceeds to chest compressions and use of a defibrillator,” the authors write. “Delaying bystander CPR to [put on personal protective equipment] should only be considered when the prevalence of COVID-19 infection is substantially increased.”

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Houston’s Public Health Authority and EMS medical director Dr. David Persse added, “Performing bystander CPR generally more than doubles a person’s chance of survival from sudden cardiac arrest. The person you are most likely to perform CPR upon is a family member.

Research has shown one’s chances of contracting COVID disease while performing CPR is about 1 in 100, and the chance of becoming seriously ill is estimated to be less than one in one thousand. The extra added risk of contracting COVID and becoming seriously ill is very low, while the chance of saving one’s life is comparatively very high.”

Houston Medical Times

Page 9

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Texas’s First Moms’ Maternal Mental Wellness Program Virtual Program Designed by Moms, For Moms, Offers Customized Care Packages and Connecting During A Crisis Support Group

B

eing a mom is challenging during the best of times. Moms carry a heavy mental load, but the COVID-19 pandemic has added another level of stress and anxiety while removing vital support systems like daycare or school. Recognizing this, The Menninger Clinic launched the Menninger Moms Program, first-of-its-kind virtual services for moms in Texas. The program focuses on mental and physical wellness and provides supportive solutions designed to help moms cope and develop a long-term healthy self-care regimen.

“There are plenty of services that focus on moms during pregnancy, but post-delivery there’s a misconception that moms ‘should have this by now’ - and many don’t,” says Jessica Rohr,

PhD, psychologist, The Menninger Clinic. “We’re here to help bridge the gap and provide a real-world wellness skill set for all moms with kids under the age of 18.”

It’s no secret that psychological distress is high due to the COVID-19 outbreak and, now more than ever, there’s a huge need for maternal wellness. In fact, a new research study authored by psychologists from the University of Calgary and the University of Manitoba found 44% of mothers with children aged 5-8 years old are experiencing depression and 30% of those mothers are also experiencing anxiety. The percentages are also elevated for mothers with children up to 18 months as well as those with children 18 months to 4 years old.

As part of this program, Menninger is offering a free support group for any mom in Texas. This forum unites moms via teleconference and aims to offer support during a crisis like the COVID-19 pandemic.

By forming a community, the group gives moms a way to lean on other moms who are going through the same difficulties due to the healthcare crisis - this important connection may be missing in their lives during the new normal.

Moms may also combine therapeutic services that include individual, couples and educational

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groups that are supplemented with daily check-in calls from one of the Menninger professionals. The paid therapeutic group and education services tackle topics like managing guilt and crisis survival and offer a safe place for moms to share their stories and receive support.

“We want moms to know they’re not alone. The services we offer focus on wellness and are intended to support women along their journey as mothers,” says Elisabeth Netherton, MD, psychiatrist and physician, see Texas’s First Moms’...page 12

Houston Medical Times

Page 11

Hospital News Bridgemoor Transitional Care Adds New Pulmonary Program in Webster

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ridgemoor Transitional Care in Webster recently added an advanced care pulmonary program to its list of patient services. In partnership with Respiratory Health Services, Bridgemoor is now able to provide around-the-clock, therapeutic treatment for non-COVID-19 patients with complex respiratory problems.

“We started planning our advanced pulmonary program more than a year ago, and we’re proud to include it in our list of patient care services at our Webster facility,” Mark Fritz, president of Bridgemoor Transitional Care, said. “None of us could have anticipated the global pandemic and while we are not treating COVID-19 patients, we are able to assist our hospital partners by accepting patients with other complex respiratory problems, freeing up ventilators and hospital beds.”

The advanced care unit offers a variety of services for numerous diagnoses including chronic obstructive pulmonary disease (COPD), pulmonary hypertension, bronchiectasis, and congestive heart failure. Patients who are recovering from heart surgery, such as coronary artery bypass and mitral valve annuloplasty are also accepted.

Through the advanced care pulmonary program, patients have access to ventilator weaning, 24/7 registered nursing and respiratory therapy, an on-site nurse practitioner, high-flow oxygen, as well as an on-site lab and pharmacy dispensing system.

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ouston Methodist and UnitedHealthcare have finalized a n ag reement that ensures UnitedHealthcare members enrolled in employer-sponsored, individual and Medicare Advantage plans can continue to receive care at Houston Methodist hospitals and from its physicians. The new, multi-year relationship is effective June 1, 2020.

We recognize and appreciate that the care Houston Methodist provides is not only important but also personal to our members, and we know the negotiations process has been difficult for them. Our top priority throughout this process was ensuring the more than 1 million members we’re honored to serve in Houston have access to quality, affordable health care, and this new agreement accomplishes that goal.

We appreciate Houston Methodist’s collaboration in helping achieve

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We are honored to continue supporting the more than 3.9 million people throughout Texas who depend on us for access to quality and affordable health care. medicaltimesnews.com

July 2020

Houston Medical Times

Page 12

Oncology Research

From all of us at the

Continued from page 5

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Mental Health

Continued from page 6 are currently available.

In addition to making an appointment with a health care professional, Ramos and Guardiola suggest these tips: • Take a break from reading or listening to the news as well as social media.

• Take time to engage in distraction-related activities.

• Connect with other teens who may be experiencing the same concerns.

They must understand they are not

alone in their fear, and they know there are people who care about them and who want to help.

• Take advantage of local resources, such as Houston’s Crisis Intervention Hotline.

If you feel like your child may need additional assistance, you can reach out to UT Physicians at 888-4UT-DOCS to schedule an appointment with a member of our care team.

Texas’s First Moms’ Continued from page 10 The Menninger Clinic. “Our goal is to provide a warm, open and inviting space as well as cultivate a community for moms to support each other beyond this program.”

The Menninger Moms Program aims to shift the idea of what care looks like for moms. As moms and mental health professionals, Netherton and Rohr are spearheading this program because they know all too well the

stressors moms encounter. Their expertise, along with the immediacy and accessibility of the virtual program, are what makes this type of individualized program unique.

The program is open to moms in Texas. If you are a mom who would like to learn more, or a physician who would like to refer a patient, please call us at 713-275-5400.

Hospital News

Continued from page 11

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Houston Medical Times

Age Well, Live Well Oral Health Affects the Rest of Your Body

By Chelsea Couch, CHES Texas Health and Human Services

O

ral health and hygiene is important for your mouth, teeth, gums, overall well-being, and can significantly impact your quality of life.

Only 60 percent of Texans 65 and older report they visited a dentist in the past year. Over 32 percent report missing six or more teeth. Poor oral health can increase the risk of developing chronic conditions like heart disease and diabetes.

As we age, it is important to have a daily routine for oral hygiene. Regular preventive care by a dental provider is key to maintaining oral health.

Dental providers look for tooth decay, gum disease, oral cancer and signs of chronic disease.

Things to consider for a healthy mouth: • Brush Twice A Day Brushing your teeth twice a day dramatically affects the health of your mouth.

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Page 13

gum disease and certain chronic diseases, such as diabetes. If your gums bleed when you brush or floss, contact your dental provider.

• Nutrition Eating nutritious food is important for your oral health.

Sugary and acidic foods can feed bacteria in your mouth and weaken tooth enamel.

• Drink Water for Dry Mouth Drinking plenty of water throughout the day can help relieve dry mouth. Bacteria thrive in a dry environment and the risk of tooth decay increases. If you use a lozenge, gum, candy or mints, make sure they are sugar-free.

• Don’t Delay If you have a tooth

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bothering you, don’t delay getting it examined. Putting off treatment can make the issue worse and can be more expensive to treat later.

Dental insurance can be costly, and programs like Medicaid and Medicare often have limited or no dental coverage for adults. Transportation and assistance to appointments can also be a barrier in receiving timely oral health care.

If you need help, your local Aging and Disability Resource Center can connect you to available assistance in your area. To find your ADRC, call 855-937-2372. To learn more on oral health, visit dshs.texas.gov/dental.

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Houston Medical Times

Heroes

HOUSTON

Continued from page 1 complete care of themselves.

“Sometime in the afternoon you recognize you haven’t drank any water,” he continued. “You’re afraid to take off the mask. It’s the only thing that protects you. Surely you can last a little longer—in West Africa during Ebola, you spent hours in a hot suit without water. One more patient.”

Spencer’s detailed account depicts how dangerous the conditions are for healthcare professionals but how thorough and fearless they are in caring for those battling this unexpected and unknown illness.

While scientist and medical experts continue to seek vaccines, treatments, and contributions to

help society get somewhat back to “normal,” it is important to recognize how valuable those in the healthcare industry are—something that should not take a global pandemic for such accolades to occur.

Web Development Lorenzo Morales

Continued from page 3 to inform and update the public regarding measures to address the current pandemic made on behalf of, and at the express direction of, a health care provider.

• A call made by a county official informing citizens of shelter-in-place requirements, quarantines, medically administered testing information, or school closures necessitated by the national emergency would be made for an emergency purpose as such measures are designed to inhibit the spread of the disease.

Not Permitted by COVID-19 Emergency Exception: • A call that contain advertising or telemarketing of services do not constitute calls made for

an “emergency purpose” (e.g., advertising a commercial grocery delivery service, or selling or promoting health insurance, cleaning services, or home test kits).

• A calls made to collect debt, even if such debt arises from related health care treatment, are not made for an “emergency purpose,” As a result, communications to individuals without express written consent under the TCPA should be limited to those specifically related to their treatment by health care providers, and those related specifically to COVID-19 issues identified by health care providers and for public health purposes. 

vaccination,” he said. Varadarajan is collaborating with Xinli Liu, associate professor of pharmaceutics, who is synthesizing a new liposomal adjuvant.

Shaun Zhang, exploring vaccine by injection As the director for the Center for Nuclear Receptors and Cell Signaling, M.D. Anderson Professor of biology and biochemistry, Shaun Zhang, is used to developing new biotherapies and vaccines for unmet needs in cancer and viral infection. Now he’s turned his attention to the greatest unmet medical need before all humankind – a vaccine for COVID-19 – developing three vaccine candidates for injection, which he has evaluated for neutralizing antibody production.

So far, the results look good.

“The data collected from our studies show that our vaccine candidates

can generate neutralizing antibodies, which can protect cells from infection

by SARS-CoV-2 when tested in vitro,” said Zhang. “We are now working on further improvement for the vaccine design.”

Zhang’s vaccine candidates include a subunit vaccine containing either the entire spike protein or the receptor binding portion, which helps the virus enter the target cell, and delivered either by DNA formulation or by a herpes simplex virus-based vector.

Zhang is working to improve the formulations to simultaneously enhance the immune responses, simplify the procedure and reduce the cost of preparation.

Treatment

Continued from page 4 understudied.

Varadarajan is using the spike protein, which helps the virus enter the target cell, and is the major target for neutralizing antibodies as it binds to the cellular receptor called angiotensin converting enzyme-2 (ACE2) for virus entry. He prefers using proteins because of their ability to induce strong immune responses, flexibility and scalability, and absence of infectious particles.

Varadarajan notes several considerations of pivotal importance in designing an efficient, but safe mucosal vaccine.

“As with any vaccine, a variety of factors determine their efficacy including the antigen used for electing a response, the adjuvants and immunomodulators, the efficient delivery of the antigen to appropriate target cells, and the route of July 2020

Director of Media Sales Richard W DeLaRosa Senior Designer Jamie Farquhar-Rizzo

Legal Matters

• Second, the content of the call must be solely informational, made necessary because of the COVID-19 outbreak, and directly related to the imminent health or safety risk arising out of the COVID-19 outbreak.

The FCC also gave several important examples of communications permitted and not permitted under the exception for COVID-19: Permitted by COVID-19 Emergency Exception: • A call made by a hospital providing vital and time-sensitive health and safety information that citizens welcome, expect, and rely upon to make decisions to slow the spread of the COVID-19 disease.

• An informational call designed

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Page 15

CARING TAKES TRUE COURAGE. THANK YOU FOR YOUR SACRIFICE.

THANK YOU TO EVERY PHYSICIAN, NURSE, FIRST RESPONDER AND HEALTHCARE WORKER IN THE GREATER HOUSTON AREA. Thanks to those being called away from their own families to be of service to yours. And we thank the people of the Greater Houston area for taking every step possible to safeguard your own health. Thank you for the sacrifices you’re making. And for the impact you’re having on all our lives.

Advancing health. Personalizing care.

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ThankYouHouston.org

July 2020

Houston Medical Times

COVID-19 and Adult CPR If an adult’s heart stops and you’re worried that they may have COVID-19, you can still help by performing Hands-Only CPR.

Step 1

Phone 9-1-1 and get an AED.

Step 2

Cover your own mouth and nose with a face mask or cloth.

Step 3

Step 4

Perform Hands-Only CPR.

Use an AED as soon as it is available.

Push hard and fast on the center of the chest at a rate of 100 to 120 compressions per minute.

July 2020

Cover the person’s mouth and nose with a face mask or cloth.

KJ-1424 4/20 © 2020 American Heart Association

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