The Maynard Institute for Journalism Education’s Oakland Voices community journalism training program continued its series of community discussions, Oakland Voices Tonight, on Tuesday August 25, 2020. The evening’s guest was Dr. Gerard Jenkins, Chief Medical Officer at the Native American Health Center, with locations in East Oakland and the Mission district in San Francisco.
Dr. Jenkins is an internal medicine physician with over a decade of experience, serving a myriad of committees for a clinical peer review, care utilization management, and quality improvement. Originally from Michigan, he now calls the Bay Area home. He previously worked at Sutter Health before joining the Native American Health Center. The center offers free, outdoor COVID-19 testing, among many other services (find out more about NAHC here and about their free COVID testing here).
Dr Gerard Jenkins participated in an enlightening discussion with Oakland Voices Coordinator Rasheed Shabazz about fears and stigmatization of taking the COVID-19 test, touching on raising community awareness for testing. Dr Jenkins also provided some insights on other health factors impacting the same communities disproportionately affected by COVID-19.
Below are edited excerpts from the discussion.
Dr. Jenkins on how he got into the medical field, expanding your knowledge and practice, and mentorship
I grew up always interested in science and I always loved science. I always thought medicine was really cool. But one of the things I realized pretty young is that if you understand how things work, the intricacies of science in cells and in those pathways, that is kind of the cornerstone to help you learn other things.
For me, I’ve always really had an interest in science and different types of science. In Michigan, that’s what led me to do biochemistry and then actually when I finished at Michigan, was debating if I wanted to go to med school or graduate school. And that’s what I need to go to graduate school at Columbia. I left Columbia and started to do my masters in biotechnology. As I was finishing up there, there was a course in pharmacogenomics and biomedical informatics. And so I took a medical informatics class and the professor said “Hey this is something, that you decided to do something in healthcare informatics, it will give you a whole different skill-set.” So I stayed actually at Columbia and worked on my second Masters degree and stayed in New York City for a little bit and then I headed for Vanderbilt. Even when I finished medical school, I wasn’t sure if I wanted to go on and practice. I think research is still really great. So my mentor and the dean of students at the time said, “Take some time to figure it out.” So that led me to look at UCSF and doing other things back in the biological sciences. That’s what led me to do pharmacogenomics and that type of work, which was fascinating.
And then I got another great piece of advice as I finished that. If you have a medical degree but you don’t practice medicine, it doesn’t have the same type of value. “At least do residency” [was what I was told], and that’s what led me to California and work there. So everything I’ve accomplished, I really am grateful for it. It’s been great, but I also owe that to a lot of great mentors along the way. I think that one of the things I want to encourage people. Even now, I still have mentors, even at my age of 41, so I will seek good advice from good people and listen to them on their wisdom, because sometimes they can be really good pearls to help you out in your future.
How Dr. Jenkins landed at Native American Health Center
As a hospitalist physician practicing at Sutter Health internal medicine training residency, I was at Sutter Health. I’ve been there for about six years and I love inpatient medicine. I love the acuity of it. It’s always fascinating to make decisions right there and see how it works. Though a lot of what I saw was that a lot of patients would continue to come to the emergency department or get admitted for things that I felt could be managed at home. You know, things that you manage in an outpatient setting. So one of the things I challenged myself was like, well, you can make an impact for people in the inpatient setting but can you do the same things upstream and help people at home on a regular basis or in a primary care setting? So that’s what led me to look for opportunities and I was referred by, again, another great resource or person who advised me to go to CHCN, where I was the medical director. I was there for about a year. Then I met Greg, Mr. Garrett, who was taking over the COO role and he said we need a medical person with a different perspective and your background is fantastic. He referred me to come over to Native American Health Center. A lot of those opportunities opened doors just by having great people give you really good advice on things to do. So I’ve been here now for about eight months, roughly.
Background on the Native American Health Center
The Native American Health Center was started in 1972 and it’s primarily made for people who are Native Americans. Obviously, the demographic has changed over the course of the last 34 years in Oakland. But the premise was helping Native Americans with their health and understanding their needs. Similar to other federally qualified health centers that have a certain demographic, so for example of Clinica de la Raza, with Hispanic and Latino population, there were the Native Americans. Even though our population is a little bit less than it was in the past, in the 70s and 80s, there’s still an emphasis in making sure we support Native Americans and supporting a lot of other members of our diverse population. We have a large Hispanic and Latino population. We have a good African American population and Asian Americans. We’re open to all. And so I just want to make sure I emphasize that. Its roots are in Native American culture in history, but we’re open to all different types of people of race, ethnicity, religion, etcetera.
On why there are so many COVID-19 cases in East Oakland
This has to do with statistics and some of it has to do with testing. So the short answer to that question is that it’s multifactorial. At the beginning of the pandemic, if you look at the Fruitvale, especially off of International Boulevard, it was very limited on resources available to do testing for people in a community. If you think about large organizations like Kaiser or even a private hospital like UCSF, Stanford, early on and in the pandemic, they had the capacity that enabled them to test them earlier. We were fortunate to get resources from UCSF, which I am immensely grateful for, and other people working with us to help us to allow us to do testing in March, April, and part of May. Because we had such limited testing resources available, we had to choose people who were only symptomatic. So we created a very defined criteria. When we did that, we found that our positive rate was roughly about 30% and 33% of people we’re testing.
What that means is statistically we have a higher pretest probability. Which means that we’re screening people who we think have it, then we test them, and one third of those people do have COVID-19. So that’s why numbers were initially very high. And then, over the course of around June or July, we started having more resources available. That’s why our numbers were initially very high and then over the course of around June to July, we started having more resources available. We started partnering with companies. We partner with the technology company called COLOR and Carbon Health and both of those are in conjunction with Alameda Department of Public Health, supported increased testing in the Fruitvale. That was immensely helpful. So now instead of testing roughly maybe 30 people a week, we can do 300 people a day, which is substantially greater.
Instead of being selective about people’s symptoms, we said, “It doesn’t matter if you’re in this community. If you want to get tested, we’re going to have this available for you.”
If you look at the data, it shows that roughly about 6 1/2% are positive. Which means our positive rate has now gone down from 33%, but that difference is because we’re no longer doing selective testing of people who are only likely this as COVID-19. It’s like the entire population. And that number is a little bit higher from what I recall of what is in the United States. We still have a very strongly positive population of people in the Fruitvale.
I just wanted to make sure that people knew that this entire thing has been a very interesting process and the follow-up to that, it may change again. Because flu season is right around the corner. Right? So if you think about it, we start giving the flu vaccine around the middle to end of September. Flu season starts really picking up in October, November. So now, it is similar to when COVID first started in March. Is it flu? Is it pneumonia? Is it streptococcus? Is it COVID-19? Your differential for what those symptoms might be goes up. So we may have to adjust again the way we do testing but that’s one of the things about this pandemic and why they call it novel. Because it is. It’s something that we just haven’t experienced before.
On the stigmas of testing in communities of color
In a community of color where, if you look at historically, [testing] invokes fear and angst. ’Cause you look back historically that has happened, like with Tuskegee and things like that. One of the things I’ve noticed was that there was a [stigma] for a very long time. I say for the first three months of the outbreak. Just friends of all different types, not just in healthcare but friends in tech, friends who work in finance. And the whole stigma of like, “Oh, you’re getting tested, that means you have it,“ which means like, “stay away from me” type of thing.
Then as testing became more common and as it was more of an emphasis of, you want to know so you can social distance, so you can isolate, so I can help prevent spreading it to someone you love. It then shifted a little bit. Now it’s something it’s good to know so you can help prevent spreading it. I think there’s been a little bit of a change of that perspective.
I think we’re at the point now where people understand that it’s a good thing to be able to know, so that you can prevent [spreading it]. And even myself. My parents moved here from Michigan not long ago. They live 10 miles away from me and I didn’t see them for four months. I work at Native American Health Center and I still do a few shifts a month at Sutter. So I don’t want to expose them to anything, right?
And then once I got into the regular testing, it really made a difference. Another thing too, for health professionals. If you’re on the frontlines and you’re seeing patients actively or even healthcare professionals that are working in hospital settings, it’s one of those things if you can get tested, you want to know. That way you know you’re not spreading it.
One of the things I’ve tried to emphasize to my friends and others is by getting tested and knowing, you’re doing yourself a favor and helping reduce that risk for others. And we’re at the point now in healthcare and medicine where those things can make use for benefit.
On the Latinx and African American populations having higher rates and dying at higher rates
Great question. And so with the Latinx and Hispanic population in terms of positive rates, it’s much higher than that of Caucasians in both rates and also mortality. And I would say that there is, again, I think it’s multifactorial. I’ll be honest, prior to COVID-19, you can look at data on things such as diabetes, and hypertension, and heart failure and COPD (chronic obstructive pulmonary disease) right? You can look at these other types of health diseases and see in that data that is adversely affecting people of color, Hispanics and African Americans in particular, if you look at the cause of death.
Even if you look at other things such as infant mortality, death rate from delivery, that are adversely affecting people of color. Those populations haven’t had the same type of resources and are overlooked. So COVID-19, in my mind, is not drastically different from that.
They don’t have the same access to healthcare professionals, for primary care physicians. They don’t have the same access for medication, they may make it harder to get into an appointment to see a provider. Even taking off of work, working multiple jobs where you’re, you know, sick. You don’t want to be sick because you have to go into work, you’re one of the people supporting your family members. Some of those same factors, in my mind that are affecting those other areas of healthcare outcomes, are also affecting that of COVID-19. So as a society, my answer — my bigger picture answer to that — is that as a society, we really need to work. We are doing the work — I don’t want to say that we’re not in that regard — but we have so much more work to do.
One of the things that’s also made it a little bit challenging for myself, especially in the primary care setting, is that we have patients who don’t want to come into clinics [right now]. The feeling is though that if I go to the clinic, I’m going to get COVID-19, even though we’re doing weekly testing for anyone who’s coming onsite. You’re getting the temperature checks and symptoms screening at the door. We’re minimizing the number of people that can be in the clinic at the same time. We’re doing all these things to reduce risk of transmission. So I would say, the primary health clinic is probably the safest place to be. That stuff isn’t happening at, you know, at your local supermarket or your local pharmacy. They may not be doing that same type of screening. But people have a stigmatism of, “I don’t want to come into the doctor’s office,” and therefore certain things that you would normally be able to do, whether it’s your blood pressure check, your fundic eye screening for diabetes, checking your labs for your cholesterol level, checking your kidney function — some of those things may not be happening as efficiently as they normally would be. And I think that’s one of the challenges that we’re working with too. And again, that’s affecting a lot of the minorities in particular.
When will the pandemic end?
I wish I had the answer to that. That’s the millionaire dollar answer. So one of the things that I would say, until we have a treatment, until we have, a home test that you can take at home. And people can say “Do I have COVID?” I can check in to get the answer in 30 minutes and now I know I need to isolate.
Maybe if we have like a little bit more standards within the United States kind of across-the-board. And have a little bit more standard testing strategy. Ideally, we have some of those things lined up. I don’t want to get political on Facebook, which happens a lot now. If you had invested more upfront prior to the pandemic starting, I think we would have made more headway and I think any healthcare professional would tell you that. The concern that I have is that going into September and October, when you have flu season picking up you have pneumonia picking up, as I was just mentioning, it makes it really harder to decipher, what is this? Is it COVID or flu or something else? So I really think that from a policy level, from local, state or federal, we have a strategy of testing or a strategy of isolation or even a treatment, if there’s a treatment that comes to be. Unless we have something on each of those types of layers, I think the pandemic is going to be difficult to really manage and control. This is my opinion, of course. But I think if you ask a lot of other healthcare professionals, those people working in a clinic such as Native American or even those people who are working on the frontline at the hospital and emergency department, or admitting people to the hospital. It’s scary to think about what the fall might be like. Even if you look at protection like PPE, face shields, gloves, gowns, things like that. I think that having a face mask is great, having a visor is great. Those are great steps in the right direction. Handwashing, hand sanitizers. That’s great. So we’re moving in the right direction overall but I wish I had a black box to answer that to know what that looks like. I’d probably make a lot of money.
I think right now, it’s going to be a little bit piecemeal until we come up with the full on strategy and if you look at data from other countries. You look at Korea, you look at Japan, some other places in Asia where they’ve actually had some uptick in COVID-19. Not a lot, it wasn’t a substantial amount, but there was some uptick for a while. So there’s a possibility that even as our numbers start trending down, as I saw this week and over the weekend, there still a real possibility it could jump back some time soon.
On herbal and natural remedies
Great question. There have been some communities, East Asian, South Asian as well, that want to do a traditional, herbal medicine, as opposed to Western medicine. We’re just saying, take care of yourself, with hydration and fever reduction, etcetera. So, if people or communities feel that they wanted to do some herbal supplements, I’m not one to say, don’t do it if you feel like it. Because there’s not, like, a true treatment.
Though as I mentioned earlier, understanding medicine and understanding the biopathways and how things work, I can’t say it does or doesn’t work. If it makes someone feel better and it’s an over-the-counter or a tea, then I say go for it. But if someone is truly sick and really in bad shape, I say, use the technology and use the medicines that are created. Go to the hospital, get IV fluids, whatever it is that you may need at that point. But to fully answer the question, if you have something that makes you feel better when it’s just a tea or remedy over the counter, then great. But do I think that that will fully stop it? Not necessarily, right? And that’s the thing that I just want to make sure that people understand. I can’t endorse that, but if it’s something that you feel personally — like Gatorade — makes [someone] feel a lot better, then go for it.
On COVID-19 data and data bias
So data is only as good as what you collect, right? It is only as good as what you’re choosing to look at and collect. Especially if something is self-reported, so for example, if you have 100 surveys and you’re going to send it out to East Asians and Southeast Asians then miss African Americans, you may hypothetically have 100% return of Caucasian, which may have a 20% return for African Americans. So some of the information that is self reporting in particular is biased because it’s self reporting.
Another example is the CDC came out adjusting the testing protocol in who should get tested and there’s some things in there that seem way more conservative than it was before. That changed, and that also changes the amount of data that you’re going to collect from different populations as well.
So if you stopped testing as many people, your numbers go down, right? And that doesn’t mean that COVID is not there, that just means that you’re not testing as much. The data looks much different. Whenever you’re doing any particular study, you always have to be cognizant of the data: Where is it coming from, how is it collected, and what it’s actually trying to show.
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Looks like a great talk, so sorry I missed it. I no longer live in Oakland, but I see how this pandemic plays out first hand at the urgent care center I now help run. These conversations are essential.