Healthy Spaces

 David Bishai, MD, MPH, PhD By the rivers of Babylon, there we sat down, yea, we wept when we remembered Zion. Psalm 137:1. Pity the eternal frustration of priests--knowing what people ought to do and never being able to get them all to do it. The priest's playbook ties promises of heaven and hell to scriptural conformity.  "Repent or be damned!" echoes from pulpits and tabernacles.   Tales of Babylon and brimstone hailing down at any hint of idol worship still quicken the blood of would-be sinners.  Maybe before the printing press and the enlightenment olden-day priests came close to wiping out sin, but I doubt it.   Other social species are wired for conformity, but in humans the neural circuits for assent run through the frontal lobe.  For 1000 people to do the same thing, 1000 brains have to deliberate.  F or 990 out of 1000 conforming is the easy way.  Doing what others do can save time and effort.    Independent thought ...

Structural Racism and COVID-19  A View from the Trenches David Bishai, Health Officer of Harford County February 15, 2021 In my county whites are three times more likely than blacks to have been vaccinated for COVID-19.  As health officer it's my job to fix that.  I must do so mindful of the generosity of the American taxpayers who paid for all the vaccines entrusted to our health department.  Those taxpayers want justice, fairness, and an end to COVID-19.  This is one of those situations where a common process that is not designed to offer advantages ends up succumbing to built-in disparities in terms of who knows what, who has what and past lived experiences that are not the same for everybody in today's America. Vaccine clinic appointments are creatures of the internet.  Some seniors can get online or get their kids to go online for them.  For others there is the telephone.  I have made the public health department's vaccine pre-registration sy...

Why a   Professor Becomes a Health Officer David Bishai, MD, MPH, PhD On January 1, 2021 I left my job as a tenured public health professor to become a full time health officer for Harford County Maryland.  I did this to help save lives and ultimately to help rescue a discipline that is in disrepair and disarray. There is no way to spin 2020 as a success story for American public health. Professionals must be judged by their results.    Architects whose buildings collapse, coaches who lose, doctors whose patients die, must all re-examine their approach. Americans  have been dying. Public health must avoid the temptation to just blame politicians and skimpy budgets.  We must soul search and recommit to all of our discipline. Public health is the practice of science in a value rich environment. Historically, public health has helped transform foul, dank, sewage strewn communities into clean healthy human habitats. Public health conquered, TB, cholera, malar...

ACE Blockers and Coronavirus Infections David Bishai, MD, MPH, PhD Johns Hopkins Bloomberg School of Public Health March 19, 2020 After the SARS-CoV-2 virus gets into a person’s nose,   throat, or lungs it can’t make them sick unless it actually gains entry into the inside of the epithelial cells that line those tissues. There is a receptor on human respiratory epithelial cells called the Angiotensin Converting Enzyme 2 (ACE-2). Its usual job is to cleave proangiotensin into  smaller molecules like angiotensin1-7 that help repair blood vessels in the lung. ( McKinney, et al. 2014 )   The SARS viruses became pathogens when they mutated to have an affinity for one small spot on human ACE-2 (Figure 1).   When ACE-2 receptors are attacked there may be less angiotensin 1-7 and less ability to repair blood vessels in the lung. Gurwitz (2020) Figure 1. Electron microgram of the ACE-2 Receptor (Purple and Blue) and SARS-CoV-2 virus (Yellow) Source Ya...