HJNO May/Jun 2023

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAY / JUN 2023 29 onAccess to Lethal Means”(ED CALM). We funded the evaluation of this and in it, found that among parents who went through this when a youth would present pro suicidal attempt, 100% reported guns were locked up post intervention. Again, that’s just talk- ing with people about the importance of this and giving them the tools that they need. I do think together we can make such a difference. We have opportunities at so many touchpoints in a person’s life and in various aspects of the community to do so. Some of the successes that we have seen over the years are when you look at things like viral hepatitis, 750,000Americans have been treated with hep C medications in the past decade. Similarly, we are now seeing that for children, our MMR vaccine cov- erage is now exceeding the 90% target again for over a decade, really having those impacts. I led the first opioid prescribing guideline at CDC. We’ve now seen a 40% decrease in high MME prescriptions. We’re also seeing a decrease in deaths from anti- biotic resistance from safer stewardship — about a 28% decrease since 2013 — and we’re seeing HIV deaths in the U.S. have dropped by about 50% in teens and up. I just want to thank all of you. I can’t imagine being back at a better place know- ing that Tulane has at least 30 MD/MPHs a year. I know that this has been a really spe- cial place for many of us. And just looking at the middle row, I could just talk about all the accomplishments of my classmates and the work that they’re doing, and I hope that all of you have the chance to talk with them at the reception. So, thank you for having me here today. Audience Question Any updates on Mpox? Houry With Mpox, we are seeing that cases are coming down. We’ve, at CDC, actually brought it back to a center-level response, but I think with Mpox, one of the things that’s really important to do is, just like with hepatitis and HIV, this is the time to screen for other sexually transmitted infec- tions and to use that as a moment when we’re screening for HIV because we saw a lot of co-infections. But we are happy that the numbers have continued to remain low, so we are optimistic. I think it’s still an opportunity to look for other STIs and other conditions. Audience Question I was fascinated by your comment about the pilot program for community health workers in Louisi- ana. We had another alumnus who spoke yesterday who runs a healthcare opera- tion in Uganda and trains community health workers, has been very successful and improved a lot of health indicators. I remember he mentioned he had a conver- sation with Tony Fauci, and he said, “Why don’t we do this in the United States?” I think that’s a great question because so many L/MICs have this community health worker model; and it sounds like we’re getting there, but is this something that CDC has a broader strategy for imple- menting for improving health outcomes? Houry Yes, we were fortunate this past year to receive funding for public health infra- structure. So, actually, Louisiana is getting about $46 million now to focus on hiring the public health workforce. And some of that will likely be community health work- ers with 40% of that going to local health departments and communities. Our hope is that it really does build the public health infrastructure to support more of that. I also think it’s not just the community health workers, but then we look at agriculture and some of the extender programs in rural areas — that’s another untapped area. But I agree. I think community health workers trusted in the areas can really link to com- munity populations. And it’s something we just started in the past year or two at CDC and look forward to seeing more of. Audience Question I’m curious; the COVID pandemic really seemed to come out of “nowhere.” How is the CDC preparing for the next thing on the horizon that we maybe haven’t even thought of yet? Houry I’ll give you an answer, and I’ll give you a nonanswer also. Because as I’ve been watching a lot of the health issues that are leading causes of death, I think COVID cer- tainly has been a huge issue, and it’s strained an already strained health system and pub- lic health system. We certainly need to do things like genomic sequencing and sur- veillance, and we are doing that, and now we have a lot more syndrome surveillance. We’re looking at emergency departments for surges in different sorts of influenza- like illnesses and working internationally as well. That being said, things like overdose, maternal mortality, suicide, firearms were all going up pre-pandemic, and I don’t want to lose sight of those as well. So, that’s my nonanswer. Audience Question I know that since the COVID-19 pandemic, rates of antibiotic resistance have raised pretty dramatically in numerous pathogens of significance. So, since it’s obviously a viral pandemic, what do you think was the biggest con- tributing factor to that? And hopefully, we don’t have a future pandemic of the size of COVID-19; but if there was, what healthcare policy changes do you think we should enact to prevent the rise of AMR? Houry During the initial stages of the pan- demic, some people had secondary infec- tions, so we were treating with antibiotics, and I think there was also such a focus on COVID itself that some of the other prac- tices slid. We weren’t doing the same antibi- otic stewardship as we were, and we did see, as you pointed out, a significant increase and, really, a backslide of it. I think it’s just reheightening what we’re doing in continu- ing surveillance in hospitals and sharing this information to continue with appropriate antibiotic prescribing. I think we’ll see a trend back in the correct direction as we’re now focusing on, again, I think with COVID, a lot of it was secondary infections and truly the focus of COVID and less on some of the bacterial infections. n