 HBC Dutchess Radio, welcome back. I'm your host, Jared Carter. We are continuing our coverage of the global response to the COVID-19 pandemic. And we are having specific emphasis on our dynamic leaders, faculty, staff, students, alumni who are playing a significant role in keeping black communities and campus communities protected and informed during this response period. There is no better guest to have on than our distinguished leader today. He is Dr. James Hildreth, the president of the Manhattan Medical College in Nashville, who has made headlines over weeks for his expertise and his forward thinking, along with that of his faculty, in trying to develop medical solutions and treatment options with a particular emphasis on the African-American community during this pandemic. So, doc, it is an honor to have you on today, man. Thank you so much for having me. I'm so pleased to be here. So today you announced that, or at least this week, leading up to this, you've been talking about the priority that the nation has to take in protecting the lives of brothers and sisters, particularly those of us in African-American communities, where we know that the statistics on our infection and death rate are higher and disparate in comparison to other ethnic groups. You have recently talked about Mahary's effort to develop antiviral treatments for this. This is obviously a huge thing in breaking news. Can you talk about that process and what is happening at Mahary to help the nation and the world, in fact, get to a better place with this pandemic? So we have a great team of scientists that Mahary, who are interested in infectious diseases, they've done work on HIV, of course, which is my field, on Zika, parasitic infections, terpenisomes. And so clearly, like the rest of the scientific world, we'd like to turn our expertise to try to find a solution for this horrible virus that's causing a rick and such havoc in our communities. And so we're doing two things, really. One, myself and one of our faculty members are working on antivirals. We're actually taking drugs that we were developing for HIV and another one for Zika. We are changing the composition slightly to make it targeted to the coronavirus. And we're gonna be evaluating those two compounds to see whether or not they have some value in slowing down the virus or blocking infection by the virus. And I'm very excited about that. The other thing that we're doing is we set up an assessment center for COVID-19 back in early March. We weren't able to launch it right away because we couldn't get supplies that we needed, but we launched it at the end of the month and we've now tested hundreds of people from our community. And I just feel it's very important that we do that because, as you said, the virus when it infects members of our community, the outcomes are not as good as they are for other communities. I heard you on another interview talk about the, and I guess I don't have the right terminology for it, but the infection rate for this is about a four. I mean, for every one person, there's a possibility of spreading it to four people. Can you kind of explain that to folks who've never really gotten into the details about what this virus is and how it gets transmitted so quickly to different people? So in virology, we rate the infectiousness or contagiousness in viruses according to how many people an infected person could possibly transmit the virus to. A familiar virus is measles. It has an effective, basic reproductive rate of 12 to 18. That means that every person who is infected by measles who does not have their virus controlled can infect somewhere between 12 and 18 people. The number for the coronavirus in this case is considerably lower, but it's still significant. Depending on the area of the country you're looking, it's gonna be somewhere between two and five. And if we just say that that number is four, that means that every person infected with coronavirus could pass the virus on to four other people. And that would mean if you do the math, that a single person over the period of 60 days could be responsible for a million people getting infected. That's just how infectious this virus is. And that's how we get to the numbers that we have worldwide. For African Americans, there's such an emphasis, at least over the last two weeks, about the disproportionate numbers that we're facing in infections and death rate. And so much of that conversation has talked about these underlying health conditions, asthma, and cardiovascular issues, and things with lung capacity. As a doctor, as a practitioner, and as an academician, do you look at that and say, hey, this is a hard fact? Or do you look at it and say, well, there's more to the story than that? There's a other narrative beyond the one that just leaks out black folks who are just unhealthier than other people. Well, there are layers to this, and I would start with the biology. The biology is that when a virus infects our bodies, the immune system is responsible for expelling it from our bodies. So if your immune system is not functioning at the highest level, you will not get rid of the virus as quickly as someone who might. The other thing is viruses tend to damage the organs that they target. So for example, hepatitis virus causes liver damage and because it infects the liver, there are viruses that infect the heart that cause myocarditis, they cause heart failure because they infect the heart and it fails. In this case, coronavirus is targeting the lungs. And so if you have any condition whatsoever that compromises your lung function, you're not gonna do as well as somebody who does not have that. So if you smoke, if you vape, if you have asthma, if you have any other condition that makes your lungs less than optimal, when you get infected by coronavirus, we can predict that you're likely to have a poor outcome. And there are other things that fit that category, cardiovascular disease, asthma, diabetes, hypertension. Those are all things that either in combination of the immune system and our lungs, they cause them not to function as highly. So this was highly predictable that in the African-American community, we were gonna be hit much harder than other populations. Because as you know, for decades now, this is not a new thing. There's been a disproportionate burden of those diseases in our communities. And a great example is the other pandemic that's still raging, which is HIV. We're only 13% of the population, but 43% of all the HIV infections occur in African-Americans. So this is not new. And the biology explains it. The social constructs that make us less healthy than others, they will have to be addressed. And I think that I'm hoping that one thing that will come out of this pandemic is that leaders in the appropriate settings will make the decision needed to change that. But for right now, because of social determinants of health, we are less healthy and the virus is racing to our communities and causing much more harm than it is in other communities. Let's go back a little bit because you raise an interesting point. One of the effective things that HBCUs in particular do is they build awareness in black communities about health maladies and treatment options and the importance of going to a doctor regularly, the importance of participating in trials. Can you kind of reflect on when you first heard about this novel virus and when the moment kind of occurred for you, like man, this is gonna be serious and this is gonna hurt or kill a lot of people? In January, when I started reading the reports coming out of China, and keep in mind that China is a very racially homogeneous place. There's not a lot compared to other countries, of course, that genetic diversity in terms of racial attributes is much less in China than it would be elsewhere. But even in China, if you smoked, had heart disease, diabetes or high blood pressure, they also observed that those individuals tend to die much more often and have severe disease. So if you extrapolate to the fact that this virus is definitely gonna spread around the world, and unfortunately, we as a country got a late start because of the politics and just be honest about that. We had a late start, but knowing that, they had observed that in China and knowing that the virus was gonna spread around the globe, you could extrapolate fairly quickly and a lot of people did, including me, but this is gonna be bad news for our communities. And unfortunately, that has turned out to be the case. What has been your reaction to the social distancing guidelines are at least at this point, our capacity to observe them and kind of slow down the spread, even though we're still in kind of a dangerous place? Have you been satisfied with those things? Do you think that we should be more aggressive? And what's your reaction to, I guess the socioeconomic part of this, particularly as a practitioner, because you gotta look at this and say, yeah, we need jobs and money and all that, but people gotta be alive to have the jobs and the money. Well, yeah, I mean, that's the other thing, is that layered on top of the diseases or conditions that make us more prone to severe disease, we are not necessarily able to do the things that other people are doing or do them as well. For example, if you live in a multi-generational household, you may not be able to do the social distancing when you're in your home, if someone happens to test positive for COVID-19, which means that if you're living with an elderly grandparent or parent and you get positive and you can't move out of the house or have somewhere to go, there's a great probability that that virus will now spread to that whole family of it, right? So those social factors are contributing to a rapid, more rapid spread in some communities, i.e., some African American communities, then would be the case in some white communities where the density in the house and the ability to socially isolate and keep distance in the house is much better. So one of the things that I've been advocating for is that in our communities, we're gonna need the capacity to provide lodging or place to stay for some individuals for some sort of period of time so they don't have to go back to the household where there are elderly parents or grandparents. In other words, to keep those individuals protected, we have to provide accommodations for those who might test positive who otherwise will be going back into the family setting and infecting others. And that's one of the biggest concerns I have is that it's not as easy for some folks in our communities to do those things as it is in majority communities. And so that's just another factor that's adding to the challenge we have to deal with this virus compared to the majority population. When you think about the numbers of African Americans, particularly with this virus, do you think that even as large as they are that that's accurate or could we be missing a sizable portion of people who never reported being sick, never reported to a hospital, maybe dying at home? Are you afraid that there may be under-representation in those figures? Well, I'm convinced that the numbers we have are not accurate. And in fact, in New York, I just read or heard, they're gonna reclassify some people who died in recent weeks, who almost certainly died of coronavirus infection. And at the time, they didn't get tested or we weren't fully appreciating what those symptoms might have represented. So they're actually going back and changing some death records to reflect the fact that those individuals probably had COVID-19. Another thing you point out, which is really, really important here, many individuals can be infected, have no awareness that they're infected, while at the same time transmitting the virus to those that they interact with. The great example that everybody probably knows is Joe Stephanopoulos, who's a journalist who works for ABC, I think, who got the virus, was tested positive, and according to him, and there are many others like him, he never had symptoms that would have made him think he had a viral infection. And so, and that may be related to the status of one's immune system. It might be related to the mode of infection that you have, but I'm convinced that the virus was circulating in the American population, U.S. population, long before the full awareness of it was there. And I said that because the world has become a small place and people are traveling between continents freely now. And I'm reasonably sure that one of the major airports that was connected to China, San Francisco, New York, Miami, whatever it might be, that we've had the virus in this country for a few months, much longer than part of far. Let's go back to the work that you and your team are doing with the development of these anti-viral treatments. What kind of support have you gotten from state, federal agencies in funding or knowledge-based transfer? What is that behind the scenes look like for institutions like Meharry that are at the forefront of kind of helping to develop solutions for this? Well, of course, we have very limited resources, but I think like other organizations, we've decided to invest some of those limited resources in this because it's so important. So what we're doing is we're trying to get preliminary evidence or preliminary data to show that there is something worth pursuing here. And at that point, we're only a couple of weeks away from having that. Then we're going to submit proposals to try to get some additional funding for this. Drug development is a very expensive undertaking. And we want to make sure that you have some good solid evidence that what you're pursuing might actually be something worthwhile. And so we're in that stage now. And it's so promising based on the science that's already been done. So we're in the process now of confirming in kind of test tube experiments that this compound can target coronaviruses. And once we have that preliminary data, we can move on to the next step. And we are collaborating with, I'm collaborating with some scientists in Brazil, for example, and I know that's happening all over the world that people are collaborating globally, trying to accelerate the discovery process. And for me as a scientist, that's very exciting to know that that's happening. And then we finish up with what I hope is not an easier question, but certainly one of note that a lot of folks, particularly in your seat, are considering, you're a little unique in that your student body and your community is comprised of graduate students, medical school students. But when you look at the future of, I guess the industry of higher education and what happens with international students and student recruitment, what happens with people coming to campus, what happens with researchers coming to campus, are you concerned that the industry will change so much because of what we have to do just to stay safe and alive? That Mahari or other HBCUs may look really, really different in the near and distant future in terms of what a campus looks like and how it operates. Well, I think one thing is that the pandemic accelerated a process that was already underway. And that is converting a lot of our teaching to a flipped, we call it a flipped classroom whereby the students are learning in their own spaces through technology. A lot of our professors have committed their lectures to a video where the students can watch it when they want to or need to. And then the face-to-face time, which is really by Zoom or through technology is now about discussion. So to one degree, the pandemic just accelerated a process that most universities had already undertaken to change how we teach is a little bit more complicated when students have to be in a clinic interacting with patients to learn their craft. And so we've had to bring back all of our students who are in clinical rotations for safety reasons, but also to free up PPE for the doctors and frontline folks. So we are like all the other medical schools trying to figure out how to make sure our students can have acquired the skills they need to finish their medical training and go on to their residency. But I do think that when we get back to normal it's not gonna be the old normal, it's gonna be a new normal. The virus is gonna be with us until we find a vaccine probably for 18 months to two years. And so I would say that during that time we're all gonna have to find ways to keep ourselves protected in our communities. So folks need to know it's not gonna be going back to normal. We're not gonna flip a switch and be finding ourselves sitting in a crowded theater with hundreds of people and more for a little while. And I think in terms of education and teaching a lot of it's gonna remain in the flipped classroom kind of modality. But there's some things where you have to be in somebody's space. And a good example of that is our dental students. Our dental clinics are virtually shut down because by their very nature what dentists do create aerosols. And aerosols, of course, are one of the ways that this virus is transmitted. So from my perspective that the influence or the impact has been pretty profound especially for our dentists, our dental faculty and our dental students. But we're adjusting, we're learning from other medical schools, other dental schools. And that's been exciting as well to share best practices so we can all get through this together. But you're absolutely right. Things are gonna be different. We're not gonna go back to the old normal. We're gonna be going back to a new normal which is a combination of things we used to do but some new things we have to do just to keep each other protected. So I think that's gonna last probably for 18 months or so.