In episode 13 of Knights Do That, we speak with Elena Cyrus, an infectious disease epidemiologist at UCF’s College of Medicine. She discusses her expertise and research in infectious diseases, public health and COVID-19 vaccines.

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Elena Cyrus: One of the major things about COVID that has changed our experience, it has been a really exciting creative time for science. I don’t know how else to describe it. Usually for me as a scientist, by the time I get my grants funded, the science is outdated because you go through all this bureaucracy and there’s all this red tape and everything. Because there was this emergency and because there was this need for everything to go through in an expedited manner, we had more bandwidth to do things that we typically would not have done. And so that really, really spurred the innovation of science.

Alex Cumming: Welcome back to another episode of Knights Do That. Today, I’m speaking with an infectious disease epidemiologist Elena Cyrus from UCF’s College of Medicine. As we approach the one-year mark since the vaccines were granted emergency approval we wanted to sit down with Elena to discuss public health, COVID-19 vaccines and learn more about her expertise in the areas of infectious diseases. This is an incredibly important conversation and I’m excited to share it with you all.

What got you interested in epidemiology?

Elena Cyrus: Like most people, probably before COVID, when I started doing public health training I didn’t know what epidemiology was either. So I started doing my master’s in public health at University of Miami a long time ago, many years ago. And there part of the core classes for public health, one of them is epidemiology. It’s one of the core foundational classes for public health. And there I met one of my primary mentors. Her name is Dr. Mary Jo Trepka. She was part of the Epidemiology Surveillance Unit for the Department of Health. And so she was the first person that introduced me to the concept of epidemiology and she’s still my mentor to this day. She’s the chair of the epi department actually at FIU and on the task force for COVID. She’s the one that trained me specifically to be prepared for this epidemic.

And then within public health there are multiple things that you can do. Public health is broad, like medicine. But I really gravitated towards epidemiology because epidemiology is the sort of crossroads between statistics and clinical medicine. So I don’t have a background in biology or in physical medicine.

I actually have a background in liberal arts. So it’s easy for someone who doesn’t come from a classical science background to enter through something like epidemiology because I was good at math, I was good at statistics, and I was good at writing. And that’s essentially what epi is. It’s really a method for systematic problem solving through data analysis. And so I fell in love with it and have been doing it ever since over 20 something years.

Alex Cumming: I liked that you said that there’s a background in liberal arts mean that somebody like myself could — science and math are not my strong suit and I’ve never gone into the data analytics field. But do you come across people who are just incredible at math and science, but stringing a sentence together that’s where they get weary?

Elena Cyrus: Yeah. Maybe I shouldn’t have always outed myself, whenever I tell people I have a liberal arts background and they go, “Why are you a professor of medicine?”

But a key part of our job as epidemiologists is interpretation of data. And so you have to be able to be good at the written word, as well as the spoken word. It’s important not only for interpretation of data in terms of the messages that you convey to the community, but it’s important for manuscript writing, for grant writing. And so actually some of the best epidemiologists we have are really strong writers, usually, or they have very good editors.

Alex Cumming: That always helps. Believe you me, being a part of this show, good editors help, believe you me.

Elena Cyrus: Yeah.

Alex Cumming: Is there a difference between, you’d mentioned, an epidemic and a pandemic? Is there a specific detail that makes them different?

Elena Cyrus: Pandemic is essentially a type of epidemic. The origin of the word epidemic means the spread of a disease within a population, right? So demos is population and epi is usually related to disease and so forth. A pandemic now refers to a global epidemic. So an epidemic can be something that’s local or concentrated within a region, a city, a state, a country. As soon as you put the word pan — and pan is global for anything, Pan-Africanism, pandemic, Pangea — then you take on a more global perspective.

Alex Cumming: Sweet. I didn’t know that. Cool detail. So, I can imagine that the pandemic has impacted your work quite a bit during this time. What is your work been like?

Elena Cyrus: One of the benefits of being an epidemiologist typically, or most people that go into this line of work, they typically like solitude. So epidemiologists traditionally are in their office with tons and tons of data analyzing and writing. And we’re sort of the background person. When we find key findings or key results, we send it over to policymakers. We send it over to programmatic people and they’re the ones that disseminate messages.

One of the biggest differences, not just for me, but for most epidemiologists that work in the U.S. is the level of visibility that we’ve had in the past two years. So three years ago, if I said to someone that I was an epidemiologist, they would mix it up with a dermatologist. They would start showing me their skin. I’m like, “Well, I can’t help you.” Now, there is a clear understanding of the field, of what we do. The internet is there so people are way more knowledgeable. I think that is one of the key things. And that was a huge amount of stress on us because not only with the demands in terms of the workload had that exponentially multiplied, but also the demands of just our physical presence, requests and meetings, requests boards, everyone was concerned.

And I think one of the things that happened with COVID that highlighted one of the weaknesses of the U.S. is that we are a public health system was not robust enough. It wasn’t staffed enough. And that was evident even at our level, there aren’t enough epidemiologists, right? The society for epidemiological research is a fairly small society. We all knew each other. I trained under Anthony Fauci when I was coming up, to tell you like how few of us that are. I think with this epidemic, it has given visibility to the field. So we’ve seen an uptick in terms of applications to the programs, at all levels, at undergrad, master’s level, as well as doctoral level. And not just in public health, but in just technical, like health sciences, nursing medicine. And it’s a great boon for us because, just to give you an example, (when) I started doing public health and epidemiology it was so unknown that the state of Florida subsidized my degree because they were trying to get more people to be interested in preventive medicine and epidemiology. That’s not the case now, obviously, but in the early 2000s, that’s how it was. So that’s one main thing I think is more awareness of the community about the role of epidemiologists, that we exist, and how much we influence policymakers, the programs, and social programs that exist.

The other major thing is that, you can be an epidemiologist like you can be a physician, but there are all types of epidemiologists, right? There are infectious disease epidemiologist, people who do chronic disease, environmentalist. So I specifically am an infectious disease epidemiologist. And before COVID existed, I trained specifically in HIV, STD research, substance use and some of these factors. So when COVID emerged, there were certain similarities of that particular epidemic that aligned with the experience of HIV from the ’80s into the early 2000s.

And so you saw typically within the field of epidemiology, those who were more aligned within HIV research, they were called upon into the COVID pandemic. So then you have a subset of people, so an even smaller group of people. And for all of us our work doubled essentially. So I think of it in a sense of two years ago, I might’ve had one job at UCF and now theoretically have four jobs because I have my pre-existing research portfolio for all those things that were important for the community, things that had to be addressed. Plus now I have two additional grants related to COVID. So yeah, it’s been a stretch on personnel, on time, on the volume. So those are two things and I think those are the key things.

I think the other thing that’s interesting to me is with HIV, and you’ll hear other HIV researchers talking about this, there was a natural stigma that was associated with HIV because it was a sexual route of transmission. And there was this idea of morality that was associated with HIV. And that sort of made sense to me, right? Especially the way the demographic profile of the disease (was) when it initially emerged. With COVID ironically, even though it was something that was asexual, if you will, there was still that level of stigma. It was stigma and a sense of — I just heard Dave Chappelle the other day talking and he said when he got COVID, he felt dirty. And that was the feeling that was being I think implied in the earlier parts of the disease. Those who got the disease, it was almost like they were in a lower social class. They were unhygienic, they did something ethically or morally that made them more susceptible and more vulnerable to COVID-19. And so that was a big problem for us because stigma, apart from it just being an unkind thing to do, stigma is a huge barrier in terms of public health. It prevents people from testing, from screening because they don’t want to know. If they do test or screen and they don’t report it so that affects our patient contact tracing, if you will. It also affects, in terms of certain programmatic things that we can do, public health messaging. So stigma that we saw with HIV throughout the world, again, throughout Sub-Saharan Africa and Latin America, Caribbean region, and here in the U.S., we saw it again with COVID.

And so some of those things we had to move over into the line of COVID research as well. I think those are like the three big things for me for the past two years.

Alex Cumming: Wow.

Oh, I’m glad to hear that the epidemiology field is being so noted among these young, college-age students.

I can imagine that a lot of people, when they’re inquiring about going into medicine, you think about what you said, like dermatology or maybe dental school or going into being a nurse. But I think epidemiology is, especially now we’ve seen the importance of these individuals and, as you said, we’re lacking in numbers. So it’s good to know that there’s this reinvigoration in the field for epidemiologists and we’ve seen their importance firsthand of — what was it, what did Anthony Fauci, was it not sexiest man alive? I remember he was on that cover that magazine.

Elena Cyrus: People, I think.

Alex Cumming: Something like that. He was like fashionable or cool like that. Everybody knows who that man is now, regardless if they know his background and he’s been in the public eye 30 something years now.

Elena Cyrus: I would say in terms of the popularity, we see it even at UCF. So last year at UCF in the College of Medicine, I had two mentees, two medical students who approached me that asked me to sit in my lab and be part of the lab. And our research experience this year, I had I think 16 students that asked me and we accepted eight into the lab. I’m saying that to say that typically epidemiologists can be Ph.D.s, but a lot of them are physician scientists.

So most of my mentors are M.D.s and Ph.D.s. And outside of the U.S. to be an epidemiologist typically you need an M.D. as well, not just a doctoral level. So different qualifications in different countries. But yes, there’s been a huge surge in popularity.

Alex Cumming: That’s good to hear. More scientists and doctors the better. You said you were mentored by Anthony Fauci, for your time working with him what did you learn and what did you learn from the pandemic as a whole?

Elena Cyrus: So I guess I should get the context in which so I am a Fogarty Fellow and Fogarty Fellow are typically global health fellows that the National Institutes of Health sends out all over the world to train in global health research and equity research specifically. So, it’s like Fulbright, but Fulbright is liberal arts and Fogarty is specifically health sciences. And so Anthony Fauci, comes in annually for every cohort of 40 fellows to lecture with them and also to find out where they’re being placed within the world and what mission we’re doing on behalf of NIH. Before you are placed — so I was placed in Peru, I stayed there for two years. So typically before you’re placed, you will go before him and you’ll just do a one minute spiel and say, “Dr. Fauci this is where I’m going, this is what I’m doing, do you approve? And so that’s how that happens. So I saw him more in a global health context, if you will. And I think what is interesting for all of us is that we never believed that we would see this level of an infectious disease epidemic in the United States.

I’ve lived in Sub-Saharan Africa. I lived in Latin America and Caribbean region. And I know what it is to have an emerging pathogen in that setting.

So I think what I’ve learned from him, I think when he finished with HIV, when he finished with NIAD, he sort of felt like his legacy had been set and that was it for him. And he was sort of off the hook and it was on to us the new generation to deal with whatever was coming after him.

Alex Cumming: I believe it entirely. It’s a daily thing to have to think about and reflect on how to get the best information out there.

Elena, you have a background as a clinical trials manager. Very cool.

Elena Cyrus: Thank you.

Alex Cumming: I know that some people have had some qualms about the timeline when it came to the development of the COVID vaccine. Can you give some insight into the process of vaccine development?

Elena Cyrus: Yeah, it’s typically a very long process. It goes through phase one all the way up to phase four and depending on the drug and the types of side effects, that entire process can be anywhere as far as 10 years. So I understand people’s lack of trust, hesitation and suspicion that this vaccine was developed in such a short period of time, given the traditional trajectory for drug development. But there’s a number of unknowns or I think things that are not widely understood by the community. It was perfect timing. I don’t know how else to describe it. I saw that you had another interview with one of the developers of the mRNA, and I’m sure he spoke to this. So the mRNA was in development for several years before COVID existed. They were looking at it for different outcomes. They were looking at it for cancer, for HIV, but it had moved quite far along in terms of the clinical drug development trials, so it was right there in human subject development. When COVID emerged, we were able to, and this is another thing we took from HIV, which is what the mRNAs were being developed for. We just took it immediately and said, “OK, there are other virologists and immunologists have been studying the virus, the coronavirus now for decades, because we’ve had MERS, we’ve had other SARS viruses. So they understood the family of viruses. And then you had the mRNAs that were in development and poised to move into human subject research. So those two things were at a fairly advanced stage of research and development. It’s nothing more than luck, if you really — well they were just able to take that technology and quickly adapt it over to COVID-19, look at the safety profile, see that it made sense, and then implement it.

That’s why it rolled out as quickly as it did. The other thing is that NIH partnered with industry, right? So industry has resources available that we may not necessarily have available to us in a public space. With that, what do you say symbiosis or a combination or collaboration with industry? Again, we were able to move faster. I would admit that since I’ve been doing this type of work, it is the fastest that I’ve ever seen anything happen. But with my background in clinical trials research, with my background as an epidemiologist, and I’m also an interventionist, I understood all of the processes that were occurring. And I felt really confident in terms of the integrity of the data, in terms of the standards of operating procedures. I knew where the technology came from. So it made perfect sense to me, but I understood how from an outside point of view, it sort of looked like magic.

The other thing, to go back to one of your questions you asked me, one of the major things about COVID that has changed our experience, it has been a really exciting creative time for science. I don’t know how else to describe it. Usually for me as a scientist, by the time I get my grants funded, the science is outdated because you go through all this bureaucracy and there’s all this red tape and everything. Because there was this emergency and because there was this need for everything to go through in an expedited manner, we had more bandwidth to do things that we typically would not have done. And so that really, really spurred the innovation of science. So while it was a morbid time and the casualties were great, I think in the long run, in terms of scientific research and development, you’ll see many trickle-down effects of this period that really will have impacted the field in a positive manner.

Alex Cumming: I remember Darin, who you’d mentioned a couple minutes ago, he had said that the development of the vaccine was fairly fast. It was the getting it approved to make sure that it was safe for people was what the longer process was. Was that your experience too, from what you said?

Elena Cyrus: Well, in terms of this specific vaccine or in general?

Alex Cumming: For this specific one. But he also mentioned that there were multiple companies going at the same time trying to develop. So it was almost like, not like a one-upmanship, but like, they’re developing, they’re developing and they’re developing, of course, you know, the big three of Pfizer, Moderna, and Johnson & Johnson.

Elena Cyrus: Yeah. So the regulatory aspect of research, which is a necessary evil, yes, it’s always the rate limiting factor. I can give you stories of not even just to get approval for the drug, but I’ve had instances where I was trying to conduct research just to get approval to do the research would take me 18 months before I could even start. And then you get the results and then you have to present the results into the FDA and to whatever ethics board, and that could take another two to three years. So yes, the regulatory aspect of research — but it’s necessary for the protection of the community. So what that required with COVID is that yes, the science moves quickly, but then it required all of the policymakers, all of the reviewers, all of the board people to coordinate, and get themselves together and review the data quickly. It’s a lot of pressure, I would say it’s huge volumes of data and there’s nuances of that analysis. And, sometimes you can see artifacts of data that may not necessarily be there. So you have to be really careful when you’re looking at these things, especially when you’re looking at the safety of the community. So yes, I would imagine for those regulatory beings, they were probably working overtime.

Alex Cumming: I don’t doubt it.

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We’re coming up on a year since the vaccines for granted emergency approval and the past couple of months they’ve been getting FDA approval. Can you speak about the efficiency of the vaccines and the need for boosters in the recent months?

Elena Cyrus: So in terms of the vaccines, we know for a fact the reason that they were able to move from emergency approval into full FDA approval is because we have more safety data. The safety profile of the vaccines is more known. We feel more comfortable. So we’ve moved it into full approval where the research is now is sort of beyond that, even beyond boosters. What they’re looking at is mixing and matching of vaccines and how efficacious that is and the need for boosters, and also at different populations that weren’t approved before. So younger populations and that sort of thing. So they’re looking more at wider dissemination and what uptake of that vaccine would look like in a non-optimal environment. So an optimal environment would be that you took it in a very regimented time period. You took it here, you took it at six months, you took it at this time period, and you took one type of vaccine, so it was Pfizer all the way through and that’s it. We have, especially for Florida, we have a lot of migration. We have international migration, domestic migration, we have all kinds of things happening. It’s not uncommon for someone, a Florida resident, to have maybe one vaccine that was administered in one country and then they come into the U.S. and they get another. What happens in a situation like that? And so the data that we have just to help people with that is that it’s just as efficacious, if not better, so that there’s no issues in terms of side effects or safety. So that is completely fine.

The other exciting research that I’ve seen with vaccines that has come out. We obviously know that it prevents hospitalizations deaths and cases. But let’s say for those who were unvaccinated, who got COVID and then they get the vaccine after the newest research shows that for them, it will prevent to some extent long haul COVID, or chronic COVID, with long-term symptoms.

So even for those that have some level of natural immunity from having the virus before there is a benefit of receiving that vaccine. So I would even encourage those who are unvaccinated (and) before got COVID, it’s still to some benefit to that individual. And I would say the proof is in the pudding. You see now that we have higher acceptance of vaccine rates as a direct correlation to the drop in positivity rates.

So we have enough data now to show categorically to the population, to the community. If you do this, this is what will happen. And, and the side effects are minimal. In terms of boosters, do you want me to keep going?

Alex Cumming: What should people know about boosters?

Elena Cyrus: Boosters are something that are definitely recommended for people who have low immune systems, underlying comorbid conditions. And I think as we move forward, when people ask me about what makes sense for them in terms of boosters, I always tell it’s a matter of calculating your own risk and also timing. So for example, if you’re a person that’s fully vaccinated with two dose level, but your COVID-19 exposure is fairly minimum — you’re still a remote worker, you’re working at home, you’re not in a high public area with a lot of density of people — there’s not a sense of urgency to get the booster, right? But if you know that as an individual, even with those two vaccines, let’s say you work in the airport or you work in a grocery store or you’re a frontline worker and exposure is higher for those individuals, I would recommend more for them to get the booster. Now there’s some discussion now of getting the fourth booster as well. So it’s not just the third, it’s also the fourth booster because just like the flu vaccine every year, there’ll be some variation of the virus we’ll have to change or find the vaccine for that particular context for that particular setting.

So I think we’ll probably even have to get away from saying things like boosters. It will just sort of be your annual COVID-19 shot. If it comes to that, there’s a lot of things that we don’t know yet about the virus. The long-term effect of virus and individuals, the long-term coverage of vaccines. What happens after three doses? What happens after four doses? And we won’t know those things until time elapses. In summary, what I would say is that for those who consider themselves to be at particularly high risk, and there are certain factors that contribute to risk in terms of being in crowded, densely crowded areas or having a specific job or anything like that, the booster definitely (is) something that should be considered.

And in terms of timing, I am saying to people, I would do it on or about the holiday season. Because the other thing for Florida, we don’t have to worry about the cold and people moving inside. But we do have to worry about our culture. We’re a very diverse population. We’re very into multi-generational living and family and social outings and gatherings. And as we move forward into the holiday season and there’s a sort of relief coming out of someone and things are reopened and the state of emergency has dropped people will want to socialize more. So I say and this is just my anecdotal thing. I’m sure some other epidemiologists, a practitioner might have different advice if you’re thinking about it maybe right before Thanksgiving, right? When you know you’re going into the highest peak of social activity.

Alex Cumming: You’ve spent years in Miami, you know how busy it gets down there in summer and spring break time. Right before COVID really shut things down, I was in Miami for a brief period of time and I was on Miami Beach. And when they said that Miami Beach is shutting down. I was like, “Oh boy.”

Elena Cyrus: It needed to shut down.

Alex Cumming: It did. And then like the next day was when I got the email from UCF that we had extended spring break. It was a very long spring break indeed. But what do you think causes people to be so hesitant to get vaccines?

Elena Cyrus: I think it’s multifactorial. I think it’s some of what we spoke about before that it came out so quickly. And when you look on the internet, you see that a specific drug takes 10 years for development and this comes out in 10 minutes, that causes concern, right? So my flagship study with NIH is called TRUST actually because there is a historic level of distress between the scientific community and the lay public for a million reasons. And before COVID existed, we were having an issue in terms of — if I use HIV as an example, we have something called the HIV Care Continuum where we want people to screen regularly. And then if they’re diagnosed with HIV, then we want them to adherent to their treatments and to stay with end treatment and care for the entire life, if possible. And people would not access care for all different types of reasons, and they wouldn’t take their medication and wouldn’t do their treatment daily as they should. I think some of those factors are also applicable for COVID. Sometimes it’s issues you wouldn’t even think of it. Some of the simplest things; Transportation. For me to get the vaccine and to got two doses of vaccine, if I’m in a desolate area and there’s only telehealth, how am I getting to this clinic? And how am I going to track any of that? Transportation too is a big issue in Florida, not just in Orlando, but in general, all over the state. So we see a lot of issues with that. People are worried about cost because they’re not always aware that everything is being subsidized by the state. And also, there are differences by zip code. So in certain zip codes within the state there’s greater levels of access, there’s more clinics, higher levels of insurance. There are just certain areas in our state and in the country that, to be honest, sometimes remind me of Sub-Saharan Africa as though I’m still working there to some extent.

And for those people, I don’t know that it’s always hesitancy. It could be a barrier. It really could be a barrier of access into care. Either way, whatever the reason is, whether it’s hesitancy or inability, it’s where my research that is funded by NIH for COVID, that’s what they’re funding. They would like to understand specifically what is happening in certain communities that these populations continue to have higher cases, higher levels of death. For example, American Indians, huge problem in terms of COVID we don’t even have the data understand completely how problematic it is.

Alex Cumming: That’s something I hadn’t even thought about that I would need to reflect in myself. You see some numbers in certain areas that, like you said, maybe a little more desolate than the bustling metropolitan, and you say, “Why aren’t they getting vaccinated there?”

Of course, in my own experience, my brain automatically wants to go to, “Oh they’re holding out for personal needs.” I hadn’t really reflected on that. It just may be, it could be they just physically cannot get to the office.

Elena Cyrus: We’ll do it, whatever it is. We have in some zip codes in the state of Florida, we have vaccine rates of over 100%. It’s not possible. But you understand what’s happening there. And then you go to somewhere else and it’s as low as 20%, 30%, that can’t all be hesitancy, that has to do with something gaps or deficiencies in the healthcare system that is preventing the uptake.

Alex Cumming: It’s interesting what your brain automatically wants to assume and to somehow assume the worst an individual and population, but there’s a lot of factors. There’s a lot of people in this country. So with all that, recently you published a paper on the burden of COVID-19 in African-American communities. Can you give us an overview on that issue and how it may relate to other populations?

Elena Cyrus: So that paper is not so recent anymore. It feels like it was five years ago. That paper happened because in the midst of when COVID was emerging — I am a disparity researcher, meaning that I usually always look at differences for certain vulnerable populations. I look at prison populations, immigrant populations, communities of color. And I want to try to understand what factors for those communities make them have more deleterious health outcomes in general. And so when COVID emerged, I knew everything that I had been researching before for HIV and substance use I knew it was going to happen with COVID. So colleagues of mine, Dr. Wagner, Eric Wagner, and Dr. Rachel Clarke, we started downloading data from CDC, like all hours of the night, just to see if we would see the same pattern of disparity. We chose African American populations because it was the simplest thing to do at that time, the easiest thing to do at that time and there was a clear distinction. That paper showed very clearly that in cities where there was a higher level of African American density at that time, there were poor COVID-19 outcomes and a higher number of cases. And it didn’t mean that African American people genetically were predisposed to COVID. It was showing that social determinants or their environment, or their lived experience, was making them more susceptible to COVID-19. That’s what that paper highlighted. From that paper we were invited by, the same investigators, Dr. Wagner, myself and Dr. Clark, the NIH to hypothesize about that at a broader scale for the entire country.

So they wanted to know what is happening for not just Black populations, but for Latinx populations, for Native American and Indian populations as well. And how has the policy, how has what the government, what we’ve been doing for the past two years and the way that has been administered within the country? Because there are differences. There wasn’t a federal policy, right? Everything was by state and then it was again by counties. So how do those differences in policy, how did that impact the COVID-19 outcomes in those populations? So we have a grant where we’ve already started to look at that.

And those papers will be released, I think maybe spring or February. Some of those key findings have already I’ve presented on them in different conferences. It’s quite interesting, the different factors that are relevant for each community. It’s not monolithic. It’s not that every Black person had the same experience. Caribbean and West Indian people versus African immigrants versus African Americans, it was all different. Within the Latinx population there were differences. The Native American population, we had such low data on them that we almost had to have a separate meeting for them completely. We had to leave the state of Florida to go into Arkansas to get more data, to supplement what we were seeing for it to make sense, if you will. So that’s what that paper spawned. It created more of an interest. And I’ll tell you the other interesting thing about that particular project, which came to me in my sleep and was unfunded, so no one was paying me to do it. I was just doing it because I was really curious, off the clock. It’s funded now, but I have several projects that are funded by NIH and we have several lab meetings and I have never had a project officer from NIH sit in on any of my lab meetings, they have no interest. NIH typically just gives you the money and they’re like, “Please minimize the side effects and do something extraordinary.” That’s what NIH does. On my COVID meetings the project officers sit in every single week. Dr. Mujuru, she has a keen interest in the timeline of the papers, of the findings of the cyclical analysis of the modeling, how we’re looking at it, at the definition of things. And I know it’s because her director, Dr. Pérez- Stable, who is the director of the National Institute for Minority Health and Health Disparity Research, they are quite interested in how disparities contributed so extensively to the spread of COVID-19, right? If disparities weren’t as large as they were in this country, it may not have been as bad.

It was because these communities were lagging, and they were the ones that were driving the spread. So if we had more equitable healthcare options to begin with, it would not have been that bad. And that’s why NIH is now I think sitting in on my weekly meetings and watching us keenly to see what we’re doing.

Alex Cumming: Yeah. You have to understand the societal and the cultural impact of different communities. This is a question I’m thinking about now, but the same way that you market, I use the term very loosely, market getting a vaccine and getting a booster in an upper-class society or upper-class communities (is) that the same way you could market it and maybe a more disparaged community?

Elena Cyrus: No.

Alex Cumming: You can’t.

Elena Cyrus: No.

Alex Cumming: And we spoke about transportation a little moment ago, and a lot of these communities that we’re talking about, it’s very common and like you said, lagging communities that maybe you have a large African American population that the transportation is not ideal and that can even prevent people. And a lot of times maybe if they have to take the bus, a bus is a very crowded space, or take the subway.

Elena Cyrus: I’ll give you two other examples of things. When we moved into COVID everyone moved into telehealth and that was convenient for the majority of the population. This is great. I don’t have to drive anywhere. I don’t have to go into my doctor’s office. I can just sit on my couch, in my whatever and diagnosis. I work with trans populations, transgender populations. For that population, that was not the case because housing is an issue for them.

So when I tell them that the only way I’m going to treat you or take care of you is if you have a device, access to internet and housing, they can’t. So that is another thing that we sort of overlook. There are some public health interventions that can be implemented broadly. Seatbelts, everybody should do it. There’s no distinction there. But then there are some things that have to be tailored by community. Otherwise it doesn’t make sense and it’s a waste of taxpayer money, to put it bluntly.

There’s a whole field of public health called health promotion and disease prevention, and they’re essentially the marketing division of public health. So when the epidemiologists finished and they find all the things that are wrong and they said, “OK, well these are all the things that are wrong. And we also think this is how you should fix it.” We literally just handed off to the health promotion people and we say, “OK, well now it’s your job to market this idea and package it and make it make sense for whomever, right?” It’s a whole other thing.

Alex Cumming: I want to ask you while we’re on this subject. Can you talk to me about the increase in substance use when it comes to the time that people spent at home? And then I promise we’ll get to a more optimistic question. I’m just, I’m curious for my own —

Elena Cyrus: I shouldn’t laugh, but the only reason I laugh is because I’m exhausted.

I’m also funded by the National Institute for Drug Abuse and also the National Institute for Alcohol Abuse by both and NIAAA and by NIDA So I looked at patterns of drug abuse way before COVID ever existed because it is related to stress and to mental health. And typically when you have, forget COVID, but typically when you have vulnerable populations, its substance use is a symptom of an exacerbation of their really poor living conditions. And there’s a whole theoretical model around it. It’s called multiple minority stress theory. But if you are a minority in this country that may be let’s say, a racial minority, an ethnic minority, and sometimes even a sexual or gender minority, your levels of stress are disproportionate to someone else who’s not underrepresented. You need to cope with that stress in some manner. If you are in a higher socioeconomic status, you might cope with that stress by going to a therapist, by exercising because you have access to some of this build network. If you are living in an urban setting with no disposable income and not access to some of these resources and facilities, the easiest thing might be to self-medicate. So before COVID we were already seeing, concerningly, an uptick in overdoses and addiction specifically for opioids and among women as well. I published on it right before COVID. We looked at cannabis use in adolescents and that was published in the current journal of Current Opinion in Psychology. I just lectured on this two days ago because CDC released the data for the increase of substance use. We have no definitive research right now that shows a direct association between the existence of COVID-19 and that uptick of substance use overdoses. We can assume on some level that it’s part of that natural trend that we were seeing before COVID-19. We were already seeing an increase in terms of substance-use addiction in the country. We were even seeing lower ages of debut, so younger children starting drug use earlier… you can say that is a continuing trend, but [compared to] what we expected to see it is much higher. I think it’s, I don’t want to misquote, but it’s something like eight times where we were maybe two or three years ago in terms of substance use and addiction. What you will see now as COVID-19 becomes endemic, so hopefully if we get through this next fall season and spring season COVID-19 should become endemic and should be sort of like a faded memory, but the long-term impact of COVID-19 in terms of mental health, substance use and chronic COVID… that I think we’re going to be dealing with for decades. PTSD, trauma, especially for younger children where we can’t identify in terms of mental health disorders, we can’t identify it immediately. So we’re going to have to wait for time for those things to manifest. I think it’s of huge concern to everyone, to NIH, to CDC, to practitioners everywhere, is what we will see in terms of mental health, stress and substance use within the next 10 to 20 years.

Alex Cumming: Those are the things you don’t think about. In my own experience, of course, the pandemic happened to me when I was coming to the end of my college career. And I wonder if I could change the time that had happened would I’d rather it happen when I was post-grad, an adult or when I was younger as a child in high school. And in many ways, I’m thankful that it did happen when it did. I was with my family, but you don’t think about those things and it’s really scary and intimidating.

Elena Cyrus: I would say, even for you, you don’t even know. You may think that you went through it unscathed, but the mind is an incredible thing. And you may repress, you may have things related to trauma that you have no idea, and won’t happen until — if it will, hopefully not — but let’s say three to five years. Some unexplained panic attack, some unexplained anxiety attack, it could happen. So I would say for everyone, and I said this before COVID happened, we don’t pay enough attention to mental health because it’s not tangible. If we have a fever, we know we take fever medication, we go to the doctor to get a diagnosis, it’s resolved. Mental health symptoms manifest, they present, and no one does anything about it. They let it sit there, they let it fester for years and years and years until it’s almost detrimental.

Alex Cumming: But this young generation that is so acutely aware of, and they have communities where they can share their experiences and it’s more openly spoken about. Sometimes I’m on social media and I think that the humor is maybe taken a little too far when it comes to the discussion of mental health, the humor, disparaging mental health, is taken too far. But when it’s more openly discussed, is this the beginning of a new chapter of a new generation that can point that out in younger people, as opposed to maybe 30, 40 years ago where it was swept under the rug.

Elena Cyrus: Yeah. I have to admit I’m not on social media, so I’m not sure what the dialogue or discourse is now. I notice this in general, yes, people tend to be more open and there’s more public service messaging around mental health and normalizing it and acceptance of it. And yes, I don’t have a crystal ball, I don’t know what will happen, but my hope is that this will become more routine in terms of person’s medical care so that when you think about your annual treatment, you think, “OK, I need to go to my primary care doctor. I need to go to my dentist. I need to go to my OB GYN person.” You’ll also say, “And I need routine mental health therapy.” I want it to be part of everyone’s suite, if you will, of self-care. So I hope yes that this will happen more. And I definitely do with my daughter, so I talked to her about it all the time. So in that way, I have hope, yeah, for younger people.

Alex Cumming: I’m glad to hear that coming from yourself. And I want to transition to the more optimistic question I have, what makes you optimistic about all this, about the growing conversation, about mental health, about what you see from your data, about disenfranchised communities and for the future of individuals who may need more focus on housing and internet communication?

Elena Cyrus: Yeah. I’m not like 100% hopeful, Alex. I’ll put it like this, five years ago I felt like maybe some of my work was moot. I felt like maybe I just did it for myself and the other scientists that I work with and it fell on deaf ears. I don’t think it was important, really. The things that were important at NIH were like cancer, like the National Cancer Institute, huge, massive. Nobody cared about disparity or mental health — or they did care about substance use, they cared a lot about substance use. When a lot of white women started dying in Kentucky and the Midwest, it became like an issue for NIDA specifically at that point and for NIH at that point.

So where I am now, maybe before I felt like despair and also that my work didn’t have any impact. Now I feel like it might have some influence. I feel like there’s definitely more support, not only at the institutional level with UCF, but at the federal level, at the state level. So I’m still concerned that, whenever you have a major event, 9/11, COVID-19, immediately after there is this nostalgia and this motivation to do the right thing, but then that eventually wains and people revert to old habits and that sort of thing. I’m concerned that yes, right now we have a little bit of momentum in terms of addressing disparities, addressing public health issues. I wonder what will happen in the long-term, if it will be sustainable, if it will be maintained. We have a tendency, I think that’s how we got caught up with COVID, we have a tendency in the U.S. That when things are going well, we kind of forget everything that just happened like a year or two ago. It’s like, “Oh, you know, everything’s fine.” And then we just go right back until the next cycle. So that’s what dampens my hope slightly, is that I’ve been doing this work long enough that I understand that there are peaks and valleys.

Alex Cumming: So you’re saying to keep an eye on the past. Was it, “Those who fail to study history are doomed to repeat it.”

Elena Cyrus: Perfect quotes. Keep that in mind.

Alex Cumming: Perfect. So with all that, what advice would you give to somebody who wants to do what it is you do?

Elena Cyrus: Wow. What a question. Well, don’t think about time or money because —

Alex Cumming: I’m an actor, trust me.

Elena Cyrus: Yeah. Don’t think about either of those things. This is a profession to do if you are passionate because you really have to enjoy (it) quite a lot. The training is one thing. So I was in school, I don’t know how many years, many, many years. I have three degrees. I completed four fellowships everywhere and when I came out, I owed a lot of money. I would say that but I feel such a huge sense of fulfillment, especially now, especially in this period when I see my mentees do — it just really makes me feel so happy. Like I just had one mentee that just got accepted to NYU. I had one before that that was accepted on full scholarship at like a million Ivy League universities. My postdoc is doing really well. And these are all women of color and I have that opportunity to train them and to make a space for them that might have been intimidating or unwelcoming. I make it for them and make that pathway for them. The other thing is, what people didn’t tell me about this job is there’s a lot of travel. So I don’t know how many different places I’ve lived in and no one ever says that to you. When you start off, they’re just kind of like, “Yeah, you do this Ph.D. And then you’re a researcher.” No, I’ve moved my family several times. I’ve changed institutions multiple times. Right now, as I sit here I have three institutional affiliations. To withstand all of that, you have to have sort of like an altruistic sense of what you want to do and why you’re doing it. So if you are interested in a more direct individual experience with helping people, you might consider nursing, medicine, physical therapy, but if you’re interested in making a large scale, population-based impact where you can see the impact of your work almost immediately, ‘epidemiology’ is that. It’s population-based medicine and preventive science.

Alex Cumming: How cool. I’m glad to hear about the representation that’s coming out, it’s important in all aspects. I believe science and arts, especially in my field, that everybody has a different experience. Everybody has a different perspective and I’m glad to hear that this is the swing of the future.

Elena Cyrus: I’m happy that it’s happening. When I started off, they couldn’t put me as a number in a table because the cell value was so small. So if they said there was a Black female epidemiologist, everyone knew it was me if I went into a meeting. Like, “Oh it’s Elena.” So we’re moving away from that. And I think that’s amazing.

Alex Cumming: Very glad to hear that. Getting categorized like that is, it’s not ideal. So what’s one thing that you’re still hoping to do, and I want to hear it on a personal level and on a UCF level.

Elena Cyrus: Okay. Give me two minutes. There (are) a million things that I want to do.

I really want to be able to finish all of the research that we have ongoing. Sometimes it’s more difficult. I think COVID has put more than a hiccup in some of the processes and everything. So I’d really like to finish what we started. Number one on a professional level right now at UCF, a little plug for my department, so I sit in a College of Medicine but we are trying to build a Department of Population Health Sciences, which is a little different for the College of Medicine. Population health sciences is more in the realm of social and behavioral sciences within a clinical setting. And so I’m working with my chair, Dr. Eric Schrimshaw, to hire faculty, to build out the curriculum, to build a program around public health. And we are also in addition to just building this public health program for the College of Medicine, and also for the health science students. I am also responsible for the global health infectious disease initiative for UCF. And we’re opening up clinics in Peru and one in Guyana so that students at UCF will have an opportunity to do exchange experiences, a study abroad experience in Lima, as well as in Georgetown. We were supposed to initiate next year, but with COVID and all the travel restrictions that has delayed. But I would love the experience. I think really and truly I’ve been really, really lucky. I’ve had some of the best, as you can tell, I have some of the best mentors in the world. I’ve trained with some of the most elite scientists. I’ve been to all different types of institutions. I would like the students at UCF to have that as well, to enter into that network. And so with Dean German, she has given me full support to expand the Fogarty program here at UCF, through these global health initiatives. And then with Dr. Schrimshaw, we hope within a year to two to have a population health sciences division department at COM. And it will address all the things that we talked about in terms of research, methodology, disparity, research, cancer, epidemiology, HIV, substance use, we’ll have all of it.

And then on a personal level I just want to continue to see my daughter, my students, my mentees, I just want to see them continue to do well. It’s my secret retirement plan. So I tell them, I’m like, I’m just going to travel around from summer house to summer house. So that professionally and personally, for me, I think it might be intertwined because as you could see when things go well at work, then I’m usually quite happy.

Alex Cumming: Well, I’m glad to hear all that.

And I’m excited to hear about your travels from summer house to summer house.

Elena Cyrus: Hopefully you’ll be one of the summer houses, you have to let me know where to show up.

Alex Cumming: Yeah, for sure.

Elena Cyrus: Yeah.

Alex Cumming: Elena, thank you so, so much for joining us. I loved this conversation today and I appreciate your time. Thank you.

Elena Cyrus: Thank you.

Alex Cumming: Hey everybody, thanks for listening. I’ll see you on the next episode of Knights Do That, where I’ll be speaking with planetary scientist Phil Metzger as we take a deep dive into space exploration, and even discuss his research on Pluto being a planet. If you want to know more about why UCF is referred to a SpaceU, you don’t want to miss this one.

Phil Metzger: The future is amazing. If I could look into the future and tell you what I see, this is it. I see civilization reaching beyond planet Earth. So we’re no longer just doing exploration in space. We’re actually doing the economic activities of life beyond planet Earth, and that’s going to happen in this century. We’re already in the process of starting that and it’s accelerating. It’s really exciting to be a part of making that happen right now. This is the generation of graduates from UCF and from other schools, this is the generation that is going to make all that happen during their careers. Right now I understand UCF puts more graduates into aerospace engineering than any other university in the United States. So we’re going to continue pumping students into this. And those aerospace engineering students and business students and every other field is going to have a lot to work on in space. It’ll be an exciting time.

Alex Cumming: If you’re doing something cool, whether that’s at UCF or somewhere you took UCF that we should know about, send us an email at  [email protected], and maybe we’ll see you on an episode in the future. Go Knights and Charge On.