Lessons in Lifespan Health

Marc Vermulst is an assistant professor of gerontology at the USC Leonard Davis School, who focuses on the role of genetic mutations in human aging and disease. He recently spoke to us about how his research into transcription errors, essentially copying mistakes, aims to strengthen vaccines and delay or prevent diseases. On transcription errors …when you go from DNA to a protein, there's a short intermediate molecule that needs to be created, and that is an RNA molecule. And so conceivably you can make the wrong proteins … if a mistake occurs in the process of making an RNA molecule and that process is called transcription. So we study how frequently mistakes occur when RNA molecules are generated and what type of impact that has on aging and disease. When I first started this project the reason why it hadn't been studied much was because there was no technique capable of actually finding them, so it was something that we just could not see. So what my lab did is was we designed a novel tool, a molecular biology tool, that allowed us to find these transcript errors across the entire genome. So it was this massive improvement, and suddenly we could observe things that were previously unobservable and what we discovered with it was that these errors are really, really frequent and when they happen, there are a couple of impacts that they have. The most important one probably is that they result in incorrect proteins and those proteins tend to fold in the wrong way. Proteins are large 3d molecules. In order to function, this long molecule needs to fold in a particular structure. And when you make a mistake in the generation of that protein, because of a transcript error, the protein tends to misfold and as it turns out, misfolded proteins are a key component of numerous age-related diseases, including Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis. All of these diseases are caused by misfolded proteins. So, what I think that we really found is a new component of the etiology, the origin of all of these diseases. … transcription errors occur a hundred to a thousandfold more frequently than genetic changes. So most of the mistakes that occur in proteins are not due to genetic changes, they are due to these transcript errors. One of the things I'm really interested in is the occurrence of age-related diseases for example Alzheimer's and Parkinson's disease. And one of the major questions is why do people get these diseases? There are families that have a mutation that makes them more predisposed to getting these diseases, but that really only explains five to maybe 15% of all of the cases. The remaining 85 to 95%. We really have no clue why these people get these diseases. So what I'm trying to do is I'm trying to explain these remaining 85%. Because all of these diseases are caused by misfolded proteins, and transcription errors cause these misfolded proteins, I think that we have found a new mechanism that can cause these diseases. And if the mechanism is indeed correct that means we can now do something about it. So it's really about finding the origin of the disease itself in order to be able to design medicine for it. That's one of the major goals. We're also asking when aging actually happens. We have reason to believe that the events that lead to aging can occur many, many years earlier, probably decades. And perhaps in certain cases, the pace of aging is actually set in our twenties or thirties. And that's one of the things we're trying to prove as well, On COVID-19 … one of the reasons why viruses become resistant to vaccines or to drugs is because there is always one viral particle that happens to get a mutation that allows it to be resistant. So one of the major things people want to know about viral particles and different kinds of viruses is how fast do mutations accumulate in the genome of these viruses. And they want to do that for two different reasons. First of all, they want to know that because they want to be able to predict how quickly viruses might get resistance to certain treatments or vaccines. The higher the mutation rate, the faster that would happen. Secondly, they want to be able to predict what type of viruses might erupt in the future. So we now know that for example, that a coronavirus has a certain genetic composition, but that composition might be completely different next year or the year afterward. So by doing these mutational analyses, we're able to predict hopefully what the virus might look like in the future. So we can better prepare for an outbreak in 2022 or 2023. It's been a really rewarding project. So the reason why I got into it is because of my interest in genetic mutations and that's a key component of the viral particles. We've used this super powerful big data tool to study how the virus mutates inside cells and we have a couple of different goals with it. First of all, we want to determine how quickly these mutations actually happen. Right? So that will give us an answer as to how quickly viral particles might come up with mutations that make it resistant to certain pigments and vaccines. And we've already heard in on the news that new mutant versions of the virus have come up, right. , it's a strain from Brazil, there's a strain from England that are more virulent and more dangerous and the initial coronavirus. So that is one of the consequences of the genetic changes. The virus has a key protein that it needs to make in order to produce the envelope of the virus itself, all kinds of surface proteins and these proteins are essential. So certain genetic changes will destroy those proteins, and that will result in the death of the virus. So if we do a massive analysis of the entire genome of this virus, and we do that over time, what will find is that there are mutations present everywhere on the viral genome, except for those few spots where the mutation kills the actual virus. So by virtue of looking at locations in the genome, or finding them where mutations do not occur, we can find these Achilles heels of the virus. And that would allow us to guide the development of vaccines to that specific spot. … if we target the vaccine to a spot that cannot be mutated, that means that the virus has two choices. It can either be destroyed by the vaccine or a treatment itself, and in an effort to try to get out of it, it could mutate that position of its genome, but in doing so, it will kill itself, so it's a no win situation for the virus. That is one of the goals of this project also.

Hussein Yassine is a professor of medicine at the Keck School of Medicine at USC and is uncovering links between nutrition, genes, and risk for Alzheimer's disease. He spoke to us about his research on APOE4, omega-3s and inflammation in the brain. On APOE4 and Alzheimer's risk So APOE is a gene on chromosome 19. It exists in the population in three different forms. The two form, not very common, the three form, the most common and the four form, which makes about 20% of the population. The four form, if you get one copy from your parents, your chances of getting Alzheimer's disease increased two to four times. If you inherit two copies, meaning you get one copy from mom and one copy from dad, your chances of getting Alzheimer's, or the odds ratio, goes to 12 times, meaning an APOE4 E4 homozygote, uh, 50% of those homozygotes by the age of 80 will have Alzheimer's disease. On the work of his lab My lab is working to understand whether omega-3s can slow down cognitive decline in people at high risk of Alzheimer's disease, based on APOE4. We are working on three different fronts. One, we have basic science models where we study the brains of APOE4 targeted replacement mice. We use brain imaging to study labeled DHA brain uptake in the human brain, and we do clinical trials where we give people omega-3 supplementation and look at outcomes. On omega-3 supplements versus dietary interventions At this point in time, we do not have high quality evidence to suggest that supplements make a difference. But we know from landmark observational cohorts, for example, the Framingham in the US, the Triple C in France, the Rotterdam in the Netherlands, and many others that people who consume at least one serving of fatty fish per week have lower risk of developing Alzheimer's disease. In contrast trials that have involved omega-3 supplements have not panned out. And as we discussed, omega-3 supplements might be too late to be given to patients with neurodegeneration because they may not reverse neuronal death. Giving omega-3s to the general population may prove to be very difficult because the majority of people do not develop Alzheimer's. So we need more research before we can recommend supplements. In addition, we don't know exactly what kind of supplements we should be providing, the exact dose, the composition that duration. More research is needed to figure out those questions. On what can people do to reduce Alzheimer's disease risk I think timing is key. I think if you know that you are at increased risk based on family history or APOE4 genotype nutritional and lifestyle interventions during middle age will provide you likely the most benefit. Our research and others suggest that between the ages of 45 and 65, those at risk individuals should be on certain lifestyle modifications, whether it is at least one serving of fatty fish per week, or some good exercise regimen. We're not talking about marathon running, maybe three times a week, 15 minutes per day is good enough. Lifestyle modifications, no smoking, reduced consumption of simple sugars to avoid complications of diabetes and obesity, increased intake of green leafy vegetables, which are enriched in polyphenols and antioxidants, good sleep, listening to music, certain forms of meditation, or in some individuals praying. And, uh, all of these factors, we know that have positive effect on mitigating or decreasing the chances of getting Alzheimer's. One additional factor that I did not discuss is hypertension or blood pressure control. Blood pressure is known as a silent killer, because people have blood pressure, but they don't know that they do so. Blood pressure control, diabetes control, cholesterol control in middle age together with these lifestyle changes can really pay dividends decades later. Once people start having symptoms and we're talking now 60 to 80, they often come to us and they're talking to us about omega-3 intake, about all these changes. And unfortunately at this time, the interventions are not very effective. On the most important points Dr. Yassine hopes people understand from his research? The biggest takeaway is that there is a life-course risk of Alzheimer's disease risk in APOE4 carriers that starts shortly after birth. But mainly it takes decades before symptoms start. We know from imaging studies, between the ages of 20 all the way to 60, that the APOE4 brain is compensating to maintain cognition. Once this compensation fails, APOE4 carrier brains starts deteriorating, and you see signs of neurodegeneration and Alzheimer's dementia. Our research emphasizes the importance of a healthy lifestyle, which includes sufficient omega-3 consumption, defined as at least one serving of fatty fish per week, lifestyle factors such as exercise, sleeping, music, meditation, family connections, combating depression, and social isolation, and social isolation is a problem now with COVID. And in addition to that, not smoking and reducing the amount of simple sugars consumed to reduce diabetes and cardiometabolic risk. Those interventions, we all know that they are critical, but our research suggests that there's a critical time to do these interventions during middle age, to prevent the progression to Alzheimer's at the age of 65 to 75. Once patients develop this disease, those interventions become less effective. So this is the greatest takeaway from the research we are doing. On his message to young people So my message to young people is that if you have a family history of Alzheimer's disease, or that you know that you are an E4 carrier, plan in advance. Learn about the risks of Alzheimer's disease, learn about the risks of carrying the APOE4 genotype and get informed, because we have cutting-edge research to help you out in preventing the risks of this disease early on. On the importance of Alzheimer's research Up to 25% of individuals carry APOE4. So in a room of a hundred people, 25 people will have one copy of APOE4, that's enormous. And they make the bulk, up to 50%, of patients with Alzheimer's. We have so many APOE4 carriers in the community, and I think more research in this area is very important to the future of mitigating or changing the risk of Alzheimer's disease. We should start early and we should try the best we can to prevent this disease because we know once it happens, it's very difficult to treat. On how to reach Dr. Yassine If anybody listening to the podcast has family members with Alzheimer's disease, they are concerned about being an APOE4 carrier and would require more advice or perhaps participate in any of our trials. Please feel free to email me. My email is hyassine@usc.edu, and you can look me up at the USC directory website and I'm happy to help.

John Tower is a professor of biology and gerontology. He spoke to us about his research on the roles of sex differences and mitochondria in aging. Highlights from our conversation: As you may know, in humans, women live longer than men. And the reason for that is not entirely understood and also malfunction of the mitochondria, which is also called the powerhouse of the cell is, directly implicated in aging and multiple aging-related diseases, including Parkinson's disease and Alzheimer's disease and cancer. And so we'd like to understand at a very basic level, why does the mitochondria malfunction during aging and does this, or does this not have, uh, is this related to, or a result of sexual differentiation of the male and female? While there's no consensus in the aging field on pretty much anything. But, I would say at this point, antagonistic pleiotropy is the most favored model for how the genetics of aging works across species. And the idea is that genes can be beneficial in one context, but detrimental in another context. Specifically they're likely to be beneficial early in life, promoting things like differentiation and growth and sexual reproduction and in the long term, the same genes are detrimental and have a cost during aging. I've made a complete about face, from thinking that sexual differentiation was not important, to thinking that well, maybe sexual differentiation is actually causative to a large part in the aging process. In other words, in differentiating the male and the female, you set up the situation for sex specific trade-offs between reproduction and aging, and some aspects of these trade-offs are common between the male and the female. And some of them are unique to either the male or the female in that there are pathways that promote a reproduction, but then have a cost for the long-term maintenance of the animal. That's the kind of antagonistic pleiotropy my lab is focusing on right now which is the idea that a gene can be beneficial to one sex, but detrimental to the other, or a gene could be detrimental to each sex in different ways Across species, we see a decrease in mitochondrial gene expression and mitochondrial gene function during aging and the relevance to sex is that the mitochondria is transmitted to offspring only through the mother. And so this means natural selection can only optimize mitochondrial gene function for the female. This means that the male inherits a mitochondria that is less optimal for his physiology than, than it might be. And so what we see is that mitochondria isolated from female mammal tissues function better than mitochondria isolated from males consistent with this hypothesis. And so this may be one reason why females tend to live longer than males I think what I would expect is we're going to see sex-specific interventions in aging and aging-related diseases, even diseases common to the male and the female, like Parkinson's and Alzheimer's, that having an intervention that's tailored, to the male or the female will be more efficacious.

Dr. Kerry Burnight is the chief gerontologist at GrandPad, the creators of an internet-connected tablet designed specifically for seniors. She spoke to us about how the device aims to combat loneliness and abuse and about the sense of purpose that powers her gerontology career. Selected Quotes On being a gerontologist Kerry Burnight: // to this day, if anybody asks me what I do I say I'm a gerontologist // a person who studies aging. And our goal is to try to make aging a better experience for all of us. And then people are right on board. So I think there's like a million different ways to express your gerontology ness. And I honestly feel so like the world is the oyster of undergrad master's and PhD gerontologist and the only thing that will hold you back is not going for it. On using technology to address loneliness "And so, all things being constant being lonely or socially isolated would put you at greater risk for elder abuse and exploitation, but also at significantly greater risk for cognitive impairment for stroke for heart disease and even mortality. So you're 25% more likely to pass away than those who are not lonely and something. //And so I was thinking, gosh, you know, maybe technology could help us." On providing a vulnerable senior with a GrandPad "He was able to connect with all of us but without any of the scammers are perpetrators and so he was a guy who listened to jazz music and he loved to listen to it on his GrandPad and we did all these video calls and the reason it was so helpful is because it was so different." On considering seniors in technology research and development "Standard technology creates technology targeted and built for those in their 20s and 30s// It was never designed intelligently and to honor you to honor your autonomy. //Many organizations are all about "training seniors" and it's so silly. If you even take one step back and you think, don't train them. It'd be like saying let's train people to wear size two pants. No, you need to make size six pants and size eight pants and size 20 pants not shove people into the tiny pants." "Einstein says that the greatest sophistication is simplicity and it's true, like the hardest thing in the world that you can do is to create something simple and it's not because seniors are less than. It's because we have listened. The best thing of my job is that I employ a group of seniors ages 86 to 106 who are called our grand advisors and every step of the way. It is just by listening of what matters and what doesn't matter to people." On the flexibility of a gerontology degree I say you can literally do anything you're interested in because aging is living// My aspect now is human connection and technology. But, if you're interested in food, you're interested in transportation, if you're interested in entertainment…basically, in my opinion, any facet of being a human in this time of demographic revolution needs a gerontologist to really be thinking at it in a systematic way from what it means from an aging perspective. On the importance of stepping up to help older adults "All you have to do is spend time with older adults and then you realize you don't have the luxury of being shy because it's not about you, it's about what you can do to serve. And actually it was a senior who told me that one time I was speaking, there was a crowd of 1000 and I was getting nervous. And so this older person said to me, 'you need to get out of your way'. And I got really struck me that I was the one like I'm scared to talk in front of people. I don't want to, blah, blah, blah. Get out of your way because if you're going to help aging and our own aging, then you better get to work."

Professor John Walsh, vice dean of education at the USC Leonard Davis School joins Professor George Shannon, holder of the Kevin Xu chair in Gerontology for a conversation on how teachers and students can make the most of online instruction and to discuss how our life experiences can help us meet this challenging moment in time, both in the classroom and outside of it. Quotes from this episode: John Walsh On isolation Many students are feeling isolated right now and it's obviously forced isolation and they just want to connect. The premed class I'm teaching right now, I have 50 students. And, and so here we are, two weeks into the semester and class ends at the hour 50 minute mark, and I'm having, 10 to 15 students stay afterwards just to hang out and, talk about anything. And they just want to feel connected and, that's a good thing because we got to help them through this. On always learning I always tell my students that I've never stopped being a student and that I always want to keep learning. And, so I will deliver a lecture, we'll get centered on a topic and philosophically, I know from my reading and from looking at websites or watching videos about how what we're discussing applies to furthering society or helping you in the workplace. But I love hearing the actual application from students where they're down, boots on the ground, and they've experienced this. And they may even say, " those guidelines, or those principles are all good, however, in my experience…" And, and then you put that in your back pocket… and then you use that in future lectures. I'm constantly learning and I tell the students, I don't know everything and I really want to learn from you. On online classrooms: Well, I think this is a game changer. It was forced down our throats with a pandemic, but this is a game changer. We, as a program have always been a leader at USC in terms of online education and we can't stop being a leader. We just got to keep up on it. These platforms do offer a level of interactivity that we weren't utilizing before. On collaborative exams I was just so amazed and so excited watching the active learning that went on during these collaborative exams. I know now that when we are back in session, // I'm going to be sitting there in the auditorium, I'm going to break people up into groups of six or seven, and they're going to do the collaborative exam right there in the auditorium, because it's, I think it's a really cool way to learn. George Shannon On his transition from elevator repairman to successful actor to USC professor I was 55 years old. I didn't have an undergraduate degree. So I spent two years in undergrad getting my undergraduate degree because I had hundreds of units where they were scattered all over in different things that I had touched upon. And then I went into the master's program and did that in two years and was accepted into the PhD program. And so yeah, so that's a long winded way of saying there are, there are lots of things that you can do that come to an unexpectedly. I always say, if someone opens a door for you, don't slam it in their face, go walk in and see what's going on, because it might be an opportunity that can change your life in a very positive way as it did for me. I had four kids and a couple of wives and lots of bills and, and I survived all of that because I didn't turn my back on something that I had never thought of before. If something presents a change or a mode that you're not expecting, it may be something that can lead you to something that's even more exciting that gives your life more meaning. People ask me if I'm thinking about retiring and I I'm astonished. Of course, I'm first of all, astonished that I'm 80 years old, but secondly, I'm further astonished that anyone would think that I would ever consider retiring as long as I have my faculties about me and I'm able to perform. Because life is an endless performance as long as it lasts. On online classes in some ways, from my perspective, I like Zoom because I have on the screen the 40 or 50 students, so I may have in class and I can pick them out and ask them specific questions instead of being in the auditorium where they're all trying to hide in the back of the room. And so I, I find there are some really some positives from this experience.

Reggie Tucker-Seeley, the Edward L. Schneider Chair in gerontology and an assistant professor at the USC Leonard Davis School is joined by his colleague, Jhumpka Gupta, an associate professor in the global and community health department at George Mason University. The two discuss issues of racism and hate and the implications for health across the life course. Selected quotes: Reggie Tucker-Seeley: "… with the COVID-19 global pandemic, we know that across racial and ethnic groups, that there is differential access to testing, different levels of access to quality healthcare, differences in the navigation of healthcare, differences and caregiving responsibilities, and differences and financial resources to navigate and manage healthcare and caregiving. And these differences have been shown across various health outcomes and almost always Black and indigenous people and other people of color generally fare worse than their white counterparts. Because we have seen this over and over for many health outcomes, many of us health disparities researchers, often state that we are so tired of still just describing the problem, but what does an intervention look like that addresses racism and hate towards Black and Brown people? That is, what this action and this space look like?" Jhumka Gupta: "There are certainly is not a shortage of research describing health disparities, but what I would like to see more supported is the health benefits of explicitly addressing racism, whether that's specific anti-racist policy, or if we are talking about implicit bias training of healthcare professionals, how does that not only change attitudes, if at all, among healthcare workers, but how does this training translate into patient health outcomes? How does this training translate into reduced feelings of being in fight or flight among BiPOC and especially Black patients or on a campus community or a specific city?" Reggie Tucker-Seeley: "I'm reminded of a quote that I've used several times related to when does our knowledge about health disparities move us to collective action. And it's a quote by Sir Jeffrey Vickers from an article he wrote in the New England Journal of medicine in 1958, he stated, 'The landmarks of political economic and social history are the moments when some condition passed from the category of the given to the category of the intolerable. I believe that the history of public health might well be written as a record of successful redefining of the unacceptable.' And I use this quote often. And I think the question is when will anti-Black sentiments in the US across our various systems from education to criminal justice to healthcare move from the tolerated to the unacceptable." Jhumpka Ghupta: "We also know that these circumstances don't just happen randomly. They were purposefully shaped by decades and decades of policies, and they won't be remedied with a one shot or, or simple solution to address health disparities and systemic racism." Reggie Tucker-Seeley: "My first recommendation and its related to the discussion that we are, we are indeed having in the field of public health, is not only to focus on differences across racial ethnic groups, or that is to think of race as a risk factor, but to think about racism as the risk factor - that is to think about not just group membership as being the risk factor, but the experiences of what group membership means as the risk factor." Jhumpka Gupta: (On what prompted them to write their 2016 Huffington Post piece on racism as a public health issue): "We realized that these very critical issues were being discussed more and more in high profile spaces, such as the BET awards, but what was missing was the discussion of health implications. At the same time, it was a presidential election year and the hateful rhetoric of the Trump campaign was only getting worse. And the rhetoric was targeting Black communities, Black and Brown immigrants, refugees, women, and girls, and other communities such as LGBTQ, Muslim, and disabled communities. And for those of us who are trained in and do research in examining health inequities, we could just see the crisis coming. So we wrote the Huffington Post piece to number one, bring the public health lens into the conversation around social injustices by really laying out the decades of literature on how racism and discrimination impact health inequities and 2) to mobilize the public health field to not only study the etiological role of racism and producing patterns of health inequities, but also consider the need to respond to this hateful rhetoric in all spheres of life, outside of academia in our everyday lives." Cited Works: Huffington Post To Promote Public Health, Fight Hate Where We Live, Learn, Work, And Play Health Affairs Asian Americans Facing High COVID-19 Case Fatality TEDx "Experiencing Racism in VR", Dr. Courtney Cogburn from Columbia University medium.com "White Academia: Do Better. Higher education has a problem. It's called White supremacy." by Professor Jasmine Roberts, The Ohio State University. "See No Stranger: A Memoir and Manifesto of Revolutionary Love" by Valerie Kaur

Donna Benton, research associate professor and director of the USC Family Caregiver Support Center, joins Professor George Shannon to discuss the challenges faced by family caregivers during the coronavirus pandemic and how they can be addressed at individual, community, state, and national levels. Here are some highlights of what she said: On who is a caregiver "Rosalyn Carter who was the wife of one of our former President Jimmy Carter, at one time said that the world kind of divides up into four types of people. Those are people who are currently caregivers, those who will be caregivers, those who know a caregiver, or those who will need a caregiver." On increased social isolation among caregivers due to COVID-19 "But now this is very different in our pandemic right now because, maybe before with their relative, they were able to say that you were able to go out and go shopping together. Or you could have somebody else come, a neighbor could stop by, and say you know I'm going to go out for a couple of hours, 'Can you come and sit with mom or dad and while I go out?' Well you can't do that. You can't bring someone into your home comfortably, safely because now you're putting that person at risk. They probably have some medical condition that makes them at a higher risk for contracting Covid-19. And so the isolation is that the caregiver really can't take what we call respite which is the ability to take a break and to get away from the caregiving situation." On how to contact a California Caregiver Resource Center 'Well, pre-COVID and post-COVID, I think it's important that caregivers look for support from both formal agencies that are out there such as, in California we have the California Caregiver Resource Centers that are serving— just focusing on you, the family caregiver across the states. … A lot of it starts with a phone call, so that you have someone that you can talk to that understands what you're going through. … You can start by calling even 1-800-540-4442, so that you can get connected to the right resource center." On the need for policies to protect caregivers "But what we can do for caregiving is have policies that help relieve some of that care when we're not able— so that we don't always have to make a choice between, say a paycheck and caring for someone, going in sick to work and caring for our relative, being able to sleep and caring for our relative. So we need to have built in policies that allow for breaks, allow for alternatives when we choose to have them there. And all of those things may not be a direct pay to the caregiver, but it provides more options for care, for both the caregiver and the person they're caring for." On how to advocate for caregivers through personal stories "People get scared about talking to a legislator or their elected official and they go, 'Well I don't know how to develop policies.' Well, you know what? You don't have to come up with the wording. What you can do is tell your struggle, tell your story, tell not just the struggles but also why you do what you do. And your story will be enough for the policymakers. They're the ones that need to understand where the gaps are. And to understand what your needs are. And so when you tell your story all you have to add is, 'And I wish that someone could do blah.' Don't worry if it's there or not right now. You just give out your wish list." On the health impacts of caregiving "Twenty-three percent of caregivers say that just by being a family caregiver, their health has been made worse. And why is that? Because they're spending time— they're taking their relatives to the doctor and they're not going to the doctor themselves for their own health care. Because they may not have time to do it. They have to make a choice. I can either get my relative, who is sicker than I am, to the doctor. Or I can go to work. Or I can use my sick time for me. And so, you know, having to make those kinds of choices— that means that we really need to have better policies overall for long term care services and supports in our communities." On the need for caregivers to take care of themselves too "And again, that's often because we don't see ourselves separate and apart from our role as a caregiver needing, what we call needing your oxygen— putting your oxygen on first. So if we don't care for ourselves we're not going to be there in the long run to care for the person that we want to, but we tend not to want to put the oxygen on first." On racial and socioeconomic health disparities "You know, the pandemic right now has really just removed that very thin veil that was covering up the health disparities and disparities in social determinants of health in our society right now. Racism has always pushed our African-American, Black, Latino, and other ethnic and racial groups to the margins in terms of how we've set up policies to help them with family care overall. Even when the in-home support services were set up, part of that was that there were not reimbursements for being a caregiver in terms of benefits that you could pay into Social Security or things like that. So that people that worked in domestic work never could, kind of, build up equity for themselves— financial equity. And then when it comes to health disparities right now for the African-American community, diseases like Alzheimer's are considerably higher among that population and we're more at risk because of other health disparities. And that all comes down to the fact that we've had health policies that have not been equal or access to health care has not been equal. And so that our older adult population might be sicker than other populations. And during this during the time of COVID that health disparities have just been shown through the fact that we have much higher rates of death and infection among the African-American population… And we have to look at, you know, where people are living and do we have enough medical facilities in the neighborhood? Do we have enough adult daycares and child care centers in neighborhoods? Do we have enough grocery stores in the neighborhood? And do we have the right types of food and fresh vegetables and things in the neighborhood?" On how to better support dementia caregivers "So I think for dementia, the policies need to be there so that we get better diagnosis, that we have more physicians who are trained to recognize and help family members, that social service and physicians also know where to refer people to once they have a diagnosis of dementia and how to help the family because, you know, it's not going to be— the physician isn't going to be there to help with support groups. They're not going to become the support group person. They're not going to help them navigate, so other social services. But if they make the right referral to, say an Alzheimer's Association or AARP or a California Caregiver Resource Center system. When you make that referral, that actually helps start the process so that the caregiver will have somebody who they can call once, you know, whenever they need to— over the course of many years as the disease progresses, you're going to need different training, different information."

Dr. Pinchas Cohen, USC Leonard Davis School dean and a professor of gerontology, medicine and biological sciences joins Chief Communications Officer Orli Belman in a conversation about COVID-19 risk factors and research directions, with a focus on how research focused on delaying aging processes holds promise for improving outcomes for older adults. On the relationship between age and mortality rates: "Older adults are so much more dramatically affected by this terrible pandemic. While of course middle-aged people and young people are affected by this and their rate of infection can be very high, the mortality of younger people is very, very small, but rises dramatically as people age." On vaccine response rates and older adults: "We all know that vaccines are the number one goal for the biomedical industry right now, but some of you may or may not be familiar with the fact that vaccines are extremely efficient in young people, but among older adults, the response to vaccination is sometime very ineffective. For example, flu vaccine has a non-responsiveness rate that approaches 50% in older adults, which are of course the group that needs it the most." On the need to develop cytokine storm blockers: "When people look at what actually causes people to perish from COVID 19, it's not so much the viral pneumonia that they suffer from, but rather something known as a cytokine storm that the body responds to the virus was this secretion of inflammatory cytokines like, something called interleukin six and TNF alpha and interferon, which the body then responds to with really shutting down of the lung and eventually death. So the development of blockers of this cytokine storm, are going to be critical. And that's an area that geroscience has been leading for many years." On the importance of gerontology and geroscience research: "Post-COVID-19, I think that gerontology education will only become more important. Furthermore, research on the policy and social impact of the pandemic will be prioritized. Our leaders, our thinkers will continue to be at the forefront of that. Research into geroscience, particularly immunosenescence and inflammaging will be a major goal for the National Institutes of Health. Prevention of chronic disease, which has been really the biggest risk factor for older adults will return as a national priority." On how coronaviruses differ from influenza viruses: "Coronaviruses are quite different from influenza viruses. They're biologically unique, very separate. Also, influenza viruses affect primarily the airways, while coronaviruses can attack various parts of the body, but they're deadly when they end up attacking the lungs, which influenza does not. Influenza predisposes the lungs to bacterial infections, which could be lethal. But they're quite distinct. That's why there are limited lessons that we can learn from influenza when it comes to COVID 19. But we do have enough previous knowledge to allow us to deal with this crisis and for future crises." On the roles of age, genetic and underlying conditions: "Young people get infected just as easily as old people. The difference is that many young people have a completely asymptomatic course that they're able to have the virus go through their system, develop antibodies, and never have any sign or symptom. The genetic determinants of who is going to get illness as opposed to who's going to remain asymptomatic is something that we totally don't understand. Obviously having poor health is important..but there's also going to be genetic reasons why some people develop or don't develop severe disease and then whether or not you're going to survive, you know, be really sick and, and get better, whether you're going to have a very, very bad outcome." On what matters most: "At a time of great global uncertainty, what matters most is clear now than ever before. Health matters, older adults matter, science and especially geroscience matter. I think that this is going to be a challenging year ahead of us, but together we will prevail."

Throughout his career, Dr. Tyler Evans '02 has been on the front lines of major disease outbreaks around the globe. He was in South Africa at the height of the AIDS crisis and he treated Ebola patients in Sierra Leone. He just joined the New York City Emergency Management Department as the chief medical officer for the COVID-19 branch. The USC Leonard Davis School "Impact Maker" joined Professor John Walsh to discuss the current pandemic, global health, and how students can best serve populations in need. Here are highlights from what he shared: On how we were not prepared for COVID-19 "Folks in public health, especially in the communicable disease world, knew that the greatest sort of threat to society was not necessarily going to be war; it was going to be a microbial onslaught. And if the infrastructure is there, I'm not saying it's not bad, but the risk is definitely mitigated. And we were not there. I mean, we're getting better now. but we were not ready." On health disparities and vulnerabilities "When we look at variability, even between states and certainly even within states and within cities, and when you look at the granularity, you're going to see a lot of differences, and those differences, I think, really highlight the disparities that naturally exist throughout this country." "I'm sitting here in a tennis field hospital with incredibly sick people, but they all have what we refer to it as the social determinants of health. They all have a number of chronic comorbidities. They're people that historically don't have a great access to healthcare. So there are a lot of factors involved that have led them to be more vulnerable for adverse consequences." "We can't move forward in life being afraid to come outside. We can't move forward in life being afraid to touch other people. I do think that the shelter in place measures were a good thing. I don't think that we completely thought out all of the unintended consequences on the most vulnerable populations in the U.S. and abroad when it comes to food insecurity, when it comes to other kinds of chronic diseases or access to care." On how we are all in this together "I think, hopefully, it'll kind of bring us all together; more solidarity across the world to better understand that we are really all in this together. Despite the fact that the term is a little cliché, I think that if people really listen to what that means, they will grasp onto it and really understand how we focus so much on differences, but the reality is we really are all potentially impacted by this." On how students can help and find meaning in their work "There are a lot of opportunities to get involved, not just for COVID, but for the prevention or management of other diseases. You don't have to be a physician. You can be a student. But you've to find ways where your contribution is not just meaningful to you. I've had a number of really meaningful and translatable, sort of transformational experiences throughout my own life, but we also have to ensure that we're giving back to society when we're doing these internships or whatnot. So finding something that might not be as glamorous but could truly be meaningful and helpful is good. You might be having to create a database or code, or help to develop infrastructure. A lot of the developments are not as sexy and cool and exciting as people think they are. But all of those parts ultimately end up leading to our ability to save lives. So finding your niche, finding something that you're really good at, and doing it, and contributing is important." "For the students that are watching this, it's so important that throughout your career, whether it's in medicine or public health, or whatever field you decide, to just try to really do the right thing. Try to lead your career with your moral compass and ultimately try to impact populations that need it the most. And I assure you that ultimately your lives, both professionally and personally, will be very rich and meaningful." "So the world needs you guys to help populations that are in need, whether it's now, or whether it's building it, or whether it's in acute management. Like I said, it's not just healthcare systems, it's economics… there's so many intersections in our globalized world. And as long as folks really lead with their moral compass, I think they'll have a very meaningful life."

Cary Kreutzer, associate professor of gerontology and pediatrics and the director of the USC Leonard Davis School's master of science degree program in Nutrition Healthspan and Longevity, joins Chief Communications Officer Orli Belman in a conversation about how to eat healthy, shop smart, reduce stress and stay connected through food as we practice social isolation due to the Covid-19 virus. Cary Kreutzer quotes from this episode: On staying connected through food "I think as we all are sequestered to our homes and may or may not be with extended family, using whatever sources of media to make those connections with family members and reaching out to them to either have them on the line as you're preparing an old family recipe or having them on the line as you're enjoying a meal and feeling as if they're there with you at that meal are all great ideas of how you can bring family in." On what food items to have on hand "I think as we try to eat more at home, or are in a position where we need to be eating more at home, and are less able to make quick trips to the grocery store, which probably isn't a smart idea, [we should be] looking for foods that have a longer shelf life: those that need to be refrigerated, those that we can store in our freezer, or even looking to canned goods that we can have as a backup plan should we need to grab for those items." On canned fruits and vegetables "A vegetable is a vegetable, and they all are going to provide vitamins and minerals. [In terms of] the processing of frozen and the processing of canned vegetables or fruits, we lose minimal amounts of nutrients in that processing. Many items are either quick-canned or quick-frozen and we're losing very little nutritional value. … For those that worry about their salt intake, my only caution I would say for canned foods would be to rinse the foods that are canned, that can be rinsed. Many foods like soups or even sauces, you can now buy low salt versions of those just as a way of decreasing and salt intake." On choosing prepacked fresh produce "I would choose bagged or fresh fruits and vegetables that are in containers, whether it's a bag or whether it's plastic containers. I've toured those food preparation sites where lettuce and other foods are put together, and they're very sanitary with their practices. In a grocery store, we don't know whether people are carrying this virus while they're shopping. If you're going to buy loose carrots and your plan is to cook those carrots, I think you would be fine. But I would not buy something like a raw head of lettuce that I was going to rinse and then chop and put in a salad. I would probably stick to bagged lettuce just to be safe." On safe supermarket shopping strategies "I would suggest trying to limit the number of times you're going to a store right now. ... It is probably is prudent to try to get what you need once a week, or longer if you can do that. And definitely have a shopping list. Sometimes if it's the store I always go to, I'll try to write things on my list in the order of where I pretty much know they are in the store: all the dairy together, all the canned foods together, all the breads together, meats together so that I can quickly get through that list. … [If you can't find an item], find someone who you can ask where to find that item so that you can get in and get out quickly." On take-out food "With picking up food or even having food delivered, try to stay focused on warm foods that you can reheat in the oven or heat up to 180 degrees, which is a warming temperature in the oven. I would only use raw ingredients that you're preparing at home to add to those foods. And I definitely would throw out any packaging that comes with those foods. I'd use my own dishes. I would also throw out bags or plastic or things that they come in and make sure I wash my hands well because we do know that the virus can live on some surfaces longer than others." On staying hydrated "Avoid foods that cause you to be dehydrated; coffee, as a natural diuretic, as well as alcohol can be dehydrating. Try to focus more on water. Herbal teas are good. You can add squeezed fruit or frozen fruit to a juice if you need to add some flavor for those. With diabetes, you need to watch the amount of sugar-sweetened beverages you're consuming. So limit the juices; while those are good in terms of nutritional value, they're usually pretty high in sugar, and a little bit every day is really all we should be consuming." On ways to avoid stress eating "I think, for all of us, being aware and recognizing that this can be stressful and coming up with plans for activities … to think of 'What are all the things that I've been putting off that I can do around the house?' [such as] weeding, or planting my garden a little bit earlier. Thankfully, we're not restricted with our ability to go out. That could be riding bikes, that could be going for a walk. It doesn't have to be intense exercise. … In my neighborhood, there were some neighbors that were going to have a meet and greet. Many of us have seen the video of Italy and people on their balconies singing together. In my neighborhood, that there were people that were going to go out on their porch and just wave to one another across the street. … You can use all types of social media, whether it's calling friends or family on phones now we can do video chats, we can do Skype through our computer. So lots of ways to connect with other people. I would also say, I know for my religious affiliation, they have sent lots of ideas of how I can stay connected to my religious beliefs and not feel alone. So, reach out to those resources that are provided for whatever your religion may be and work on trying to destress your environment."