American Heart Association’s Dr. Eduardo Sanchez on Heart Health & COVID

American Heart Association’s Dr. Eduardo Sanchez on Heart Health & COVID

Dr. Eduardo Sanchez is the Chief Medical Officer for prevention at the American Heart Association, the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. Dr. Sanchez previously served as the Texas Commissioner of Health and has had advisory roles with the CDC, the Institute of Medicine, and the National Quality Forum. Throughout my professional career as a heart surgeon, the American Heart Association has played invaluable roles in my own training as a researcher, a teacher, and as an active clinical surgeon. Dr. Sanchez shares with us why our own good heart health is so important to reduce the risk associated with the COVID virus, and why zip code can be a better predictor of our own health than our genetics.

Dr. Eduardo San…:        You’re also more likely if you live in that zip code, to have the kind of job, essential worker, that puts you in contact with lots of other people and just being around more people puts you at higher risk, period.

Senator Bill Fr…:           You’re listening to A Second Opinion, your trusted source engaging at the intersection of policy, medicine, and innovation, and rethinking American health. Dr. Eduardo Sanchez is the Chief Medical Officer for prevention at the American Heart Association, the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. Dr. Sanchez previously served as the Texas Commissioner of Health and has had advisory roles with the CDC, the Institute of Medicine, and the National Quality Forum.

Throughout my professional career as a heart surgeon, the American Heart Association has played invaluable roles in my own training as a researcher, a teacher, and as an active clinical surgeon. Dr. Sanchez shares with us why our own good heart health is so important to reduce the risk associated with the COVID virus, and why zip code can be a better predictor of our own health than our genetics. I’m your host, Senator Bill Frist. Welcome to A Second Opinion.

In the beginning the coronavirus was described as a purely respiratory virus, respiratory illness. And which it is, but now we’re learning that it seems to be a lot more. That’s a narrow characterization, and that has changed over time. Tell me a little bit in terms of what you’re hearing, what your observations are from the front lines about this virus.

Dr. Eduardo San…:        Sure. From the beginning when the first reports were coming from China, what became clear is that while it may manifest mostly as a respiratory illness, there were the beginnings of observations of things like heart failure, fatal arrhythmias. But from the standpoint of the American Heart Association, the thing that struck out to us was that while predictably case fatality rates, that is how many people die who get COVID-19, is high for people in their seventies and eighties, I think we found it particularly interesting and foreboding that persons with cardiovascular disease as an underlying condition, persons with hypertension as an underlying condition and persons with type two diabetes, those last two are risk factors for cardiovascular disease, were also experiencing higher case fatality rates. So we began to pay attention because here’s this virus primarily respiratory that has a disproportionate effect on people with underlying medical conditions that are of concern to the American Heart Association.

Senator Bill Fr…:           Then explain that a little bit more. So you have a virus, it’s, I’ve forgotten, 70 to 80 or 90 nanometers. So if it’s in a hail, it’s a respiratory virus. That’s where it starts. It goes deep into the lungs. It causes inflammatory reactions, it sends off cascades, it has a direct damage on the lung. What is the impact that it has on the heart? Is it independent of that or is it this systemic response that’s caused by this attack of and within the lung?

Dr. Eduardo San…:        So it’s not completely clear? It is probably in large part the result of a very, very, very dramatic immune response. The body goes a long way to protect itself, and sometimes it does damage while it’s trying to protect itself. And as you know, fever is one of the ways that it tries to “kill virus”. But there’s all kinds of other things that are happening at a cellular level, and infiltration of the heart by that cellular response may be one of the explanations of what’s going on. The other may be that one’s ability to mount an effective immune response, for example in the case of type 2 diabetes might be compromised. And therefore for a different reason we’re seeing these kinds of outcomes.

I will say Senator, that one of the things the American Heart Association has done is that we have stood up a COVID registry whose reason for being, we are the American Heart Association, American Stroke Association, is to be able to collect and aggregate data from hospital states that will help us better understand the mechanisms that will answer the question that you just post to me. We don’t know all of it yet. And while we’ve got this observational data that gives you a clue about what might be going on, we’re hoping that by tracking patients who are in the hospital, and that is up and running, we will have better insight into some of the mechanisms.

Senator Bill Fr…:           Yeah. Tell me a little bit more about that, there are a bunch of known unknowns about this virus. And the basic one is how many people out walking around are infected because you don’t have to be symptomatic and can be infected. Will there be a second wave or a third wave, or will it research back in the fall? We don’t know the immune response really yet. Is it a week? Is it a month? Is it two months? Is it three months after you’ve had it? There are whole range of these and therefore it’s important for us to learn everyday.

And that means getting data every day. And talk a little bit more about that because these known unknowns eventually we’ll know them, but it takes this accumulation of data, the assimilation of data, the analysis of data. So let’s go back to what you said, how does somebody going into a hospital or to a doctor’s office or to a clinic get into your registry, such that it can be compiled by you or by others in partnership with others. How does that actually flow?

Dr. Eduardo San…:        So the unit of organization is a hospital. So hospitals sign on to be a part of the COVID registry. But let me give you a little bit of background. The American Heart Association has a set of modules on quality improvement modules around four areas, atrial fibrillation, heart failure, resuscitation and stroke. And for a number of years we’ve been doing this work in thousands of hospitals in the United States, where we are capturing, we are using a systems approach to make sure that guideline based medicine is being practiced in those hospitals using checklists and using registries that monitor what’s getting done. And what we’ve demonstrated Senator is that when one adheres and one periodically reviews how they’re doing, improvement happens. Improvement happens in fact in a way that reduces disparities in outcomes.

The kinds of disparities that you and I know have existed, and sometimes and in some instances continue to exist in terms of healthcare outcomes for people of different race ethnicities. So it is about using a systematic approach to knowing what to do, doing it, seeing how you’re doing it, and then making corrections so that you do even better quality improvement. We’re using that same platform and that same approach to try to collect the data that we think, and I think we think is the operative word that we think will help us get insight into what exactly is happening in the course of COVID-19 as it relates to cardiovascular and cerebrovascular conditions.

In some instances, it didn’t start that way but it evolves to become that heart failure and fatal arrhythmias. In other instances, people show up at the hospital who have already underlying conditions. We’re making sure we’re tracking and we’ll be able to sort that data out. So the unit of organization is the hospital as opposed to an individual.

Senator Bill Fr…:           And how much range do you have now? Do you have these databases collecting one out of a hundred hospitals, one out of 50 hospitals or hospitals that concentrate on heart disease? About how many hospitals or ratio do you have connections with?

Dr. Eduardo San…:        So at this time… And mind you, we stood this up, if I remember right, it’s late March, early April. At this time we have 50 hospitals or so signed up, and we have many, many more in the queue. Because part of this… you’ve been in the business. I’m saying you want to do something at the level of two folks who want to do it, who represent two different organizations is but the first step of a long journey that generally involves people looking at agreements and signing contracts. And so all of that is getting done.

So the fact that we’ve got as many as we’ve got already on board is pretty spectacular. And the line is long and we’re just working our way through that. I’m a believer that big data can be useful if you organize it the right way and have the right people looking at what it is that that data should be telling us. And we’re trying to set things up to get to that place. So it’s not just collecting the data, but it’s understanding what we want to collect and then understanding how we’re going to analyze that so that it gives us the insights we’re seeking.

Senator Bill Fr…:           Dr. Sanchez, if you look at the American Heart Association and it’s past, it’s done so much. And for many of our listeners and our viewers, they may not be familiar because they’re not a doctor like you or me, or even if you’re a doctor if you’re not in the heart field. But paint that perspective of for our listeners and our viewers of the American Heart Association, how long it’s been around. And I’ll preface it by saying, even as a little boy a long time ago, 60 years ago when my dad was president of the Middle Tennessee Heart Association and an affiliate of the AHA, I would go with him in our community and collecting coins at the time to support the great research that was going on in Middle Tennessee at the Vanderbilt and the University of Tennessee, but indeed around the world.

And then as I myself went to medical school and sort of gradually moved towards the heart as being the organ that I was going to focus my entire career on, and ultimately went into heart surgery, then the research capacity was the American Heart Association that would give grants, and then it was the American Heart Association who would hold large conferences to peer review the research that I would present. And then that’s the way medicine and science progressed. And in my own field of things like heart transplantation, it was absolutely critical. But tell us a little bit about the American Heart Association.

Dr. Eduardo San…:        Well, let me say first of all, thank you so much for collecting coins 60 years ago, and thank you so much for being probably a dues paying member of the American Heart Association and participating in our organization. But you did a really fabulous job. I’m only going to fill in with a little bit of detail. We’re about a hundred year old organization. We are an organization that we are known for a few things. If you are a healthcare provider of any kind or you’re a lay person and you’ve taken a basic life support class and, or advanced cardiac life support and all the derivations of that, the science that informed that has been a science that we at AHA would say is our science. Of course, it involves other people. I’ll talk a little bit about that in a moment.

We are the organization that is the second largest funder of cardiovascular research in the United States of America. I’ll be honest, we’re a distant second to the National Institutes of Health. However, we are the organization that not a week goes by that somebody doesn’t say to me, “I got my first grant. I got my first research grant funding from the American Heart Association.” I think we’re up to 14 persons who have gotten Nobel prizes that can trace their research back to an American Heart Association fund. And Brett Giroir, the Assistant Secretary for Health, is somebody who I don’t think he’d be mad if I said he commonly says, “I got my first funding from the American Heart Association.”

We have about 30 plus thousand professionals who are members. They’re not all physicians, so it’s multidisciplinary. Everything from physicians, researchers, nurses and all disciplines in medicine. We are an organization that has initially dedicated itself to taking care of people when bad things happen. You have sudden cardiac arrest, you need cardiac life support. You have a heart attack or you have a stroke. And that’s a reminder to me, we are the American Heart Association, American Stroke association, but that’s way too many words. So we shorthand it much to the chagrin of our stroke and our neurology members. But having said that, we are an organization that’s gone from just thinking about saving people to beginning to think about two decades ago, how we reduce the risk factor profile of a person. As you know, if you’re a smoker, if you are overweight, if you eat unhealthfully, if you’re physically inactive, all of those contribute to the things that lead to cardiovascular disease.

And we’ve gone a step further now on, about a decade ago we put a stake in the ground and said, “It’s not enough to just reduce risks, let’s be about improving health.” And so we are an organization that is about improving the cardiovascular health of all Americans. We do have a different mission statement now, different goal, but I will show you the number seven that’s on my lapel. That’s life’s simple seven, the seven factors that we define cardiovascular health with, not smoking, healthy eating, physical activity, healthy weight, healthy blood pressure, healthy cholesterol, healthy blood glucose. I need to say that every single day. For me that’s like eating an apple a day, so I feel healthier already.

Senator Bill Fr…:           We’re seeing some populations that are disproportionately impacted by this virus, by the disease COVID-19. We mentioned that those already at risk for cardiovascular disease, people who are at risk for strokes, people with diabetes. And then you mentioned that the American Heart Association really has gotten much more involved over time to broader issues which we know determine cardiac and morbidity as well as neurological stroke and the light morbidity. And then that takes us to the social determinants themselves. And the Robert Wood Johnson Foundation that I serve on the board of, we look a lot at these vulnerable populations that are impacted. And it’s not new, but the zip code ends up being very, very important if you look at not just healthcare and healthcare delivery, but overall wellbeing, that larger meaning of health. Comment a little bit about zip code, where you live as well as how you live in those zip codes in terms of the impact in this COVID environment.

Dr. Eduardo San…:        That’s a great question. And I like to say zip code may be more important than genetic code, but that doesn’t make my geneticist colleagues very happy when I say that. It makes the postal worker volunteers, people who contribute that makes them happy to hear that though. So having said that, I talked about ideal cardiovascular health. As we have done what we can to encourage from a policy perspective and a personal persuasion perspective to get people to adopt healthier lifestyle, to get better on those life’s simple seven, what’s become clear, Senator, is that one’s personal ability to be able to do that might be dependent on zip code. And the reason is that zip code is an insight into a few things. One, zip codes tend to have aggregations of people at certain income levels.

So, you and I may live in zip codes where most of the people who live there have an income of a certain amount and have an educational level above a certain amount. And we both live in communities where we know zip codes where the income level is low, the unemployment level is high, the schools aren’t very good, the graduation rates are low. And that’s not to blame people who live there, it’s to understand that those characteristics can be predictive of one’s ability to not smoke or more importantly, the likelihood that one will because you and I live in neighborhoods where if I walked out on my front lawn and started smoking a cigarette, I can only imagine that my neighbors just their looks would get me to put that thing out.

And others of us live in different places where you can do that, and it may not be the worst thing going on in that particular neighborhood. And not to judge neighborhoods because I don’t wanna make it about that, but zip code matters. And again, it’s the things about those zip codes. We know the following things. One’s likelihood to be able to go from a lower level of socioeconomics to a higher level of socioeconomics is defined by things having nothing to do with medical care. Let me see if I can get the four factors that I remember off the top of my head.

One is living in a mixed income neighborhood. So it’s a neighborhood where there is a mix, everywhere from lower income to higher income. It’s neighborhoods where the schools are high quality, they’re graduating young people from high school and they’re going on to college. And that’s enough. The third is, and this is just a fact of what’s been observed, neighborhoods where there is a higher percentage of two parent families. It doesn’t mean you have to be in a two parent family, it just appears at that adds or is characteristic of neighborhoods where kids thrive.

And then the last is neighborhoods where the adults are engaged in activities beyond what goes on in their home. It could be a faith community involvement, their church, it could be a social organization, it could be a civic organization. Those four things, and notice I said nothing about medical care, those four things are the strong characteristics that predict the likelihood that as an adult you will raise kids in a zip code that has more of those characteristics than less of those characteristics.

Senator Bill Fr…:           I think that was a perfect outline. And in those studies about the inequality of going from those lower quartile moving to the higher quartile, whatever measure it is but measures of prosperity, are so much dependent on those four factors and the neighborhoods themselves. What’s interesting about COVID, and I’d love your reflection on it, is that these sorts of inequities in our society preexist COVID. We know that they’re vulnerable populations that are disproportionately impacted, African-American, Latinos, people lower on the socioeconomic ladder, people with disease, preexisting chronic disease.

These inequities that are there seem to have been made worse by COVID. If the inequities were there before it seemed like the COVID virus. And part of it is because people if you’re homeless or you’re in a prison, you can’t socially distance yourself. You’re just not capable. You have to be out of school and the whatever learning inequities are there, they get worse if you don’t have more formal instruction over time. Is there anything that we can learn from that? It blows out these inequities where we see them more I think. But then coming out of all of this, what are the lessons that we can learn?

Dr. Eduardo San…:        Sure. I’m going to go back to zip code for one second. Because zip code can probably predict where one might expect there’s going to be more COVID-19 and worse outcomes of COVID-19, for the combination of things that we talked about. If you are in that low income zip code, you are more likely to live in housing situations that are crowded to a degree that social distancing is a bit of a problem. You are more likely to be uninsured. And while the clinical factors or the medical care factors may not be a factor of moving from one socioeconomic group to another when you need healthcare, i.e., I’ve had a persistent cough and fever and I’m worried to have COVID19. If you don’t have insurance, your access to care is different than somebody who does have insurance.

You’re also more likely if you live in that zip code, to have the kind of job essential worker that puts you in contact with lots of other people, and just being around more people puts you at higher risk, period. Particularly because you can have COVID-19 without any symptoms at all and be spreading the disease. So if you’re a bus driver and all kinds of people are walking on the bus and breathing on you and saying, “Hi Senator Frist.” That would be an interesting thing. Or if you are somebody who works in a supermarket or in a meat packing plant or clerical staff in a hospital, or you have to ride the bus, all of those are situations that put you at higher risk. And by the way as we talked about, depending on race, ethnicity, you are more likely perhaps to have some of these underlying medical conditions. You put the two things together and you’ve got literally a tinderbox.

So lessons that we need to learn I think on the other side. One is that it won’t be enough to just focus on the public health infrastructure necessary for adequately responding to the next pandemic. We have to think about the socioeconomic and these underlying health conditions, and begin to think about how as we invest in a different system, because I think we need a different system, we need to consider that health, public health and medical care are actually part of what should be one system.

And I think that COVID-19 has demonstrated to us that when you have an inadequate public health system, and I think I’m comfortable saying this public health system has not served as well as it could’ve. And we have an inadequate medical care delivery system, and I think you and I would agree that there’s room for improvement there as well. The two together have created this tinderbox. The solution has to be looking at the whole thing and not one versus another. Seems to me.

Senator Bill Fr…:           I think you said it so beautifully. And I think because of this disease, this virus affects all of us so intimately. 350 million people in this country feel it. And I think the observations are exactly right. The inequities where our systems have been broken in the past, whether it’s public or whether it’s in the acute side of physical health delivery or mental health delivery, we have this opportunity seeing how important it is to holistically fight a virus, and these viruses are going to keep coming back, to fix a lot of those things.

And that does take me back to what I mentioned earlier is the research, power potential, the reality that the American Heart Association makes possible. Are you doing anything? It has in my career as a heart and lung transplant surgeon and in the residents that I’ve trained, just almost everyone has been impacted by the American Heart Association. Are you doing anything specific in terms of research on COVID today? Any programs, or funds, or programs on the virus itself, or research around it?

Dr. Eduardo San…:        I’m smiling cause these feel like softballs. I might’ve said earlier, I ran the state’s health department and I had to sit in front of committees of senators and representatives in Texas, and those weren’t always friendly and softballs kinds of questions. So this is beyond pretty good. So the truth is with regards to COVID-19, I talked about the COVID-19 registry earlier. But the other thing that we did is that we have put two and a half million dollars to fund COVID research. Really, the call for proposals was about as broad as it could be. Everything from the pathogenesis of disease to social determinants and all things in between.

And we were only going to fund 10 projects, 10 proposals, which was known. We received 700 proposals, 700 proposals were received. The deadline was April 6th, to be received on April 20th. After a lot of work by a lot of volunteers and staff, I hear that 150 American Heart Association volunteers stepped up to review those 700 grants. We got it down and the 10 have been funded. And it really is across the board. Is that enough? Absolutely not. But as I said before, we feel like we sometimes are the tip of the spear and what we’re hoping is that the NIH follows along.

I think that the other thing that I would say as it relates to research is that Circulation, one of our journals, our banner journal but many others, the New England Journal of Medicine, the Journal of the American Medical Association, have dedicated a fair amount of page space to COVID-19 observations and early research. And I think it’s a testament to our desire to really understand what it is that’s going on, but more importantly to help others understand based on what we’re seeing and putting it out there.

And I think if there were a few silver linings of COVID19, I’m seeing a collegiality by researchers that sometimes are competing against one another, who have said the common enemy is COVID-19 and what it’s doing. And people are working together to understand what’s going on, figure out how we can accelerate and identify and accelerate treatment that can be offered to people. And you can’t help but see that around vaccine discovery, same kind of level of cooperation. And there’s a race to the finish, but it’s a race of friends. It’s not a race of enemies.

Senator Bill Fr…:           But I think what’s also interesting, you’re exactly right, this common enemy of virus, it can impact all of us in a deadly way, everybody. And it’s a global issue. We’re seeing our global scientists, the best scientist in Germany, and Italy, and in Singapore, and China coming together, daily conversations, the race for the vaccine, the rates for the antivirals. So I think that’s a really important point you make. And I would just add to it from the policy world and from your average person who’s on the street, I think there is an appreciation that science matters. We need to invest in science.

The endpoint of this virus and just our own safety in our homes is science. Science is only thing. The virus is not going to change. The virus is going to be out there, be a deadly virus, but science is the one thing that can vanquish this foe. So I think there’s going to be this general appreciation for science, for medicine, for clinical research that wasn’t there in the past. The one last issue is the hunkering down, the sheltering in, the social distance saying, the closure of hospitals to elective procedures of catheterizations of angioplasties, of hypertension checks.

It looks like over the last six weeks that a lot of people have stayed at home, could be out of fear. It could be because of sheltering and stay at home, the global mitigation order, or it could be a fear of going to a hospital, of getting the virus or sitting in a waiting room. Characterize that a bit. Have we seen fewer heart attacks? Have people stayed at home and had mini strokes or many heart attacks. Mini, M-I-N-I and M-A-N-Y. And what is it going to do in terms of the catch-up phase? What has COVID done to recognition and treatment and diagnosis of heart disease?

Dr. Eduardo San…:        The American Heart Association along with many of our sister organizations is really concerned by a couple of things that we have seen happen and believe they’re connected. One is that there has been a decrease to your point of folks on calling 911 for heart attack and stroke symptoms. We know that. On the other side we know that there’s more out of hospital deaths happening that aren’t necessarily related to COVID. And we’re worried that there’s a relationship between the two, i.e., people are in fact dying at home of MIs, strokes, maybe even sudden cardiac arrest and there’s a fear to even call EMS. So about a week ago, AHA and seven sister organizations did a call to action, call 911 if you think something’s going on. We’re trying to convey the message that the hospital is a safe place to go. And it is the place where you need to go to get evaluated.

And in turn we are concerned that as you’re so adeptly describing not only has there been an effect in the hospital setting of taking care of what sometimes gets characterized as elective procedures and elective issues, but there’s been a decline in visits to run of the mill every day, care of cardiovascular disease, risk factors, high blood pressure, type 2 diabetes. There’s been a move to tele-health, but I think you would agree that tele-health has not completely replaced. That is there hasn’t been a wholesale replacement of those visits, and we are concerned that people may not be getting the access to care and the care they need in a timely manner. So we are trying to get the message out, at the very least, call your doctor’s office and check in. And determine whether there is an opportunity to do at tele-visit or a way to arrange a visit in person.

I’ve heard of drive-bys. I just heard of an FQHC that is doing blood pressure checks and hemoglobin A1c checks for people who need them on a drive by basis. I just find that so clever. We were doing drive by testing for COVID-19, so folks are trying to figure that out. I think that we are potentially losing ground. And my hope is that innovations like tele-health, messages about calling. Other providers, I heard yesterday about a provider who’s taking advantage of decreased visits to do the following when patients with high blood pressure come in, they are checking to see how accurate their home blood pressure monitors are. Bring your machine in, we’ll test it.

And so people are trying to be creative about how to use that downtime, but I do think we need to do some catch up because I do worry that not only are things not being paid attention to, but for all the reasons we talked about earlier, the lag in care is going to disproportionately affect a group of people who can’t stand to have a lag in care. Because they’re already behind, because they already have high blood pressure at a higher rate than others, or already have type two diabetes at a higher rate than others, they need to have that under control.

I think the last one thing that I do want to say, if we have the opportunity in the midst of all this, and I can’t imagine that this will run and we will still not be in the time of COVID, take all the medicines your doctors have prescribed unless your doctor suggests otherwise. And don’t do it because you heard something on the TV or you heard something on WhatsApp, get on the phone and talk to your doctor about how to manage your medications.

Senator Bill Fr…:           All right. Very well said. And I think if you because I’ve talked to friends and talked to former patients, I do think that this COVID impact will include a feeling of responsibility that, “Yes, I can hunker down, I can shelter in and that’s going to protect me from the virus. But I can also eat a little bit better, not so much processed food, not so much sugar and that’ll help my immune system. Maybe I need to pay attention to getting seven hours of sleep instead of six or seven and a half or eight hours of sleep.”

This whole sense of I control my own destiny given the genetic code and the behaviors I’ve done in the past and today, that there’s a lot that I can do as well. And I’m hopeful coming out of this that people will combine the very best of the clinical delivery, what we know in science with the most that they can do as individuals in controlling their own destiny or at least shaping it in terms of food, what they put in their body, how much time they spend in nature, how they release stress coming through.

So there’s some encouraging things that as you said, aren’t silver linings but are opportunities if we seize them. I’ll have to come back and most of our listeners and our viewers are all over the country and all over the world, but in Nashville we have a program called NashvilleHealth, that’s one word. And it’s an ongoing collaboration, and we have a very specific program with the American Heart Association on population health efforts to improve heart health. And we’re seeing great results in our community at Middle Tennessee with this collaborative approach, working hand in hand with the public sector, the private sector organizations, especially like the American Heart Association. Why are these partnerships people coming together so essential, especially right now?

Dr. Eduardo San…:        Well, we’ve always known and seen that when you bring lots of people together around common cause you get better outcomes. And when you apply an evidence based to do that back to science, when you use science to collectively harness that good will, you can get great, great, great results. And so I think basically that is it. And when you have organizations like NashvilleHealth, and I’m going to say the American Heart Association, we are an organization that is a trusted brand.

And back to the comments just a little while ago, we are a voice that’s trying to say in this time of COVID and not here are things that you can and should be doing at home that might make you healthier. But in partnership with others, A, many voices together make a choir and many voices together have more reach than a single voice. And many of us working together can carry heavy loads and overcome challenges much better than we can individually. And I think that there’s an African proverb that says if you want to go fast, go alone. If you want to go far, go together. And I think what you’re describing about national health is a commitment not to be fast, but to go far because the goal is the destination, not the speed at which you’re going to get there.

Senator Bill Fr…:           I think these community collaborative like NashvilleHealth pull the very best together of the academics, of the business community, the 120 nonprofits in Middle Tennessee that are focused on health and wellbeing, whether it’s the zip code and the social determinants or whether it’s the science behind heart disease and brain disease and the chronic disease. And when you put it together and you establish the sort of metrics that we were talking about earlier in our conversation, pulling in that data, setting very specific goals, things really move. It moves the needle. We’ve seen it with NashvilleHealth.

And I’ll just have to close and say that partnership with the American Heart Association with the decades, a hundred years of experience in the research and in the organization and the delivery and in the prevention really to me is the power, is the magic in lifting everybody up, of minimizing the inequities in healthcare and the disequities in healthcare, and lifting everybody up to a healthier wellbeing and a healthier lifestyle. So really appreciate that worked together. Any final comments? I know you’re right in the middle of it. I think you are representation of the American Heart Association, officially as the Chief Medical Officer. And looking at prevention, looking at wellness and looking at the health metrics, you put all that together, you’re right in the middle of anything. Any last words for our listeners and our viewers on either COVID or on the role that the American Heart Association might play in their lives?

Dr. Eduardo San…:        I think I’m going to restate a few things. Science is really, really important. And I think an extension of zip code matters, is that what happens in the geographic area that not only your neighborhood is in, but the city, county that you’re in really matter a lot. And the way things like COVID-19 play out, I believe are highly dependent on what’s happening at the local geographic area. Keyed the science, follow the science, look to trusted voices and for guidance. And the American Heart Association in this time of lots of information has been saying a couple of things. We’ll tell you what we think is right. We’ll also direct you to the places where we think there’s good information. Right now we are saying is a pretty good place on overall what you ought to do, but your local health department is the place where you’re going to find out exactly what you need to do in your local situation.

I think one last thing, Senator, the science sometimes doesn’t align with what elected officials are saying. Please, please look at what the science is saying. COVID-19 will not change because our mayors or governors or otherwise say go back to whatever you’re doing, follow the science. When it’s time in your community, your public health authorities will be saying, “We’re seeing a whole lot less activity than we were seeing a week ago and two weeks ago.” Heed the science, go to trusted sources for guidance. NashvilleHealth is probably one of those in the community directly around Nashville, Tennessee.

Senator Bill Fr…:           Dr. Eduardo Sanchez, Chief Medical Officer for prevention and chief of the Center for Health Metrics and Evaluation for the unbelievable organization, the American Heart Association. Dr. Sanchez, thank you for being with us today.

Dr. Eduardo San…:        Thank you. It really was an honor and privilege. To get an email from Senator Frist is like getting a message from on high. So thank you very much.

Senator Bill Fr…:           Thank you very much. This episode of A Second Opinion was produced by Todd Schlosser, the Motor’s creative group and Snapshot Interactive. You can subscribe to A Second Opinion on Apple Podcasts, Spotify, or wherever you are listening right now. You can also watch our interviews on YouTube and on our website. And be sure to rate and review A Second Opinion so we can continue to bring you great content. You can get more information about the show, it’s guests and sponsors That’s A Second Opinion broadcast from Nashville, Tennessee, the nation Silicon Valley of health services where we engage at the intersection of policy, medicine, and innovation.