Reflecting on COVID-19 and combustion [PODCAST]

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“Decreasing the burden of combustion material, whether from a cigarette, a power plant, or an engine, will not only pay off now in reducing COVID-19 but also in future pandemics and in reaping the health care benefits of decreasing the constant toll of tobacco and air pollution in our communities. As physicians and others in health care who want to do all we can to bring an end to this pandemic and build healthier futures for our patients and loved ones, we should make sure to reach out to our local city council, county, and other elected officials to take fuel away from COVID-19 by advocating for clean air. ”

Erika Maria Moseson is a practicing, board-certified pulmonary and critical care physician. She is founder, Air Health Our Health, an educational website and podcast on the importance of healthy air and a stable climate, and can be reached on Facebook and Instagram.

She shares her story and discusses her KevinMD article, “An anniversary: Reflecting on COVID-19 and combustion.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we welcome back Erika Moseson. She is a pulmonary and critical care physician, and she’s the founder of Air Health Our Health. She wrote the KevinMD article “An anniversary: Reflecting on COVID-19 and combustion.” Erika, welcome back to the show.

Erika Maria Moseson: Thank you very much for having me.

Kevin Pho: So we’ll get into your article in a little bit, but for those who didn’t listen to our first conversation, can you just briefly share your story and journey to where you are today?

Erika Maria Moseson: Absolutely. So I’m a pulmonary critical care medicine physician. I practice out here in Oregon, and I first got involved with becoming more passionate about air quality and tobacco control just seeing it in the ICU. I think a lot of the time, when you’re just going to work every day, a lot of physicians are just taking care of sick person after sick person after sick person in the ICU and taking care of them as they’re dying. And I really started to worry about burnout, and I really wanted to focus more upstream on how do I prevent people from getting here? Because you’re holding the hand of someone’s loved one who’s dying, and it’s just so heartbreaking that they’re there because of cigarettes, or they’re there because of disease that’s either caused or worsened by air pollution.

And so I had started getting more involved. The American Lung Association had asked me to speak to the legislators in my home state a little bit, and some policymakers, about different issues on air quality and tobacco control. And it was just really eye-opening to see how little our lawmakers and policymakers understand, and also how little, frankly, our community understands, how little, often, physicians understand. I’ve certainly learned a lot more about the impact of air pollution on health just as I’ve started looking into this work with the American Lung Association. And then also realizing the outsized impact that lobbies, like tobacco lobbies or business lobbies or construction industries, et cetera, have on policymakers versus people standing up for patients.

And so that’s what really drew me to do Air Health Our Health. I’m a full-time clinician, I mean, I’m a 1.0 FTE, so to add in the podcast and the website on the side was also just to be more efficient with my time to share this information. So if I’m doing a night shift, someone can still be listening to a podcast about air quality.

Kevin Pho: So tell me about your interactions with lawmakers. What are the challenges with you as a physician doing that, and for physicians who are thinking about doing the same, how can they make a difference by interacting with our lawmakers?

Erika Maria Moseson: Well, I think it’s really important to know what you know and say what you know. And then it’s interesting how people have their different worldviews. Definitely a lot of the worldview of lawmakers seems to be influenced by the budget, and then also by what the loudest constituents or voices in their particular district might be. And a lot of the time, people with lung disease or who are sick can’t breathe. They can’t talk, they can’t advocate for themselves, they can barely get to all their doctor’s appointments.

And so I think the doctor as an advocate is really important, because we’re the ones that see the toll of the decisions that lawmakers make, right? So when they allow tobacco and vaping advertising near schools, where we know that we had this 23 percent increase in teen vaping, and just saying, “Oh, well, it’s free market,” or “That’s the small business. You don’t understand business margins. They’re barely staying ahead.” And I’m like, “Yeah, but they’re staying ahead on addicting a new generation to lifetimes of disease.” It’s just so short-sighted from a financial standpoint, right? Because kids who start vaping are more likely to switch to combustible cigarettes, and then all of us are paying Medicare, Medicaid premiums, health insurance premiums, these insane costs for that lifetime tobacco addiction.

So it’s just such a short-sighted bottom-line look sometimes, and I think a doctor can help bridge that perspective, right? They do think most people are people of goodwill who are trying to do the best thing that they can, but sometimes it’s just the loudest voices, or the voices that make the short-term business bottom-line case, that win. And a lot of the time, the voices for health and clean air and that sort of thing, we have a longer time horizon, but ultimately much more devastating costs if we don’t take care of it. So I think trying to help lawmakers see that is really important.

Kevin Pho: And when you shared your perspectives with lawmakers, how receptive were they to some of your arguments?

Erika Maria Moseson: Well, I think some people are and some people aren’t, and I’m sure it comes from their different perspectives. Or sometimes people will say, “Oh, yeah, no, that makes a lot of sense, but I can’t vote that way because of whatever the local concern is.” Again, I do think most people are really trying to do the right thing. It can be very frustrating, especially now, I think, with the current political climate. Trying to let science inform policy seems harder and harder with how divisive everything is, and this kind of tribalism is really sad.

Kevin Pho: And if physicians want to be more involved politically, or want to become advocates and interact with our lawmakers, what kind of advice and tips can you share with them?

Erika Maria Moseson: Well, I recommend trying to get in touch with organizations that you think you’re aligned with, who would know who’s efficient to talk to. When I first did it, I literally was just looking up on the legislative website who all the members of the health committee were and going and trying to meet with them. And then you quickly find out, “Oh, well, they don’t. The health committee has no say over this tobacco policy; that’s over in Ways and Means.” You’re just like, “I don’t know how to navigate this.” So things like the American Cancer Society, the American Lung Association, the American Heart Association, a lot of the time, depending on what your passion is, can be really helpful if they’ve got a lobbyist in your legislature.

And then the other thing I recommend is actually getting to know who represents you in your state legislature. So if you’re trying to move a bigger policy, then you need the bigger landscape, but I think it’s very important for all of us to. So much of tobacco policy and air quality policy happens at the county level, the local city level, the state level. And so looking up, OK, who’s my county commissioner, who’s my state legislator, who’s my state senator, who are these people? And just sending them an email or calling and saying, “Hi, I’m a doctor who lives in your area, and this is what I see for tobacco. This is what I see for air pollution. This is ozone.” Even just looking at what your report card is for your county with the American Lung Association “State of the Air” report, and just saying, “Hey, my county was out of attainment for ozone, and I’ve got a kid with asthma,” or “I’ve got, you know, that’s damaging to this. What are we doing to get newer diesel equipment? What are we doing to move the needle on air pollution?”

And I think those things can be really helpful, especially if they’re coming from a doctor. I think doctors’ voices are really important, because frequently we’re the only people in a lot of people’s lives who have scientific literacy. Really, I mean, a lot of people don’t study science beyond whatever their last high school biology class was, and so the person who knows the most about science in their lives is often their doctor. And we see this with vaccine hesitancy; we see this with so many things. And so we can help explain to patients, too, the connections between the air they breathe and their health, whether it’s indoor air quality, mold, cockroaches, to particulate matter, ozone, and why it’s important that the construction that’s going on in their neighborhood is being done with newer tiers of diesel engines and that sort of thing.

Kevin Pho: So let’s transition now into the KevinMD article that you wrote. It’s titled “An anniversary: Reflecting on COVID-19 and combustion.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Erika Maria Moseson: Yeah, actually, this relates to some of my legislative advocacy work. So at the time I hit that, I realized it was the anniversary of the first COVID-19 patient that had come to our hospital system. Our legislature was also considering bills to do a regulation of diesel emissions, or particulate matter emissions, at different construction sites and densely urban areas, as well as considering tobacco retail licensing. Because actually, in Oregon, hey, I don’t know if you want to start a side hustle, but you can just roll into the state now and start selling cigarettes out of the back of your pickup truck. There is no retail licensing in our state. So we would just like to have a basic “You need to have a license to sell tobacco.”

And just thinking about that, because we’d also recently crossed the 500,000 deaths from COVID mark, and I was just thinking, 480,000 people die every year of tobacco in the United States, right? And COVID’s in the headlines every day. We are losing half a million Americans every year to tobacco already, right? So this should also have this public health urgency: How do we get in control of this pandemic? And then there’s also this likelihood that people who have COVID-19 have a more rapid progression if they smoke tobacco, right? The tobacco industry has actually tried to publish articles in the literature saying that tobacco smoking is protective. One of those was actually withdrawn from publication after the tobacco ties were found. So they’re still doing their misleading misdirection stuff. They were all found guilty of racketeering, I mean, and they’re still doing it in the medical literature.

And then just a similar thing: thinking about the generations of kids growing up in North Portland affected by air pollution, and we’re not. And again, there’s another study that recently came out showing that living in a high density of construction sites also increases your risk of acute respiratory distress syndrome, which is obviously how people die most severely from COVID. And just realizing, these are things where we have this acute crisis with COVID-19, but we have these chronic crises of air pollution and tobacco that interact with COVID-19, right? So 17 percent of the mortality in the United States is actually attributable to PM2.5 density. So 17 percent of the people who’ve died from COVID-19, that tip over into death, was related to the air pollution in the area, right? And in some areas that are very polluted, it’s almost a quarter, in some parts of China. Italy had a similar pattern. So part of our resiliency to future pandemics has to be cleaning up tobacco and cleaning up our air, so that when the next pandemic comes, or the next surge, we are more resilient as communities.

Kevin Pho: So hopefully in the next few months we’ll be at the tail end of the pandemic as immunizations become more prevalent. Keep our fingers crossed, right? So tell me about some of the legislation that you envisioned that can perhaps be influenced by the pandemic. Now, you talked about, of course, particulate matter in the air, air pollution, but is there anything specific within Oregon, where you practice, that may be influenced by the recent pandemic?

Erika Maria Moseson: Well, yeah. The things I would hope for would be tobacco retail licensing; that’s a first step. Oregon’s already raised the tobacco age to 21. Personally, I think, once we’ve reached age 21, why should you be able to sell them in grocery stores? I personally think it’s offensive that the pharmacies sell tobacco, that grocery stores are selling it. I mean, the kids can see it in the aisles. I think there’s a lot more to be done there.

And in terms of air pollution, Oregon’s working to try to help businesses transition to cleaner diesel fleets. So I think things like developing funds to help, because you don’t want your businesses to go out of business, right? So it’s trying to support businesses to be able to buy newer trucks, or to retrofit older engines, or make sure there’s electrical infrastructure in place; bills that allow for a transition to more electric fleets, right? We just need to stop burning things as a mode of transportation, right?

So the American Lung Association published this entire “Road to Clean Air” report, which looked at the amount of money we would all save from decreased asthma mortality and burdens of disease and sick days and all that stuff just from transitioning, when a transition to electric vehicles finally happens. And the sooner we can make that transition to electric vehicles happen, for both our transportation sectors and our individual sectors, construction, wherever we can go depending on technology, the fewer people are going to die and miss sick days and have lifelong illnesses.

And so I think just continuing to try to push it at both the local and national level. Obviously, the national level would be more helpful, right? It’s silly to try to patch these all together on the state-by-state level. But your air resource board, like the California resource board, looks at different areas that are not in attainment for air pollution. And so working to push everyone to consider, when they make a policy decision about changing freeways or doing whatever, that they actually look at, OK, well, what’s the burden of pollution in that neighborhood or in that area already, and how is this choice going to affect that? And then what can we do to be different?

Can we offer a clean contracting standard, for example, where you say, OK, part of our bid is going to say not only who’s going to build this fastest and cheapest, but who’s going to do it with the cleanest equipment, right? Who’s going to make sure that the kids playing in the park nearby aren’t inhaling black carbon and ozone at very high levels while they’re doing it? Because kids are very, very vulnerable. And I have three young children myself, so I think about them a lot. Because they breathe more than we do, right? They inhale a lot more pollution or tobacco, and any of the things they’re inhaling are just much more likely to cause them lifelong disease.

Kevin Pho: Now, as you reflect on the past year of the pandemic through your lens as a critical care pulmonary physician, what do you think are the most important lasting legacies of the pandemic?

Erika Maria Moseson: I think you’re going to see a lot more doctors as advocates. I think a lot of us thought there were adults in charge. I mean, I don’t know how to say it more bluntly, but I think I had a different idea of what the United States government was. I think I had a different idea of how leaders would respond in a crisis: prioritizing life, prioritizing people’s safety and recuperation. And just watching, and maybe it’s limited to one administration, but I’m not sure, just being willing to let people die to make numbers look good was, I think, disturbing to a lot of people in a way that a lot of us didn’t expect.

And so I think you see a lot of physicians stepping up and saying, “Wait a minute, I am going to become an advocate. I am going to try to, I don’t know, run for something.” I mean, that is not a path that I have any interest in, but a good friend of mine who’s a pulmonary critical care doctor here in Oregon ran for the state legislature, and now she’s a state representative, and she’s an ICU doctor. And I remember when she was jumping up and down, and we were talking daily and writing a letter to the governor to shut down in Oregon, just seeing what we were seeing, talking to our colleagues in Washington State and in Italy, and just realizing this is coming, and the people who are supposed to be in charge are not taking charge.

And so I think a lot of doctors, we like to compartmentalize our lives, and we’re so busy, right? And we train, and we assume that everyone else has similar hierarchies of expertise in their world. And just realizing that when it comes to our local government and our national government, we have to be active and vocal. I think a lot of people like to say, “Oh, I don’t do politics,” or “I don’t want to talk about that.” And unfortunately, politics leads to policy, and we all saw the massive failure of policy that left all of us at risk. We lost doctors. I lost professors of critical care who’d taught me, who have died in the pandemic. I mean, people have lost colleagues, family.

I think the option of compartmentalizing our lives as doctors and pretending that we don’t have to worry about who’s in charge and who’s running the show is just not true, and we need to get involved. And it has to be thoughtful and science-based, and not just whatever tribe or team we happen to like. I mean, it’s not sports, unfortunately. We have to lead with science and a respect for life. And I think that’s the not all step up the doctors, and I’m hoping that’s the good lasting legacy of COVID: that everyone gets more involved.

Kevin Pho: We’re talking to Erika Moseson. She is a pulmonary critical care physician, and she’s the founder of Air Health Our Health. She wrote the KevinMD article “An anniversary: Reflecting on COVID-19 and combustion.” Erika, one of the things that you mentioned is that physicians need to step up and be advocates, and in order to do so, it really helps if they have a platform. So I know you have a podcast and a platform; I have a podcast and a platform as well. Tell me about your journey in building that platform. What are some of the challenges that you face in doing that? And can you just share your story in the context of also being a busy practicing clinician as well? Because I know a lot of physicians are wondering how they can build their own platforms while also practicing medicine.

Erika Maria Moseson: Yeah, well, actually, I mean, COVID-19 lit a fire under me. So I had bought the airhealthourhealth.org domain name a couple of years ago, after I first started. I was realizing I didn’t have the bandwidth to go to all these town halls about diesel. I mean, I just couldn’t do it. I couldn’t do that and put my kids to bed and do my shift. So I was like, “Well, I should just put up a website where I put all this information out there.”

And then I’m a big podcast listener, and then COVID happened, and everything shut down, and everyone got vacations canceled. And I had tuned into something about people, these different interviews with doctors who made websites and podcasts and stuff. And I remember I had downloaded a WordPress site, and someone was like, “Well, doing WordPress isn’t that hard,” which was the opposite. The first time I tried to do something, I found it so unintuitive. I was like, “This is too hard. I can’t do it.” Then I felt like it was a little challenge. I was like, “Well, yeah, she can do it. I can do it,” right? So then I opened up some YouTube videos and figured out how to do it. And then I just started out using this Anchor app off my phone, where literally my first podcast interviews were just over the phone, because COVID was shutting down.

And I actually started really because I was like, “I have to do this,” because I thought we were all going to be in the ICU all the time, and that we wouldn’t have time for clinic. And I didn’t know how many of us were going to die, which is kind of a brutal thing to say. But when that very young physician in China had died, I was like, if we’re going to lose pulmonary doctors, and there’s this massive quantity of lung disease out there, I want this knowledge to be there, so people can listen and learn. And I put up parts of the website like the Twitchy Airways Club, for people with airway disease and stuff, because I do think there’s a lot of self-education. Once patients with lung disease understand what’s affecting their lungs, there’s a lot that they can do to avoid triggers, to just understand the illness, understand what’s happening with mucus plugging and stuff like that.

And so COVID was the impetus for “This has to get out there.” And then once you start doing something and you build a pattern, you figure out what’s sustainable. I’m like, “OK, well, I don’t know how you do an episode every day. That’s mind-blowing.” I do one every two weeks. And I made my landing page bilingual, because I’m not a native speaker, but my mom is, and we speak Spanish at home. And I was like, this really is needed for the Spanish-language community, because when I first did some Instagram Lives during the wildfires, the Spanish-language ones were far more well attended. And the Latino community in Oregon and all over is much more vulnerable to wildfires, outdoor work, that sort of thing. So now we’ve recently started the Spanish-language series on asthma, COPD, stuff like that.

And I’ve incorporated them as after-visit links, because with a lot of patients, you don’t have time; in a 15-minute or 30-minute visit, you don’t have time to talk about all the things that can affect your breathing, right? And so I have this list of things, and I can say, “OK, pollen, go listen to the one on pollen.” Or there’s, like, so I did one on cleaning agents, right? So people who work in housekeeping, cleaning, that can actually have an effect on your lungs like a pack a day at times, depending on what you’re using. And so there are links on that, where people can just go find it and listen and learn.

So yeah, I think it’s start by starting. Someone told me that the world will be saved by B-plus work, or C-plus work, or whatever. It’s ugly. My website is not pretty. My podcast audio, I’m like, “Snip, there we go.” And now I’m getting some help with everything, which is great. But yeah, it’s a creative outlet. I recommend physicians do it. It’s a creative outlet; it gives you something outside yourself. For me, it feels helpful that if it can prevent anyone from ending up in my ICU, that’s a win.

Kevin Pho: Yeah, and just to add on to that, someone told me that if you start a podcast and your first episode is perfect, that means you started too late.

Erika Maria Moseson: Well, good. No, no, I definitely did not start too late.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Erika Maria Moseson: As always, don’t light things on fire and breathe them into your lungs.

Kevin Pho: Wonderful. Well, thank you for coming back on the show, Erika, and thanks again for sharing your time and insight.

Erika Maria Moseson: Absolutely. Thank you.

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