New York Public Health Now
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New York Public Health Now
Navigating Public Health in a Political World; A Conversation with Dr. Demetre Daskalakis
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What is it like to practice public health in ever-changing political climates? Dr. Demetrre Daskalakis reflects on lessons learned at the CDC and the importance of humility, trusted messengers, and coordinated action amidst political pressures and public health challenges.
If you have an idea for topics we should discuss, please let us know: PublicHealthNowPodcast@health.ny.gov
Hello and welcome to New York Public Health Now podcast. This is where we talk about the why, so you can decide what to do. I am Dr. Jim McDonald, Commissioner here at the New York State Department Health coming at you live from the 14th floor of Corning Tower, where, by the way, right now it is sunset as I'm recording, and there's this gorgeous pink color just falling down upon the Capitol right now. and I'm here with my co-host Johanne Morne, Johanne, how are you today?
Johanne Morne:Oh, I'm doing great, and I'm loving the sky right now.
Jim McDonald:It is amazing, we get to work in a lovely building with a beautiful view. And today we're talking to Dr Demetre Daskalakis, who is just an awesome public health professional. Hey, Dr. Daskalakis, how you doing?
Demetre Daskalakis:I am doing well. Thanks for having me.
Jim McDonald:you're a public health hero to a lot of people, and it's not without hard work getting there, right? Like you went to Columbia University. You're an NYU School of Medicine graduate. You were at Harvard when you did your residency. You were at Beth Israel Deaconess, like you're really quite an accomplished professional. Got your Master's of Public Health from Harvard. You worked at Mount Sinai in Brooklyn. You're formerly of the Centers for Disease Control and Prevention here, you've worked at New York City Department Health. You know, you really are an accomplished public health hero, and we're really glad to have you on here, having said all that stuff about you, can you just tell me a little bit about you? If you don't mind?
Demetre Daskalakis:First of all, it takes one to know one. So I love being among heroes. So thank you very much. You and Johanne, I think, are some of my public health heroes, and we go way back. So thank you. Let's see. I think that, you know, I am a very proud dog dad. How's that?
Jim McDonald:Love it, I love it.
Demetre Daskalakis:Yeah, I have two. I have an older gentleman whose name is Iggy, and a younger pup whose name is gizmo, and gizmo is five pounds, and he is technically the boss of my entire house, including the boss of me.
Jim McDonald:That is awesome
Demetre Daskalakis:I'm allowed to be here because of gizmo.
Jim McDonald:That is awesome.
Johanne Morne:That is awesome and so glad to know you're in good company. We all have dogs. We all love our dogs, and they're a huge part of who we are, right? So, Dr. D, there's so much to say. First of all, let me just start by saying thank you. Thank you for the commitment and the work that you've done as it relates to public health. I think obviously, for anyone that's listening that's joined us today on this podcast, what we know is that your work has been so incredibly impactful. So I'm just curious on the start, how did you decide to go to medical school?
Demetre Daskalakis:Yeah, so I've wanted to be a doctor since I was two years old, and I should be unbranded. So I will be unbranded, but a certain toy company made a doctor's kit, and I used to walk around with it in my house. And when people would come visit, I would ask if I could listen to their heart and take their blood pressure with my little fake kit. And if they said no, I would give them their coat and say, I'm sorry you're going to have to leave. So I wanted to be a doctor forever. But, you know, my parents were immigrants. My dad worked in restaurants, my mom was an executive assistant. They were amazing, but they knew nothing from how to be a doctor. And so I said I wanted to do it, and they, they gave me all the support, all the love to make it happen, but I didn't know the path. And so my the moment, that sort of turning moment where it went from this abstract to something concrete was on college walk at Columbia University in the city of New York. I was doing a display of the AIDS Memorial Quilt in 1995 April 23rd in fact, of 1995 and when the doors opened and I saw the folks coming in, and really the despair in that era. I remember standing there looking at alma mater. It sounds like an ad for Columbia University. And I said, I'm going to be an infectious disease doctor. I'm going to do HIV medicine so no one has to suffer from this again. And so I went from like abstract, you know, doctor's kit, to very concrete. This is what I want to do with my life, and that's what I did.
Jim McDonald:That's fascinating. I mean, love that story. It's funny I was at Columbia yesterday, and I kind of picture where you were, and so you're a first generation physician. And I think that's, you know, it's interesting. I'm a first generation physician as well, and I love hearing people's origin stories about why they chose to go into medicine, but medical school is such an influential time. And you know, the things I'm really curious about is like, you know, I have all these warm memories from my medical school, Loyola in Chicago. But do you, is there anything in medical school that really influenced you? Just really curious where that where they came from, or what's going on there?
Demetre Daskalakis:Yeah. I mean, I think that you know someone in your ranks was very important in my story for what the inspiration was in medical school. And so I have to shout out your friend, Charles Gonzalez, Dr. Charles,
Jim McDonald:Yeah
Demetre Daskalakis:who was one of my ID attendings when I was a medical student. And let me sneak on to the AIDS ward to meet patients living with HIV and it was a place that medical students didn't go very much in that era and, and so, you know, it's sort of seeing that sort of gusto for for patients and science, I think was extremely influential. And, I mean, again, huge New York City shout out, New York State shout out is, you know, when you're a med student at Bellevue boy, you really learn what health equity means. And I really learned it by, living it every day. So I think those are my influential moments in med school. By the way, I love med school. Loved it.
Jim McDonald:I had a great time there as well. It's funny, I don't know what people think about medical school, but mine was very nurturing and supportive. I had a really good time at Loyola, learned a lot, met a lot of really amazing people who just positively influenced me and nothing but warm memories there.
Demetre Daskalakis:Yeah, I agree.
Johanne Morne:So I just have to ask. When you say you love it, what did you love about it? You know, in medical school and you have fellowship, what did you love about all of those opportunities.
Demetre Daskalakis:I mean, I loved sort of being given the privilege of taking care of people. There's something very special about, and also, the other thing to say is, I always say this because it's kind of true. If I'd known what different medical specialties, medical professionals do, I may have ended up being a nurse instead of a doctor. I just didn't know better, because like, that moment of being able to care for people, I think it's such a privilege and an honor. It's such a sacred relationship that you have with your patient, sometimes contentious, sometimes challenging, but never boring. I think that's sort of where, that's like, where the fun comes, because not everybody gets to do that right? It's a very special moment in terms of your professional life. Like lawyers get to do great lawyer things. I'm sure they have similar feelings, but I think there's something magic about sort of working with people at moments where they're their happiest or their most vulnerable, to try to make sure that you try to get their health as best you can.
Jim McDonald:Yeah, I mean, that's, that's really well said. You know, it's funny you're just reminding me, when I was in medical school, people would ask me, what kind of doctor did I want to be. And I would often say, a good one, because I just didn't know the answer to that. You knew you wanted to go into infectious diseases, which I don't know that most people, I don't even know that everybody really knows what infectious disease is. But you had to go through a residency in Internal Medicine, so that's three years. Then you did the fellowship. Fellowship is really extended postgraduate training, where you literally become an expert in everything that can infect another human being, whether it's a bacteria, a virus, a fungus, a parasite, like you do, go deep, deep, deep into infectious diseases. Become a very profound expert. And I'm just curious, like, was there a sentinel moment in your fellowship that really shaped you?
Demetre Daskalakis:Yes, it's really funny, though. You know, I think the thing that brought me back to New York, that shaped me. So I was doing my fellowship. I was in my second year, and I decided that I was going to do lab work. So I actually, interestingly enough, I think another sort of person well known in New York is Dr. David Ho, he was in the same lab, and I pretty much took over a decade later, some of the work that he was doing looking at acute HIV infection. And so I was working in the Mass General clinic where people would sometimes present with acute HIV. And I in the walk in clinic, I would diagnose them, and then I would, talk to them about a study, consent them for the study using my IRB approved consents, draw the blood and then take it to the lab and do all of this really exciting basic immunology. I really loved it, and I learned so much. Really helped influence, like, my ability to sort of work in the lab space and think about it sort of as a public health executive. But the moment that was important was, I was in the lab doing a fical, which for anyone who knows lab work is, you know, like trying to get white blood cells off of mixed blood so you could do more specific tests. A very sort of laborious experience. And I was listening to the radio because we didn't have the internet really then, and on the radio comes Tom Frieden, who at that point, was the commissioner of health in New York City. He came on saying, there's a case of acute HIV infection with multi drug resistance and rapid, rapid progression. And so we want to raise the alert that there may be a strain of HIV that's scary and dangerous. Now, of course, like that ended up being something completely different. But sitting in Boston, away from the city, that sort of taught me, like why I wanted to do this work. I was like, this isn't for me anymore. I can't be in the lab anymore. I need to go back. And so I called my my deans at NYU and said, hey, help. They connected me to Dr. Judy Aberg, who you all probably know as well, who was at NYU and then ultimately at Sinai, and she hired me to come back to New York City so I could be closer to the source and do the thing that I love, which is infections are infections. I understood them, and I grew to love them, and I learned so much about them, and they're they're fascinating, and everyone should be an infectious disease doctor or a pediatrician. I'll give you that. But the thing that really was important to me was that infections always, did this thing that I learned in fellowship, actually in residency, the Chief of Medicine at Beth Israel Deaconess was Robert Mullering, who's was a really amazing infectious disease doctor. And one of the things that he taught me was something called locus minoris resistentiae, which is the idea that infections go to the point of least resistance. And like, I remember the man saying that's true both in the body and also in society. And I was like, this is it. Like, I want to do this because the social aspect of medicine is such an important piece of what infectious disease doctors do. And so, thinking about who gets sick from TB are people who are disconnected from services, often immigrants, people who just don't have the ability to access who gets sick from HIV, folks who have, you know, housing difficulties, potentially drug histories, history of behavioral or mental health issues like so that's sort of how I got to ID, and then I ended up loving the science so that that's the story.
Johanne Morne:Wow. You know, it's so interesting, right? Because anytime we talk about public health and we talk about the areas of work that we focus on, it always leads back to those social determinants of health, doesn't it?
Demetre Daskalakis:Sure does.
Johanne Morne:You know something else though. I'm glad that the roads that you've taken and the journeys you've taken always lead you back to New York as well. So, that said you did incredible work at the New York City Department of Health and Mental Hygiene. Can you talk about that? How long were you there? What were you focused on? Certainly, you know, many of us know the incredible work that you did around HIV as well as other sexually transmitted infections.
Demetre Daskalakis:And by me, you mean we right Johanne, because we did that together? Just want to be clear,
Johanne Morne:It was a we thing.
Demetre Daskalakis:The most important and biggest thing to say on this podcast is that New York City and New York State are strongest when they have working relationships, such as the one that Johanne and I have.
Johanne Morne:That is right.
Demetre Daskalakis:So I just want to say just how important that is.
Jim McDonald:It's true. It really is right.
Demetre Daskalakis:So true. So yeah, I worked at Department of Health. I initially started as the Assistant Commissioner for the Bureau of HIV, and I don't even remember the year anymore, but it was right when the ending the HIV, the ETE, ending the epidemic, sort of work started. I think one of the very first things that I did was go on the task force, and that was just amazing. And what I learned there was that if you have community engagement, the political will and the science, you can put that together, and you can really push an infectious disease far away. And so I, with my partner Johanne, we were able, I think, to do some great work, state and city together to create innovative programs with that political will, which meant resources to be able to really move the needle on HIV in a way that had never been done before in New York. And, we drove that down to levels that were just unprecedentedly low and also way faster than anyone expected that we could. Once she resourced it, it went down just so fast. It was a dose response curve that was amazing. So I did that for a while, and, you know, learned so much about community engagement and working sort of across agencies. And then was asked to be the Deputy Commissioner for Disease Control, and that's the chief of ID for Department of Health and Mental Hygiene in New York City, and that's, you know, all of the infectious disease groups as well as the public health lab. And I remember I was interviewed by my predecessor, who said to me, oh, you know, you're going to have some emergency responses every now and then don't worry, it's going to be like, a couple months of the year, and then you'll be fine. Subsequently, I was in an emergency response the entire time I was there, because it went from Legionella to Legionella to hepatitis A, and then the big measles outbreak in the Haredi community in Brooklyn, where I learned so much of what I learned in public health, and then ultimately covid-19 as the incident commander for about 10 months. It's also where I learned how to do applied public health. And so I think, Jim you talked a lot about the fact that I went to Harvard and did this, you know, the degree is really nice. I learned a lot of things. But you know, the public health professionals, the folks who were former EIS officers from CDC, they actually taught me how to do public health on the ground. And so, that experience was pretty, pretty inspiring. So I did a lot of stuff in New York.
Jim McDonald:Which is great to hear and you know, it's interesting. I was just thinking about, when you talk about applied public health, I think it's one of the things the things the public doesn't quite appreciate what happens sometimes, because it's funny, as a state health department, a lot of things occur here every single day that prevent some bad thing from happening. But if you prevent an outbreak of something, no one knows it was prevented, right?
Demetre Daskalakis:Yes!
Jim McDonald:and I sometimes talk about like, it's amazing how much work goes on at the state health department so that nothing happens. Like, in other words, the fact that you can walk can walk into any restaurant in New York State and enjoy a meal, it's not accidental, right? The fact you can walk into a hospital and get, first class care, there's a lot that goes into that. The fact that you can just go outside and take a breath of fresh air, you'd be amazed how much work goes into that as well. But it's amazing how much goes on and so but one of the things that got me thinking too, was your time at the New York State Department of Health was like, is there something that stands out that was most impactful? And that may not be a fair question to ask, if there's something that's more impactful, because so much of what happens in public health is impactful, but maybe the public doesn't even know it even happened, you know, I'm just curious any thoughts on that?
Demetre Daskalakis:I mean, I think that there's so many things that, when I think about, have been sort of so important and in the every day, and that, I think, is what's so hard. Because the most impactful things, as you said, were things that people just didn't know. Right, like the outbreak that never became an outbreak.
Jim McDonald:That's right.
Demetre Daskalakis:I mean, so many memories about, for me, I think one of the most interesting things completely outside of my universe, outside of my sort of, you know, just what I learned in general infectious diseases and HIV medicine was like, you working through very complicated Legionella outbreaks and, what you learn is that public health is a team sport. And then all of a sudden, I know every like, I honestly, Jim used to know, I could tell you everything about an HVAC system for a while.
Jim McDonald:And that's so interesting about Legionella, right? It's plumbing! it's heating, ventilation, air conditioning, right? Like, and how much chlorine do you put in these things? Right? Like there's a lot moving parts to this.
Demetre Daskalakis:it sounds weird. Like, this guy who does like, HIV, sort of is thought of as, like, a big HIV person. I mean, there's things like I can say, like, being the first health department to sign on to undetectable is equal to untransmittable. that's like you know, seismic like, that was, an amazing moment that, frankly, changed the landscape in New York, and then, sent ripples that changed the landscape in the whole country. And then I got to go to CDC and say, guess what guys, we're going to do what New York did, and we're going to go under this you equals you thing as well. But that's probably one of the most impactful things. But I still think, the stuff that I loved was the stuff that no one saw, like working with environmental health people to figure out, you know, going up to a cooling tower to sample it in a Tyvek suit, so we could make sure that New Yorkers weren't going to get Legionella. That's the stuff that no one sees, and like, literally every day, makes sure that people stay healthy. So I could have my big ticket items, like the you equals you stuff, but I also have my every day, which was just, public health lets you actually, you know, I'll give another example. Like, what do I know from chickens, right? What do I really know from chickens? Bird Flu at CDC, I know so much about chickens. I know how chickens are culled. I know, the circumstances, like it's a completely different mindset and so, like so much of the things that were, talking to a farmer. What like, what do I know, talking to a farmer? I mean, I think, you know, you all are different in the state but in New York City, like there was an operating firm in Staten Island, but I think it's closed. I think. it's just that ability to sort of take the sort of core skill of community engagement and like, science and like, be so mercurial and change, you know the new thing that comes like, you have to sort of adapt that skill. And I know you all are just nodding with me agreeing, but like, you have to change the skill to rise to that moment and that occasion, but realize that you're flexing that same sort of intellectual and emotional muscle that you need to be an effective public health leader.
Jim McDonald:when you're talking about chickens and bird flu, like one of the things I find that's so fascinating about public health in general is how quickly we need to learn a new topic, and you're talking about learning about chickens, you're right. I was surprised how much I learned a little bit about how chickens are culled and how chickens are farmed and all this. But like when I did my preventive medicine boards, one of the things I remember saying to myself was it's a mile wide and a mile deep. It's amazing how much I had to know, on a deep level about everything, which is really the thing about general public health and general preventive medicine, there's just so much to actually know it is kind of mind boggling in so many ways,
Demetre Daskalakis:Yeah, but it makes it fun. It makes it so fun. And like, everyone should still go into public health. Don't be scared because of the chaos right now, there's going to be a role for people in the future. And like, listen to like, you know, we're not 22 year olds. We're speaking with such enthusiasm, even like during chaos, because it is the most fun and the best in the world. And you like, change what happens, not only for one person, you change what happens for like, communities. And it's just, it's awesome.
Jim McDonald:Yeah, it's really true. I mean, every day is different every day is a challenge. It's kind of what I hoped for many years ago, when I really made the move from just clinical medicine to clinical medicine and public health, and now just full time public health.
Johanne Morne:Yeah, I think we can think we can all agree, there are no dull days when it relates to public health, for sure. Dr D, among other things, there was travel for you when you headed to Atlanta, right and you headed to Atlanta to the CDC, but shortly after your arrival, you were met with a pandemic and challenges and impacts and any number of things. Can you just talk about, like, what was one of the most impactful things as it related to the pandemic response and to the other emergencies that you've responded to?
Demetre Daskalakis:I think the count is, I had six jobs at CDC in five years, which is, you know, boy that's a lot of experience. I think that the probably, the biggest lesson was the importance of trusted messengers, across all of those things, like the importance of like trusted messengers and the actual implementers of public health. So, from the lofty height of CDC, you're providing some very important support, whether it's expertise, laboratory, the resources that go into some of the work that folks do at the local health department, state and local. But I think that the common strand is how humility is needed at that level, because the people that actually know what they're doing and are doing the work are the folks at the front line. And learning how to sort of weave that together with a more national mission was really fun. And also, I think the thing that across the board, like, whatever it was like, booster one covid 19, I was the head of vaccine Task Force. I'd been at CDC for two and a half months. I barely knew how to turn on my computer. But I was like leading this large event, trying to make sure that, no, we got through the regulatory, got through the administrative, got vaccine on the ground. Because it was in the era when it was being distributed by the US. Like it was all like very similar muscles to what you would do for bird flu or for covid 19. And it was, how do you support the people doing the work? What do they need? And so really thinking about, CDC and response, being sort of leaning forward and affecting change on the ground, but also just being like a service organization that serves the jurisdictions that actually do the work. So that's like the thing that I think I've learned throughout the entire sort of era, which is and that's also the fund of doing sort of that level of public health, which is that, New York State is not the same as Connecticut, which is not the same as Virginia, which is certainly not the same as Mississippi, and not the same as Texas. And so sort of learning how to exist in a political environment while still doing like the best work. And that's, I guess we're going to get to this, I think. But that's what's a little bit hard now, because public health, it is inherently exists in a political world. It should not live in a bipartisan fight. And so that's like, I think, where the problem is. But yeah, so that's what I learned. I learned that, you need to know who your colleagues are and your who are the effectors. And really like, have CDC provide, the connective tissue, the blood that allows the effectors to actually show the muscle.
Jim McDonald:You know, it's interesting. You remind me, kind of an old saying in public health, if you've seen one state health department, you've seen one state health department.
Demetre Daskalakis:Totally.
Jim McDonald:But there are core functions of public health. You know, we do exist in political environments. I get a great deal of autonomy in New York. I know that not all my colleagues in certain parts of the country do that and it is interesting. Like, when I look at where CDC used to be and where CDC is. It is a little bit different. And, I don't know what you think about this maybe, but I'm just wondering, do you think CDC would be stronger if it was actually outside the political environment completely?
Demetre Daskalakis:So we're learning some lessons right based on what's happening now. So right now, somebody is deciding to press the delete button on CDC, right? That's kind of where we are. And you already see that the evolution is that they're like, sort of regional efforts are rising up, which is very interesting. But then like, the next level is how do those regional efforts then coordinate and so, I think that the liability of having CDC so close to folks that are really, potentially just doing political sort of work, I think, has been highlighted. And I think it speaks to like, where does that sort of coordinating center live? Does it need to be up sort of in the federal entity, or is there a way where, like, different parts of regional efforts go together and create, I'm going to just call it a council of elders, or something like that, that can really help coordinate and then, frankly, demand that the federal government pay for it, right? I think that that's a really big piece of it, where it's like, the state send money to the federal government and then the federal government sends it back. I think that that's, like, an area of really important discussion. You know, we should never be in the position where someone can dismantle public health again, we should learn the lesson from what's happening today.
Johanne Morne:Absolutely. I think through any of the experiences that we've had, if we don't take the lessons learned then, then we've certainly missed something really significant. So on that note, let me ask you this, through all of the challenges that you faced during the pandemic, otherwise in your career, would you do it all over again?
Demetre Daskalakis:Totally, I would. I would 100%. I think that one of the really fun things about a career, and I'll sort of use medicine as the example, as a doctor as an example, is that, you know, there's so many different incarnations that you can have and still have a really huge effect on people that you serve. And so I think, what I've learned in my last 15 years is that it's okay to work seeing patients transition to being like a governmental public health person. Think about doing other things that impact health and just being more sort of, you know, fluid about where you may fit at the moment. Because that, I think, is what's so important, is like there's, I think if you're good at public health, there are different moments in different places where you may have a different role. And so I would never change a thing that I've done. I think it's, I'm so proud of my career, like the experience that I've had, I think is amazing. I think that everybody who gave me all the multiple jobs at all the times have made me like a special little unicorn that seen only things that only I have seen, but I feel like, I would never change it. But I think, also, I think listening to where it takes you is really important. It can take you all sorts of places. We go way back Johanne and you know, I don't think either of us, if we spoke how many years ago, would say that we're doing what we're doing now. You never can predict because, public health, like, the part that's really, like Jim was saying, the thing that really makes public health great is that you need to get ready for the next thing, and then be ready to be the super expert on the next thing. And that just trains you for your whole life.
Jim McDonald:I sort of have a feeling, as much as you've accomplished in life, that your best is yet to come. And maybe that's a prophetic word for you. We'll see. But I'm just interested, you're a physician. So if someone's considering a career in medicine, they want to be a doctor. What's the most important advice you'd give somebody who said, hey, I want to be a doctor. If you were going to give someone, who's rising as a medical student, going to go into medical school, what would be the advice you'd give somebody?
Demetre Daskalakis:I would start by saying, early in your career, it's really all about the patients, right? Like that, I think is probably my most important advice, which is that you will learn so many things, you will have so many classes, you will have so many rotations. But there is no one who teaches you more than the patient that you talk to. So always listen to your patient. And I would up the ante and say like, if you decide to do something different and go more into the public health space, the equivalent of listen to your patient is listen to your community. So I think that my most important advice is, listen. And also, this is one that is one of my favorites, which is, it's really important in medicine to listen more and speak less. Because I think you you learn so much from the people that you listen to, and that includes your patients. And so even in the moments where you are trying to look like you know everything in the textbook, take a deep breath and realize that the thing that is the most impressive to a patient is the ability to listen, not the ability to make a list of which molecules are connected to which other molecules to create a drug. So listen, very important.
Jim McDonald:You remind me of that old saying in medicine, which is, if you listen to your patient long enough they'll tell you what's wrong with them.
Demetre Daskalakis:Same with the community.
Jim McDonald:I find that to be so true, and I think that's really true for communities as well. It's just getting enough people to just sort of get the word out there, which is part of why we get outside the ivory tower quite often actually.
Demetre Daskalakis:Yeah. I get to say I've seen a lot of state health departments, so I have very fond place in my heart for the amazing work that you all do. It's pretty remarkable.
Jim McDonald:So today, we've been talking to Dr. Demetre Daskalakis, and I want to thank you for joining us. Demetre, thank you Demetre, it was great having you.
Demetre Daskalakis:so good being here! Thank you, see you in New York soon.
Jim McDonald:I look forward to seeing you in New York soon, and I'm sure we'll connect up when you're here. So I want to just say to our listeners, thanks for listening today. This wraps up today's episode of New York Public Health Now podcast. As always, if there's a topic of interest you'd like to hear us talk about you can send us an email at publichealthnowpodcast@health.ny.gov
Johanne Morne:And to hear the latest New York Public Health Now episode on your favorite podcast player app like Apple podcasts, Overcast, Spotify, YouTube and Google podcasts, search by our podcast titled New York Public Health Now, or by keyword, NYSDOH, then tap the subscribe or follow button to be notified when we release a new episode, which is about every other week.
Jim McDonald:And if you like what you hear, please leave a review for the New York Public Health Now podcast, I'm your state health commissioner, Dr. Jim McDonald.
Johanne Morne:I'm Johanne Morne
Demetre Daskalakis:And I am Dr. Demetre Daskalakis,
Jim McDonald:and thank you for listening.