Skip to content

Pitt Infectious Disease Specialist Details COMPASS COVID-19 Study

We welcome Dr. Ken Ho, Infectious Disease Specialist at the University of Pittsburgh, to overview the COMPASS Study – Community Prevalence of SARS-CoV-2 Study.

COMPASS will estimate the percentage of people affected by SARS-CoV-2, the virus that causes COVID-19. Pitt is one of 15 sites nationwide involved in the COMPASS study that will survey residents around the Pittsburgh area to learn who has antibodies against SARS-CoV-2 and who is carrying the virus at the time of the test.

Ho will detail how the study hopes to recruit 4,000 people: 500 from nursing homes and assisted living facilities, 500 from doctors’ offices and other outpatient facilities and 3,000 from the community. Recruitment will end in July or earlier if researchers meet their goal before then.

The overarching goal is to capture a cross-section of the community that represents our diverse populations and translates to data that will help us understand the epidemic better at the national and the local level.

 
 

 

Transcription:

Good afternoon, everyone. This is Audrey Russo, President and CEO of the Pittsburgh Technology Council thrilled to be here on amazing day in Pittsburgh, we have a great guest, I will formally introduce Dr. Ken o in a moment. But before we get started, I want to give a shout out of recognition to Jonathan kersting. He's vice president of all things media and marketing at the tech Council. He tells a lot of stories, right stories shines the light on people who are doing incredible things in our region. He's also always keeping his eye on the chat while we're here today. And he will do that today as well. So we have I want to give appreciation on Huntington bank, they've been our partners through this entire series of 200, and blah, blah, blah, how many have we done to awesome 240. Really, this is how many we've done, try and keep the community tethered together on topics that affect each and every one of us from a business perspective, from a personal perspective, and from a collective community perspective. And today is no different 40 by 80. That's the wholly owned subsidiary of the Technology Council. And that's our 501 c three, and we are focused there, you're gonna hear more about our apprenticeship program, as well as the work that we continue to do in entrepreneurship, and K through 12. So, without further ado, I want to remind everyone, we've muted you. And we've done that on purpose. And this is a time for you to only ask questions about the topic at hand. And our guests, this is not a time for you to sell your wares. Or to shine the light on the work that you yourself, do we have plenty opportunities for that. And if we want to follow up with Dr. Ho afterwards, we'll we'll figure out pathways there. So I am welcoming now. Dr. Ken, whoa, to the to the limelight here. And I'm thrilled to have him and before, you know, before we sort of get into a lot of the questions here, what I really want to do is as and I do this for everyone who, who is who are you? Meaning How are you doing? What, how did you get to where you are right now. And we'll talk a little bit about your passions and some of your interests that are tied to the work that you do. So first of all, thank you so much for taking the time. I know you have a very hectic schedule on life and are doing a lot of important things. So thank you for taking the time. So doctor, whoa, or alcohol, you can if that's okay, that's completely fine. So tell us about yourself. Tell us about a little bit about your academic background, your appointments at UPMC, and Pitt, and a little bit about some of the work that you've been pretty passionate about. Yeah, so

I think I've been in Pittsburgh since around 2004, which was when I came here for residency training in internal medicine and then went on to do infectious diseases, because initially, I was going to go into practice with my dad, because that's what everybody does. But, but then at some point sort of fell in love with, with actually HIV care and infectious diseases. And it just seemed like a space where you could do so much with the knowledge that you had, and you could sort of seeing no real results. And you know, being that we're at the University of Pittsburgh and academic work is a large part of what we do. And so staying on was an opportunity to work both like in clinical trials of kind of new agents to prevent HIV was able to have a clinic where I took care of people who had HIV, and then started up a clinic where we prescribe prep, which is a medication that's used a daily medication that's used to prevent HIV for people who are, you know, who may have risk for integrity. And then, so that's kind of what I was doing for the past couple of years as a junior faculty, and then COVID hit, and then all of a sudden, we found ourselves and you're deep in COVID, vaccine trials, epidemiologic studies, and you're really rushing to figure out okay, how do we address this epidemic really quickly and sort of learning so much about it, that it's more than just the infection itself, it's sort of really unearth all of our, you know, all of the social determinants of health the issues that are wrong with our social structure, and class and race and, and what have you that that contribute to disparities and basically, make COVID more successful. So that's, that's kind of where we're arriving today, where I'm working on all these COVID related studies, the HIV stuff is still there, and it's my original passion, but these days, I I feel like it's hard to sleep because there's so much going on.

Well, let's pause for a second on the HIV piece. Okay, let's not let's not, you know, be you know, brushed that aside because of COVID. Because that's a that's a reality that is still alive and well. And you know, even though I was growing up HIV was very different than what it is now. I don't I don't think gets in the limelight enough in terms of how it impacts, you know, our friends and colleagues and people that we don't know. So could you talk about that a little bit?

Yeah, I mean, I think Legion is one of those. It's not the virus and it's, it's sort of become so much more than that. So many people, I think some people believe that HIV is still like this death sentence, and we can treat it but I think most people are aware of the fact that, you know, we, we have combination therapy that allows people who get HIV to actually not get sick, they take their medication, they come to the doctor, and they basically live out the rest of their their lives. And they can be healthy, and which is very different from the, the environment back in the 1980s, and the 1990s, when we didn't have successful therapy. You know, these days, I think in the past just couple of years, we actually started to make some headway in terms of like the new number of new infections of HIV, it was very stable within the United States at about 50,000 per year until think about like 2018 or 17 or so. And we start to see some declines, which we think are related to a lot of sex successes and prevention, prep, treatment as prevention, meaning that if you treat someone, you basically prevent them from spreading it to other people, and trying to, you know, and different models for kind of providing both of those, both of those things. And so I think it was, it was very heartening. And I think we were trying to see, okay, how do we go the next step? How do we really end AIDS? And so, you know, the, we saw the emergence of these end epidemic, kind of organizations, and we set up one here called AIDS free Pittsburgh as well, kind of looking at Okay, how do we go that last step, and then COVID, hidden kind of changed everything, but, but it doesn't change the fact that all that work still remains present, and, you know, something that we need to tackle moving forward?

Well, what do you want to say to all of us in terms of that work? Is there any like, thing that you just want to remind all of us that it has still an issue? Yeah, no,

I think it

like anything that's really stigmatized, I think it's sort of human nature to not talk about it. And I think I would, I think what we've learned is that to kind of try to erase stigma, it makes sense to have discussions about HIV, about the things that put us at risk, and about the things that you know, that impact our health, sexual health, or what have you, we tend to shy away from all those things. And I think trying to create more conversations about the things that we don't necessarily want to talk about whether it's with doctors, whether it's with no partners, or sexual partners, or recreational partners, or whatever, I think that all needs to happen more so that we're able to better address some of these risks that kind of lie in front of us. And I think that's how we get to zero.

That's great. That's great. And I and I know he didn't come on the show to particularly talk about that. But just given your background, and given all the work that you've done, I think it would be a disservice for people for you not to have an opportunity to talk about that.

Thanks so much. I think some people have compared HIV to COVID, as well. And so I think some of the lessons learned that we, you know, that actually, many of the lessons learned, I think, are actually applicable to

So what are some of those? What are some of those, because we're going to talk a little bit I wanted to jump in, in terms of sort of the history of scientific exploitation. Hey, you know, I wanted to talk about that maybe you can draw some similarities, and we can get into some of your work on COVID. Right, right. You know, I

think, you know, for one thing, just sort of connecting back with the the previous statement, like, okay, you know, having conversations, I think that women don't talk about things, I think what happens is they sort of invent kind of an alternative narrative that may or may not be consistent with what is true. And I think this kind of gets into what people know or understand about COVID or understand about, like, say vaccines vaccine hasn't Cincy versus vaccine confidence. And I think it becomes a big part of what we do now combating stigma, commenting, like trying to dispel myths, things like that. And that's something that we've done both in the HIV realm. And you know, and now we are doing currently with with COVID and COVID vaccines and all the treatment. So it's

interesting, if you want to ask this question, Jonathan, that Ben brought in, and then I'll, then I'll go to see it.

Absolutely. Good question here. So Ben wants to know, um, can you share some of the some of those lessons? last second here? There we go. Can you share some of those lessons learned, especially on public messaging to get people, you know, to to do to wear a barrier that some complaint is uncomfortable?

Hmm.

So there's a parallel?

Yeah. So kind of about just to confirm like about messaging, it sounds like yeah, it's, it's always challenging. I think what we at least have learned from the HIV realm is that fear based messaging tends to not work very well and tends to actually create worse stigma like, you know, for example, in the pre exposure prophylaxis for this, to know this HIV Be preventative, you know, one of the initial messages was like, you don't know what they might have, you better take this medication to prevent yourself from getting something bad. And then, you know, then all of a sudden, this medication was something for you to take when you did something bad. And as a result, I think doctors weren't prescribing it, people didn't want to take it, because they didn't want to be perceived as having done something kind of negative or what have you. And so that didn't work. And so the conversation changed to become one of like health and wellness, you know, take care of yourself, sex is part of what we do, you know, you should be taking care of yourself and working on these things. And part of that involves getting regularly, regularly tested for HIV involves taking this medication for prevention, having these conversations with your providers, it would be nice to kind of see that a little bit, I realized COVID is slightly different, especially in the way it is transmitted. But there is certainly stigma as well.

There is even this whole thing of mask wearing and barriers, various around that many people are just tired, they're fatigued. And I would imagine there's the same kind of fatigue that has happened over time with with AIDS and HIV. So let's let's jump a little bit, we're going to talk about, you know, addressing a few things, I started talking about the history of scientific exploitation. You know, we talked about, you know, there's a history there, you have a focus now, on a project that I'd like us to talk about. And it's really, you're also part of this group called the community vaccine collaborative. And that's also part of eradicating or addressing medical distrust. So you want to start with that, and then sort of jump into the project that you're, you're leading? Yeah, sure. So

um, the community vaccine collaborative, is sort of housed within the University of Pittsburgh, Clinical Translational Science Institute. And it's sort of headed by a pediatrician named Liz Miller, who's phenomenal. And, you know, she brought together academicians, clinicians, vaccine researchers, and then large community stakeholders, and leaders within various diverse communities, the African American community, about the next community, you know, bring together as many people as possible, and it's one that continues to grow, to talk about, you know, what is going on in the space of COVID, in terms of like, the vaccine research, in terms of vaccine distribution, in terms of the community concerns regarding safety, when it's something that you know, even today, for example, with the news on j&j, there's always something to address. And so that organization meets, and has met weekly, I think, since summer of last year, and I think is largely tasked with kind of two parts. One is kind of addressing mistrust of medical and scientific institutions within the community. And then also, kind of more along the lines of the clinical trials piece, trying to make sure that there is community representation that you have representation of minorities, which have been traditionally underrepresented in these studies, but you know, has a lot of impact in terms of what we do moving forward with vaccines, and also know the perception of research. And so kind of, you know, tackling it from those two points. And so yes, we come a large group. And from that, you know, they discussed like, Oh, you know, what can we do with regards to vaccine hesitancy, and so formed a speaker's bureau, where several of us are available to speak in the community, at various town halls to vaccine confidence versus hesitancy and information that's very much desired of various groups.

That's great. That's great. And is there anywhere that we could find out information about this?

Yeah, there there, there is a website

and I can actually send that to you. There's websites for both the ctsi as well as the speaker's bureau, like if you were interested in, for example, that

would be great. We could share that when we when we save this. So let's talk about this study this big study that you're part of a national study. And, you know, sort of tell us about the big picture about the study and how, what what the objectives are for Pittsburgh and how you're going about.

Right, right, so, so I'm one of the investigators for this study. It's called the compass study. And I guess it stands for community prevalence of SARS, kobie. Two, so the virus that causes COVID-19. And the study is a really big study, it's I think, in 15, or 16 different cities around the US and they want to enroll like 70 to 100,000 people to do COVID antibodies on everybody COVID testing and administer surveys. So it's actually a very, like, takes about 15 minutes to do a study. But the information kind of in aggregate over 100,000, I think will give us a lot of information on the way COVID impacts our communities and they're looking at things like for example, how does COVID impact the old versus the young versus children things that we already know something about? I think, you know, for example, I think especially in children And then also in the nursing home populations, those are two populations that we are going to really try to get at and add more data and try to really enrich what we know, to study the disparities between Oh, I guess in COVID, in communities of color, which we also are aware of that COVID disproportionately impacts communities of color, especially the black community next communities where COVID hits harder, and a greater amount of death, greater attack and transmission rates as well.

Talk about why can you talk just pause for a second and talk about why Yeah, I think social determinants,

right, yeah, exactly. Kind of, as you mentioned, it sort of boils down to what we call social determinants of health, where, you know, it's not necessarily something about biology, though. I mean, we always talk about we theorize that maybe there could be some biology, but I think the majority of it in the the kind of more pressing an urgent issue is that many of these communities are not able to do the things that other people can to protect themselves from COVID. Whether that involves, you know, being being able to socially distance, many of them are essential workers and can't actually stay home. So they have to go to work. Many of them are in financial situations, yeah, where they can't afford to even take off work if they're sick. And then many of them have situations where it's like, you have several families living in a small space and transmission occurs much more efficiently in those particular areas. And then, of course, you have to add to that the whole issue, issues of vaccine hesitancy being able to get the vaccine being able to access the vaccine, as well as just healthcare in general.

Well, you know, the vaccine now is available, I think, as of today, to anyone in the state of Pennsylvania, I think over the age of 16. Is that right? Or 18?

It would be 16. For Pfizer, as long as they are getting Pfizer, 18 from Madonna and Johnson and Johnson Johnson

have any sense of where you think we are in terms of that? hesitancy?

Yeah, no, it's,

well, gosh, you hear all sorts of things. And it's not head or it's not yet it's very heterogeneous. It's like in different groups of people sort of have different amount in different communities have different uptake of the vaccine. I and this is just based on like the news, I saw something that I'm kind of like, I think, was it rains or some military group, it was like, 40% of people were saying no, which I was like, Oh, that's, that's not gonna be very good. And then you hear, you know, there is and was, I think, continues to be a lot of hesitancy in minority communities, I think. And that kind of gets back to histories of exploitation and scientific research as well. But then you have a lot of communities where, where people are very much in line with getting the vaccine because they believe in the science, we believe in the efficacy of the vaccine, and we believe that it will get us to a place that's closer to what we used to the way we used to live essentially.

So now. So now let's talk about the study. You've got like a massive amount of work between now and July. Right? So talk about how you're going about that? Because I'm going in here saying how did they get to enroll in the COVID, 19? antibody study as well. So Oh, yeah. So

yeah, the goal of this study is to kind of capture this snapshot of Pittsburgh in kind of an unusual way. And so it's Unfortunately, not as easy as like, you can just sign up for this study, it's, we set up various tents and kind of stations, at places around the city kind of randomly selected places where we think there will be community traffic, and then we just started approaching people in those venues. So you can't actually sign up for the study necessarily, you just sort of have to kind of be you have to sort of cross our path or we cross your cross your path, so to speak. And then and and then you kind of get in. And that's part of the way the study was designed to capture a representative sample. And I, I know it sounds a little bit odd, it sounded a bit odd to me when I first heard it too. But I think kind of incorporating all this randomness into it. And to be perfectly honest, we are trying to make sure that we have a little bit of pull to make sure we capture diversity, as well, you know, we were we're leveraging our connections with the LGBTQ plus community going through some of those clinics, we have a advisory board that consists of black and Latinx leaders in the community to try to find venues in those communities as well, because traditionally, those places have been more hesitant to participate in research. And so we're almost trying to over sample to account for that. So we're just trying to be all over the place. And I guess, you know, when you talk about overall population, it's just a fraction, but we're trying to get the right fraction through this sampling.

So what are some of the give us some examples, you know, anything where you're going to be over the next week at least right? Well,

currently and I was going to take the call from here we were we're currently supposed to be over in Frick park right now by the blue slides. So if you're if you happen to live in that area, look out your window, you may see our cap. There, I just happened to be my house, which is actually pretty close by two. But we've been a giant eagles. We are going to be working in like the width of the beach beach in Brookline communities as well as Homewood and Hill district trying to find like areas there. Various parks, we've been up north shore Park, Shen Li, oval schenley Plaza. And and we are continuing, you know, we sometimes do events, like, for example, food distributions at the one of the organizations called Shepherd wellness community, which creates a Community Food education for people who are living with HIV. And that was actually really heartwarming, because we've got impressive responses. There's so many people there who are willing and interested in the study, because they want to help. And I think just seeing that, for me, it was actually kind of an emotional experience. I was like, wow, this is sort of the power of community. But we also see those days where like, no one really wants to talk to us like a baseball game. And they're just trying to get to the baseball game. And I hear Oh, it's okay.

So what's entailed with the study what's entailed, so? Yeah,

it just has three parts, it has a, so you do your own COVID tests, you actually swap your nose, so you don't have to stick the swab all the way up there, you just sort of rub you got maybe about an inch in. So we call that an anterior turbinate swab, that's self administered. And so that gets sent for COVID testing to class. So people do their own COVID test, they get a tube of blood sent for the antibodies, and antibodies are kind of a research study. So unfortunately, the way it works right now is that we can't return those results to people, we don't even get them. But but that's that's kind of the main point of the study, that's what's being studied is to kind of look at who has antibodies, which, which correlates with who has had prior infection. And then finally, a survey that captures you know, people's risk factors for COVID, their behaviors, their experiences with COVID, if they've had COVID in the past, and things like that, how is COVID changed their lives, I think kind of putting that all together will give us a more full picture of COVID in the United States.

So your goal is to capture how many people by what date

4000 people by July 31, I found out

Okay, so so that's a lot when you enter your methodology is not traditional.

Yeah, it is a lot. And you know, we have a saying we have this small army of very eager graduate students and college students who have actually, we're really excited to go into the community and talk to people about COVID. And I think that that helps we've been running with a very small team that's, you know, then basically consists of like me and a couple other people, and we were doing the best we can, but I think sometimes having really young, energetic, far more attractive people may may help with, with recruitment. And, and it's just, I think it's just sort of it is what it is. And then I think also trying to leverage community connections, because there really is there's that element of trust, where, you know, if people don't trust you, and I hear with and acknowledge where that comes from, then they're not going to participate. And so we need to try to be as approachable and open as possible.

So how many other cities are a part of this?

There is I think about 15 other cities that are a part of this and including Puerto Rico, which is not a city. Right, I think it's San Juan. But, um, but yeah, kind of across the, across the country, I think the west and the east, Texas, some sites in New York, and we are I think we're the only site kind of local to this area of Cincinnati, and then us, I guess, in the Midwest,

and so do you talk with the other researchers at all to see what they're finding? Are they having the same kinds of issues? In terms? Yeah, even though immunity? That

Yes, and in a way, it's a little bit heartening, because we're not the only ones having issues. It's very interesting because Puerto Rico sort of like enrolled 1000s of people off the bat, they're almost done in a period of almost like a month, but I think it's also very, culturally very different, the weather's much better. And so you know, Puerto Rico and the US, the mainland us sites are, have had very different trajectories. I think a group from Texas presented yesterday and was, you know, kind of really talking about the the degree of distrust, especially within some of the Texas venues, and we see that here, but I think overall, we were actually doing a little bit better than than they are just in terms of numbers. But we certainly we feel their pain to just because it's, it is hard. So Jonathan,

there's two questions that I'd like you to grab one from Mariana one from Ken.

We'll start with Marianne says basically COVID has created drastic changes in our socio economic environment. This is the first pandemic we've essentially experienced on a broad global basis. And there is fear there's more to come. So what needs to happen to prevent future pandemics is a need greater levels of funding. Good research.

Yes, yeah, I think that that makes sense. It's kind of all the above. You know, we the one of the reasons we had a COVID vaccine so quickly is actually because of prior research that was conducted on SARS and MERS and, and they were developing a vaccine, but then all of a sudden SARS just vanished. And so there wasn't really need to test that any further. And so that's kind of a good example of how no prior research actually can inform future generations and future epidemics. No pandemic preparedness, I think under the Obama administration, there was more, there were more Reese's resources put into that, and that all kind of vanished with the next station. But um, but I think it speaks to the importance of public health and and supporting public health research, as well as infrastructure for delivery of public health intervention. So I think both the research as well as the people out there in the field and in the trenches to, unfortunately, public health is one of those thankless jobs where people where it only gets noticed when something is going wrong when things are going right. You never hear anything about it. Because

Absolutely. Here's an ask the doc question from Ken. Patrick here wants to know, what is a current recommendation for a person fully recovered from COVID? pneumonia? getting vaccinated?

Yeah, yeah, there is actually some confusion there as well, I think. So there's this question as to whether or not people should wait 90 days after they're after having an COVID infection to get the vaccine. And my understanding from the CDC is, that's not necessarily like a safety issue, like you can get the COVID vaccine after having COVID infection. But the thought is, if you've survived, you know, if you've done okay with COVID, and then you probably have some form of immunity. And the thought is that should at last should last at least three months. And so it's an option to hold on the vaccine, you know, if you feel like, okay, you know, somebody else should get that, since I already have a certain degree of protection. It's kind of one of the things do do you actually, do we recommend that you actually wait the full three months or not? I think that's kind of an individual decision. Honestly, if that vaccine is in front of you, and it's not going to go to anyone else. I mean, I would probably take it and I don't think that anyone would fault you for getting the vaccine ahead of nine days as well, because that is something that the vaccine is something we know has evidence for protection and efficacy, so why not get? Um, I think in terms of like the other end, like what's the shortest period of time usually, they say you want to wait at least 14 days after your infection. And the reason for that is you don't want to expose somebody who's giving you the vaccine to COVID while you have an active infection.

What about booster shots? Will they will they know soon whether we'll need boosters for hopefully, I

mean, these all this the trials, they started kind of in July, and then kind of over the upcoming months. And so you know, they actually haven't been following people that long. It's certainly less than a year. And I think, right now, you know, it seems like we just continue to see more publications that show like, okay, it seems like for example, Pfizer is seems to protect at least six months. And once we see, you know, if we start to see waning or dwindling immunity, then that might be kind of where we start to say, Oh, we maybe we need booster shots. And I think that's probably something that's being studied. And then of course, the other issue is variants, you know, with the, the arrival of the different COVID variants result in less vaccine protection, and then maybe the need necessarily for booster, but for kind of almost a different vaccines as well.

So what you know, we're coming up to the end. So there's a good question from them saying, what can we do to help support, which is one of the things that I wanted to wrap us up with, but there's just a longer statement in there. And I think the gist is, you know, the side effects. And while there might be a one in a million chance of some midterm side effect, what medical points can be, you know, pointed out to give confidence now, and that's what I think you're trying to do. Right?

Yeah, right. It's really challenging, because the, yeah, a lot of it is, as Jonathan pointed out, there's a lot of media sensation sensationalization, I guess. And overall, these vaccines have been quite safe. They haven't seen very many safety signals at all, most of it is just sort of in you feel kind of icky, like a little some fever, achy arms and what have you. But then kind of the the emergence of some of these other weird symptoms like the the clots and everything like that are coming up, we're talking tiny, tiny numbers, and so they're pausing out of caution. But I think it's important to sort of, sort of look at the big picture and say, you know, millions and millions of people who've received the vaccine, and you know, and we see say, six of these kind of this this rare case, which is a little bit unusual for something that's rare, and it's in a certain group, so it needs to be investigated further, but the overall thing is, we have like very safe, we have a series of very safe vaccines on our hands that they're just investigating more. And we have 600,000 deaths in the United States. So kind of when you compare the two, it's like, you have to kind of realize that, you know, we're dealing with a very serious pandemic here. And the risk of dying from COVID is probably a lot higher than some of the risks of the right, really vaccine side effects.

So and then so to wrap it up, I mean, I, we really appreciate you spending the time with us. I know you've got a ton of stuff going on, what can we do to help support and promote this study? Besides having this conversation here? What else can we do?

Well, if you if you see us, you know, please come visit us, we'd

love to see you.

But also, I think just you know, we were talking about community leveraging community connections and things like that if you know of events, or you know, groups of, you know, people where there's traffic where people are currently meeting who you know, would be able to have us come in, we were outside, we were, if we weren't inside, we make sure to stay distance and everything like that, then then we would be interested in potentially having you all come on as a venue or whatever. I think this is a great opportunity for me to just interface with with some different communities as well. And and I'm very thankful for that.

Well, I think, first of all, appreciate the work that you've done and the commitment that you've made to these fields. It's it's pretty remarkable. How can we make connections with you? Can you want to put your email out there?

Yeah, I'm happy to do that. Go

out there, please. Is there any other way that you can? Do you see the chat? I do. Yeah. He did it.

For my life. So.

Yeah. So I can this has been fabulous. Thank you for taking all this work so seriously. And being a great ambassador. It's not easy work. I can't imagine you're trying to do all this by July on the compass study. And if there are other ways that we can be helpful, please, honestly, don't be shy ask us. Because you really do care. And we want we've seen what's happened over over the past year, you've seen it in many, many other kinds of situations, like with HIV, and men's health. So you know, don't be shy. We're here to try to pass, you know, shout and share the Word anything that we can do. So I want to thank you so much for taking the time with us today at noon. I know that you have an event over at Frick near blue side, slide Park, so if anyone's over there, you know, out during lunch, go over there. And, you know, say hello and see if you can participate. So thank you again, Jonathan. What's up? What's next

brush up on your German tomorrow? Audrey, we have two representatives from Pennsylvania talking about business and trade opportunities in Germany say I was looking to expand our markets here in Pittsburgh, that's for sure we can help you do that.

That's great. All right. Well, thank you so much, Dr. Whoa, really appreciate it. Thanks, everyone, for joining us today. Keep up the great work.

Thank you so much.

Transcribed by https://otter.ai