Is delta different? As Southern hospitals struggle to deal with the latest wave of COVID-19, we’re left wondering how we should respond. What steps should we take as individuals? What steps need to be taken collectively? And what can we learn from this for future outbreaks and viruses?

I spoke with Dr. Henna Budhwani, a medical sociologist and Assistant Professor in Public Health at the University of Alabama at Birmingham, to answer some of the most pressing questions about COVID-19 and the delta variant.

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The conversation has been edited for length and clarity.

 Reckon: To start, can you tell our readers a little about your background and expertise?

Henna Budhwani: I’m a Medical Sociologist and an Assistant Professor in Public Health working to promote health equity in resource-constrained setting across the United States and abroad.

Reckon: In the South, it feels like the Covid situation is worse than it has ever been – and that was before a Category 4 hurricane hit the Gulf Coast – and yet we are not taking the same precautions we were this time last year. What’s your biggest concern about our response?

Budwhani: Oh gosh. I have so many concerns. I’m worried about the children who are still ineligible for vaccination; their health is of utmost concern, but I’m also concerned about their educational attainment after having experienced a modified school year. My heart goes out to the parents, because the parents are not okay – we’re all trying to buffer our children from the chaos while providing as normal of a childhood as possible. I’m concerned for folks who are mis-informed, through no fault of their own. There are some really wonderful people who have been told falsehoods and have internalized vaccine distrust. I’m deeply concerned about the well-being of health care providers and hospital systems that are buckling under the weight of patient care related to COVID.

Reckon: With the start of school, return of football season, concerts, festivals and other large events, it is starting to feel inevitable that everyone will be exposed at some point in the next few weeks. Will we be able to handle that?

Budwhani: People who are at higher risk, should avoid exposures. I was just on the University of Alabama campus on Friday. The same place that is all over TikTok for #bamarush is also home to multiple successful vaccine pop-up clinics for students. But, circling back to your original question, will we be able to handle this? I don’t know. I think if we increase vaccination, we will be better prepared, because we know that vaccination is protective against severe disease, so even if people do get sick, they – we hope – they will not require hospitalization.

Reckon: What precautions should vaccinated people be taking right now? What if they have children under 12 or immunocompromised people in their home?

Budhwani: If my fellow citizens can, they need to minimize potential exposures. My children are too young to be vaccinated. While we traveled this summer when COVID cases were low, we postponed future air travel and have stopped eating out. Thankfully, our children attend a school that has implemented thoughtful and comprehensive COVID precautions, including universal masking, but we live in a suburb that started the school year with a mask-optional policy that may have unintended consequences related to disease transmission and exposures trickling into non-school settings. I’d also suggest that people who are around unvaccinated children and the immunocompromised, regardless of their personal vaccination status, mask when going out; I don’t think anyone wants to bring COVID home to their friends and family.

Reckon: What actions should leaders – whether it’s mayors and governors, principals and university presidents, faith leaders and employers, and/or the federal government – take to try to slow the spread?

Budhwani: On one hand we have Governor Ivey who seems immensely frustrated with the anti-vaccine sentiments in this state; on the other we have political officials spewing unsubstituted nonsense that is increasing skepticism. Former President Trump was just in Alabama hosting a rally, and he was boo-ed when he stated that he accepted the vaccine. Supporters of the former President boo-ed him for – in my opinion – doing the right thing, trying to de-stigmatize the COVID vaccine. We need to depoliticize vaccination; we need to implement tailored communication to reach into local communities with messaging that speaks to real people’s lived experiences and concerns. We need all hands on deck. We need the preachers preaching pro-vaccine messaging. We need the teachers explaining the science of mRNA that is – as my husband says – that of a recipe. The mRNA vaccines tell your body what to do; they do not inject you with live virus. There are no microchips; the vaccines are safe and effective.

We need large employers and government agencies, including hospital systems and universities, to consider both vaccine incentives and mandates. We need to bring vaccination into the community, to make it easy to access.

Reckon: What have we learned about the public health response in the South that has surprised you? What lessons can we take away from the past two years to prepare for other endemic viruses or future outbreaks?

Budhwani: I wasn’t surprised by anti-vaccine sentiments; we live in a state where autonomy is paramount, and people do not like the government telling them what to do. The antagonistic reaction to a vaccine that was seemingly developed too quickly and promoted by experts, was not surprising.

That said, there have been times that I was impressed and inspired. I was recently on a panel with Dr. Scott Harris, Chief Medical Officer of the Alabama Department of Public Health, and the enormous lift undertaken to address COVID-19 related demands in addition to existing public health responsibilities, is commendable. Vaccine incentive programs continue to encourage folks to do the right thing to protect themselves and others. Volunteers, including retired clinical providers, stepped up to administer vaccines, because they cared for the well-being of society. Friends and neighbors shared supplies. People went out grocery shopping for those who could not. Those with social capital spoke up on social media and said, “I am vaccinated,” knowing that they may be lambasted by some of their peers; that was really brave.

As to takeaways, we need to bolster our infectious disease infrastructure. That means investing in departments of infectious diseases, strengthening infectious disease functions within departments of public health, and supporting ongoing vaccine development. Concurrently, we need to promote equity in health, meaning those with the least – least access, fewest resources, etc. – need to be supported to be healthy, one mechanism would be through Medicaid expansion. We need to involve people with skills in promoting behavior change, understanding societal dynamics, and messaging in our teams, namely sociologists, psychologists, anthropologists, and communication specialists. We need to be linked with the community. The schools and Churches and youth centers and community-based organizations, they all need a permanent seat at the table of public health, so when we need help, they are already mobilized and ready to go.