How Will We Know When the Pandemic is Over? Brown Univ. Pandemic Center Director Explains

Jennifer Nuzzo

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Marianne O’Hare : Welcome to Conversations on Health Care. This week , we welcome
Dr. Jennifer Nuzzo, i naugural Director of the Brown University School
of Public Health ’ s Pandemic Center on how to get this pandemic
under control w hile prepa ring for t he next one.

Dr. Jennifer Nuzzo : There's going to be more pandemic threats in the future , a nd we need
to make sure that we're never again caught so vulnerable in the ways
that we were for this one .

Marianne O’Hare : Lori Robertson joins us from FactCheck.o r g. And we end with a bright
idea , improving health and wellbeing in everyday lives. Now, here are
your host s Mark Masselli and Margaret Flinter .

Mark Masselli: When experts said the end of COVID pandemic is not like a sporting
match, there will not be a w h istle telling us it's all over. But there is a
process and data that are essential to helping us understand where
we are in the situation as we head into the fall.

Margaret Flinter: Joining us to break down these details is Dr. Jennifer Nuzzo. She's
leadi n g a new effort on pandemic preparedness and response at
Brown University School of Public Health. And Dr. Nuzzo and her team
are working to address the urgent issues that have been exposed in
this pandemic and are intrinsic to every pandemic.

Mark Masselli : Dr. Nuzzo , welcome to Conversations on Health Care.

Dr. Jennifer Nuzzo: Thanks for having me.

Mark Masselli: You know, we point out that the White House Corona Response
Coordinator Dr. Ashish Jha hired you when he was d ean at Brown , and
his boss, Preside nt Joe Biden , said the pandemic was over , then tried
to clarify his words . The U.S. is still averaging over 400 COVID deaths
each day. So , where do we stand on this question? Are we still in a
pandemic?

Dr. Jennifer Nuzzo: So , first of all, when I first be gan the thought and conversations with
Ashish about coming up to Brown to work on pandemics, it was
actually in between where we saw a rise in cases and then the
subsequent meteoric rise of the Omicron variant. And that just tells
you that even when the ca se n umbers are low, even when perhaps
there's a glimmer of hope in the future, it's worth still working on
these issues and digging into them , b ecause, you know, even if the
virus were no longer part of our daily thinking, there's going to be
more pandemic thr eats in the future. And we need to make sure that
we're never again caught so vulnerable in the ways that we were for
this one . It's still clearly a significant health threat . The fact that we
have more than 400 Americans dying each day , thousands of
A meri cans each week , is really quite serious, and something that we

Jennifer Nuzzo

have to continue to do work on.

Are we in the same situation as we were in 2020? Absolutely not. But
that's as a result of the hard work that we've done over the past two
years. And I guess one of the concerns that I have is that, you know,
we're headed into a fall where we could see a rise again in terms of
the cases , which happens every fall, winter. And many of the tools
that we have used in order to make COVID not what it once was, are
p ossi bly going to become increasingly out of reach for people . And so
really what happens in the future is up to us and to make sure that we
continue to work such that people who get up - to - date on their
vaccines, and we make sure that all tools are availabl e to everyone
who needs it , a nd there's still a lot of work to do to make that
happen.

Margaret Flinter: Well Dr. Nuzzo , restaurants are full , people act like the pandemic is
over , kids are in school , a nd yet we see these numbers of cases. When
do we get t o de clare the end of a pandemic? What would be the
measure for that?

Dr. Jennifer Nuzzo: Well, it's important for people to know that from an epidemiologic
perspective , that when we use the word ‘ pandemic ’ , what we really
are describing is geographic sprea d. So , by that measure, this virus
isn't going away , b ut what is changing is how much this virus has the
potential to upend our lives. The fact that people are living differently
than they were two years ago, signals progress . Whether we stop
calling it th e pand emic, I think is probably going to be more of a social
and political decision rather than a true epidemiologic one. And I say
that because the virus that caused our last pandemic, something that
happened in 2009, the H1N1 flu pandemic, which I'm find ing a lot of
people have forgotten about, that virus is still with us and continues
to s icken people every single flu season. So , these viruses are not
going to go away , b ut with tools like vaccines and therapeutic drugs
and tests, we can better manage the m such that they don't pose as
much of a risk to our broader community as they once did , a nd that
the ways that we deal with them is not just simply , “ Don't go out,
don't see people , don't go to restaurants, ” etc. We just have more
options for protecting o urselves t han we did two years ago.

Mark Masselli: I know you said a moment ago that obviously as we come into the fall
we'll see some spikes. But the Washington Post recently reported that
a major fall COVID surge is unlikely. What should we be prepared f or?
I kno w there's a variant . Some suggest that it will take over where the
two variants are right now.

Dr. Jennifer Nuzzo: Yeah . So , I'm not sure that I can say that a major surge is unlikely . In
part , what's likely depends on what we do between now and t hen
with res pect to vaccinations . And one of the things I am most worried
about is that we have a large gap in coverage of booster doses among

Jennifer Nuzzo

the people who are most at risk of severe illness. So , the fact that we
have people over the age of 65 , 30% of th em who haven't gotten
boosted , and about 60% of them who haven't gotten a second
booster is a real worry . And so if we want to make sure that we have a
fall and winter that's not marked by rising hospitalizations and deaths,
we absolutely have to double do wn on making sure the people , in
particular the people who are at greatest risk for illness and death , get
boosted. We shouldn't only do this, but if we do nothing else, we have
to make sure that those who are at greatest risk of severe illness and
death g et boosted.

Will we have another Omicron level surge? I don't think so. But I
actually didn't expect us to have a surge that great. So , I'm a little bit
humble in terms of my predictions that it won't be as bad. I do think
that the amount of immunity we'v e amassed in our country, both
through vaccinations, and the infections that have happened, d o I
think blunt the level of severe illness. And what I'm most focused on is
making sure we keep people out of the hospital and keep people from
dying . It's r eally hard to prevent infections, not that we shouldn't try.
And there's more, much more work we need to do to make sure that
doesn't happen this fall and winter .

Margaret Flinter: I was curious about a comment that I think was described to you that
there' s thr ee ways to prepare society for the next pandemic , a nd that
they hark back to the Great Baltimore Fire of 1904 . Heard a lot of
reference to the great flu pandemic of 19 1 8 , h aven't really heard this
reference back to the Great Baltimore Fire of 1 90 4. So , exp lain these
ideas to us .

Dr. Jennifer Nuzzo: So this really came out of -- I was actually given the privilege of being
asked to give a TED Talk and they asked me what I wanted to talk
about. And at the time, I was actually quite worried that COVID w as
star t ing to fade from the headlines, the cases were falling, but there
was still more work we needed to do to not just address the
continued hospitalizations and deaths that were still happening, but
also to make sure we never have to go through an even t like C OVID
ever again. And there's a lot of hard work building the medical and
public health infrastructure and other things that we needed to do.
But I was really worried that people were starting to forget.

So , I was looking for a way to try to describe to pe o ple , or make clear ,
that just because COVID may end, it may end in the sense that it no
longer consumes our daily thoughts. Our vulnerability to infectious
disease emergencies remains , and in particular, we are seeing an
increase in the number of infec tio us d isease emergencies that have
been happening over time . And so just because COVID may sort of
fade from the headlines, it doesn't mean that we're safe for the next
100 years. COVID sometimes is called the once - in - a - century crisis . It's

Jennifer Nuzzo

actually a wrong desc ription for it. But I didn't want people to
somehow think that once COVID is over, we've gotten 99 more years
of being safe until we have to worry again.

So , I was looking for analogies, you know, what are other hazards that
we encounter and prepare f or tha t once they're over w e don't just
assume that we're safe once they're done. And the more I heard
about the Great Baltimore Fire of 1904, and how really devastating
that one event was, but also how catalytic that one event was in
terms of changing how we a s a cou ntry deal with urban fires such that
now we don't have them nearly as frequently as we once did , a nd
part of the reason why they're not nearly as frequent is that we rolled
up our sleeves . We did a lot of hard work to make ourselves
protected . And so I id entified three areas in which the country
committed itself to action after the Great Baltimore Fire of 1904. They
were in the area of data, drills and defense. And I pose d that if we
committed to action in those three areas, we would be much le s s
vulnerable to the recurring hazards of infectious diseases, and that we
could deal with a future that may see more and more pandemics, but
that we wouldn't be as vulnerable , or experience the same severity of
impacts as we did during COVID.

Mark Massell i : Oh, I think that's a great example. You know, I think I read that you
grew up near where a polio outbreak is now occurring in New York.
And of course, the disease had practically been eliminated in the
United States. But this gets to the heart of the va c cination education
campaigns that have worked in many cases, but still seem to have
resistance in some communities. And I'm wondering if social science
can better help all of us in the public health try to break through with
anti - vaxxers , people who a r e re sistant to getting vaccines , with some
new strategies . Just telling them the facts and urging them to get
vaccinated , doesn't seem to be working.

Dr. Jennifer Nuzzo: No, it doesn't seem to be working. And I was so , so disappointed to
learn about polio r etu rning to the U.S. , and particularly circulating in
communities that were so close to where I grew up, in part because I
always heard growing up from my mom who was actually very proud
throughout her life that she had been part of the early polio vaccine
tr ials . She always used to tell me with pride that she was a polio
pioneer, did her civic duty for something that was very much feared,
particularly by her generation. I think many people who gr o w up
today , have never met somebody who has experience d polio . I did. I
mean, you know, people in my mother's generation certainly were
affected by it, and many people who ha d lifelong consequences of
those infections. So it was a very much a feared thing . And so , for a
generation of people to be able to participate i n developing a tool
that would take off the table polio ’ s abilities to kill , or harm people for
life , was something very much a point of pride. So , it's unfortunate

Jennifer Nuzzo

that people haven't lived with that same fear , b e cause they don't , you
kn ow, then be able t o compare that to the benefits that vaccines
offer .

I think we do have to figure out what are people's motivations and
figure out how to better reach them. You know, many of us have been
engaged over the past two years talking to p eople a bout vaccines , a n d
I am hopeful that we can actually make more progress in convincing
people of the benefits of vaccines, but we need to have more
evidence - based ways of doing that. And it's going to take all of us .
This is something that probably need s to be done from the ground up
rather than the top down , and so the more evidence and guide that
we can all use to have these conversations, I think the better . And
that's really where I think social science research comes in. And if we
do nothing else after this pandemic, in vesting in how to reach people
and talk to them about risks, including how to protect themselves
from it using vaccines , is I think a really important pandemic lesson.

Margaret Flinter: Dr. Nuzzo , you're obviously engaged in a lot of lea dership activity in
your roles in public health . But one of them is that you c o - lead the
Global Health Security Index, which for people not familiar with it , it
aggregates publicly available data to create a picture at the national
level , health secu rity ga ps from 195 countr ies . Maybe share with our
audience a little bit more about what the intent of the Security Index
is. And what do you say to some comments I think that British Medical
Journal has said recently that it gives a false sense of securi ty to s ome
nations and may be undue critici sm to others?

Dr. Jennifer Nuzzo: Yeah . So , we started the Global Health Security Index a number of
years ago . We published the first one in December 2019 , so just
before the pandemic . And what we really set out to do , was create
basically an inventory of the capacities , and to some extent the risks
countries have about future pandemic threats and other types of
threats, including deliberate outbreak , something that could be
intentionally caused. So , really, threat ag nostic, but capacity foc used.

We were doing this in part because, you know, work has been
underway for many years to try to strengthen countries ’ abilities to
respond to not just threats like COVID, but Ebola , and flu seasons, you
know, all sorts of types of even ts. But we know that not all countries
have the same capacities , a nd that was actually made quite clear
during COVID when we saw huge differences in how much testing
countries did. Then the fact that there's so much discrepancies
between the amount of tes ting s countries d id , gives us a very
different impression of how countries have been infected in p art
because we've just looked for the virus in different ways.

So , we published the first index just before the pandemic , a nd what
we concluded was no countr y had everything. In fact, there were

Jennifer Nuzzo

many important gaps in all countries. You know, when we saw the
pandemic unfold, and we saw countries that scored higher , like the
United States really struggle to respond to COVID , t hat was deeply
disheartening . But i t also wasn't sur prising, in part, because we knew
that even the top scoring country like the United States had really
important gaps , a nd really any of these gaps can be paralyzing . But ,
that's actually one of the things that made me start thinking about
f ires as an appro priate analogy, because, you know, the index
basically measures the tools that countries have . And so if let's say
you're trying to create an index for a fire, if one of the tools you
measure is a fire alarm, and if you want to look at the risk for fire, a nd
you look at perhaps whether the re 're building codes that require the
installation of fire alarms, that's quite important for understanding
how well a country may do in an emergency like a fire.

B ut we don' t actua lly measure whether countries are going to use the
capacities they have , and so what we saw unfortunately during the
pandemic was many countries like the United States , chose not to use
the capacities that they had, which was quite unfortunate . Because
going back to that fire analogy, it's sort of like they had the fire
alarms , and the alarms were going off, but they just chose to sit there
and remain in their seats despite what the fire alarm is . And so we
don't measure that piece , y ou know , whethe r we wi ll evacuate the
building when the fire al arms go off. And , you know, unfortunately
th e capacities aren't the only thing , i t's how you'll actually use them
that also matters.

So , my hope is that it's a wake up call for all countries, and that all
coun tries c ould benefit from improving their capac ities. But just
having them doesn't mean they're going to be okay. It requires a
commitment to using them , a commitment to continually
strengthening them and exercising their use, just like we do fire drills
ju st to m ake sure we know what we're doing.

Mark Masselli: You know, you're also involved with the Outbreak Observatory, which
really is focused on collecting information on challenges and solutions
associated with the outbreak response and share broadly with t he
Public Health Preparedness and Response Community Center. I'm
wondering, are we learning more about how China handled or
mishandled the initial COVID outbreak . And how can we expect a
different response as we think about societies that aren't as
transpa rent?

Dr. Jennifer Nuzzo: You know, I think clearly the initial response to COVID, not just in
China, but in many countries , was not what it needed to be. I think, in
particular, in the incidence of China, you know, the thought that there
may have be en more information tha n was shared publicly is
i nexcusable frankly . We all depend on each other , a nd we all suffer

Jennifer Nuzzo

when we don't share the information. So that is I think a clear lesson
that has come out of COVID is that we need countries to first have the
ca pacity to do tests and to gather data . That i s a clear first step. But
then , once they have that information, to be transparent, and to
share that with others , t hat is also a second step.

I think there are some other lessons that we saw later in COVI D , i n
f act, actually during the Omicron wave where there were some
countries that really leaned in, in terms of collecting data, and sharing
that with the world , and I'm thinking to South Africa sort of alerting
the world to the discovery of the Omicron v ariant. And that was really
heroic and extraordinar ily helpful from a public health perspective.
But then what happened afterwards , was actually the opposite of
that , which we saw a number of countries, including the United
States, implement reall y harmf ul travel bans, that struck at the kind of
economic c onsequences for South Africa for having shared that
information , b ut also, you know, hindered the supply, the transport of
important laboratory reagents that the scientists were using in orde r
to tell us more about the Omicron variants.

So , we still have a number of important sort of governance and policy
barriers that may deter countries from being forthcoming with
information that they have about situations that are happening within
th eir bor ders. And, you know, we really also have to work on
eliminating those barriers if we're going to expect countries to be
forthcoming with what's happening.

Margaret Flinter: Well Dr. Nuzzo , even as we look forward to COVID quieting down,
some ha ve suggest ed that maybe we're just living in a new era of
pandemics, and th at they will continue and they will be more
frequent. Are you in alignment with that thinking? And if it's the case,
are there some fundamental ways you think that society will change
to ad ap t to that kind of environment?

Dr. Jennifer Nuzzo: So , we live i n an age of pandemic threats . We see an increasing
frequency of new diseases emerging or old diseases reemerging that
threaten our public health . They don't all become pandemics, but
som e of them can , a nd that just means there's probably more
pandemics in our future. So , that's very much the bad news. But the
good news is that I absolutely believe that there are important steps
that we can take that will reduce our vulnerabilities t o these threats.
Again, I could go back to that fire analogy. It's not that the risk of fires
went away, it's just the U.S. after the Great Baltimore Fire of 1904,
undertook steps such that we are now , as a country , less vulnerable
to large urban fires .

And we can do the same for pandemics . We can take steps such that
we detect t hese events much earlier, that we can tell people how to
protect themselves, give people tools in order to protect themselves

Jennifer Nuzzo

so they can continue to live , despite the presence of a new p athogen
around them , a nd that we have a defense force . You talked abo ut the
fire department . One of the problems is that we went into this
pandemic with a defense force , our public health infrastructure , that
was really decimated due to continued fu nding c uts year after year
after year. You can't fight an emergency with tha t . You can't just hire
a bunch of people in an emergency and expect that it's going to
unfold.

W e have to resource and staff public health agencies for the
emergency in advance. We need t o make sure there's a large cadre of
very trained professionals who can act in a way that protects us ,
o f tentimes , you know, sort of even out of sight . But we very much
need th e protections that we can put in place like improving the
quali ty of a ir in our buildings, and the availability of tests for people to
test themselv es at home. And this just gives people more power to
continue to live despite this recurring hazard of infectious diseases,
but in a way that they can do so more safely. A nd, you know, I think
we need to work towards that vision such that we don't put our lives
on hold, but we also don't succumb to these repeated viral threats in
the process.

Mark Masselli: Yeah . I want to sort of pull on the thought . You just said that we ne ed
bett er trained health professionals , and one additional silver lining
perhaps in the COVID experience is the increase of students studying
public health . Maybe what's the biggest lesson they need to learn as
they prepare for their careers?

Dr. Jennifer N uzzo: Y eah . So , I think it's really heartening that many people now
understand wha t public health is . I joked, often joke that I used to
have to tell people that I was an epidemiologist, and explain to people
what that was. So , it's great that w e have this heightened
understanding of what public health is . I think for our future public
health professionals, I think there are a few lessons. One is that it's
important to think about the virus, but we also have to think about
the people and the systems in which the virus circulate. And we need
to recognize that much of our vulnerability to viruses is in part the
structure of our societies, the fact that we don't all have equal access
to the tools that we can use to protect oursel ves. So , we have to work
to serve people and meet them where they're and, you know, fill the
gaps in terms of acce ss.

The other thing is that a lot of people, they know what public health
does, but they've probably never met a public health worker in the
same way , and so , in their mind, it 's probably medicine . And so I really
think that we have to have better integra tion of public health and
medicine. Over these past two years, I've had conversations with lots
and lots of people ab out COV ID vaccines. And a common feature of

Jennifer Nuzzo

the conversations I've had with people who haven't yet been
convinced of the benefits of these vaccines is often that they don't
have a regular health care provider. So , we really, I think, need to
understand how people come to health issues , and make sure that
they can be served by health care providers and public health in their
day - to - day lives , and not just kind of show up in people's lives in the
midst of an emergency and sort of expect automatic cooperation an d
partn ership.

Margaret Flinter: How are things in Rhode Island? We're seeing case rates for
hospitalization are popping way up in Connec ticut? Are you seeing the
same thing in Rhode Isl and?

Dr. Jennifer Nuzzo: You know, actually I haven't looked at the hos pitaliz ations . I was just
looking at the cases the other day, and actually all of our data are
much harder to interpret than they ever h ave been. Things look pretty
flat. But I expect to see them go up. I just I fear though that our
surveillance has reall y erode d in part because we've shut down so
much testing , so .

Mark Masselli: That’s right.

Margaret Flinter: Yeah . That's why the hospita lization rates are worrisome because
they're going up.

Dr. Jennifer Nuzzo: It used to be like clockwork, you'd see the cas es go up and then about
two to three weeks later you would see the hospitalizations and
deaths . And like , those trends have just —

Marg aret Flinter: They have separa ted out.

Dr. Jennifer Nuzzo: They are hard to reconcile . You know , in hard to reconcile and
interpret ways , i t's really unfortunate.

Mark Masselli: Right.

Margaret Flinte r: Well Dr. Nuzzo, thank you so much for your important work, your
contribution to the public's health, and for joining us today . And
thanks to our audience for joining us. You can learn more about
Conversations on Health Care , and sign up for our u pdates at
www.chcradio.c om . Dr. Nuzzo , thank you again so much.

Dr. Jennifer Nuzzo: Thank you for having me , I appreciate it.

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Mark Masselli: At Conversations on Health Care we want our audience to be truly in the kn ow when it comes to the facts about health care reform a nd
policy. Lori Robertson is an award - winning journalist , and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate for voters that aim to reduce the level of deception in U.S. po litics.

Jennifer Nuzzo

Lori, what have you got for us this week?

Lori Robertson: Denmark has announced a plan for its fall COVID - 19 vaccination drive .
The country said it will offer the new Omicron specific booster shots
to high risk individuals including everyone aged 5 0 and older. But
those peddling misinformation in the U.S. , misleadingly suggested this
means the shots are unsafe for those under 50. The Danish Health
Authority said that is a misinterpretation. Rather , the Danish Health
Authority is focusing its fall vaccination drug on those who are most
vulnerable to sev ere illness, hospitalization and death from COVID - 19 ,
w hich means those who are over age 60 . But the health system is
offering the boosters to everyone 50 and older as a precaution.

A spokeswoman f or the Danish Health Authority told us the
vaccination drive is aimed at 2.5 million people , or nearly half the
country . Aiming to vaccinate that many people , shows the Health
Authority is convinced the vaccines are safe. The Omicron specific
booster shots a lso wil l be given to those under 50 who have
underlying health conditions that put them at higher risk for severe
illness, as well as those who work in health care or elder care,
relatives of those who are at high risk , and pregnant women. As of
mid - Septemb er, abo ut 82% of Denmark's population was fully
vaccina ted, compared with about 68% in the United States.

And that's my fact check for this week. I'm Lori Robertson, M anaging
Editor of FactCheck.org.

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Margaret Flinter: FactCheck.org is committed to f actual accuracy from the country's
major political pl ayers , and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked, e mail us at www.chcrad io.com . We'll have
FactCheck.org's Lori Robertson ch eck it out for you here on
Conversations on Health Care.

[ Music ]

Margaret Flinter: Each week , Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. When W ichita
Kansa s Nurse Practitioner Michael Waw rzewski learned of the harsh
and often fatal conditions that expectant mothers endure in Sub - Saharan Africa, all because they live too far from a medical clinic, believing that every human being should hav e acces s to quality health
care, he came up with a solution , Clinic In A Can , transforming
shipping containers into fully equipped mobile clinics and operating rooms that can be shipped anywhere in the world where there i s a
need.

Michael Wawrzewski : When you wal k in the inside, you will believe or think t hat you're

Jennifer Nuzzo

inside your doctor's office , or maybe you're in an emergency room or
an ICU unit . They look exactly the same.

Margaret Flinter: Wawrzewski learned from his early iterations that gas - powered
genera tors c o uld be problematic in low resource areas, and switch ed
all of his portable clinics to solar power, which he says was a game
changer.

Michael Wawrzewski : There's no part of the world that does not have sunlight , and so solar
power has become the corn erstone of how we re - engineered how we
power a cl inic so that now six solar panels on the top and eight
batteries is enough to run a clinic for 18 hours .

Margaret Flinter: Since its founding a decade ago , Clinic s In A Can have been delivered
to war - torn Sudan , and mo re recently , to Santa Rosa, California ,
decimated by the wildfires that also destroyed the main Community
Health Center there . Santa Rosa Community Health Center CEO
Naomi Fuchs says that the portable clinic provided a lifeline for her
patients , and w as a godsend for her providers.

Naomi Fuchs : These are converted shipping containers that arrive fully equipped as
a medical exam room. Th ese ha ve been an outstanding way to
respond to emergencies , to set something up very quickly.

Margaret Flinter: The ro ughly 120 square feet shipping container cl inics are designed to
become a permanent fixture in low resource areas.

Michael Wawrzewski : A containerized clinic is something that's a turnkey . We equip it with
the best equipment and we ship it as a c omplete d project that once
on the ground , within 20 t o 30 minutes it ’ s ready to be used .

Margaret Flinter: Clinic In A Can , a professionally outfitted shipping container ready for
deployment anywhere in the world where disaster strikes , providing
quality stat e- of - th e- art medical facilities in a low resource area , n ow
that's a bright idea.

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Mark Masselli: I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health.

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Marianne O’Hare : Conversations on Health Care is reco rded in the Knowledge and
Technology Center Studio s in Middleto w n, Connecticut, and is
brought to you by the Community Health Center , now celebrating 50
years of providing quality care to the underserved , where health care
is a right not a privilege , www.chc1.com and www.chcradio.com .

Jennifer Nuzzo
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