Pediatrician Dr. Nadine Burke Harris was appointed California’s first Surgeon General in 2019, and today is at the forefront of the state’s COVID-19 health response. In a WAM Weekly exclusive, she tells us how she and the nation’s largest state are handling the increased demands on the medical and mental health systems, and why the most vulnerable among us are the hardest hit.

WAM: As California’s first Surgeon General, you were recently asked by Gov. Gavin Newsom, to create a series of guides to help people manage stress during this time of crisis. You believe stress, especially traumatic stress experienced as a child, contributes to a lot of illness, including being a risk factor for Alzheimer’s later in life. With the stakes so high, what stress management advice do you have for all of us to get through this?

Dr. Nadine Burke Harris: Yes. Normally, when we experience something stressful, our bodies make more stress hormones, including adrenaline and cortisol, which do things like increase our blood pressure and blood sugar and activate inflammation to prepare us to respond to the threat. However, when the stressor is severe or prolonged, the body can make more stress hormones than is healthy. This can lead to worsening of physical and/or mental health problems, such as diabetes, heart disease, anxiety, depression, smoking, or unhealthy use of alcohol or other drugs.

Traumatic stress in childhood can lead to the chronic over-activation of the stress response, which is associated with increased risk of long-term health problems such as heart disease, cancer, and, yes, Alzheimer’s. Here in CA, public health data demonstrates that a person with four or more Adverse Childhood Experiences (ACEs) (including abuse, neglect or growing up in a household where there was domestic violence, substance abuse or mental illness) is associated with 11 times the risk of developing Alzheimer’s or other dementia related diseases later in life as compared to someone with no ACEs. There’s a lot of research that needs be done to better understand the biological links between early adversity and long-term health outcomes like Alzheimer’s, but we do believe that over-activity of the biological stress response plays an important role.

The good news is there are simple things you can do every day, at home, to help regulate your response system and keep it functioning in a way that promotes health. Safe, stable, and nurturing relationships can protect our brains and bodies from the harmful effects of stress and adversity. Healthy nutrition, regular exercise, restful sleep, practicing mindfulness, staying connected to our social supports, and getting mental health care can help decrease stress hormones and improve health. We put these six evidence-based stress busting strategies into two guides that are available online now—California Surgeon General’s Playbook: Stress Relief During COVID-19 and the California Surgeon General’s Playbook: Stress Relief for Caregivers and Kids during COVID-19 can be found in multiple languages at

WAM: It’s become evident that this pandemic seems to be hitting the most vulnerable populations hardest, especially African Americans. Why do you think that is, and what’s being done to address this?  

Dr. Burke Harris: We recognize two major reasons for COVID-19 racial/ethnic disparities. First, people of color face increased exposure to the virus. Second, the infection can be more severe and progressive once in place. 

Wealth disparities that track with race significantly increase the risk of exposure to the virus. Additionally, a higher proportion of people of color are also in essential service sector jobs exempted from stay-at-home like postal work, public transportation, farm work, food services, and healthcare. These disparities are the result of historic policies and practices that biased access to education, certain jobs, and neighborhoods for people of color. 

For myriad and complex reasons, Black Americans also have a higher rate of underlying health conditions that increase risk for serious COVID-19 infection. These include heart disease, high blood pressure, chronic lung diseases, diabetes, kidney disease, and some cancers. A factor that contributes to the increased risk of underlying medical conditions is that Black Americans face higher levels of cumulative adversity over the lifetime. Sources of adversity that disproportionately affect Black Americans include racism and Adverse Childhood Experiences (ACEs). 

A robust body of science has shown that repeated or prolonged activation of a child’s stress response, without nurturing or buffering caregiving support, can lead to long-term changes in the structure and functioning of developing brains and bodies or even the way DNA is read and transcribed. This is known as the toxic stress response.

Social determinants of health (SDOH), such as poverty, discrimination and housing insecurity are associated with health risks. While we don’t refer to SDOH as ACEs, we recognize that they may also be risk factors for toxic stress. 

And an individual with four or more ACEs has a 70% higher risk of kidney disease and more than double the risk of heart disease and chronic lung disease. For COVID-19, these can all mean more serious infection. 

In California, Governor Gavin Newsom is taking clear actions to protect our communities. Actions like protecting low-income residents by providing testing and treatment for COVID-19 at no cost, restricting evictions and home water shutoffs, California’s Project Roomkey to extend stable housing to unhoused people at greater risk for COVID-19, and a $125 million public-private cash assistance partnership for undocumented Californians who do not qualify for federal benefits, are lifesaving. Further, California is providing COVID-19 testing and treatment for any patient, regardless of immigration and insurance status, now free in any clinical setting.

WAM: What’s something everyone reading this can do today to help someone else in their community cope with stress?

Dr. Burke Harris: Supportive relationships is one of the most effective stress regulators and actually impacts our bodies biologically. So it’s important to stay connected to our supportive personal connections right now; it is truly healing.

Simple things like asking people how they are. Thanking those working at the grocery store or delivery drivers and engaging in conversation. This isn’t just important for morale, but staying emotionally connected to one another is biologically crucial for our health.

Volunteering is also biologically beneficial. If you are healthy and able to volunteer in your community through local food banks and shelters, donating blood, or meal delivery are some of the ways you can get involved and help. California Volunteers has a great way to help you connect with the needs throughout the state: