Tag Archives: COVID-19

Protecting yourself means more than a mask; should classes be moved outside?
Mari K. Hopper, PhD
Associate Dean for Biomedical Science
Sam Houston State University College of Osteopathic Medicine

Disruption sparks creativity and innovation. For example, in hopes of curbing viral spread by moving classroom instruction outdoors, one Texas University recently purchased “circus tents” to use as temporary outdoor classrooms.

Although circus tents may be a creative solution… solving one problem may inadvertently create another. Moving events outdoors may be effective in reducing viral spread, but it also increases the skin’s exposure to harmful ultraviolet (UV) radiation from the sun. The skin, our body’s largest organ by weight, is vulnerable to injury. For the skin to remain effective in its role of protecting us from pollutants, microbes, and excessive fluid loss – we must protect it.

It is well known that UV radiation, including UVA and UVB, has deleterious effects including sunburn, premature wrinkling and age spots, and most importantly an increased risk of developing skin cancer.

Although most of the solar radiation passing through the earth’s atmosphere is UVA, both UVA and UVB cause damage. This damage includes disruption of DNA resulting in the formation of dimers and generation of a DNA repair response. This response may include apoptosis of cells and the release of a number of inflammatory markers such as prostaglandins, histamine, reactive oxygen species, and bradykinin. This classic inflammatory response promotes vasodilation, edema, and the red, hot, and painful condition we refer to as “sun burn.”1,2

Prevention of sunburn is relatively easy and inexpensive. Best practice is to apply broad spectrum sunscreen (blocks both UVA and UVB) 30 minutes before exposure, and reapply every 90 minutes. Most dermatologists recommend using SPF (sun protection factor) of at least 30. Generally speaking, an SPF of 30 will prevent redness for approximately 30 times longer than without the sunscreen. An important point is that the sunscreen must be reapplied to maintain its protection.

There are two basic formulations for sunscreen:  chemical and physical. Chemical formulations are designed to be easier to rub into the skin. Chemical sunscreens act similar to a sponge as they “absorb” UV radiation and initiate a chemical reaction which transforms energy from UV rays into heat. Heat generated is then released from the skin.3  This type of sunscreen product typically contains one or more of the following active ingredient organic compounds: oxybenzone, avobenzone, octisalate, octocrylene, homosalate, and octinoxate. Physical sunscreens work by acting as a shield. This type of sunscreen sits on the surface of the skin and deflects the UV rays. Active ingredients zinc oxide and/or titanium dioxide act in this way.4  It’s interesting to note that some sunscreens include an expiration date – and others do not. It is reassuring that the FDA requires sunscreen to retain their original “strength” for three or more years.

In addition to sunscreen, clothing is effective in blocking UV skin exposure. Darker fabrics with denser weaves are effective, and so too are today’s specially designed fabrics. These special fabrics are tested in the laboratory to determine the ultraviolet protection factor (UPF) which is similar to SPF for sunscreen.  A fabric must carry a UPF rating of at least 30 to qualify for the Skin Cancer Foundation’s Seal of Recommendation. A UPF of 50 allows just 1/50th of the UV rays to penetrate (effectively blocking 98%). Some articles of clothing are produced with a finish that will wash out over time. Other fabrics have inherent properties that block UV rays and remain relatively unchanged due to washing (some loss of protection over time is unavoidable) – be careful to read the clothing label.

Some individuals prefer relying on protective clothing instead of sunscreen due to concerns about vitamin D synthesis. Vitamin D activation in the body includes an important chemical conversion stimulated by UV exposure in the skin – and there is concern that sunscreen interferes with this conversion. However, several studies, including a recent review by Neale, et al., concluded that use of sunscreen in natural conditions is NOT associated with vitamin D deficiency.5,6 The authors did go on to note that at the time of publication, they could not find trials testing the high SPF sunscreens that are widely available today (current products available for purchase include SPFs over 100).

Additional concern about use of sunscreens includes systemic absorption of potentially toxic chemicals found in sunscreen. A recent randomized clinical trial conducted by Matta and colleagues investigated the systemic absorption and pharmacokinetics of six active sunscreen ingredients under single and maximal use conditions. Seven Product formulations included lotion, aerosol spray, non-aerosol spray, and pump spray. Their study found that in response to repeat application over 75% of the body surface area, all 6 of the tested active ingredients were absorbed systemically. In this study, plasma concentrations surpassed the current FDA threshold for potentially waiving some of the additional safety studies for sunscreen. The authors went on to note that the data is difficult to translate to common use and further studies are needed. It is important to note that the authors also conclude that due to associated risk for development of skin cancer, we should continue to use sunscreen.

Yet another concern for using sunscreen is the potential for harmful environmental and human health impact. Sunscreen products that include organic UV filters have been implicated in adverse reactions in coral and fish, allergic reactions, and possible endocrine disruption.8,9 In some areas, specific sunscreen products are now being banned (for example, beginning January of 2021, Hawaii will ban products that include oxybenzone and octinoxate). As there are alternatives to the use of various organic compounds, there is a need to continue to monitor and weigh the benefit verses the potential negative effects.

Although the use of sunscreen is being questioned, there is the potential for a decline in use to be associated with an increase in skin cancer. Skin cancer, although on the decline in recent years, is the most common type of cancer in the U.S. It is estimated that more than 3 million people in the United States are diagnosed with skin cancers each year (cancer.net). Although this is fewer than the current number of Americans diagnosed with COVID-19 (Centers for Disease Control and Prevention, July 20, 2020) – changes in human behavior during the pandemic (spending more time outdoors) may inadvertently result in an increase in the number of skin cancer cases in future years.  

While we responsibly counter the impact of COVID-19 by wearing masks, socially distancing, and congregating outdoors – we must also continue to protect ourselves from damaging effects of the sun. As physiologists, we are called upon to continue to investigate the physiological impacts of various sunscreen delivery modes (lotion, aerosol, non-aerosol spray, and pumps) and SPF formulations. We are also challenged to investigate inadvertent and potentially negative impacts of sunscreen including altered Vitamin D metabolism, systemic absorption of organic chemicals, and potentially adverse environmental and health outcomes.

Again, solving one problem may create another challenge – the work of a physiologist is never done!

Stay safe friends!



  1. Lopes DM, McMahon SB. Ultraviolet radiation on the skin: a painful experience? CNS neuroscience & therapeutics. 2016;22(2):118-126.
  2. Dawes JM, Calvo M, Perkins JR, et al. CXCL5 mediates UVB irradiation–induced pain. Science translational medicine. 2011;3(90):90ra60-90ra60.
  3. Kimbrough DR. The photochemistry of sunscreens. Journal of chemical education. 1997;74(1):51.
  4. Tsuzuki T, Nearn M, Trotter G. Substantially visibly transparent topical physical sunscreen formulation. In: Google Patents; 2003.
  5. Passeron T, Bouillon R, Callender V, et al. Sunscreen photoprotection and vitamin D status. British Journal of Dermatology. 2019;181(5):916-931.
  6. Neale RE, Khan SR, Lucas RM, Waterhouse M, Whiteman DC, Olsen CM. The effect of sunscreen on vitamin D: a review. British Journal of Dermatology. 2019;181(5):907-915.
  7. Matta MK, Florian J, Zusterzeel R, et al. Effect of sunscreen application on plasma concentration of sunscreen active ingredients: a randomized clinical trial. Jama. 2020;323(3):256-267.
  8. Schneider SL, Lim HW. Review of environmental effects of oxybenzone and other sunscreen active ingredients. Journal of the American Academy of Dermatology. 2019;80(1):266-271.
  9. DiNardo JC, Downs CA. Dermatological and environmental toxicological impact of the sunscreen ingredient oxybenzone/benzophenone‐3. Journal of cosmetic dermatology. 2018;17(1):15-19.

    All images from:
    Royalty Free Stock Pictures – Public Domain Images

Prior to accepting the Dean’s positon at Sam Houston State University, Dr Hopper taught physiology and served as the Director of Student Research and Scholarly Work at Indiana University School of Medicine (IUSM). Dr Hopper earned tenure at IUSM and was twice awarded the Trustees Teaching Award. Based on her experience in developing curriculum, addressing accreditation and teaching and mentoring of medical students, she was selected to help build a new program of Osteopathic Medicine at SHSU. Active in a number of professional organizations, Dr. Hopper is past chair of the Chapter Advisory Council Chair for the American Physiological Society, the HAPS Conference Site Selection Committee, and Past-President of the Indiana Physiological Society.

Physiology Educators Community of Practice (PECOP) Webinar Series

The American Physiological Society (APS) is pleased to announce a new webinar series focused on our educator community. The monthly series includes live webinars focused on education best practices, synchronous and/or asynchronous teaching, establishing inclusive classrooms and publishing. Educator town halls will also be featured as we strive to support and engage the educator community throughout the year.

Starting this month, take advantage of the educator webinar series by visiting the events webpage on the APS website. Register for each webinar, learn about speakers and their talks today!

What to do on the First Day of Class: Insights From Physiology Educators?
July 23, 2020
12 p.m. EDT

Join in the discussion about how to greet students on the first day of class and set the tone for the rest of the course.


  • Barbara E. Goodman, PhD from the Sandford School of Medicine, University of South Dakota (Vermillion)
  • Dee Silverthorn, PhD from the University of Texas at Austin

A successful semester: Applying resilient and inclusive pedagogy to mitigate faculty and student stress
August 20, 2020
2 p.m. EDT

As we head into an uncertain academic year, spend an hour with us to consider strategies which will help you and your students navigate our changing academic, professional, and personal lives. Participants will work through pragmatic and concrete strategies they can transition into their own work to promote student learning and minimize stress.


  • Josef Brandauer, PhD from Gettysburg College (Penn.)
  • Katie Johnson, PhD from Trail Build, LLC (East Troy, Wisc.)

Writing & Reviewing for Advances
September 17, 2020
12 p.m. EDT

This session will be a chance to encourage all who have adapted their teaching during the COVID-19 pandemic to share their work. This topic also ties in to the Teaching Section featured topic for EB 2021.


  • Doug Everett, PhD from National Jewish Health (Denver, Colo.)

A Framework of College Student Buy-in to Evidence-Based Teaching Practices in STEM: The Roles of Trust and Growth Mindset
October 22, 2020
12 p.m. EST

This topic is relevant to building trust, which goes hand-in-hand with inclusion and diversity. Trust is essential for the different modalities of teaching which educators and students will experience in the fall.


Educators Town Hall
November 19, 2020
12 p.m. EST

A chance to talk about what happened during the fall semester and also plan for the upcoming year

A Sabbatical in Australia Cut Short and the Rapid Transition of Course Delivery of an Australian University due to the COVID-19 Global Pandemic
Emilio Badoer, PhD
Professor of Neuropharmacology
School of Health & Biomedical Science with the College of Science, Engineering & Health
Royal Melbourne Institute of Technology (RMIT) University, Bundoora (Melbourne, Victoria, Australia)

Patricia A. Halpin, PhD
Associate Professor of Biological Science and Biotechnology & Visiting Associate Professor at RMIT University
Department of Life Sciences, University of New Hampshire at Manchester (Manchester, NH)

I was thrilled to spend my sabbatical performing education research at RMIT University in Australia during the spring semester of 2020. I met my collaborator Emilio Badoer at the APS ITL in 2016 and at that time we vowed to collaborate someday. I had a smooth flight to Melbourne AU and as we left the airport, I got my first view of the city covered in a smoky haze from the bushfires to the north1. The radio broadcast playing on the car stereo was alerting everyone to the tropical cyclones headed for the east coast and these would soon cause massive flooding in New South Wales. “Welcome to Australia” Emilio said, little did we know at the time that the worst was yet to come. The COVID-19 outbreak in China had caused Australia to close its borders on February 12,3 to foreign nationals who had left or transited through mainland China.  I arrived February 9 and the focus of my attention was the excitement and anticipation of starting our two research projects.  At my small college, my courses usually enroll 10-24 students, at RMIT our first study was working with a large nursing class (n =368) with the primary goal of using Twitter to engage them outside of class with the course content. 

The nursing cohort started two weeks prior to the start of the term, and in the third week, the students went on clinical placements for five weeks. This course is team-taught and Emilio taught during the first two-week period so that content was the focus of our research for this study. We designed the study to collect data using paper surveys to be distributed at face-to-face class meetings at the beginning and end of the term to ensure a high rate of survey completion. The second study performed with his Pharmacology of Therapeutics class (n=140) started on March 2 with one face-to-face meeting followed by four weeks of flipped teaching (FT). During the FT period, we would engage them on Twitter with course content and they would meet during weekly face-to-face Lectorial sessions for review during the usual scheduled class time.  Students completed the paper pre-survey in the first class meeting and the scheduled paper post-surveys were to be distributed during the final Lectorial sessions on March 19 and 20.  Then on Monday March 16th everything changed; Victoria declared a state of emergency to combat the COVID-19 pandemic4 and Qantas announced that they would cancel 90% of their international flights5, with the remaining flights cancelled on March 31. 

I was contacted by friends and family back home urging me to come home right away. RMIT announced the decision that learning would go online starting March 23. In the United States, colleges had previously announced that students heading home for spring break should stay home as their classes would be delivered online due to the COVID-19 concerns 6. The faculty at the US schools had spring break to prepare the transition of their course content for the new delivery mode. At RMIT, they had recently started their semester with no spring break normally scheduled and the only break on the horizon was the distant Easter holiday (April 10-13) long weekend. Our hopes for data collection were quickly dashed as during the last Lectorial sessions only a few students attended, and we would not be able to survey the nursing students in person when they returned from placements.

My focus shifted to leaving the country as soon as possible. The only way to change my airline ticket home was through a travel agent and my personal travel agent spent a total of 11.5 h on hold with Qantas over a two-day period to secure my ticket home. I left Australia with hordes of anxious Americans. The airports were overwhelmed as we formed long lines trying to check in and then go through security. Everyone had a story to tell of how they had to cut their trip short and then changed their tickets. In Los Angeles I was joined by more Americans who were coming from New Zealand. Many of the American travelers were undergraduates very disappointed that their universities had called them home and they were leaving their semester abroad adventures. We would all soon arrive home safely to a country living in a new reality.

Meanwhile, in Australia, the situation at universities evolved rapidly. In line with the Australian Government mandate, students were told that all new arrivals into the country must self-isolate for 14 days effective March 16. Public gatherings of over 500 people were no longer allowed. Although universities were specifically exempt from this requirement, RMIT University proactively cancelled or postponed any events that were not related to the core business of learning, teaching and research. It also foreshadowed a progressive transition to lectures being delivered online where possible.  The University also indicated that students would not be disadvantaged if they chose not to attend face-to-face classes during the week of March 16. In response to the rapid changes occurring internationally, on March 20, the Australian Government restricted all non-Australian citizens and non-Australian residents from entering the country.  While Australian Universities could remain open and operating it was clear that this would not last for long 7. In response, RMIT University mandated that from Monday March 23 lectures were to be made available online but tutorials and seminars and non-specialist workshops could continue face-to-face until March 30.

On Sunday March 22 the State Government of Victoria (where the main RMIT University campus is based) mandated the shutdown of all non-essential activity from Tuesday March 24 to combat the spread of COVID-19 7. Immediately, RMIT University suspended all face-to-face learning and teaching activity on all its Australian campuses. Overnight, faculty became online teaching facilitators. Emilio produced and is continuing to produce new videos (15-30 minutes duration) covering the content normally delivered during the face-to-face large lecture session. Each week 3-5 videos are produced and uploaded onto Canvas (RMIT’s online learning management system) for the students. 

Unlike many of the US schools that are using Zoom, RMIT is using Collaborate Ultra within Canvas as its way of connecting with students on a weekly basis. Collaborate Ultra has the ability to create breakout groups and faculty can assign students to a specific breakout group or allow students to self-allocate to a specific breakout group. Emilio has allowed students to move between breakout groups to increase engagement. The only stipulation was to limit the group size usually to no more than six. Each student was originally registered to attend one small group Lectorial session that meets once per week for one hour and these groups have between 45-50 students each. The Lectorials were replaced by Collaborate Ultra sessions that were organized for the same times and dates as the normally scheduled small Lectorial sessions. The students and facilitators would all meet in the so-called “main room” where Emilio would outline the plans for the session. The main room session was conducted with Emilio’s video turned on so the students were ‘invited “into his home” and could feel connected with him. Dress code was also important. Emilio was conscious of wearing smart casual apparel as he would have worn had he been facing the students in a face-to-face session. In this way he attempted to simulate the normal pre-COVID-19 environment.

Following the introductory remarks outlining the tasks for the session, students were ‘sent’ to their breakout rooms to discuss and work on the first problem / task discussed in the main room. The analogy used by Emilio was that the breakout rooms were akin to the tables that were used in their collaborative teaching space in which he normally conducted the Lectorial sessions. Each table in that space accommodated approximately six students (hence the stipulation of no more than six in each breakout group). Emilio and another moderator ‘popped’ into each breakout room to guide and facilitate the students in their discussions. To date, the level of engagement and discussion amongst the students themselves generally appears to be much greater than that observed at face-to-face sessions which was a fantastic surprise. After a set time had elapsed, students re-assembled in the main room where the task was discussed with the whole class. This ensured that all students understood the requirements of the task and they had addressed all points that were needed to complete the task to the satisfactory standard. Next followed another task that differed from the first providing variety and maintaining the interest of the students.

Examples of tasks performed.

1 – Practice exam questions

A short answer question requiring a detailed response that would normally take at least 10 minutes in an exam environment to answer properly. Such questions were based on that week’s lecture (now video) course content and was contextualized in a scenario in which physiological/pathophysiological conditions were described and the pharmacological treatments needed to be discussed in terms of mechanisms of action, adverse effects, potential drug interactions or pharmacogenomic influences etc.

2 – Multiple choice questions – Quizzes

Emilio ran these using the Kahoot platform. By sharing his screen, Emilio could conduct such quizzes live providing instant feedback on student progress. This allowed Emilio to provide formative feedback, correct any misconceptions and discuss topics. Additionally, students were able to gauge their own learning progress. These tasks were performed in the main room with all participants.

3 – Completing sentences or matching answers

These could be done effectively in the breakout rooms, where a ‘lead’ student could utilize the whiteboard function in Collaborate Ultra which allowed all students in the group the opportunity to write on the whiteboard allowing discussion regarding the answers written.

4 – Filling in the gaps

Here Emilio would share his screen in which a diagram / figure / a schematic of a pathway etc. with labels/ information missing was provided and students were asked to screenshot the shared information. Then in breakout rooms, one student shared the captured screen shot with the group and the missing information was completed by the members of the group.

The Collaborate Ultra sessions were also utilized to provide students with a platform in which group work could be performed. With a lockdown in force and gatherings of groups forbidden, this utility was very important for enabling connection between students working on group projects. It also provided a sense of belonging within the student cohort.

In conclusion, with minimal preparation, a huge Australian University converted face-to-face teaching and learning to an online digital teaching and learning environment where working remotely was the new norm. It is almost inconceivable just a few short weeks ago that such a transformation could have happened in the timeframe that it did. It is a truly remarkable achievement.  


1 Alexander, H and Moir N. (December 20, 2019). ‘The monster’: a short history of Australia’s biggest forest fire. Sydney Morning Herald Retrieved on April 10, 2020 from https://www.smh.com.au/national/nsw/the-monster-a-short-history-of-australia-s-biggest-forest-fire-20191218-p53l4y.html

2 Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV) (Jan. 30, 2020). Retrieved on April 10, 2020 from https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)

3 Travel Restrictions on China Due to COVID-19 (April 6, 2020). Retrieved on April 10, 2020 from https://www.thinkglobalhealth.org/article/travel-restrictions-china-due-covid-19

4 Premier of Victoria, State of Emergency Declared in Victoria Over COVID-19. (March 16, 2020) Retrieved on April 10, 2020 from https://www.premier.vic.gov.au/state-of-emergency-declared-in-victoria-over-covid-19/

5 Qantas and Jetstar slash 90 per cent of international flights due to corona virus (March 16, 2020). Retrieved on April 10, 2020 from https://www.abc.net.au/news/2020-03-17/qantas-coronavirus-cuts-capacity-by-90-per-cent/12062328

6 Hartocollis A. (March 11, 2020). ‘An Eviction Notice’: Chaos After Colleges Tell Students to Stay Away. The New York Times. Retrieved on April 10, 2020 from  https://www.nytimes.com/2020/03/11/us/colleges-cancel-classes-coronavirus.html

7 Worthington B (March 22, 2020). Coronavirus crackdown to force mass closures of pubs, clubs, churches and indoor sporting venues. Retrieved on April 10, 2020 from https://www.abc.net.au/news/2020-03-22/major-coronavirus-crackdown-to-close-churches-pubs-clubs/12079610

Professor Badoer has held numerous teaching and learning leadership roles including many years as the Program Coordinator for the undergraduate Pharmaceutical Sciences Program at RMIT University in Bundoora AU and he coordinates several courses. He is an innovative instructor that enjoys the interactions with students and teaching scholarship. He has also taught pharmacology and physiology at Melbourne and Monash Universities. In addition, he supervises several postgraduate students, Honours students and Postdoctoral Fellows.

Patricia A. Halpin is an Associate Professor in the Life Sciences Department at the University of New Hampshire at Manchester (UNHM). Patricia received her MS and Ph.D. in Physiology at the University of Connecticut. She completed a postdoctoral fellowship at Dartmouth Medical School. After completion of her postdoc she started a family and taught as an adjunct at several NH colleges. She then became a Lecturer at UNHM before becoming an Assistant Professor. She teaches Principles of Biology, Endocrinology, Cell Biology, Animal Physiology, Global Science Explorations and Senior Seminar to undergraduates. She has been a member of APS since 1994 and is currently on the APS Education committee and is active in the Teaching Section. She has participated in Physiology Understanding (PhUn) week at the elementary school level in the US and Australia. She has presented her work on PhUn week, Using Twitter for Science Discussions, and Embedding Professional Skills into Science curriculum at the Experimental Biology meeting and the APS Institute on Teaching and Learning.