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Ever Wish You’d Taken those Epidemiology Classes More Seriously?

I confess, I am a bookaholic.  My family members complain that on vacations, my suitcase is filled with (paper) books and at least 2 Kindles, which they consider excessive.  So, choosing one book from the current stack was hard – so I’ve chosen 6!! 

Fiction(al)? Lessons in Chemistry  by Bonnie Garmus? It’s a wonderful read! The main character becomes the face of a cooking show through which she educates her viewers in chemistry, self-worth and agency. And she even includes a bit on outdoor rowing teams!! 

Non -Fiction? Song of the Cell by Siddhartha Mukherjee?  He is an articulate and a beautiful writer (and a Pulitzer Prize-winning oncologist), who explains our evolving understanding of the body’s smallest structural and functional unit — and its implications for everything from immune therapy and in vitro fertilization to Covid-19.  I can’t speed through this one, though the immunology research is fascinating. 

Auto-Biographical? Orbiting the Giant Hairball by Gordon MacKenzie (subtitled a corporate fool’s guide to surviving with grace)?  It’s an oldie but SO relevant for living in organizations right now.

My Final Top 3?   Making Sense of the Whiplash of Recent Years

How about something that ties together present, past and future for those of us working in health care and GME?  For most of us the past few years have been whiplash-inducing, and the future effect on our workplace finances and people remains uncertain. 

·       The impact of the COVID pandemic (and the specter of others ahead) has rocked our almost-nonexistent public health infrastructure, shaken the medical/health care delivery system to its core, triggered long-latent economic, social, and political upheaval. 

·       Disparities between communities became starkly evident when access to ventilators, medications and vaccines were publicly acknowledged. 

·       And we did not do well as a country:  as one of the most highly technically developed, economically advantaged countries in the world we lost more people to illness than during the 1918 flu epidemic.  At the beginning of the pandemic, would we have guessed that we would have over a million deaths (and many more chronically ill as a result?) 

·       Remember everyone staying at home, sewing cloth masks?  Remember our confusion about transmissibility early on?  (I recall one of our infectious disease physicians yelling “droplets people!!”) before we knew COVID was airborne.  Remember wiping everything from the grocery store with wipes?

More poignantly, how many of us know residents, faculty, family members who died as a result of the disease?

And while we now know much more than we did, we still are debating the source of the pandemic (Wuhan market?  Raccoon dogs?  Pangolins?  Laboratory leak?)!  What will be the next global threat, and how will we respond?

#1: How did we get here? For historical perspective and depth of understanding, no one writes better than Laurie Garrett, in Betrayal of Trust:  The Collapse of Global Public Health.  This book was published in 2000, is half footnotes, and is a must read, especially now.  Garrett was one of the first journalists to document the state of infectious disease and the need for vaccine support, production, and safety.  (She documents an unguarded laboratory with a stash of smallpox virus, which was declared eradicated in 1980).  She accurately predicted that future epidemics would not be resolved by simple local measures (like the removal of the pump handle by John Snow in England’s cholera history).  The impact of changing population, political disintegration of public health governance, and increasing global travel on disease transmission is starkly predictive of what occurred in COVID and what can still occur in the next pandemic. 

#2:  What happens when science and agility collide with the uninformed?  A second fast read by a popular author, Michael Lewis’s The Premonition details the efforts of the state and local public health officers across the US who formed an unofficial network (called the Wolverines). Their purpose? To communicate about COVID containment, epidemiology, and treatment in addition to, and sometimes avoiding the federal government messaging.  The book is a speed read that unveils the tenacity of the public health and physician health leaders who used their own data and observations to serve their communities as well as they could.  The wrenching stories of abuse from hate mail to threats which were heaped on these leaders by both laypersons and their colleagues, underscores the impact of our lack of scientific education that also lives with us today.

#3: A painful and apologetic memoir by Deborah Birx MD?  Silent Invasion details the inner workings of the political response by the US government, the CDC, the White House, and HHS to the pandemic.  Poignant in its viewpoint, as a woman leader in a turbulent setting, Birx details her struggles to manage messages about safety.  She describes the efforts she and her colleagues made to go from state to state, where resurgences were predictable. They sought to work with these state governors, local public health officials, and community leaders to message prevention, containment, and treatments at each local level, while knowing that her role in the White House was largely ineffective.  She describes the herculean efforts to get vaccines ready and distributed as rapidly as possible, an amazing feat by industry and military partners alike. 

Final Thoughts

While many of us were inside health care settings, overwhelmed by staffing crises, lack of resources (gowns, gloves, masks, ventilators), illnesses of colleagues, protecting trainees, and managing COVID emergency status for GME, these public health systems and leaders (and authors) were doing their jobs to keep us (all) safe from physical and economic harms. 

As I have read these, I have become more committed to the need to train all health care professionals in the basics of public health, the principles of prevention, and support for our public health infrastructure and communication systems to help us with the next (inevitable) global health crisis.

And I wish I’d taken those Epidemiology classes more seriously many years ago.

Katheen Zoppi, PhD, MPH – Member AIAMC Board of Directors