I usually stick to data, but today will be Personal Day.
Lately I’ve spent a lot of time talking to reporters about what an epidemiologist does, how public health investigations work, and essentially giving them crash courses in Epi 101.
They apologize for taking up so much of my time, but I love doing it. I love epidemiology, and can wax evangelical about it. Just ask any of my former students, a few of whom I’ve converted. But what I really appreciate is that local reporters, even those known for “gotcha” type of stories, want to understand. For many, this is outside their comfort zone, yet they’re willing to learn every thing they can. Not only does this mean they can better report the story, it means readers will understand it better. That’s a win for everyone.
As a political science major who wanted to work internationally, who became a biology major, I stumbled upon epidemiology in my college’s career center (pre-Google days). It was like lightening bolts shot down. A few weeks before the admissions deadlines, I signed up for the GRE and sent my applications off to Yale, Boston University, and San Diego State University. Back then there were only 27 Schools of Public Health in the country. An Ivy League school would have been a pipe dream for a kid with my background, but I had an older sister who had recently graduated from Cornell Medical School. So why not try?
As a Latina, with stellar GRE scores but a lousy GPA from UCSB, I’m pretty sure I was a diversity admit to Yale’s Epidemiology and Public Health program. I’m totally ok with that.
Most people think epidemiology is a number crunching game. While I am a huge data nerd, I came of age in epi in a different time.
I was “raised” by old-school epidemiologists. My Yale professors were often physicians who had spent many years working in out of the way places in Africa, Asia, South America. They had discovered Lassa Fever virus, had worked the original Ebola outbreak, and so many other outbreaks. They developed vaccines after directly seeing the diseases decimate populations. The younger crop of professors tended to be PhDs, but still very field oriented.
When I interviewed with my prospective MPH thesis advisor (a young PhD), he asked me if I had done field work (not really). Was I ok with traipsing through jungles without typical comforts? Totally. I’d traveled in Europe on a shoestring, was an outdoors person, a backpacker. Not the same, but I was adaptable. I was drawn to the field because I wanted to work with people of different cultures — but as a scientist understanding disease.
Such was the path that took me to Costa Rica (VSV and sandflies), Oxford, England (ticks — not quite so exotic but still exciting), Kenya (African trypanosomiasis and tsetse flies), and as a post-doc, the Thai-Burma border (malaria parasites).
Those old professors spent a lot of time explaining how to investigate diseases in places where you wouldn’t have access to high tech resources. No lab, no computers, no sterilizing equipment. How do you make something work? You MacGyver it. Having grown up with a dad who was the ultimate MacGyver, this was a natural fit. I’m not quite so handy, but I can look at a disease investigation and say:
*“What resources do we have?”
*“How can we maximize these resources while we wait for more/better/higher tech?”
My PhD involved the study of the genetic relationships between the mosquitoes that transmitted malaria. It was relatively high tech (for the time) and more basic science focused than my epidemiology brain would have liked. So I infused every element of it with the epidemiological impact of the research. Then I translated that experience and knowledge to the malaria parasites in refugee camps along the Thai-Burma border. There was plenty of MacGyver-ism to be done, but also a need to understand the cultural, political and economic dynamics of the region, which is what drew me to epidemiology in the first place.
And that brought me back to applied epidemiology in our local health department. I was “trained” in boots-on-the-ground field epi again. My mentor did not have the credentials of my esteemed professors at Yale or Notre Dame, but taught me similar lessons. It was like being a detective, only the “criminal” was a disease. Know the culture you’re entering into and adapt questions accordingly. Knock on a door, ask about the family, look around. Often we wanted to find the source of the disease, but more often, we needed to prevent its spread.
Hired to develop plans against bioweapons, that quickly turned into planning for a flu pandemic (and hurricane response, shelter management, legionella, and more). If you’d told me when I started grad school in 1992 that I’d be planning for a flu pandemic in 2005, I’d have laughed.
But that’s the basis of being an epidemiologist: being willing to adapt and change to what’s needed. Having the knowledge base to build upon, as new information emerges or new studies are needed.
One of my early mentors told me, “Don’t study just one thing, be open to whatever needs to be studied.” And that’s how I went from sandflies, to arboviruses, to mosquitoes, to parasites, to respiratory diseases, to HIV/AIDS and TB, to Immunizations to health policy.
These days, while I’ve spent a lot of time using my epidemiology expertise for COVID-19, my regular job is to prevent infectious diseases through vaccination — via education, systems improvement, and public policy. And epidemiology.
Epidemiologists study data, follow disease trends, make predictions, recommend policy based on those data (I turn to the newer crop of epidemiologists who are experts at modeling). Epidemiologists review the science — transmission, testing, immunity, all of which is ever changing. We evaluate populations, how they interact, what behaviors may contribute to the spread of pathogens, what interventions could work.
And we put all that together to come up with a plan to slow the spread of disease. Sometimes, we need to MacGyver it.
Nov 2020 update: I have left Immunizations, and am now CEO of the San Antonio AIDS Foundation. Not exactly epidemiology, but utilizing that epidemiology expertise with experience in non-profit organizations to fight another global pandemic: HIV.