Testing, Tracing, Containing: COVID Response Strategies are Anything but New

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For many people, COVID may be the first time you’ve thought about public health beyond things like the existence of vaccines. You may never have known that some diseases have to be reported straightaway to health authorities and that someone calls you if you’ve tested positive. You may never have heard of an epidemiologist or thought that we do something with skin.

Since COVID, though, you’re likely hearing terms like “contact tracing,” “quarantine,” and “isolation” all over the place. You may have heard about PCR testing and serological surveys using antibody testing. It’s possible you’ve even become a bit of an armchair epidemiologist. It might be the first time you’ve heard these words, but they’re far from new to public health. Below I talk a little about some terms you may have heard related to public health and some of their history.

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Season’s Greetings: Welcome to Influenza Season

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The air is crisp, the days are shortening, Starbucks is hocking their pumpkin spice creations, and I see people sneezing into their hands everywhere I go. Although we often think of there being only four seasons, many cultures recognise more than just those four. In Bangladesh, there are 6 in total and autumn is broken into shorotkal (early autumn) and hemontokal (late autumn). For public health practitioners, we also acknowledge a special season: Influenza Season.

Public Health measures the calendar year broken into what we call CDC or Morbidity and Mortality Weekly Report (MMWR) weeks. They run Sunday-Saturday and Week 1 begins the first Sunday of each year. Influenza Season (in the Northern Hemisphere) is generally considered to be between Week 40 (around the first week of October) through Week 20 (the end of May).

Unfortunately, just as cold, dry air makes our noses more hospitable to the virus entering our bodies and and poorer weather keeps us indoors, school also begins and large numbers of children spend whole days sneezing on each other and refusing to wash their hands. It’s an annual recipe for disaster.

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Reframing Violence as a Community Epidemic

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In a previous post, I discussed the intergenerational effects of violence and trauma, but today I’d like to dig a bit more into violence as a disease in communities. We often think of violence as something that one person does to another—and that is certainly accurate—but the individuals who commit that violence have often experienced it themselves. Like influenza spreads through a community from person-to-person, family-to-family, violence also spreads through the spaces we inhabit.

We model what we see and what we live and then pass on the love and pain we experience to others. Please be warned that some of what I’ll discuss may be upsetting or trigger memories of abuse that you may have suffered. Please be gentle with yourself. 

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We Carry Them With Us: How the Health of our Great-Grandparents Shapes Our Own

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Last week was both Columbus Day and Indigenous People’s Day in the United States. Thanksgiving is right around the corner. These days remind me of the stories I heard in school as a child about the “discovery” of America and the “first people” to come here. As an immigrant family, the stories of these holidays weren’t a part of our home life, but they certainly appeared at school each autumn. I remember being told to memorise a poem about Columbus in first grade and the narrative of the first thanksgiving appearing in each US history course I took. 

While having time off from school and work is nice (I certainly enjoy that part of civil service), these days are also wonderful opportunities to talk about the health disparities we see between Native American/Alaska Native (AIAN) and other groups in the US. Native writers have spoken and written and researched this far better than I will here, but it’s important for all public health practitioners to discuss the ways that the health of the people who grew us and raised us shapes our own health. 

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Medicines and Vaccines Part 2: Bringing Essential Medicines to Market

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In our last piece, we talked about the pharmaceutical development pipeline and how some drugs are repurposed from other medicines, rather than being discovered as a new medicine completely. In this post I’ll talk about what that pipeline looks like for antibiotics and vaccines, two of the most important types of medicines that we have. 

Vaccines and antibiotics, like all medications, are very expensive to produce (as we discussed in Part 1), but they can’t be sold for the same high prices as nonessential (think Viagra) medications. This creates a problem for the development pipeline: how can companies afford to take risks on new development for products that won’t cover the cost of producing them? The answer was surprising for me when I first started studying public health. 

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Medicines and Vaccines Part 1: The Pharmaceutical Pipeline

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I often hear people express concern that pharmaceutical companies (Big Pharma) are making a killing on medications and vaccines and fear that we can’t trust them because of it. I also feel a lot of discomfort with pharmaceutical companies skyrocketing the prices for products like daraprim and epi pens. Drugs are really, really, really expensive to make and somebody has to foot the cost for developing them, but we also have people dying because they can’t afford the basic medications they need to live. There has to be a better way, but it’s hard to know what to think when the process is so mysterious. This piece is the first in a 3 part series on how medicines and vaccines are made and what they do. We won’t be able to cover every aspect of it because 1. that’s the stuff of dissertations and 2. I honestly don’t know all of it, but we’ll go through an overview of how the very basics.

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A Tale of Two Cities: What's Happening in Cascadia?

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I've always been fascinated how the United States, despite being so advanced and spending so much on healthcare, can still rank so lowly in health outcomes. When I talk to friends and family in the UK, Canada, or Ireland about our healthcare, they're often baffled at how our system runs. "You send the ambulance away? But why?" "Because it costs $500 and I can drive myself for much less." My son's birth was uncomplicated and I delivered him myself in the hospital's bathroom, but received a $35,000 bill for the trouble. One of my cousins delivered her baby a couple of weeks later in Northern Ireland, received excellent care, and never saw a bill for the process because healthcare there doesn't have a fee-at-point-of-service model. She didn't have to get "pre-authorization" to birth her baby because that isn't a thing. Her health insurance company didn't say her unborn child couldn't be insured because he didn't have a birthday yet because that is absolutely ludicrous. 

We know that health and healthcare are different (though related) things, but what are the outcomes of such different social policy landscapes on the health of the people that live there? Do government social policies really make for better health? Let's discuss! 

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Vaccine Hesitancy: A Case for Compassion

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The purpose of writing this isn’t to shame parents who are vaccine hesitant or vaccine resistant or even to convince you with data. The purpose isn't to make anyone feel like they don't love their children enough or somehow aren't smart enough to be parents. Or, honestly, to make you think that I think those things. The point of writing this is to speak to the parents who are frustrated and frightened by the declining immunisation rates in places like Vashon Island in Washington State, who are worried when they see a notice come home that there’s been an outbreak of a vaccine-preventable disease in their child’s school. It’s scary for parents whose children are potentially exposed and school exclusions, while effective, can cause frustration in affected communities. 

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