Love in the Time of COVID

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It feels like so long and yet somehow also no time at all. As we think about navigating social connections—like dating—this new landscape, I want to share a little about some conversations I had with my new friend Missy Modell—the genius behind such internet classics as that Dr. Fauci song love song.

Last week, Missy had made a comment in an instagram story about wanting to continue wearing her mask and I shared that I’m still wearing mine too. As we kept chatting, I drew a parallel between establishing boundaries during sex and establishing boundaries with meeting up during COVID. Missy loved the idea and suggested we have an instagram live to talk about it more. If you’re interested, you can watch it here. We cover a lot of ground, including this similarity between healthy communication while Normal Human Dating and healthy communication navigating social connections in a pandemic.

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We've Been Here Before: Learning from Historical Responses to Epidemics

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As we close the month of June, the United States also closes out the 5th month of COVID response in this country—and we’re not even close to done with this pandemic. In these 5 months, we’ve learned a lot about the SARS-CoV-2 virus which causes COVID-19 and about ourselves. During these months, epidemiologists (like me) have watched in horror as our efforts to control the spread of the disease have been thwarted—sometimes, it seems, intentionally—by people in power. It’s been shocking and heartbreaking to watch case counts here in the United States plateau only to spike again. It’s been particularly agonising watching Nations like the Yakama and Navajo be so consistently denied the resources they need to protect their communities.

As of 28 June 2020, there have been 4,933,972 cases of COVID reported in the Americas region. Of those, 2,452,048 have been reported in the United States. This means that 49.70% of cases occurring in the Western Hemisphere occurred in the United States. For comparison, the population of the United States makes up 33.18% of the population of the Americas Region. This means we have 49.70% of the cases and despite making up just 33.18% of the population. Even without taking into account that the United States as a large, wealthy country should have some of the lowest communicable disease numbers, this discrepancy is shocking.

Something is clearly wrong here and the course needs to be corrected. It’s not impossible to break the chain of transmission, but it takes hard work and plenty of bravery on the part of elected officials. Thankfully, history is littered with success stories when humans have controlled the spread of diseases. For some of these lessons, we don’t even have to look back farther than a half century.

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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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We Live in Each Other’s Shadow: Social Distancing is Our Social Responsibility

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As you may know, a new coronavirus called SARS-CoV-2 has been spreading, causing a disease that epidemiologists have named COVID-19. The disease is new (so the majority of people aren’t immune), spreads easily from person-to-person, and can cause severe illness in the elderly and medically fragile. The spread of the disease to so many people in so many places has led the World Health Organisation to declare the spread COVID-19 a pandemic.

The situation is very, very serious, but there are lots of steps you can be taking to keep yourself healthy. At this stage, Public Health is also needing us to keep our communities healthy through actions we call “social distancing.”

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Preparing not Panicking: Finding Good Information in a (Potential) Pandemic

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COVID-19 is a respiratory illness caused by the novel coronavirus SARS-CoV-2. Coronaviruses are a family of viruses (like influenza viruses are a family of viruses) and circulate in our communities every year. They usually cause mild, flu-like illness. Notable exceptions to this were SARS (Severe Acute Respiratory Syndrome) and MERS (Middle Eastern Respiratory Syndrome). This coronavirus is new to humans and so public health scientists are still learning a lot about it. Like other coronaviruses, this one seems to be a zoonotic infection and crossed into humans from an animal—likely bats.

COVID-19, like its coronavirus brethren, causes fever, cough, and breathing difficulty. Public health scientists estimate 80% of people who come down with COVID-19 would experience mild symptoms and not need hospitalisation. Several cases in Washington State alone have managed their own illness without hospitalisation. While most people will have very mild illness, some people may get quite ill. Public health scientists expect that most of the severe illnesses will be in patients who are older. They also expect that most deaths will occur among older individuals.

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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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Happy Birthday, Epidemiology!

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There was a time not so very long ago in human history when we believed that miasmas (bad air) caused illness. Doctors didn’t even wash their hands between seeing patients because how could gentlemen be responsible for spreading illness?

There were no microscopes, so no one could look and see bacteria doing battle with our own immune system. People could only know what they observed and what they observed was that the areas where disease was most prevalent were also very smelly from the dead and dying people.

We know now, of course, that the smell so common in areas where poor people lived wasn’t the cause of their illness, but another product of the things making them sick. Bodies and human waste (lots of poo) left in the streets, rotting food, animals and humans living in close proximity, sewage in the water. Germ Theory tells us that these things become the breeding grounds of virus, bacteria, fungi, and other tiny critters which make us sick. By eliminating those risks from our environment, we eliminate a lot of the pathways those germs take to making us ill.

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When Poor Air Quality Strikes: Keeping Safe When It Snows Ash

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The air over Seattle (and the rest of the Pacific Northwest) has been very poor lately. The concentration of PM2.5 (very small bits of particulate matter in the air) has been well above what health officials consider acceptable for human health. The situation is even worse up north in Alberta when the sky seems to be permanently yellow like a scene from some kind of post-apocalyptic dystopia video game my partner would play.

There's been a lot of worry for what the air quality means for our health and why it's happening, as well as the completely understandable fear that this is our new normal. I'm going to talk a bit about what's in the air, who is at risk of poor health from it (spoiler: everyone), and some ways that you can try to keep yourself and your family healthy when these events happen.

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MNÁwesome: What Happens When We Legalise Abortion?

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If you follow me (or probably any other Irish person) (or read Irish news) (or are passingly aware of when Ireland makes foreign headlines), you probably heard that the Republic of Ireland voted last month to repeal the 8th Amendment of the Irish Constitution (Bunreacht na hÉireann). It was a massive, multiyear campaign that took off running after the tragic—and completely preventable—death of Irish dentist Savita Halappanavar.

I know that this topic is hard for many people and that there are a lot of very strong emotions. As a devout Roman Catholic, I’m familiar with both sides of the issue. I’m not going to dig into the intricacies of the philosophy on when life begins, but I will say this: I desperately wish that I lived in a world without abortion. I wish that I lived in a world in which every pregnancy was planned and healthy and no one ever had to make the decision whether to terminate their pregnancy. I wish I lived in that world, but it doesn’t exist. It is not my place to tell someone else what they need to do with their body and in no other instance do we insist that it is.

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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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Sitting with our Grief: Mental Health Matters

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My grandfather died yesterday. He was quite elderly and was battling an aggressive case of cancer, so his death was not unexpected, but it is painful all the same. We had known the end was near for several days and every time my father called I had expected it to be with the sad news. As a consequence, I have found myself feeling as though my grief were already all poured out and that I'm drowning under the weight of my guilt for being so stopped up. It reminds me a bit of the emotional equivalent of when I had appendicitis and, after days of agony, finally crawled to my bathroom consumed with the thought that I would feel better if I could just vomit. I don't expect that vomiting would do me much good this time, but I can't help think that I would feel so much better if I could just have a good cry. 

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It's Just Food Poisoning

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When I think of food poisoning, I often think back to President Josiah Bartlet calling the Butterball Hotline after Toby Ziegler warned him that cooking the stuffing in his Thanksgiving turkey would make his guests ill (and possibly kill them). President Bartlet is surprised by this and has a series of ridiculous interactions with his staffers trying to track down the truth of the matter before finally receiving some excellent advice from the Butterball Hotline.

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Who Benefits from my Work? The Problems with Voluntourism

Travelling gives me a tremendous amount of joy and I’m forever grateful that we’ve had resources enough that I’ve had so many opportunities to serve communities and enrich Rónán’s young life by seeing other spaces and making new friends. I’ve had the pleasure of admiring precious babies and adorable animals the countries that we’ve visited. I’ve made dear friends and maintain many of those relationships. I look back on those experiences with pride, but try to also be cautious about the ways that I engage with communities and the work that I do there. I’m careful that I’m always invited, that I provide a skill that is needed but not currently available, that I leave behind those skills in my new colleagues to perpetuate the work and its usefulness, and that I share power over our data and their dissemination with the community to which they belong. 

In this piece, we’re going to talk about some of the real damages that voluntourism—the practice of travelling to do volunteer work—damages the very communities that we seek to serve. 

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Bats Are Not For Snuggles: You and Nature’s Cutest Insectivores

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For the last two months, my Twitter feed has been a very long series of requests for people to not touch bats, so, in celebration of Halloween and #BatWeek, I’m going to talk about how you should (and should not) interact with one of nature’s cutest creations. I love how adorable bats are and am constantly amazed at how important they are to our natural environment. Their noses are incredible feats of evolution and wiggle like they don’t even care that my heart can hardly bear it. That said, they're not safe for humans to touch without special training and personal protective equipment. 

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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 3: Is it the Water or the Vaccines?

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In this last part of our medicines and vaccines series, we’re going to talk about how vaccines work and how we know they do. I know that vaccines are a contentious topic and I want to start by acknowledging that sometimes delaying or forgoing a vaccine is the evidence-based decision. If someone is pregnant, they shouldn’t have the varicella (chickenpox) vaccine. A child with leukemia probably shouldn’t get the measles, mumps, and rubella (MMR) vaccine. Those conditions which make vaccines temporarily or permanently unsafe for an individual are, thankfully, very, very rare. For most humans, following the CDC vaccine schedule is safe and will provide both them and their contacts with protection against those diseases.

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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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