Wednesday, 27 May 2020 17:17

COVID-19 sends disease detectives into outbreak overdrive

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Thomas Johnson and Varsha Vakil spend their days studying outbreak data and reaching out to COVID-19 patients. Thomas Johnson and Varsha Vakil spend their days studying outbreak data and reaching out to COVID-19 patients. Photo by Elise Marrion


With nearly 60 million passengers traveling through Houston airports, and Galveston serving as a major port for cruise ships, Houston is a prominent destination for global travel. As cases of the novel coronavirus continued to spread worldwide, local health authorities knew it was only a matter of time before COVID-19 would come to town. 

Varsha Vakil, an epidemiologist with the Houston Health Department, said she expected to see an influx of travel-related cases. By late January, her predictions came true. Her first suspected case of COVID-19 had recently traveled from China to Houston. 

While nurses, doctors, paramedics and other frontline workers are earning praise for caring for the sick, epidemiologists and public health professionals like Vakil and Thomas Johnson work behind the scenes as disease detectives tracking the sources and local spread of the virus. 

“We are used to dealing with different outbreaks from food-borne illnesses, measles, meningitis, pertussis, to Ebola and Zika,” Vakil said. “As epidemiologists, we are already in the state of mind that we roll up our sleeves and we are ready for anything that comes our way.” 

Vakil said her colleagues at the Houston Health Department had the expertise and procedures in place, but it became a question of applying those skills and experience to an unknown virus while handling a rapidly growing volume of cases. 

A typical day for Vakil includes phone calls interviewing cases and investigating the root cause of the disease, tracing the person’s whereabouts and the people with whom they have been in contact. The job requires recording and analyzing data, recommending preventive measures and occasionally representing the epidemiology division at local and national conferences.

But lately, those days have become considerably more hectic. She spends long days in the office poring over reports, juggling calls and meetings and she is frequently on call through the night and early morning hours.

“Before the pandemic, the field of epidemiology wasn’t widely known by the general public. In fact, many people struggle just to pronounce it, but that is changing. We are not looking for accolades or pats on the back, but it has not been easy,” Vakil said. “Epidemiology is a calling, and we are dedicated to protecting public health no matter what happens. 

“Initially, when COVID-19 testing was only conducted by the CDC, we were flooded with calls even in the middle of the night. Everyone was in a state of panic. Doctors and hot spots like nursing homes were unprepared for when patients began to show telltale virus symptoms.”

That panic has quieted now that testing centers have become more widely available, and the public no longer needs to be pre-screened for drive-thru testing, Vakil said. The Health Department expects to have at least 24 testing sites open by the end of May. See a map of city testing sites.

“As we open more centers for testing, we need more people to investigate the positive cases,” she said.

Thankfully, relief is on the way. Funding from the Coronavirus Aid, Relief, and Economic Security (CARES) Act enabled the Health Department to open 300 new temporary public health positions including contact tracers, call center representatives, community involvement coordinators, epidemiologists, nurses and other roles. Two virtual job fairs were held on May 14, drawing participation from more than 2,600 potential applicants. 

Thomas Johnson is a surveillance investigator and outbreak coordinator for the Health Department. When the virus began to spread locally, Johnson was initially working with the division that investigates outbreaks in long-term care facilities such as nursing homes, but his role shifted to coordinate outbreak efforts and track the spread of the virus originating from work sites like office buildings and public spaces such as grocery stores, gas stations or airports. 

“Over the last few months many of us have taken on new roles and adopted new identities. It’s all part of the job. We are changing with the times and living history day to day,” Johnson said. 

“There is so much we don’t know about the virus, and a huge concern is the uncertain degree of asymptomatic transmission. Positive cases now number in the thousands, so it becomes a great mystery to pinpoint the source when you have so many community interactions like going to grocery stores, bank, the drive-thru or a gas station.” 

As a public health professional working on the front lines, Johnson said he feels a personal and professional obligation to share his knowledge and insight with friends, family and colleagues. 

“There is no prophylactic treatment, so without a vaccine, you just have to follow the guidance to wear a mask, hunker down, limit your interactions and put as many barriers as you can between you and the virus.” 

Johnson said he doles out both warnings and assurances to acquaintances who are either dismissive or distressed by the virus’s severity. 

“Working in public health, we can act as a filter, give peace of mind and add much-needed context to some of the convoluted information you see on the news and social media,” Johnson said. “At the same time, I have softball friends who give me a hard time because they are eager to get back on the field. I have to tell them that I don’t want to see their names come across my desk as a positive case.” 

As the pandemic wages on, both Vakil and Johnson said their sense of purpose continues to drive their enthusiasm and work ethic. 

“It can be mentally draining and physically draining, but I’m still excited coming to work every day knowing that what we do matters,” Johnson said. “What we say can prevent the spread of the virus and save lives. Sadly, some of our patients have passed away, and you feel each loss personally because over the course of their illness, you developed a connection. 

“But you do it all with the mindset that this is what I signed up for; this is what I loved to do. At the end of the day, what we do now can have an immediate and long-term impact on the wellbeing of our city. Our work, our methodologies could be used as a model for future pandemic response practices.” 


Varsha Vakil web

Thanks go both ways

While the world expresses gratitude for essential workers, including public health professionals, Houston Health Department Epidemiologist Varsha Vakil wanted to return the favor and share a recovery success story.

“I wanted to say thanks to Houstonians for being mindful of the disease spread and diligently following the guidance offered by Mayor Turner and the Houston Health Authority Dr. David Persse. Without the support of the public, public health cannot be a success.

Setting a good example: “When I was interviewing a woman in her late 70s who had recovered, she expressed immense joy for life and the gusto to live it to the fullest after undergoing this disease, and this speaks volumes on the abundance of energy and gratitude she had for everything.

She wanted me to know that she stayed in quarantine all through her illness and said she made sure that no one would get it because of her and that she would not put anyone in harm’s way. Her compassion for others to stay safe and not be affected by the illness offers us epidemiologists the perseverance to battle the disease and that we are all in it together.

This woman was all set to make gumbo as soon as she got better, as that was something she longed for. I personally spoke to many other patients who followed quarantine measures religiously and said they would not want anyone to get this illness because of them. This gesture is simply being mindful and considerate to others. We all are Houston Strong in every sense.

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