What I Wish I Had Known Before COVID

(Little known) Lessons from an epidemiologist to help us all through the pandemic

After publishing the 3rd edition of my textbook in August, I have been reflecting on my training/career as an epidemiologist and just how much has changed because of COVID. My career as a public health practitioner began with a grassroots campaign to eliminate the use of PVC plastics in hospitals in 1999. Since then I’ve had the opportunity to work for two different state agencies, at a big nonprofit agency in Washington DC, as a research director for a hospital, as a community-based researcher, and as a teacher. These experiences prepared me for the roles I took on during the pandemic.

Pre-pandemic I was a passionate epidemiologist and statistician. I taught epidemiology and biostatistics routinely - I loved introducing students to the field of epidemiology (and made sure they all read Beating Back the Devil). My teaching style would best be described as a cheerleader on speed (my classes tended to be high energy - even at 8 am). I was quick to share my favorite books, podcasts, and TV shows with students. And was known for adapting my favorite things into assignments (who remembers “My Favorite Outbreak”?). And even pre-pandemic, I knew the next pandemic was looming and that I should prepare my students to be epidemiologists on the front line. I created a measles outbreak simulation where students were required to track down 175 “cases” on campus, conduct case investigations, complete the statistical analyses to determine the source of the outbreak, and communicate those findings to the community. Best final exam EVER.

Despite years of learning, working, and teaching about public health and (more specifically) epidemiology, there are many things I wish I had known and prioritized in my classes when I was a pre-pandemic epidemiologist.

This picture was taken on March 12, 2020 — the day before we all went into quarantine; the day before lockdowns began; the day before our lives would be forever changed. This is the woman I am speaking to in this post - the woman who didn’t know what to expect from online teaching, remote learning, isolation, the cancelation of everything, the impending doom that a new virus could bring about, and the politicization of public health.

If I could go back and talk to my pre-pandemic self with what I have learned over the past 18 months, I would tell her -

You are needed.
Your public health mind, your knowledge of diseases, your understanding of science and statistics is valued. The labels of nerd, geek, and bookworm are to be treasured. Your years of study, hours spent coding in SAS, and the endless revisions of journal articles and books will be rewarded. Everything you did, read, listen to, worked on, and contributed to is bringing you to a life-changing moment. You will be needed by your community. Keep pursuing excellence and never stop learning and being passionate. Be yourself. Accept yourself. Value yourself. You will be needed in ways you cannot imagine.

Epidemiology is narrative.
You heard an English professor make this claim at a conference many years ago. Remember this! Communicating epidemiology and helping communities implement public health programs, policies, and interventions in the midst of a pandemic will be your superpower. Translating complicated epidemiologic concepts will be another superpower. Remember what Dr. Bill Foege (former Director of CDC) said —

“The power of science is in the application. It has to be applied to be powerful.”

You will be responsible for applying the science to improve community health. Be courageous and communicate epidemiology with clarity.

Science keeps changing.
When faced with the global spread of a highly infectious disease, there will be a flood of information. Day-by-day new news will be available. Your understanding of all of the key concepts of infectious disease epidemiology — the chain of infection, modes of transmission, susceptible host, immunogenicity, herd immunity, case definition, the index case, epidemic, endemic, and pandemic — will be of interest to the world and your knowledge of each of these things will evolve over time (because it will be a new disease). Your job is to remind people of the scientific process and how it is applied in epidemiologic studies. You will need to say “we do not know at this point in time” repeatedly. You will need to speculate about what will happen next and how epidemiology will be used to answer key questions. And you will be responsible for discussing and helping others to understand how our changes in policy or mandates are not political flipflops, but rather an evolution in our understanding of a new disease.

A health threat anywhere is a health threat everywhere.
In a world where individualized medicine and personal wellness are prioritized, speak up for community health. Never forget your calling to “CREATE HEALTHY COMMUNITIES!” Teach your students and use your voice to make community health a part of everyone’s health narrative. Too often you teach/talk about the successes of public health (because of your passion) that you forget that overpopulation, climate change, racism, lack of access to care, and an animal spillover of disease could cause a shift from chronic diseases causing the most mortality and morbidity in your community to an infectious disease being the leading cause of death. We are just one bat disease, increase in global temperature, or disease mutation away from the next pandemic. We are a global society, and our health here in Pennsylvania is intimately tied to the health of our friends on the other side of the world. Local health is global & global health is local.

Though the risk factors and diseases will continue to change and challenge our understanding of public health, the science of epidemiology remains the primary tool used to understand the determinants and distributions of disease.

Develop a thick skin.
Fatigue, fear, and politics are going to cause confusion, rage, and a surge of misinformation. You will be dismissed and alienated as a human being because you are an epidemiologist. Your expertise will be taken for granted by some and dismissed by others (and you will experience the double-whammy where a single person does both on the same day). There will be days when you ask yourself “why should I stay in the field? why continue to be an epidemiologist working in the midst of a pandemic?” When those days come (and they will, more than once) — remember that you are an expert. Your voice is needed. Your ability to see the big picture and to navigate a way out of the pandemic is needed. Stay true to your mission to
CREATE HEALTHY COMMUNITIES. And never fail to —

Act justly.
Love mercy.
And walk humbly.

Prioritize your physical, emotional, mental, and relational health
To be all that you are about to be asked to be — you have no idea how much your understanding of epidemiology and ability to communicate it will be needed — you must take care of yourself. Be sure to move your body, invest in friends who will take care of you in the worst of times, and when a new yoga studio opens in town buy a membership and go religiously.

The safety lecture on airplanes - where they tell you to put your oxygen mask on first before helping others - needs to be your North Star. Take care of yourself first so that you have the strength to give to others, work overtime, overcome criticism, and see the joy in your life (both personally and professionally).

As an epidemiologist, you have been called to create healthy communities and to train the next generation. Your classroom will expand to include your whole community, your audience will grow, your ability to communicate will be needed, and your expertise will be needed.

Shine bright.