Emily Holman’s (MSc Control of Infectious Diseases, 2010) role as a Communicable Disease Controller for Long Beach Department of Health and Human Services has seen drastic changes since the emergence of the novel coronavirus. Find out how she has been responding to the outbreak using surveillance and the challenges the outbreak has brought.
How has the COVID-19 outbreak affected your work?
I work for one of only three city-run health departments in California in Long Beach, as most are county-run. COVID-19 has changed my work tremendously. Pre-COVID, my team were responsible for investigating and responding to over 80 communicable diseases on a regular basis. Now, all our focus is devoted to one disease, which is not at all what we are accustomed to! In the past year, we have dealt with challenges such as a resurgence of measles, multi-drug resistant organisms such as Candida auris, and in February when COVID-19 was still emerging, we had one of the largest restaurant-associated hepatitis A outbreaks in the State in recent history, and were able to respond quickly and pinpoint the foodborne source within days. We were so pleased with ourselves at the time, but the celebrations were cut short and we were quickly brought back to earth as we turned our focus to the COVID-19 response. We were unable to use the standard disease control tools that have allowed us to be so successful in the past. Without the basic knowledge of a precise incubation or infectious period, we are learning to respond differently, albeit slightly less efficiently. With COVID-19, there will never be that big announcement and celebration of “solving” it at any point unfortunately, as we will just continue to respond as best we can with the information we have at the time.
How have you been responding to the outbreak?
I currently lead the surveillance portion of our city’s COVID-19 response, which includes case investigation, contact tracing, data analysis, outbreak investigation, and lab result dissemination for a city of half a million people. Our unit went from six people to over 80 within weeks. Many people assigned to respond to the surge in cases came from other jobs throughout the city, including libraries, finance, and customer service, and they are now trained to conduct patient interviews and contact tracing. It has been a wonderful experience to share our role as epidemiologists with others who previously may not have even known what the word meant, and many have embraced it and are excelling in their newly-assigned positions.
There is the less-glamorous side to this as well – there is an immense amount of pressure at any given time. I have worked seven-day weeks almost consistently since February, and my family has felt the effects as well. Currently, the pressure is getting the numbers under control enough to reopen the local economy. The data and metrics we provide are often new to government officials, and never has our staff, or even our field of epidemiology, been so scrutinized and questioned. In addition, as we are seeing globally, our long-term care facilities have been hit much harder than any other sector of the population. Our staff works with these facilities, staff, and residents daily to try and provide them with the tools they need to get everything under control, but COVID-19 is a formidable opponent. We have had tearful calls from physicians, family members, and administrators alike, and we share in their frustration and at times hopelessness. Our Surveillance team is like family though, and when someone has a bad day or gets off of one of these calls and is feeling despondent, we rally around them, give suggestions and provide the support they need to keep going.
How has your country’s response to the outbreak affected your work?
The United States of America response to COVID-19 directly determines the work that we do on a local level. There have been times when I have been very proud of our country’s response, and times when the response has been somewhat frustrating. In something this unprecedented, we will always be able to look back and see what we should have and could have done differently, but I do believe that for the most part, those in local, state, and US government (namely the Center for Disease Control and Prevention – CDC) are doing the best they can, considering none of us have ever lived through, much less led, the response to a pandemic of this scale.
How has LSHTM’s training helped you during this outbreak?
My training at LSHTM has been invaluable. As a Control of Infectious Diseases (CID) graduate who had plans to travel the world but ended up settling in my home state of California, COVID-19 has felt like a response that is part of something on a global level, and LSHTM and the CID course prepared me for just that. I never thought that living in California would result in being able to work with the tropical and emerging diseases we had studied in our program, yet since being in this role I have dealt with the emergence of Zika, Ebola, and now COVID-19 and I have felt more connected to my School than ever since graduating.
In addition, having former classmates situated throughout the world and checking in with them has allowed me to feel much less isolated through all of this. We have Whatsapp groups with former classmates who are situated throughout various countries fighting COVID-19 in various ways, which allows us to check in on each other, vent, celebrate the milestones, and feel a sense of solidarity.