March 2020 - The Epidemiology Monitor

Coronavirus Pandemic Amidst Uncertainty, Epidemiology Modellers Make The Case For Social Distancing Measures

In This Issue

Most Drastic Strategy Seen As The Only Option Effectiveness Still In Doubt Developments in the current COVID-19 pandemic are happening rapidly as case counts are doubling every several days and policy interventions are being modified to keep pace with new information about how this virus behaves or is likely to behave.

Modelling A modelling study which reportedly had significant influence on decision making about social distancing measures in Great Britain and the - Pandemic con't on page 2

Notes on People - Epidemiologists In The News No More Guesses About Epidemiologists Being Skin Doctors with their epidemiologist friends or The COVID-19 pandemic has brought former neighbors to “get their take” on the unprecedented attention to epidemiologists and their work. All of a pandemic. One benefit of all this attention--No more guesses about sudden the world knows who epidemiologists being skin doctors. epidemiologists are and what they do.

Whether on television, newspapers, or social media, epidemiologists are being The Epidemiology Monitor has collected a sample of these news items involving interviewed constantly to get their opinions about various characteristics of epidemiologists to give readers a sample of the more visible public role being the SARS CoV-2 virus causing the pandemic and potential control measures. played by epidemiologists everywhere.

Old acquaintances that have fallen out of touch are reconnecting - People cont'd on page 7 March 2020

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Volume Forty One •

Number Three

-3New Short Course Planned for Next Year -6Epi News Briefs -7Notes on People -8Near Term Epidemiology Event Calendar -9Marketplace

-Pandemic cont'd from page 1

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alone still allows for 250,000 deaths in the United States was released on March 16 UK and 1.1-1.2 million in the US. “We therefore conclude that epidemic by a COVID-19 Response Team at the suppression is the only viable strategy at Imperial College in London. Entitled the current time,” says the report, for “Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 countries that can achieve it.

mortality and healthcare demand”, the Can it be done? paper characterizes the public health threat as “the most serious seen in a The feasibility of such an all-out respiratory virus since the 1918 H1N1 influenza pandemic.” It was authored by suppression strategy is very much in Neil Ferguson and 29 co-authors from the question, not only because of its inherent challenges but because it must be various centers and institutes at the implemented for a long period of time Imperial College. until a vaccine becomes available.

Otherwise, removing the austere measures Unmitigated Pandemic Impact would be likely to produce a rebound in transmission. But even if it succeeds, Without putting into place effective suppression may not completely protect control measures, the pandemic is predicted to cause 2.2 million deaths in the most vulnerable and deaths could still the US, peaking this coming summer, andbe high, according to the report. about a quarter of that number (510,000 deaths) in Great Britain, peaking a bit earlier. Of special concern is that this number of cases creates a demand for critical care beds that exceeds 30 times the current maximum bed capacity in both countries.

Mitigation Vs Suppression

The authors admit making their recommendation without consideration of ethical, indirect adverse health, and economic consequences that might be entailed by a suppression strategy. Saving lives from coronavirus death is prioritized above all else.

Proposed Interventions

With control measures possible, the Since the feasibility of effectively report makes a distinction between implementing suppression strategies mitigation and suppression strategies. remains an open question, it is important Mitigation seeks to slow but not stop virus spread in an effort to buy time for to consider what interventions are involved in a suppression strategy. the health care system to care for patients. Suppression seeks to reverse the According to Ferguson and colleagues, increasing number of cases and to keep suppression requires 1) long term sustained social distancing of the entire case numbers low. population, 2) home isolation of cases and Perhaps the most significant finding in household quarantine of their family members, and possibly 3) school and the report, according to the authors, is that mitigation strategies still result in a university closures. Under their model, long term sustained social distancing need for hospital beds that is 8 times greater than the existing surge capacity. means that all households reduce contact outside More alarming, mitigation

- Pandemic con't on page 8

Interview A Unique Short Course To Be Offered On Exploring The Linkages Between Mental Well-Being And Physical Health Outcomes Course Now Planned for Next Year A new and unique short summer course on positive well-being and physical health is being planned in collaboration between the Harvard School of Public Health and University College London. The course was to be presented next summer but has now been postponed to 2021.

discussing the idea for the course, entitled Exploring the Linkages between Mental Well-Being and Physical Health Outcomes, as a way to reach a wider audience and because there seems to be a growing interest in the topic.

“...a way to reach a wider audience..."

Both Andrew and I are doing research There is growing interest in taking a well- in the field and teach related courses at being approach to health as opposed to our respective institutions, but we see focusing primarily on disease, deficits, the summer short course as a way to and problems. To better understand why broaden our reach to more scholars and and how this new course was created and policy makers who might want to either what prospects it offers to epidemiologists contribute to knowledge production or and other health professionals, we use the evidence base for decisioninterviewed Laura Kubzansky, professor making. We also saw this as a good way of Social and Behavioral Sciences, and co- to consolidate and streamline material director of the Lee Kum Sheung Center for we’ve been developing into a five-day Health and Happiness, and director of the educational opportunity. Ideally, we Society and Health Laboratory at the would like to explore ways to grow and Harvard T.H. Chan School of Public transform the course in the future – Health. possibly making more material available online or creating additional EM: How did the idea originate and advanced courses for students to take evolve for this course? after they have completed this initial course offering.

“This field of study Kubzansky: Andrew Steptoe and I first is relatively new..." started discussing this idea in the Fall of EM: Why now? Is there something 2018. Andrew is a founding member of the special about the timing?

Scientific Advisory Board for the Lee Kum Sheung Center for Health and Happiness Kubzansky: This field of study is and has been a supporter and partner in relatively new but we are entering into the development and growth of our a period where there is sufficient Center over the past four years. A key goal evidence and for the key questions of the Center is not only to build a under study that we can begin to rigorous and interdisciplinary science of address major topics in the field by positive health and well-being, but also to presenting a foundation of knowledge build capacity for doing this work. We and also discussing began - Course cont'd on page 4

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-Course cont'd from page 3

“...cutting-edge science that sits at the nexus of epidemiology, social science, psychology, and medicine..."

“...requires broadening how we think about what health means and how we think about population health."

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discipline now regarding well-being and health? Do you have a working definition of well-being and is it different from health?

methodological issues relevant for this work. We see this course as an opportunity to grow the field by reaching Kubzansky: At our Center, we like to use the next generation of scholars. We specifically target doctoral students and the WHO definition of health: Health is a early career researchers and policy makers state of complete physical, mental and social well-being and not merely the because we hope to build a network of scholars who will lead the next generation absence of disease or infirmity. So in this way, well-being is a key part of health and of research in this area. not separate from it. That said, we also note EM: Are there similar courses elsewhere? that there may be value to considering mental and physical health separately, If so, how does this one differ? while understanding that there are Kubzansky: As far as we know, there are bidirectional relationships between them. A no other courses that focus specifically on greater understanding of these interrelationships will provide important insight exploring the linkages between mental well-being and physical health outcomes. into potential strategies for prevention and There are certainly other courses that look intervention to improve population health. at different aspects of well-being or that Part of our Center’s vision, and one that target different audiences, but ours is the Andrew and his colleagues at UCL are also working toward, is to achieve a only one that focuses specifically on transformation from solely focusing on providing up-to-date, state-of-the-art deficits, disease, and dying to creating a knowledge on the linkages between mental well-being and physical health, as broader understanding of well-being, well as on providing skills with which to incorporating a focus on health assets and resources. We see this new course as a way critically evaluate research in this field. of working toward this vision. This requires The course will introduce the next generation of scholars to the cutting-edge broadening how we think about what health means and how we think about science that sits at the nexus of epidemiology, social science, psychology, population health. and medicine with the goal of stimulating EM: Are you interested in exploring both novel, interdisciplinary work. Through the causes of well-being considered as their involvement with the course, psychological well-being and separately participants will gain concrete skills on psychological well-being itself as a cause of the different ways of measuring wellphysical health? being and evaluating linkages between mental well-being and physical health. In addition, they will gain knowledge related Kubzansky: Increasingly, people are to the social and biological processes that making the case that we should take a wellbeing approach to health – this requires a are relevant to these linkages. broadening of how we think about what is health and how we think about population EM: Is it possible to give a general health. To take a wellimpression about the state of the

- Course cont'd on page 5

-Course cont'd from page 4 being approach, we would need to think about not only alleviating misery but also how to create conditions for well-being at the positive end of the continuum and for advancing well-being all along the continuum at the population level. When you dig into what we know about positive health, you realize that much of what we know regarding which factors matter, comes from studies of disease, deficits, problems. We do not currently have a strong understanding of the distribution and determinants of positive health, and as a result, we need to further explore what we do know, and what we might like to know. This includes exploring both conditions that make wellbeing possible (or more likely) as well as understanding whether, when and how psychological well-being is a causal contributor to physical health outcomes.

EM: Is achieving psychological well-being a worthwhile outcome of its own whether or not it causes better physical health?

Kubzansky: Yes, psychological wellbeing is very important in and of itself.

Referring back to the WHO definition of health, psychological well-being is a key component of overall health. In addition to any benefits it may have for physical health, positive psychological well-being has benefits of its own, including reduced risk of depression and anxiety, positive benefits to relationships, improved moods, and a greater sense of calm.

EM: Do you believe there is a reason why epidemiologists in general should be interested in this topic area?

Kubzansky: Epidemiologists are

interested in understanding the risk factors for and determinants of disease, and social epidemiologists have focused on social structural factors in this equation. However, the traditional factors epidemiologists have studied are largely “We do not currently have a strong oriented to understanding deficits, understanding of the disability, disease and death. This work does not facilitate gaining greater distribution and understanding of the full spectrum of determinants of health. Though there was a time when positive health..." people thought studying happiness or positive mental well-being and physical health might not be a valid area of study, increasingly there is recognition that the absence of poor health is not synonymous with the presence of positive functioning; thus, if we only ever study factors that relate to being sick/dead or not, we may never gain appreciation either for what functioning well truly looks like or for factors that relate to functioning well.

Studying positive mental health may provide important new insights into health at this end of the continuum as well as giving us a new window on health more broadly.

Readers seeking more information can contact the organizers at centerhealthhappiness@hsph.harvard.edu

â–

“...if we only ever study factors that relate to being sick/dead or not, we may never gain appreciation either for what functioning well truly looks like..."

Join us on our Facebook page at: https://bit.ly/2U29gUA

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Epi News Briefs Florida Recruits 100 Epidemiologists From Its Universities Over One Weekend A Tampa Bay newspaper reports that disease experts working around the clock doing contact tracing of coronavirus cases needed help. In an unprecedented action, the state “To gather the need recruited 100 professors and students from five universities over a single weekend.

They are working part time to interview people by phone about their illness and for this many epidemiologists, I contact patterns. They will join Florida’s 264 infectious disease epidemiologists already on the job. ““To gather the need for this many epidemiologists, I don’t know if don’t know if there’s there’s ever been a situation like this,” said Janice Zgibor, a professor and associate ever been a situation dean for academic affairs at the University of South Florida’s College of Public Health. like this..."

“I haven’t heard of it in my lifetime.”

LINK: http://bit.ly/2wm8sUw

Harvard Epidemiologist Called “One Of The First Corona Influencers” A fascinating article about how coronavirus information is being transmitted and exchanged during this pandemic reveals the existence of what BuzzFeed calls the Coronavirus Influencers. It turns out the frequently used sources of information are not just the traditional expert ones you would expect like the CDC and the NIH, and not just the traditional vehicles such as press releases and journal reports. Instead, it appears that much information, good and bad, is being transmitted quickly through Twitter and other platforms. “As online social platforms have become up-to-the“The information on second hubs of information about the pandemic, a new class of corona influencers has Twitter is about half risen up,” according to Buzz Feed. One of these is Eric Feigl-Ding, an epidemiologist a day or two days and economist at the Harvard School of Public Health. His twitter account has grown from 2,000 followers at the start of the pandemic to 120,000 now. He told BuzzFeed faster than that “in a public health crisis, fast information with possible inaccuracies is better than newspapers..." waiting. He also said it makes sense that Twitter has become the central place for following the outbreak. “The information on Twitter is about half a day or two days faster than newspapers,” he said. One non- public health expert to obtain massive influence is Tomas Pueyo whose recent article on Medium has garnered over 37 million views, been translated into two dozen languages, and been retweeted by famous people. It was called the defining piece of the outbreak with its multiple charts and graphs.

To read about corona influencers, visit: http://bit.ly/3djWtaT and http://bit.ly/2IWWALv To see how freewheeling the information on Twitter is, visit the site and search on “not an epidemiologist but” ■

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Notes on People,

cont'd from page 1

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Please help The Epidemiology Monitor keep the community informed by sending relevant news to us at this address for inclusion in our next issue. people@epimonitor.net

Interviewed in the New Yorker: Justin Lessler, associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. Topics covered are the ways in which our understanding of the pandemic has improved, what we can learn from different governments’ responses, and why older adults seem to be more at risk of serious illness. “I would definitely say that what China has been able to accomplish has been quite impressive,” said Lessler.

LINK: http://bit.ly/2J1wXco Quoted in PC Gamer: Eric Lofgren (Washington State University) and Nina Fefferman (University of Tennessee, Knoxville) on the lessons learned from the “Corrupted Blood” outbreak in the game World of Warcraft. Both epidemiologists have written a paper on this topic published in Lancet Infectious Diseases in 2007 and are now working on coronavirus. "For me, it was a good illustration of how important it is to understand people's behaviors," Lofgren says. "When people react to public health emergencies, how those reactions really shape the course of things.

We often view epidemics as these things that sort of happen to people. There's a virus and it's doing things. But really it's a virus that's spreading between people, and how people interact and behave and comply with authority figures, or don't, those are all very important things. And also that these things are very chaotic. You can't really predict 'oh yeah, everyone will quarantine. It'll be fine.' No, they won't."

Fefferman’s perspective from her earlier work is "It led me to think really deeply about how people perceive threats and how differences in that perception can change how they behave," she writes. "A lot of my work since then has been in trying to build models of the social construction of risk perception and I don't think I would have come to that as easily if I hadn't spent time thinking about the discussions WoW players had in real time about Corrupted Blood and how to act in the game based on the understanding they built from those discussions."

LINK: http://bit.ly/2Uoeqfp Interviewed: Nigel Paneth, Michigan State University epidemiologist, in East Lansing Info, a non-profit citizen-run local news cooperative, about coronavirus.

Asked if current responses to the pandemic are hysteria and overreaction, Paneth said the risk of COVID-19 cannot be overblown, stating that he had never seen such a public health threat in his life. He urged more social distancing and added that proactive communities can implement interventions that will spare them the worst outcomes of this pandemic. In this sense, local communities are in control of their level of success. LINK: http://bit.ly/2U2c3A4 - People con't on page

Notes on People,

cont'd from page 7

Point-Counterpoint: John Ioannidis Stanford professor of epidemiology and statistics and Marc Lipsitch Harvard professor of epidemiology recently showcased different perspectives on the COVID-19 epidemic in opinion pieces published in STAT. Ioannidis’ article was entitled “A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data”. He raised concerns about decision making without good information. Lipsitch quickly contributed an opinion article whose title encapsulates his view, namely “We know enough now to act decisively against COVID-19. Social distancing is a good place to start.” LINKS: http://bit.ly/3a4dvHZ http://bit.ly/3be7JDQ -Pandemic cont'd from page 2 the household, school, or workplace by 75%. In this Somber Note scenario, household contact rates are assumed to increase by 25%.

The report ends on a somber note:

“…it is not at all certain that suppression will succeed long term; no public health intervention with such disruptive effects on society has been The authors conclude that it will be necessary for previously attempted for such a long duration of jurisdictions to layer multiple interventions and that “The time. How populations and societies will respond choice of interventions ultimately depends on the relative remains unclear.” feasibility of their implementation and their likely ■ effectiveness in different social contexts.”

Conclusion

Near Term Epidemiology Event Calendar Every December The Epidemiology Monitor dedicates that issue to a calendar of events for the upcoming year. However that often means we don't have full information for events later in the year. Thus an online copy exists on our website that is updated regularly.

To view the full year please go to: http://www.epimonitor.net/Events Alternately you can view individual months online: APRIL

MAY

JUNE

VIRUS UPDATES FOR PENDING EVENTS We are attempting to update our online epi event calendar to reflect cancellations and postponements. Many organizations have yet to update their event information.

If your organization has made decisions please let us know so we can keep our calendar as clean as possible. Thank you - mailto:events@epimonitor.net

Tenure-Track Assistant or Associate Professor Department of Epidemiology Infectious Disease Dynamics

The Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health invites applications for a tenure-track Assistant or Associate Professor specializing in infectious disease dynamics. We welcome applications from candidates who recently completed their post-doctoral training or who are early in their research career.

The candidate appointed to this position will have expertise in the statistical analysis of pathogen transmission, mathematical and computational modeling, and/or phylogenetic and phylodynamic methods. Applicants should have a doctorate in epidemiology, ecology, or equivalent training.

The successful candidate will be expected to contribute to teaching courses in infectious disease epidemiology and dynamics. Candidates who combine methodological and modeling work with experience in field epidemiology and data collection are particularly encouraged to apply. While the position does not require a disease-specific focus, candidates with research interests including emerging infections, dengue, influenza, malaria. or HIV are encouraged to apply. The successful candidate would be joining an active and productive group of students, post-doctoral fellows, and faculty with an interest in infectious disease dynamics.

The candidate must be committed to advising graduate students and mentoring post-doctoral fellows.

Relevant publications, early career grant funding, and classroom teaching and mentoring experience are desirable. Experience in multidisciplinary collaborations on infectious disease dynamics will be viewed positively.

The Department of Epidemiology is one of the oldest and largest departments of epidemiology in the world, with over 200 doctoral and master’s students and a diverse research program directed by 100+ faculty. The institution has a strong research infrastructure and commitment to conduct both observational and experimental research. Candidates should possess a solid epidemiologic foundation to contribute to the research and teaching missions of the Department.

Interested applicants should send their curriculum vitae, research statement and the names of three references by June 1, 2020.

Application link: apply.interfolio.com/74580 Inquiries for further information should be directed to Dr. William Moss, Search Committee Chair, at wmoss1@jhu.edu . A link of interest for this position is: https://bit.ly/2xTpKbX The Johns Hopkins University is committed to equal opportunity for its faculty, staff, and students. To that end, the university does not discriminate on the basis of sex, gender, marital status, pregnancy, race, color, ethnicity, national origin, age, disability, religion, sexual orientation, gender identity or expression, veteran status or other legally protected characteristic. The university is committed to providing qualified individuals access to all academic and employment programs, benefits and activities on the basis of demonstrated ability, performance and merit without regard to personal factors that are irrelevant to the program involved.

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