September 2020 - The Epidemiology Monitor

State Of The Pandemic

Projections By The Institute For Health Metrics And Evaluation Reveal We Are Nowhere Near The End Widespread Availability And Uptake Of Vaccine Appear To Be Many Months Away The epidemic in the US is far from complete and, even in the optimistic scenario of herd immunity kicking in after 40% rather than 60-70% cumulative infection, the country would be less than halfway through the pandemic even three months from now on January 1, 2021, according to the Institute for Health Metrics and Evaluation (IMHE).

epidemic globally is also very incomplete and the larger world will be less than one quarter through the pandemic on January 1, 2021. In short, we have seen only a fraction of the burden of disease to be experienced from this pandemic unless drastic change through vaccination or treatment is brought about.

- Pandemic con't on page 2

In This Issue -5Epidemiologist Offers Perspective on Risk Advice -7Aussie Epidemiologists Give Glimpse Into Life Under Covid

Likewise, IMHE estimates the

Former Employees Issue Comprehensive Report To Reset The Course Of The Environmental Protection Agency More than 500 former career employees and political appointees from both Democratic and Republican administrations have compiled a set of recommendations to “reset” the course of the Environmental Protection Agency (EPA). The group, organized as the Environmental Protection Network (EPN), states “We strongly believe that EPA should recommit to its mission of protecting public health and the September 2020

environment and set a course toward a new vision for the agency as it confronts pressing needs---from addressing environmental risks and inequities to vigorously confronting climate change.”

According to its website, the EPN was launched in January 2017 to harness - EPA cont'd on page 3 •

Volume Forty One •

Number Nine

-8Notes on People -9Near Term Epi Calendar -10Marketplace

-Pandemic cont'd from page 1 The Epidemiology Monitor ISSN (0744-0898) is published monthly

by Roger Bernier, Ph.D., MPH at 33 Indigo Plantation Rd, Okatie, SC, 29909, USA.

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Fatigue Even the social distancing and other mitigation activities we have that are known to work may become less effective through decreased use. There is concern that fatigue with nonpharmaceutical control measures is setting in in the US and elsewhere and that erosion of public support may lead to adoption of more hands-off approaches. These would potentially create herd immunity to eventually slow or halt the spread of the pandemic virus, however, letting nature take its course would extract a heavy price in terms of morbidity and mortality. This is because relatively low percentages of the populations in the world, with few exceptions such as Ecuador and Mexico City, have been infected.

Herd Immunity Recently, unproven claims that herd immunity may occur at much lower levels such as 40% or even 20% have appeared on social media, according to IHME. The reasons cited for a lower threshold are the role of superspreaders, non-random mixing in less dense populations, non-overlapping social networks, and some prior coronavirus immunity. The fatigue with control measures is coming just at a time when more robust social distancing measures would be called for in the Northern Hemisphere to counter the anticipated upsurge in cases by January 1, 2021. For example, another lockdown is being urged for the United Kingdom where cases are doubling.

Toll With Herd Immunity

kick in at 40% in the US, IMHE’s analyses of seroprevalence data and infection fatality ratios suggest the US would eventually experience over 800,000 deaths to get to that point. This projected number increases to over 1,000,000 deaths if herd immunity requires 50% seroprevalence and approximately 1,300,000 deaths if 65% seroprevalence is required. These numbers of deaths are approximately 2-7 times larger than the number of deaths that have already occurred in the US. Global Toll Globally, making similar calculations for herd immunity predicts the world would see 10-13 million deaths before the pandemic extinguishes itself.

Currently, just under 1,000,000 deaths have been recorded worldwide.

Needless to say, both sets of projections could be reduced considerably with widespread use of effective vaccines or new treatments. However, as we read less about when a vaccine or vaccines might be “available” and more about but when a vaccine or vaccines might be in “widespread distribution”, the return to normalcy may be months or even years away globally, and this will be reflected in a sustained number of excess deaths when compared to the years just prior to 2020.

End of the Pandemic?

A recent article in The Atlantic made this point forcefully by asserting that “the sublime post-pandemic period that so many are longing for will likely not arrive at once like a clock striking midnight on New Year’s Eve….As a matter of epidemiology, there’s no clear cut criterion that determines

Even assuming herd immunity could

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- Pandemic cont'd on page 3

-Pandemic cont'd from page 2 a pandemic is over. You can’t sign a treaty with a virus, so we have to settle for a kind of cease-fire, Columbia epidemiologist Stephen Morse told the Atlantic.

Near Term Projections The IMHE has lowered its projection of US deaths by January 1, 2021 from 415,000 to 378,320 because of steeper than expected declines in deaths in several states. Daily deaths have been steadily declining reaching 650 per day recently, but COVID remains the second leading cause of death in the United States. And with the expected seasonal surge later this year, IMHE anticipates over 3,000 deaths per day by the end of December.

Preventable Deaths Now Approximately 180,000 additional deaths are projected to occur between now and January 1, 2021 with almost two-thirds of these (115,000) able to be prevented if mask use could increase to 95%. Such an achievement appears unlikely since global mask use defined as the percentage of the population that reports always wearing a mask when leaving home remains constant globally at about 60% and is below 50% in the US. Global Near Term Projections IMHE believes it is likely that global deaths will increase from approximately 5,000 per day now to over 30,000 deaths per day in December. Hundreds of thousands of lives could be saved with increased mask use worldwide just over the next few months, that is, preventing approximately 43% of the deaths expected between now and the end of the year. ■

-EPA cont'd from page 1 the expertise of former EPA career staff and confirmation-level appointees from multiple administrations to provide an informed and rigorous defense against efforts to undermine the protection of public health and the environment.

Letter From Administrators In a letter accompanying the report, six former EPA administrators write “As EPA approaches its 50th anniversary this December, we believe the time has come to reset the future course for EPA in a new, forward-looking direction to address the environmental challenges we face today and those that lie ahead. …The Environmental Protection Network (EPN) and its over 500 EPA alumni have developed detailed recommendations for setting new directions at EPA. We invite everyone to take a look at this important report, available at: https://bit.ly/3cqg3C3“ Ten Topic Areas The report contains dozens of recommendations in 10 topic areas covering the breadth of EPA’s mandate including but not limited to air, water, toxics, pesticides, enforcement, environmental justice, science and economics. The group identified six priorities which they call critical to creating a renewed EPA. In their letter, the six former administrators agreed that these six “overarching recommendations are essential to meet the environmental challenges of the 21st century and improve people’s lives and our economy.”

- EPA cont'd on page 4

“You can’t sign a treaty with a virus..."

“...six “overarching recommendations are essential to meet the environmental challenges of the 21st century..."

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-EPA cont'd from page 3 Priorities These priorities are: 1. EPA must reaffirm its commitment to fully protect public health and the environment.

“EPA must restore science as the backbone of decisionmaking..."

2. EPA must conduct its scientific and economic analysis free from political interference.

3. EPA must incorporate environmental justice in every aspect of its work in order to address and resolve inequitable environmental conditions.

4. EPA must focus on the most significant and pervasive public health and environmental risks, prioritizing actions that provide the greatest health benefit for the greatest number of people, including vulnerable populations.

“The increasing availability of very large datasets and massive computing capacity, ..has yet to be fully tapped for the purpose of environmental public health. “

5. EPA must innovate and collaborate with states, tribes, local governments, and federal agencies as coregulators, as well as with stakeholders, including the private and non-profit sectors and community groups, to build an effective and resilient system of public health and environmental protections.

6. EPA must earn and maintain broad public trust by demonstrating the best ethical behavior, transparently considering all stakeholder viewpoints, and providing objective environmental information.

Detailed Report

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In a more detailed report entitled Restoring Science as the Backbone of EPA Decision Making, an EPN

workgroup stated “In recent years, adverse changes to the way science is used and managed by EPA has: 1) marginalized the scientific basis for EPA policies and decisions; 2) significantly reduced the credibility of EPA actions and efforts; 3) jeopardized human health and the environment; 4) and provided opportunities for special interests to have a disproportionate influence on EPA actions. " The workgroup added "EPA must restore science as the backbone of decision-making, building on its strength in understanding ecological systems to develop better systemsbased approaches for addressing complex issues. Such system-based scientific approaches are needed to reveal interventions that may positively impact multiple outcomes, while avoiding unintended consequences. The increasing availability of very large datasets and massive computing capacity, which has driven fundamental discovery in understanding the complexity of the human genome and health, has yet to be fully tapped for the purpose of environmental public health. “ Recommendations The science workgroup made four clear cut recommendations: 1. Eliminate the inappropriately-named “transparency” rule.

2. Restore the integrity of the science peer-review process.

3. Rebuild EPA’s research program.

4. Update risk assessment practices.

- EPA cont'd on page 6

Columnist Questions The Basis On Which Epidemiology Colleagues Offer Risk Advice Related To COVID-19 Briana Mezuk, the University of Michigan epidemiologist who writes a column entitled “Ask An Epidemiologist” for Psychology Today (see The Epi Monitor, July 2019 issue) raises questions in her most recent column about the basis on which epidemiologists give advice about risk and reopenings and other COVID related matters. She is especially concerned about advice which requires making judgments about tradeoffs as all risk benefit decisions do.

the type of questions she would want to have answers to. These additional questions are designed to evaluate a person’s experience, how much control they think they have on their own risk, how accurately they think about the true risks, and whether or not they are pessimistic or optimistic about life in general. These personal and psychological features of an expert’s life are influential in determining what kind of advice is given, especially when data are lacking.

Times Survey Of Epidemiologists

Mezuk concludes there is simply too much dynamic uncertainty about this pandemic to rely on data alone to make decisions. “The takeaway here is that data is cheap, but information is priceless. What is the difference?

Information empowers your understanding and decision making.

Data, especially data without sufficient context, risks impairing it.”

In her column, Mezuk recalls the New York Times article published earlier last summer which surveyed more than 500 epidemiologists to ask them when they expect to fly, hug and do 18 other everyday activities again. She questions whether the respondents in the Times survey were asked about what tradeoffs they were willing to make to stay safe.

According to Mezuk, “…the Times did not conduct a survey of expert opinion.

It conducted a litmus test of whether you are the type of person who worries about shark attacks whey you go to the beach or worries about a hijacking when you get on a plane. You don’t need any expertise in epidemiology to give a “valid” response to these questions because the responses have little, if anything, to do with the expertise these people have.”

To read the column, visit: https://bit.ly/3hOcl6b ■

“You don’t need any expertise in epidemiology to give a “valid” response to these questions..."

"...data is cheap, but information is priceless."

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

Evaluating Risk Benefit Advice Before judging the value of any risk benefit based advice given by epidemiologists or any other experts for that matter, Mezuk gives a sample of

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-EPA cont'd from page 4

“...we are hopeful for the agency’s future."

In their letter, the former administrators (Lee Thomas 1985-89, William Reilly 1989-1993, Carol Browner 1993-2001, Christine Todd Whitman 2001-2003, Lisa Jackson 20092013, and Gina McCarthy 2013-2017) state “While we are concerned about the current state of affairs at EPA, we are hopeful for the agency’s future.

EPA has a strong foundation on which to build. Capable and talented staff are ready to answer the call. They have labored in good faith across administrations of both parties to fulfill EPA’s mission by following the law,

applying the best available science, and displaying openness and transparency with the public.”

To access the report, visit https://bit.ly/32PGzBG To access the letter, visit https://bit.ly/3kCTyN0 ■

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Aussie Epidemiologists Give A Glimpse Of Their Lives Under COVID 19 What Has Changed For You Now That You Are In The Spotlight?

Highlighting the fact that epidemiologists have come to find their profession in the spotlight and themselves put on the spot more often because of the COVID-19 pandemic, the Australian Broadcasting Corporation (ABC) created a profile of how life has changed for a few Australian epidemiologists and other experts.

Excerpts from some of both the personal and professional lifestyle changes brought about by the pandemic and noted by these epidemiologists are described below.

No Dancing Lessons Latrobe University’s Hassan Vally lives alone and told the ABC that the impact of the pandemic on persons like himself was not really considered. There has been a social toll because of coronavirus restrictions, and “that’s defnintely something I’ve noticed,” he said. Vally cannot enjoy taking Latin dancing lessons anymore and wondered how long it would be before people can do simple things that he says “are part of being human.”

Talking with the Press Epidemiologist Mary-Louise McLaws is a member of the World Health Organization’s Experts Advisory Panel on COVID-19. She pointed out that “Previously I haven’t been very good at talking to the press because I’ve been too busy with my other work.” But now she feels interacting with the press is an important professional obligation.”

Postponing Meetings An air quality and health expert from Queensland University of Technology, Lidia Morawska, said she now believes it is more socially acceptable and she feels more comfortable telling students she won’t talk with them if they have a cold and wants to postpone their meetings for days later.

“There has been a social toll because of coronavirus restrictions..."

No Sports Travel At Queensland University, infectious disease specialist Paul Griffin bemoaned the decrease in travel since a big part of his winter enjoyment involved going to see the Brisbane Lions play in other states.

Tell us how your life has changed significantly for you either personally or professionally and we will share it with reader colleagues of The Epidemiology Monitor. As editor I can share that I have had more long lost friends contact me for advice and I have received unexpected invitations to speak to different lay audiences. All have been enjoyable as well as challenging.

"... interacting with the press is an important professional obligation.”

Send your comments to: editor@epimonitor.net ■

Join us on our Facebook page at: https://bit.ly/2U29gUA 7

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Notes on People Do you have news about yourself, a colleague, or a student?

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

Died: Rebecca Shadowen, age 62, following a four month battle with COVID-19.

She was an infectious disease specialist with the health care provider Med Center Health in Bowling Green Kentucky and a fellow in the Society of Hospital Epidemiologists of America and the American College of Physicians. She worked with the Bowling Green-Warren County Coronavirus workgroup. The governor of Kentucky called her a “front line hero who worked tirelessly to protect the lives of others.” According to media accounts, Shadowen was a vocal proponent of social distancing, face masks, and other guidelines meant to keep Americans healthy.

Profiled: Caitlin Rivers, in Science magazine, as a “clear-eyed, tactful narrator of the unfolding pandemic” and someone on Twitter who has “made an art of giving a big picture, 280 character view to her followers who now number more than 140,000.” Rivers trained at Virginia Tech in genetics, bioinformatics, and computational biology, with a specialization in computational epidemiology and is currently Senior Scholar at the Johns Hopkins Center for Health Security and an Assistant Professor in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health. Her research focuses on improving epidemic preparedness and response through the use of modeling and forecasting, data standards and data sharing, and public health policy. She has called for creating a National Infectious Disease Forecasting Center akin to the National Weather Service that would put modeling experts inside the government, according to Science.

Hired: Madison Riethman, as the COVID-19 response coordinator and health project manager at Reed College. With a master’s degree in epidemiology from St Louis University, Reed hired her to collaborate with the school’s COVID Risk Assessment Group and Response Team and support ongoing testing and contact tracing efforts. According to Reed, she is expected to develop and evaluate systems for tracking and reporting data and provide her public health expertise to Reed’s ongoing infectious disease prevention efforts.

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Notes on People On Leave: Jennifer Smith, Hawaii Department of Health virologist and COVID case investigator, with pay effective September 4, 2020. Smith brought attention to deficiencies in Hawaii’s contact tracing program which led to the departure of the state health director and placing the state epidemiologist on paid leave. Media reports are asking if Smith can be legally protected as a whistleblower. According to Hawaii’s governor, “No one in Hawaii should ever have to fear retaliation if they express their concerns about how people are acting. This is America for god sake.”

On Leave: Sarah Park, Hawaii state epidemiologist, has taken a paid leave of absence according to the Hawaii Star Advertiser following criticism of the COVID 19 testing and contact tracing program under her leadership. The State Health Director Bruce Anderson retired just before Park went on leave. Hawaii has seen a surge in cases in the past two months and the issuance of a second stay-at-home order which has caused “untold economic damage”, according to the Star Advertiser. A leading health professional in the state told the paper, “The removal of both Bruce Anderson and Sarah Park was an essential move to begin a new process at the executive level in the state of Hawaii…It is clear that aggressive use of testing, contact tracing and quarantine is the only way our state will be able to follow the best practice leads of the rest of the world and begin to stop the surge of COVID in Hawaii and the numerous deaths that are avoidable.”

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:

OCTOBER

NOVEMBER

2021 Epidemiology Event Calendar Are you planning an epidemiology event for 2021? We have started to build our

calendar issue and we want to make sure your event is included. To submit your event CLICK HERE

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Environmental Health Perspectives (EHP), a monthly journal of environmental health research and news published with support from the National Institute of Environmental Health Sciences (NIEHS), is recruiting a Science Editor to work in their offices on the NIEHS campus in Research Triangle Park, North Carolina.

The Science Editor serves as a science advisor to the Editor-in-Chief (EIC), and works closely with a team of Science Editors, Deputy Editors, and Associate Editors, who are recognized experts in the core environmental health disciplines, including human physiology and disease, exposure science, epidemiology, toxicology, and environmental health.

Science Editors collaborate with various editorial team members to develop, communicate, and uphold rigorous and fair peer review standards. They work with the entire EHP team on activities related to scientific content, peer review management, outreach and communications, publication policies and journal practices.

EHP seeks a diverse pool of editors and especially welcomes individuals from groups historically underrepresented in editorial positions to apply.

For detailed information about the job, qualifications and the application process – CLICK HERE

Tulane University Senior Clinical Research Coordinator School of Public Health & Tropical Medicine / Department of Epidemiology We are looking for an energetic person to join our research team as the Senior Clinical Research Coordinator (SCRC) to manage the daily operations of the Study and Data Coordinating Center for a new, NIH-funded, six-year research project on hypertension control in Jamaica and Colombia. The SCRC is required to have an in-depth knowledge of Clinical Research Protocol requirements and Good Clinical Practice (GCP) set forth by federal regulations. The SCRC will work closely with investigators to develop the study protocols, manual of procedures, and study forms. The SCRC will act as liaison between investigators in the US, Colombia, and Jamaica, other collaborators, the IRB, and government agencies. The SCRC will coordinate all research-related activities, including initial set-up of the study, participant recruitment and retention, delivery of the intervention, data collection, entry, and quality control activities, protocol compliance, and patient safety. The SCRC will also work on monitoring data QA and QC and study conduct. The SCRC is responsible for all data and source documentation, adverse event reporting, and maintenance of complete regulatory files. Some travel to study sites in Jamaica and Colombia (1-2 trips per year) will be required for training and site visits.

Requirements: Master’s degree in Epidemiology, Clinical Research, or related areas and two (2) years of related work experience. Knowledge of GCP, IRB regulations and submissions, ability to interact well with investigators, staff, participants, and the public, excellent organization, analytical, interpersonal and communication skills, and knowledge in various software programs, including data management and analysis program such as REDCap and SAS. Please send your CV to Kate Obst at kobst@tulane.edu and apply via this link: https://jobs.tulane.edu/position/IRC19426

Tulane University is an Equal Opportunity / Affirmative Action employer. Women and Minorities are encouraged to apply.

FACULTY - CANCER POPULATION SCIENCES The Mayo Clinic Cancer Center currently has opportunities for three institutionally-supported open rank faculty positions in its Population Sciences Program to develop cutting edge research programs that improve the health of patients and communities.

Successful candidates will leverage the extensive resources of the three-site Mayo Clinic Cancer Center (Rochester, MN, Scottsdale, AZ and Jacksonville, FL) and develop effective community outreach programs, including projects to reduce health care disparities. The Population Sciences Program spans three overarching themes: (1) Cancer risk factors and biomarkers; (2) Primary and secondary cancer prevention; and (3) Survivorship and health care delivery/health equity. Appointments will include substantial, long-term research support, including a highly competitive compensation package, technical and computational resources, and exceptional benefits.

LOCATIONS: Mayo Clinic campuses and the Mayo Clinic Health System encompass five states in three U.S. regions. The diverse geographies provide access to populations that include African Americans, Hispanic/Latinx, and Native Americans in rural and urban areas. A single electronic health record system enables access to patient information and electronic data from any location.

RESOURCES: Mayo Clinic is renowned for its extensive resources that support population sciences research and for its highly accomplished faculty with a breadth of expertise in cancer research.

Applicants can consult the Mayo Clinic Comprehensive Cancer Center website to gain knowledge about the Cancer Center’s resources in order to propose complementary programs that leverage existing strengths and expand vistas for advances in population science research.

QUALIFICATIONS: The successful candidates are expected to possess a doctoral level degree in a relevant discipline, and demonstrated expertise in cancer population sciences. Candidates will possess strong skills in experimental and/or observational designs, intervention research, and content knowledge of cancer control. Expertise and accomplishments related to program building, including epidemiological field work, community outreach and minority health is preferred. A commitment to multidisciplinary team science, pursuing extramural funding, and publishing/dissemination of research findings is essential.

APPLICATIONS should include a cover letter, CV with bibliography, and a statement of research interests. Visit jobs.mayoclinic.org to learn more and apply. Reference posting 130555BR for Minnesota, 130556BR for Arizona, and 130557BR for Florida. Specific questions related to the position should be directed to: Gloria M. Petersen, PhD, Search Committee Chair; c/o Jennifer Schilbe, Recruiter: Schilbe.jennifer@mayo.edu

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