InSight Spring 2020

THE UNIVERSITY OF IOWA COLLEGE OF PUBLIC HEALTH

INSIGHT

Spring 2020

THE PUBLIC HEALTH RESPONSE

FROM THE DEAN Public health often finds itself at the crossroads of society’s most difficult challenges. That has certainly been the case in recent months as our nation struggles with the COVID-19 pandemic, economic upheaval, health inequities, and police brutality. The tragic killings of Black Americans, including Rayshard Brooks, George Floyd, Ahmaud Arbery, and Breonna Taylor, have once again, very painfully, highlighted the role of racism in our society and the severe disparities that have historically characterized and remain relevant in our modern life.

We must recognize and call out the many ways structural racism permeates everyday life through the policies and institutions that people routinely interact with, including education, employment, housing, health care, and law enforcement. We must consider how we contribute to these inequities, and we must actively work to interrupt and dismantle these harmful patterns.

Public health must also continue its battle against the novel coronavirus as it spreads across the globe. This issue of InSight provides a look at some of the many ways our College of Public Health community is contributing to the fight against COVID-19, including testing the efficacy of personal protective equipment, developing disease models, and crafting communication campaigns.

You’ll hear from several of our faculty and alumni experts as they answer questions about the virus, and learn how many of our students are gaining firsthand experience in pandemic response through their internships and special projects. An interview with Professor Corinne Peek-Asa explores “syndemics”—a cluster of related epidemics—and how preventing adverse childhood experiences can lead to a lifetime of better health.

These are difficult and stressful times, and we’ve experienced many changes and losses. However, I want to acknowledge the amazing strength, resourcefulness, and resilience I’ve seen in our college and beyond as we’ve transitioned our lives to an entirely new footing.

In fact, that idea of embracing change, of adapting to new and different circumstances with an attitude of flexibility, humility, and shared purpose is a hallmark of our college and the formula we will need to move forward in a world with COVID-19. The college also is committed to moving forward in our efforts to promote equity, advocate for social justice, and address the connections between racism and health.

Wishing you and your loved ones the best of health,

2

Public Health Tackles the Novel Coronavirus

Members of the College of Public Health community are using their skills and training in the fight against COVID-19.

InSight is published twice a year for alumni and friends of the University of Iowa College of Public Health.

Director of Communications and External Relations Dan McMillan daniel-mcmillan@uiowa.edu Editor Debra Venzke Designer Leigh Bradford Marketing and Community Outreach Coordinator Mitch Overton Alumni and Constituent Relations Coordinator Tara McKee Webmaster Patrick Riepe Creative Media Specialist Katy Stites Correspondence, including requests to be added to or removed from the mailing list, should be directed to: Debra Venzke University of Iowa College of Public Health 145 N. Riverside Dr. 100 College of Public Health Bldg., Rm S173 Iowa City, Iowa 52242-2007 debra-venzke@uiowa.edu

Visit our website cph.uiowa.edu Follow us

Edith Parker

8 Big Questions about COVID-19

6 11 14

Faculty and alumni experts answer “big picture� questions about the pandemic and public health.

Pandemic 101: Real-World Lessons for Public Health Students

The novel coronavirus is providing public health students with unique learning opportunities.

Celebrating a Historic Graduation

Despite the disruptions posed by the pandemic, the public health Class of 2020 is ready to change the world.

16 LOOKING AHEAD

The college and university are planning carefully for the next steps in a challenging situation.

18 PREVENTING ADVERSE CHILDHOOD EVENTS

Professor Corinne Peek-Asa discusses how preventing childhood trauma could result in a lifelong trajectory of improved health.

20 HAPPENINGS

News and research findings.

24 CLASS NOTES

Alumni news and notes.

25 GALLERY

Alumnus Ghazi Kayali tracks viruses transmitted between animals and humans.

26 SPARK

The University of Iowa prohibits discrimination in employment, educational programs, and activities on the basis of race, creed, color, religion, national origin, age, sex, pregnancy, disability, genetic information, status as a U.S. veteran, service in the U.S. military, sexual orientation, gender identity, associational preferences, or any other classification that deprives the person of consideration as an individual.

The university also affirms its commitment to providing equal opportunities and equal access to university facilities. For additional information on nondiscrimination policies, contact the Director, Office of Equal Opportunity and Diversity, the University of Iowa, 202 Jessup Hall, Iowa City, IA, 52242-1316, 319-335-0705 (voice), 319-335-0697 (TDD), diversity@uiowa.edu. W42599/7-2020

1 INSIGHT SPRING 2020

PUBLIC HEALTH TACKLES THE NOVEL CORONA VIRUS

2 INSIGHT SPRING SPRING2020 2020

hile COVID-19 has upended nearly every aspect of society, public health practitioners have been working diligently to fulfill their guiding mission: to prevent illness and injury and protect population health.

Faculty, staff, and students in the UI College of Public Health have been putting their skills to use at the forefront of the pandemic response in numerous ways, including analyzing data and creating epidemiological models, testing the efficacy of personal protective equipment, and communicating evidence-based information about the novel coronavirus to vulnerable populations.

The following stories illustrate just a few of the valuable contributions members of the CPH community have made in helping to inform and protect our campus, state, and nation as the COVID-19 pandemic unfolds.

Modeling Iowa’s Pandemic Projections A team of University of Iowa faculty, led by Joseph Cavanaugh, professor and head of biostatistics, worked with the Iowa Department of Public Health (IDPH) to analyze data and develop predictive models to help Iowa respond to the COVID-19 pandemic.

The project consisted of three phases. The first phase was to critique a frequently cited model developed by researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. The IHME model provides both national and state-specific projections for hospitalizations, ICU and ventilator needs, and mortality.

The second phase was to develop Iowa-specific models using data from publicly available sources that provide similar projections. The third phase involved refining those models using data prepared by the IDPH, so that the models are uniquely tailored to Iowa.

The team also developed an interactive tool to model the effects of social distancing and face masks/shields could have on the future course of the disease in Iowa. The modeling application is available to the public at https://covid-19.publichealth.uiowa.edu/.

Modeling the trajectories of outcomes related to an epidemic presents a daunting challenge, one that is complicated by the unprecedented nature of the COVID-19 pandemic.

“The most comprehensive epidemic modeling approaches attempt to characterize the spatio-temporal dynamics of infectious individuals as they network and interact with

susceptible individuals, thereby exposing many of them to the virus, and subsequently increasing the incidence of infection,” Cavanaugh explains. “Infectious individuals will either recover from the disease, and presumably develop an immunity, or will succumb to the disease. In either case, they are removed from the susceptible population. With COVID-19, the dynamics are exacerbated by how easily the virus is transmitted, and by the relatively high MODELING THE percentage of infected TRAJECTORIES OF individuals who will require hospitalization.

OUTCOMES RELATED “There is a well-known TO AN EPIDEMIC adage among statistiPRESENTS A DAUNTING cians that ‘All models are wrong, but some CHALLENGE, ONE are useful,’” Cavanaugh THAT IS COMPLICATED continues. “A model

BY THE UNPRECEDENTED cannot possibly capture all of the complexities NATURE OF THE and nuances of any COVID -19 PANDEMIC. naturally occurring phenomenon. However, if it appropriately characterizes the most salient features, it can be successfully used for prediction, as well as for quantifying the uncertainty associated with prediction.”

Since COVID-19 is likely to remain a concern until a vaccine is developed, the team is hoping to continually adapt its models to provide projections after the first wave of the pandemic has passed.

“The more data that is collected, the better we will be able to refine the models,” Cavanaugh says. “Once the state has the capacity to test large numbers of individuals, including those who are asymptomatic, the resulting data should serve to substantively improve the models.”

Joseph Cavanaugh

3 INSIGHT SPRING 2020

Speaking to Communities in Their Language Media channels are flooded with updates about the rapidly evolving coronavirus pandemic, but much of this information may be inaccessible for members of refugee and immigrant communities for whom English is limited.

To help close this gap, Will Story, assistant professor, and Nicole Novak, an assistant research scientist, both in the Department of Community and Behavioral Health, collaborated with local partners to produce videos about COVID-19 in multiple languages.

Story worked with the Congolese Health Partnernship (CHP), an organization founded as a partnership between the UI College of Public Health, University of Iowa Hospitals & Clinics, and leaders in the Congolese community.

“There was a need to both provide better access to culturally and linguistically appropriate health care services in our community, but there was also a need to build trust between our providers and our community,” says Story.

To combat misinformation and confusion about the coronavirus pandemic, CHP created a video series called Protecting Our Community to provide information about the coronavirus, how to prevent it, and how to seek care in English, French, Lingala, and Swahili.

“We want to make sure people in the Congolese community are aware of what is going on with COVID-19, and think it makes sense for people to hear this information from people in their own language,” says Peter Nkumu, CHP member.

To reach additional populations, the group produced videos in Arabic, Kinyarwanda, and Spanish.

“This disease is hitting people of color disproportionately, so that is reason alone to reach out to the immigrant community to get the word out that they need to pay attention to this and make sure they are following guidelines to stay healthy,” Nkumu says.

Nicole Novak

4 INSIGHT SPRING 2020

Will Story

Novak collaborated

PROVIDING UNDERSERVED with Manny Galvez, POPULATIONS ACCESS TO owner and editor of El RELIABLE INFORMATION

Trueque Iowa, to produce a series of videos about FROM TRUSTED SOURCES COVID-19 in Spanish for IS AN IMPORTANT STEP Iowa’s Latino community.

“Some state agencies IN ADDRESSING RACIAL and other organizations AND ETHNIC HEALTH were working to develop DISPARITIES. materials in Spanish, but the information wasn’t reaching enough people and there was still a lot of misinformation and fear in the community,” says Galvez, who posts the videos on El Trueque’s Facebook page. “I wanted to educate the Latino community about coronavirus and also inform them about their rights as workers, how to find potential economic supports, and how to care for their mental health during this time.”

“We started by building off the excellent information that Will Story and his partners at the Congolese Health Partnership assembled,” Novak explains, adding she and Galvez worked with several other partners to develop additional videos.

Providing underserved populations access to reliable information from trusted sources is an important step in addressing racial and ethnic health disparities.

“When community members are educated on a topic and understand their rights and the services that are available to them, they can take appropriate action,” says Galvez.

Safely Prolonging the Use of PPE University of Iowa Hospitals & Clinics was one of the first in the U.S. to use an innovative technology in a new way to extend the use of personal protective equipment (PPE), which is especially important in the COVID-19 pandemic. Now, it’s working with other leading medical centers around the country to refine the process, thanks to a partnership with the UI College of Public Health.

“This is just one example of what can happen when you combine ingenuity with world-class health care and academic expertise,” says Suresh Gunasekaran, chief executive officer of UI Hospitals & Clinics and associate vice president of UI Health Care. “We’re fortunate to have all those resources here in one place to help Iowans and people across the country.”

UI Hospitals & Clinics developed an N95 respiTHE HOSPITAL NOW rator decontamination HAS THE CAPACITY TO process using a unique REPROCESS ABOUT 1,000 technology known as N95 MASKS EACH DAY. ionized hydrogen peroxide or SteraMist.

The reprocessed equipment must meet safety standards; Patrick O’Shaughnessy, professor of occupational and environmental health in the UI College of Public Health, ensures that vital step is not overlooked.

O’Shaughnessy is a certified industrial hygienist and scientist who researches the efficacy of respirators and other protective equipment. He directs the UI Heartland Center for Occupational Health and Safety, one of 18 such centers funded by the National Institute for Occupational Safety and Health.

O’Shaughnessy recently confirmed that a further modification of the decontamination process developed by UI Hospitals & Clinics can safely reprocess N95 respirators up to six times without a significant reduction in functionality. The original process allowed up to four cycles of decontamination.

“He’s currently helping us refine our protocol to see if we can extend their useful life any more,” says Mike Hartley, emergency manager at UI Hospitals & Clinics, who helped lead development of the decontamination protocol.

“He and the UI Heartland Center have been, and continue to be, critical players in this effort.”

The reprocessing process used by UI Hospitals & Clinics is currently one of the methods described by the Centers for Disease Control and Prevention under its crisis standards of care decontamination recommendations. Thanks to a collaboration of teams from UI Health Patrick O'Shaughnessy Care Central Sterilizing Services, Emergency Management, Employee Health, the Program of Hospital Epidemiology, the State Hygienic Laboratory, and the College of Public Health, the hospital now has the capacity to reprocess about 1,000 N95 masks each day.

“It’s been a lot of work alone in the lab, but also very rewarding to be able to provide information that can be used to ultimately aid our health care workers who depend so much on PPE to maintain their good health during this pandemic,” O’Shaughnessy says.

“We’re extremely grateful to everyone involved in this effort and all the efforts to help keep our patients safe,” says Gunasekaran.

5 INSIGHT SPRING 2020

Big Questions

about COVID-19 Faculty and alumni experts answer “big picture” questions about the pandemic and public health.

In a matter of months, the novel coronavirus has dramatically changed how we live, work, eat, learn, travel, and socialize.

Public health has been an integral part of responding to the crisis and shaping how we move forward into a new reality, yet many aspects about the virus remain unknown. We asked several faculty and alumni experts “big picture” questions about how the COVID-19 pandemic has reverberated through their respective areas of public health and what may lie ahead.

6 INSIGHT SPRING 2020

How has the State Hygienic Laboratory coped with the surge of testing for COVID-19 along with its usual load of newborn screening, environmental testing, and other communicable disease testing?

I’ve worked in clinical microbiology and public health for more than 40 years, and this is the most challenging moment in my career. It may not be the biggest public health threat faced by Iowa’s State Hygienic Laboratory (SHL), which began in 1904 and weathered the 1918 pandemic and assorted other outbreaks over the decades, but it’s close. In public health, we meet whatever problems nature presents us with, and I’m privileged to work with a tremendously talented, professional, collegial, and committed team of colleagues.

Since mid-February SHL staff has worked, quite literally, nonstop to manage an ever-accelerating inflow of COVID-19 specimens and turn around results to health care providers at a record pace.

As of May 6, as Iowa has entered what I believe to be the initial crest of the virus outbreak, SHL had processed more than 30,000 specimens. In addition to getting individual patient tests from clinics across Iowa, we’ve processed thousands of tests from our “strike teams” at meat packing plants and long-term care facilities. As a result, our staff is working nearly 24 hours a day, seven

days a week, and we’ve added new staff, volunteers, and equipment to help keep up with the demand.

In the meantime, we’ve managed to continue processing tests that have typically been the foundation of SHL’s lab work: newborn screening, well water and other environmental testing, and foodborne illness testing, among others. Because of the dramatic impact COVID-19 has had on Iowans’ lives, and because people are largely staying home, however, requests for these tests are down dramatically. We imagine these numbers will increase over time as the pandemic eases.

In the meantime, we’re grateful to have all the bandwidth we can get to help turn the tide on this historic public health challenge.

—Michael Pentella, director of the State Hygienic Laboratory at the University of Iowa and clinical professor of epidemiology, UI College of Public Health

What are some of the reasons that health experts are urging the permanent closing of live wildlife markets around the world?

As a DVM, PhD, epidemiologist studying zoonotic diseases, my career has focused on determining factors that lead to “spill over” of animal diseases to people. Live wildlife markets, known as “wet” markets, are linked to the 2003 SARS outbreak and COVID-19. Within live wildlife markets there are many potentially risky interactions, including close proximity of shoppers, vendors, and both live and dead animals. Stress of transport and holding wild animals in these crowded markets creates an environment where viruses are able to spread from one species to another. Viruses subsequently “spill over” to humans through handling and consumption of wildlife, potentially starting highly contagious outbreaks of new and deadly diseases for which we have no natural immunity.

Wet markets in particular pose a threat to global public health because wildlife comes from many different locations without any standardized sanitary or health inspection processes. The risk to food buyers, beyond consumption, is also through slaughter of animals, which can release diseasecarrying fluids like blood, saliva, and excrement into the air and onto nearby people.

Approximately 60-75% of emerging infectious diseases are zoonotic and originate from wildlife.

Ebola, MERS, and Nipah virus all originated as bat viruses. SARS and SARS CoV-2, cause of the COVID-19 outbreak, have bats as original hosts.

China recently banned trade and consumption of wild animals, including bats, in the wake of COVID-19, but there are significant loopholes relating to current legal trade of wildlife for medicinal purposes. China took similar steps after the 2003 outbreak, but lifted restrictions after perceived risk decreased.

Banning trade of wildlife in live markets is not trivial, as there is dire need for low-cost protein sources, and success will require engagement of societies to understand the risks vs. benefits of this type of trade. Despite this, to protect human health from future emergent zoonoses, live markets, which provide concentrated interactions with wildlife, must stop.

—Christine Petersen, director of the UI Center for Emerging Infectious Diseases and professor of epidemiology, UI College of Public Health

Nonprofits and service organizations are responding to an increased need for food, financial support, and other essentials due to the pandemic, especially among vulnerable populations. What are some of the greatest needs your organization is seeing?

Data coming out of several states—Hawai’i, Washington, California, and Oregon—indicate that Native Hawaiians and Pacific Islanders are seeing higher rates of COVID-19 cases in comparison to other ethnic groups in these respective states. The Micronesian Islander Community (MIC) organization, a statewide organization based in Oregon, is seeing high demand for rental and utility assistance, food insecurity, and a request for specific personal protective equipment and other supplies to prevent the spread of COVID-19. Specific personal protective equipment includes

7 INSIGHT SPRING 2020

masks and gloves, and supplies such as disinfectant wipes and hand sanitizer.

MIC is currently identifying financial resources and supplies within the state and national programs that are able to provide funding or a significant donation of supplies to support our community needs.

MIC has been able to secure a limited amount of funding to purchase cloth masks to distribute to community members and to provide limited support for families facing financial hardship.

MIC is also distributing food boxes and fresh produce, in partnership with a local food share agency, on a weekly basis. So far, we have been able to support our communities in Oregon and in parts of Washington.

— Jacqueline Leung (10MS), executive director and public health advocate, Micronesian Islander Community, Salem, Oregon

What are some of the factors that make nursing homes and other long-term care facilities more susceptible to infectious disease outbreaks?

Long-term care facilities, nursing homes in particular, are vulnerable to infectious diseases outbreaks because they house a large number of older residents with multiple chronic conditions in a closely confined place. In addition to the vulnerability of the residents, facilities are often poorly equipped to handle outbreaks of diseases such as COVID-19. Even though there are rules on how to approach infection prevention and control, these facilities may have staff shortages or employees that are poorly trained. There’s a high turnover of staff in these facilities, and any experience/training in handling such outbreaks may not continue from year to year.

Many residents in these facilities congregate for meals and other events, potentially exposing themselves to others who may be infected. Moreover, there is also a risk of staff infecting residents.

There are many steps nursing homes can take to better prepare themselves for infectious disease outbreaks. In the short term, nursing homes should focus on testing both residents

8 INSIGHT SPRING 2020

and staff for COVID-19, isolating residents with symptoms, and providing support for residents in isolation.

Nursing homes should also work closely with area hospitals to ensure that residents in need are taken to the hospital in a timely fashion.

On a longer term basis, we need adequate staffing at nursing homes. Also, nursing homes need to not only train their staff on the infection prevention and control policies, but also assess the implementation of the policies.

Nursing homes and long-term care facilities in general have seen low reimbursements from Medicaid for decades. If these facilities are to improve staffing, expand their training of staff, and evaluate whether the policies prescribed in the manuals are implemented, they need more funding.

— Hari Sharma, assistant professor of health management and policy, UI College of Public Health

How have isolating at home and practicing social distancing increased the risk for injury and violence, especially in rural areas?

Social distancing has had broad impact on injury and violence. Violence is perhaps the biggest concern, with a focus both on suicide and family violence. Isolation is a well-known factor that can exacerbate depression and is a risk factor for suicide, so we are watching trends for suicide and suicide attempts. The outbreak itself causes a type of unpredictable stress that can be particularly concerning for vulnerable populations.

Similarly, isolation and stress can be risk factors for family violence. When children aren’t in school, they are removed from mandatory reporters who can help protect or refer families to resources (and the resources themselves may not be operating as usual). Community agencies have been working hard to stay connected to vulnerable populations, but maintaining the usual level of care has been very challenging. Some news outlets have reported increases in gun permits and

sales, and we don’t yet fully know what impact this will have on deaths, but there is concern with suicide, interpersonal violence, and unintentional shootings.

Home injuries are another area we’ve been tracking. Most children are injured in their homes, often from doing fairly normal kid-like things, such as jumping off the dresser. Parents, trying to juggle childcare, work, and many other things, may not have the time to supervise kids the way they normally might.

We had initially thought that one area in which we would see reduced risk would be transportation injuries—because fewer people are using the transportation system. But that hasn’t been the case. Some states have reported very little or no reduction in the number of motor vehicle fatalities, and we suspect that risky driving has greatly increased. So, even though fewer people are driving, the risk per mile driven is actually higher. We’ll need to study this issue much more to understand the trends and their causes.

— Corinne Peek-Asa, director of the UI Injury Prevention Research Center and professor of occupational and environmental health, UI College of Public Health

What are some of the ways employers can support their employees as they return to the workplace or continue to work from home?

As we move toward recovery, now is the time for employers take operational steps to ensure the health and safety of their employees. The items below are some of the points to consider when developing return-to-work programs, policies, and procedures.

Initial planning for return-to-work includes: 1) determine which employees are most essential to business operations and economic recovery and prioritize their return to work first; 2) define which job roles and tasks can continue to be performed remotely and consider adopting permanent telecommuting policies; 3) maintain workplace controls for onsite operations, including hygiene, sanitation, screening, and reporting protocols; and 4) continue to follow public health guidelines

regarding special accommodations and protections for vulnerable or high-risk employees.

Future considerations include: 1) when a vaccine becomes available, consider opportunities to make prevention affordable and accessible for all employees (and family members, if possible); 2) document best practices and lessons learned from COVID-19 for application in future pandemic planning efforts; 3) develop a business continuity plan to minimize operational, financial, and workforce-related risks during an emergency; and 4) establish an infectious disease response team with representation from multiple departments, including safety, health, technology, communications, human resources, and benefits.

The items in these checklists are taken from the Total Worker Health® Employer Guide: COVID-19 Edition. The guide is the result of the collaboration of the College of Public Health’s Healthier Workforce Center of the Midwest with the St. Louis Area Business Health Coalition, the Nebraska Safety Council, and the University of Kansas School of Medicine-Wichita. The guide can be found at hwc.public-health.uiowa.edu/employer-guide/.

— Diane Rohlman, director of the Healthier Workforce Center of the Midwest and professor of occupational and environmental health, UI College of Public Health

How are Iowa’s small hospitals being impacted financially by the pandemic?

COVID-19 has had an undeniable impact across the globe. The impact on our physical health can be devastating, but there are also economic, social, and psychological impacts that will be felt for years. Many businesses have temporarily closed their doors, lost significant revenue, and laid off employees. One might conclude that health care organizations are immune from this as we are the most needed during a pandemic. However, this is not the case. Health care organizations all across the state canceled elective procedures, dramatically

9 INSIGHT SPRING 2020

reduced ambulatory visits, and completely closed certain service lines in order to reduce the spread of the virus and conserve PPE. It’s these types of surgeries, procedures, and visits that pay the bills for hospitals and help support services that lose money in health care. This is true for all hospitals, but even truer for rural hospitals.

The services deemed as elective and able to therefore be canceled or pushed back are mainly outpatient services which make up over 90% of rural hospitals’ income.

At Buchanan County Health Center, we anticipate a loss of $3.5 million in revenue from March through July. We have received federal funding that will blunt a lot of this initial loss, however, there is still uncertainty about the business model moving forward.

Our new processes will require additional staffing, volumes may still be down as patients scrutinize going to hospitals (sometimes appropriately and other times not), and there remains the lingering threat of a second wave that will create financial issues as we experienced this spring.

Overall for BCHC, the government has stepped up to assist us financially to get through this incredibly difficult path. The concern remains the long-term impact and business model moving forward. Our new norm will be providing the care we are accustomed to providing in an era of COVID-19.

— Steve Slessor (08MHA), chief executive officer, Buchanan County Health Center, Independence, Iowa

Local public health departments play an important role in the pandemic response. What are some of the strategies that the public health department has taken to address COVID-19 in Washington County, Iowa?

Washington County is in a unique position.

We’re a rural county on the southern tip of the Cedar Rapids–Iowa City corridor. Many of our residents commute for work, health care, and entertainment, so our opportunity for COVID-19 spread and infection is everywhere.

We’re also unique in that we have a large Amish population in the northern part of our county. Luckily, we’ve established a relationship with them via our childhood immunizations in Kalona over the years, so as we reached out to Amish Bishops, they were inclined to respect our guidance and work with us on ways to continue to meet their needs safely. I maintained at least weekly communications with one Bishop who would call to find out updates, learn how to have church services safely, and ask questions his community members had come up with.

We also have a robust Latino population, and many live with extended family members. We partnered with our local leaders from Latinos for Washington, Inc. to ensure we were able to spread information to the community about the dangers of COVID-19. The impact of meat-packing plant outbreaks has hit our Latino population hard. Fortunately, we have a staff member who is a leader in Latinos for Washington, and having her help with translation and disease investigation allows us to get more information to these residents, because it comes from someone they trust.

She is absolutely invaluable during this process.

Lastly, I partner with my local emergency manager, Marissa Reisen, to spread information. She and I work closely together in our response, and we do an informal Facebook Live Q&A every Wednesday where we answer questions and try to decipher the never-ending stream of information in a way that’s easy to digest and relatable. It’s been very well received by the community.

—Danielle Pettit-Majewsk (10MPH), administrator, Washington County Public Health and Home Care

10 INSIGHT SPRING 2020

Anne Abbott with a trail etiquette sign.

Pandemic 101: Real-World Lessons for Public Health Students The novel coronavirus is providing public health students with unique learning opportunities.

ust a few months ago, lectures about the 1854 London cholera outbreak or the 1918 Spanish flu pandemic might have seemed like ancient history to students. Now, as the world confronts unprecedented challenges associated with the COVID-19 pandemic, public health students are witnessing— and actively participating in—an extraordinary moment in their chosen field of study.

For Jessica Allen, a junior majoring in public health, her spring 2020 internship at the Johnson County Public Health Department provided an insider’s view into the early days of the novel coronavirus pandemic in Iowa.

“I’ve been able to watch this virus grow from an outbreak in China to a global pandemic to eventually a local emergency,” Allen says.

She assisted her internship supervisor on COVID-19-related projects during the county’s preparedness stages, including creating documents that were sent to people being monitored for COVID-19.

In March, the pandemic prompted the University of Iowa to close much of campus and move to virtual classes, meaning Allen’s internship also had to switch gears.

“After spring break, I had to finish my internship from home in West Des Moines,” Allen says, She completed a vaccine policy project, “but I wish I could have been able to witness more on how county public health departments handle pandemics,” she says.

11 INSIGHT SPRING 2020

Jessica Allen hiking in Colorado pre-pandemic.

Public Health in Action

Crafting Communications

Coronavirus in the Curriculum

Kaci Ginn, a second-year undergraduate public health student, was able to work on-site for her internship with Jones County Public Health in Anamosa, Iowa. Ginn worked with the public health department in coordination with emergency management and other community and state partners to plan and coordinate the county’s response to COVID-19. Her duties ranged from assisting with contact tracing and disease follow-up to communications and social media coordination.

“Being able to incorporate what I’m learning about public health emergency preparedness as well as coordinating public health’s response with the emergency manager in the county has been an amazing opportunity to see the greater reach of public health activities in practice,” Ginn says.

Experiencing classroom lessons being translated into real-life actions has made an impact on Allen as well.

“I believe this pandemic has cemented my decision about being a public health major,” Allen says. “Not only have I been able to see firsthand all of the public health information I’ve learned in college being put to use in the world, but I’m also able to explain to my family what is going on in a way that they can understand.”

As the pandemic unfolded in early March, UI administration asked the College of Public Health to help develop an awareness campaign about the importance of social distancing.

A group of CPH students and faculty, including Elizabeth Chrischilles, Jim Torner, Maggie Chorazy, Natoshia Askelson, and Ryan Carnahan, led

by Rima Afifi, professor and head of community and behavioral health, crafted a series of evidence-based messages that were distributed through university social media channels.

Several CPH students also spearheaded the creation of a university web page that lists resources for emergency housing, food, financial, and mental health assistance for students and others in the campus community.

Another group of CPH students produced a series of podcasts about COVID-19, interviewing experts on topics such as preparedness, exposure risks, protective measures, disease modeling, telehealth, and more. The podcast, From the Front Row, was recently recognized as one of the 30 best public health podcasts for 2020

by MPH Online.

Not surprisingly, faculty incorporated COVID-19 into the semester’s coursework. Undergraduates in the class Global Public Health, taught

by Kelly Baker, assistant professor of occupational and environmental health, learned about the global burden of respiratory infections and how they spread or can be prevented; how diseases emerge and the role of animals in outbreaks; and the role of social behavior and environment in pathogen spread. Students also worked on group projects to design interventions to prevent COVID-19 in refugee camps.

Renée Anthony, professor of occupational and environmental health, teaches the graduate course Occupational Safety. As part of their coursework, students normally consult on-site with local small businesses and provide recommendations on fire safety, hearing protection, and trip and fall hazards. This spring, the class had to quickly adapt as many area employers shut down normal business activities and the university moved to online classes.

“We had to think creatively and changed the class projects to focus on developing safety recommendations and materials for people working at home,” says Anthony.

12 INSIGHT SPRING 2020

Kaci Ginn outside the Jones County Public Health office.

Laura Tvedte, a master’s student in the industrial hygiene program, completed the Occupational Safety class from her hometown of West Branch, Iowa. Taking classes remotely gave Tvedte insight into some of the issues of working from home.

“Not having a proper work station setup is a challenge for me, and it’s difficult to not see people and be socially isolated,” she says. “These are some of the areas that our team addressed, along with chemical safety, electrical safety, and helping essential workers.”

The class solicited questions and concerns from employees working at home and created a website with safety materials, ergonomic tips, and more.

“This project focuses on specific ways that individuals can socially distance while they are using outdoor spaces like parks, trails, and sidewalks,” Abbott explains. “A group of students and others from the college reviewed the research on how respiratory viruses spread, developed the messages, and worked with a designer to create the materials.”

Abbott says the response to the signs and social media images has been positive.

“So far it’s been great! We’ve had a lot of statewide groups tell us how thankful they are for the materials and how much they think they are needed,” she says. Going forward, Abbott hopes to gather formal feedback and conduct a basic evaluation of the project.

plan and provide funding for emergency preparedness for the sake of all of our health and safety.”

“In times of crisis, systems that have been weakened from years of neglect or lack of funding can begin to break down,” Ginn adds. “As we work through this pandemic, interventions must be considered in terms of complete systems in order to support entire communities.”

A New Awareness

Materials for outdoor social distance: https://prc.public-health.uiowa.edu/ novel-coranovirus-covid-19-resources/

Keeping Your Distance As states ease restrictions and “quarantine fatigue” sets in, the need for physical distancing and other precautions remains, even in the great outdoors.

Anne Abbott, a PhD student in community and behavioral health, collaborated with local parks and recreation departments to produce materials that build awareness of social distancing etiquette while using outdoor public spaces.

Thematerials are free and available for anyone to download.

While the devastating impact of the COVID-19 pandemic is far reaching and much remains uncertain, Allen, who will enter her senior year in the fall, hopes the crisis sparks a new awareness of public health.

“I heard this phrase one time, ‘No one knows what public health is until we need it,’ and that is very true,” she says. “I hope this pandemic has opened the public’s eyes about the importance of public health and how vital it is to

----

Links From the Front Row podcast: https://soundcloud.com/uiowacph Occupational Safety working from home resources: https://occsafety.course. uiowa.edu/

13 INSIGHT SPRING 2020

Celebrating a Historic Graduation

14 INSIGHT SPRING 2020

Despite the disruptions posed by the pandemic, the public health Class of 2020 is ready to change the world.

raduations usually involve caps, gowns, and gatherings of friends and family, but this spring, COVID-19 forced the pomp and circumstance to move online. The UI College of Public Health celebrated its Class of 2020— which includes the college’s first cohort of students to graduate with bachelor’s degrees in public health—with a virtual ceremony.

The College of Public Health began offering the undergraduate program four years ago. Five undergraduates completed their degrees in December 2019, and an additional 45 finished this May. Bachelor’s degree recipient Autumn Moen delivered remarks to her classmates, reflecting on the historic events intertwined with the end of their undergraduate careers. “Never in a million years would I have imagined it this way,” she said about commencement.

“But we study public health. We knew a virus like this could easily become a pandemic. Yet every day as we learn more, I continue to be astounded, and sometimes in disbelief. I also sometimes find myself laughing about how

insanely ironic it is to be having a virtual graduation for the first class of public health majors because we are in the middle of a pandemic.”

While Moen admitted it can be difficult to cope with a constant influx of unsettling news, she pointed to the stories of people helping their neighbors and cheering on health care workers. “These stories of humanity bring us together and give us hope, and that’s something we need right now.”

The good news is, she continued, “there are a lot of jobs available in public health these days. Our class will go on to be infectious disease epidemiologists, we will be doctors, health administrators, and policy makers.

We will be the ones to take on the health issues tied to climate change.

We will fight for health equity and a health care system that works for everyone. When this is all over, and it will end eventually, we will go out there and change the world. Even in a time of extreme unknowns, that is something I am confident about.”

Ian Buchta, who earned a Master of Public Health degree in epidemiology, addressed his fellow graduate students.

“Our time in person was cut short,” he said, referring to the sudden shut down of campus. “This semester, I missed seeing friends before classes, running into acquaintances in the halls and computer labs, and dropping in on friends an office away. And here in graduation, walking and receiving a degree won’t be a part of our story. It’s okay to take a moment to grieve what we lost, even as we celebrate what we have achieved and endured together.”

Buchta went on to say, “But after that moment when we process and reflect, we must steel ourselves to serve a world that so desperately needs us. If nothing else, this crisis has shown that the world needs public health’s expertise and passion. And this extends beyond just the obvious pandemic. All of the inequalities, injustices, and chronic conditions that we studied together are just as dire as before the pandemic, and from what we have seen so far, likely even increasing in their harms. I hope that this crisis gives us the impetus to turn the world upside down, and fulfill our calling as public health practitioners: to bring health to all people.”

College of Public Health Dean Edith Parker recognized the undergraduates for blazing a new path. “You are the first cohort to complete a public health bachelor’s program in the state of Iowa,” she said. “In many ways, you helped us build and shape this program. Your pioneering spirit and your enthusiasm for public health have been hallmarks of your class. Your energy and fearlessness will always be your legacy here at Iowa, and I trust wherever you go in the future.

“And to all our graduates, I think you know today that the mission of public health has never been more critical than it is right now,” Parker said. “The public health skills you have learned in your coursework and research programs and the values you live out every day are the key to addressing the current pandemic, preventing future global health disasters, and ensuring a more just, secure future for everyone.”

15 INSIGHT SPRING 2020

Looking Ahead The college and university are planning carefully for the next steps in a challenging situation.

etting a mammoth public research university to pivot on a dime is no small feat, but this spring the University of Iowa rapidly changed course in a matter of weeks in response to the threat of the novel coronavirus.

Classes were moved online, residence halls and campus buildings were shuttered, research was slowed or halted, and most non-medical faculty and staff were sent home to work remotely. Within the College of Public Health, these huge changes were successfully orchestrated by dedicated administrators, faculty, staff, and students. A special nod goes to the staff of the Office of Information Technology and Office of Teaching, Learning & Technology at both the university and college levels, who ensured the transition to working and learning remotely was as seamless as possible.

“I want to thank all the members of our college for the extraordinary efforts they have made and continue to make every day to respond to the unprecedented challenges facing us at this time,” says Edith Parker, dean of the College of Public Health. “This crisis has required each of us to adapt to drastically changed circumstances, and I am grateful for the creative, positive ways everyone in our community has responded.”

Going forward, the university will employ a strategy of “right, not fast, as we consider a gradual, purposeful, and safe resumption of daily activities on our campus,” UI President Bruce Herald told the Board of Regents in late April.

The UI has announced that courses for all summer sessions will be conducted virtually and that events scheduled to be held on campus will be canceled through July 31, 2020.

As of this writing, the University of Iowa plans to resume face-to-face instruction this fall.

16 INSIGHT SPRING 2020

Parker is leading the UI Health and Safety Work Group, one of several subgroups embedded within the UI’s Critical Incident Management Team. Additional CPH experts collaborating with the UI on reopening issues include Renée Anthony, Fred Gerr, Corinne Peek-Asa, Laurie Walkner, and Rima Afifi. The teams are creating operational scenarios and guidance that will be used by the campus in order to reopen safely and deliberately.

Parker also represents the University of Iowa as one of 14 members of the Big Ten Conference’s newly formed Task Force for Emerging Infectious Diseases. The task force was formed to provide counsel and sound medical advice to ensure the health, safety, and wellness of the Big Ten’s students, coaches, administrators, and fans.

In addition to the pandemic’s toll on physical and mental health, the crisis is resulting in deep economic and social costs both globally and close to home. Since March and projected through August, the university, not including UI Hospitals & Clinics, will lose an estimated $76 million.

Despite these challenges, the University of Iowa has many strengths, foremost among them its creative and collaborative community of alumni, faculty, students, and staff.

“As we all know too well now, change is one of the only things you can count on in life. But there is no place better at embracing change than the University of Iowa,” Herald said in a message to campus. He continued, “Over the summer and into next fall, we will chart a course that will allow our campus to take charge of as much of our future as we can.

We will expect change, and we will react to it as thoughtfully and carefully as we can. Working together, with a common purpose, we can be the change we want in the world.”

Updates on the UI’s plans and procedures can be found at coronavirus.uiowa.edu.

Majors: Public Health and International Relations Involvement: University of Iowa Student Government; College of Public Health Diversity, Equity, and Inclusion Committee; Iowa Agni A Capella; 24:7 Campus Ministry Scholarship: College of Public Health Dean’s Scholar

GIVE A STUDENT ACCESS TO IOWA

Highly engaged students like Anna exemplify the deep commitment to community service that is a hallmark of public health. You can bring Iowa’s top-quality public health education within reach for other outstanding students by supporting scholarships in the College of Public Health.

Learn more by contacting College of Public Health Director of Development Madelynn Krall at madelynn.krall@foriowa.org or 319-467-3645, or you can make a gift online.

Givetoiowa.org/2021PQ99 17 INSIGHT FALL 2019

17 INSIGHT SPRING 2020

Preventing Adverse Childhood Events

BY ALISON MCGAUGHEY

orinne Peek-Asa has devoted much of her research career to violence and injury prevention. She is an associate dean for research in the University of Iowa College of Public Health and professor in the Department of Occupational and Environmental Health. She also directs Iowa’s Injury Prevention Research Center (IPRC) and is an appointed member of the National Academy of Medicine’s Global Violence Prevention Forum.

In May 2020, Peek-Asa was named an inaugural awardee of the new UI Distinguished Professorship program by the University of Iowa Office of the Provost.

The program recognizes tenured scholars of national and international distinction who are having a significant positive impact within the state of Iowa and beyond through teaching, research, scholarship, and artistic creation.

The Distinguished University Professor ranks highly among the honors bestowed by the UI on faculty members.

In February 2020, Peek-Asa delivered the 37th annual UI Presidential Lecture, “Violence, Syndemics, and the Biology of Trauma.” She delved into these topics in a recent Q&A.

Why is childhood trauma so important to the research you focused on in your lecture?

We’re learning about how trauma and violence in early childhood not only impact your development but can do so in a way that sets you up for many different health problems.

So this leads to the question, if we can prevent extreme childhood adversity, traumatic stress, and abuse, can we show a lifelong trajectory of improved health? We need to 18 INSIGHT SPRING 2020

look at a lot of outcomes, and the framework that takes this approach is called a syndemic.

Adverse childhood events, or ACEs, are traumatic experiences that impact brain development, causing a cascade of reactions that influence long-term health. These types of trauma can include emotional abuse and neglect, physical and sexual violence, household violence, substance abuse, mental illness, and even parental separation or divorce.

Increasingly—all over the world, but especially in the U.S.— ACEs are being recognized for their damaging impact on brain development. This concept is recognized as the biology of trauma. In short, the brain will organize around the most common and intense experiences, turning them into a baseline, defining what is normal. We know that people with six or more ACEs have a life expectancy 20 years shorter than those with none.

How does a syndemic differ from an epidemic, and how does one unfold? Are we experiencing any syndemics in the U.S.?

As we know, an epidemic is a health problem affecting a large number of people that has increased beyond what was anticipated. In addition to the current COVID-19 pandemic and opioid epidemic in our country, we’re also dealing with an epidemic of suicides and substance use. According to a report from the nonprofit Trust for America’s Health, this can actually be seen as a larger “epidemic of despair.” A syndemic is a cluster of related epidemics—synergistic epidemics— which are epidemics that have related causal factors and outcomes and involve larger social determinants.

that when the country joined the European Union, new roads were built in ways that did not accommodate pedestrians, especially those who had some physical limitations, like the elderly; they were having challenges getting across the road. It became clear that safety had not been a priority in decisions about transportation infrastructure.

So the syndemic framework is helpful in that it shows us we’re not going to solve the problem by installing lights, adding more stop signs or crosswalks, or having police do more patrols. We’re only going to solve the problem by building roads that accommodate all users, and by making health and safety a priority in transportation decisions.

This approach, called “Health in All Policy,” is becoming a higher priority everywhere from the U.S. Department of Transportation to the World Bank.

What kinds of shifts in public health, or society at large, might be required to see more effective prevention or intervention?

Another component of a syndemic is that the underlying causal factors interact with each other. So, for example, a child who falls off of their bike, then gets exposed to a cold virus at the same time is not experiencing interacting causal factors. Instead, imagine a child who is a victim of abuse: suffering from that abuse leads to having a depressed immune system, which then leads them to being susceptible to infectious disease. So, the risk factors are not just parallel—they interact.

Adverse childhood experiences, which have health implications so early in life, are a component of many violence syndemics. Childhood adversity, for example, is an underlying element in many of the “diseases of despair”— substance use, alcohol use, and suicide. The work we do at the Injury Prevention Research Center is pushing the boundaries of how we can address some of the larger social determinants of these violence syndemics.

We need to invest in early childhood injury intervention and prevention programs, and to think much more about health outcomes as a life trajectory. When we think about adverse childhood experiences and their ties to future substance use, we need to realize that a systems-oriented solution goes far beyond helping addicted people in rehab; a systemic approach will prevent the adverse childhood experiences. How do we as a society think about preventing child abuse? That’s a really hard question because it’s such a complex issue. Abuse is often intergenerational. It can be hard to detect. So, while we’re working on answers to this question, I want us to do our work thinking more in the big picture, focus on prevention, and how it can fit into these thorny societal issues.

This article originally was published in Iowa Now.

What sparked your interest in syndemics, and how do you see it being most useful in your areas of research?

The component of syndemics that most interests me has to do with cultural and social determinants. In other words, the nexus of adverse childhood experiences and substance use is concentrated in populations of people with limited access to health care, lower education levels, less access to resources, and fewer social connections. From a public health standpoint, it’s important to address these connections to social inequity and poverty. And that can include changing the way we design our studies to think about these broader contexts.

For example, we have done some studies in Romania showing

Corinne Peek-Asa

19 INSIGHT SPRING 2020

HAPPENINGS

Iowa Superfund Research Program Receives $11.4M to Continue Study of PCBs

CPH Names Outstanding Alumni Award Recipients The University of Iowa College of Public Health has named Ty Borders and Kari Harland the recipients of its 2020 Outstanding Alumni Awards.

Borders earned a Master of Arts degree (1995) and a doctoral degree (1999) in hospital and health administration, and a Master of Science degree (2001) in epidemiology. He is currently a professor and the Foundation for a Healthy Kentucky Endowed Chair in Rural Health Policy and director of the Rural and Underserved Health Research Center at the University of Kentucky.

Harland earned a Master of Public Health degree (2004) and a doctoral degree (2010) in epidemiology, and is now director of research operations in the Department of Emergency Medicine at the UI Carver College of Medicine and adjunct assistant professor with the Department of Epidemiology at the UI College of Public Health.

The award recognizes College of Public Health alumni who have made distinguished contributions to the field of public health and demonstrated a strong interest and commitment to the mission, vision, and values of the college. Read more about this year’s recipients at: cph.uiowa.edu/alumni/.

20 INSIGHT SPRING 2020

The Iowa Superfund Research Program (ISRP), a University of Iowa research group started in 2006 that is a leader in the study of human exposure to polychlorinated biphenyls (PCBs), has received a highly competitive five-year, $11.4 million grant renewal from the National Institutes of Health (NIH) announced in March 2020. ISRP will receive $2.4 million for the first year of the renewal.

“Airborne PCBs: Sources, Exposures, Toxicities, Remediation” is the latest phase of the project, which focuses on the airborne threats posed by PCBs by identifying the ways in which people are exposed, analyzing measurable levels of toxicity, and developing efforts to remediate PCBs already present in natural environments and manufactured structures.

“The Iowa Superfund Research Program is the only program funded by the NIH that focuses on airborne PCBs,” says Keri Hornbuckle, the Donald E. Bently Professor of Engineering in the UI Department of Civil and Environmental Engineering and the project’s principal investigator. “Our research is the result of interdisciplinary collaborations that cover the breadth of the PCB problem— toxicologists and pharmacologists who study exposure; engineers who focus on identifying PCB sources and stopping continued release; and chemists who develop the compounds that can be used to remediate spaces and surfaces.”

The research team includes CPH faculty members Brandi Janssen, Michael Jones, Hans Lehmler, Gabriele Ludewig, Peter Thorne, and Kai Wang.

Study Finds Most High School E-Cigarette Users Report Other Substance Use Nearly all U.S. high school students who use e-cigarettes also use other substances, including alcohol, cannabis, and tobacco products, according to a recent study published in Nicotine & Tobacco Research.

The study assessed the risk of e-cigarette poly-substance use (using an e-cigarette plus at least one other substance in the past 30 days) among adolescents overall and by socio-demographic characteristics.

The researchers used data from the 2017 Youth Behavioral Factor Surveillance System survey. Based on responses from 11,244 adolescents, the researchers found that approximately 12% of high school students reported using e-cigarettes in the past 30 days. Almost all (93%) e-cigarette users also reported using another substance in the past 30 days, with alcohol being the most common.

Nearly half reported past 30-day use of all four substances: e-cigarettes, alcohol, cannabis, and tobacco. In addition, adolescents who used e-cigarettes more frequently were also more likely to use other substances than their counterparts who used e-cigarettes only 1-2 days per month.

The investigators also identified several socio-demographic factors associated with e-cigarette poly-substance use. Being male, being in grades 11 and 12, reporting lower academic achievement, and self-identifying as bisexual were each associated with significantly higher odds of e-cigarette poly-substance use. In contrast,

minority race/ethnicity was associated with lower odds of e-cigarette poly-substance use compared to white peers.

The research team included CPH faculty members Paul Gilbert and Rima Afifi in the Department of Community and Behavioral Health, along with CPH alumna Christine Kava (17PhD) with the Health Promotion Research Center, Department of Health Services, University of Washington.

Romitti Honored for Lifetime Contributions to Birth Defects Research The National Birth Defects Prevention Network (NBDPN), an organization dedicated to birth defects surveillance, research, and prevention, recently recognized University of Iowa Professor of Epidemiology Paul Romitti with the organization’s prestigious Godfrey P. Oakley, Jr. Award. The award is given to an individual who has made significant lifetime contributions to the field of birth defects.

Romitti directs the Iowa Registry for Congenital and Inherited Disorders, a collaborative program of the UI College of Public Health and the Iowa Department of Public Health. He previously served NBDPN as data committee chair, executive committee member, and president for the organization.

21 INSIGHT SPRING 2020

IPRC Report Identifies Five Priorities for Addressing Overdoses The University of Iowa’s Injury Prevention Research Center (IPRC) has released a new report highlighting policy and program recommendations to reduce opioid overdose deaths in rural Iowa.

In 2017, the IPRC convened a group of stakeholders to consider actions to address the opioid crisis.

Health care providers, law enforcement officers, public health officials, and others developed a list of priorities that lawmakers and policy makers could consider.

Some of those priorities were included in a new law passed in 2018. Among them are a requirement that practitioners check the state’s prescription monitoring program before prescribing an opioid to a patient, and strengthened prescriber education requirements on prescribing medications for chronic pain.

In the fall of 2019, the IPRC convened a second group of stakeholders to consider important next steps the state and communities can take in response to the latest developments. The report, Policy and Program Recommendations to Reduce Overdose Deaths in Rural Iowa, identified the five most important priorities: • Develop programs that take a holistic view of treatment and recovery, incorporating support for employment, housing, and other social needs rather than focusing on medication-assisted treatment alone.

• Develop timely communication networks between pharmacists, law enforcement officials, employers, and other stakeholders.

• Provide funding for naloxone access and distribution.

Naloxone is a drug that has proved effective at helping people who have overdosed on opioids, but it’s expensive and not widely available.

• Combat stigma around opioid use disorder. People with substance use disorders are often stigmatized by language used to describe them or their disorder, or the reluctance of medical providers to offer services.

• Consider polysubstance drug use in surveillance, prevention, and treatment efforts.

The full report is available at iprc.public-health.uiowa.edu/.

22 INSIGHT SPRING 2020

Reports Focus on Rural Communities and COVID-19 As the novel coronavirus continues to spread across the country, concern has grown about the availability of health resources in rural communities to meet a potential rapidly increasing need.

The RUPRI Center for Rural Health Policy Analysis has produced a number of reports looking at these issues, including briefs on confirmed cases of COVID-19 in metropolitan and nonmetropolitan areas, an animated map illustrating the progression of cases throughout the country, county-level 14-day trajectories for new confirmed COVID-19 cases, and the availability of hospital and ICU beds in nonmetropolitan areas.

Links to RUPRI’s COVID-19 projects can be found at rupri.public-health.uiowa.edu/.

HAPPENINGS

UI Research Suggests Toilet Flushing Spreads C. Diff in Hospital Bathrooms Recent University of Iowa research suggests that an everyday occurrence—flushing a toilet—may play an important role in the spread of the most common hospital-acquired infection in the United States.

Clostridioides difficile infection affects nearly half a million people and causes about 15,000 deaths annually, according to the Centers for Disease Control and Prevention.

The UI researchers, led by former epidemiology doctoral student Geneva Wilson (19PhD), collected samples from the bathrooms of 24 patients with C. difficile infections at the UI Hospitals & Clinics. Air samples were collected for 20 minutes before and 20 minutes after flushing.

Of 72 samples collected before toilet flushing, 13% tested positive for health care-associated bacteria, such as Enterococcus faecalis, Enterococcus faecium, and C. difficile. After flushing, 26% of samples tested positive.

“We concluded that bioaerosols produced by toilet flushing potentially contribute to hospital environmental contamination,” says Wilson, now a researcher at the Edward Hines Jr. VA Hospital in Hines, Illinois. “Further work is needed to determine the potential risk for infection this contamination presents to patients.”

The findings were published in the journal Infection Control & Hospital Epidemiology.

The UI team included CPH researchers Virgil Jackson, Christine Petersen, Patrick Breheny, and Matthew Nonnenmann, along with Linda Boyken, Marin Schweizer, Daniel Diekema, and Eli Perencevich from the Carver College of Medicine. This study was supported by grants from the CDC Epicenters Program as well as the University of Iowa Heartland Center for Occupational Health and Safety.

CPH to Establish Maternal and Child Health Training Program The College of Public Health has been awarded a new federal grant to build a maternal and child health (MCH) curriculum and provide resources for recruiting a diverse student body interested in MCH research and education.

The grant, funded by the Health Resources and Services Administration (HRSA), addresses a growing and urgent need for a well-trained and diverse MCH workforce, particularly in states with large rural-urban and/or racial disparities.

The project will be directed by Kelli Ryckman, associate professor of epidemiology, with support from William Story, assistant professor of community and behavioral health.

The program will include partnerships with the Iowa Department of Public Health and other HRSA-funded initiatives at the University of Iowa.

23 INSIGHT SPRING 2020

CLASS NOTES TIM AHLERS (05MHA) is CEO of Guttenberg Municipal Hospital & Clinics in Guttenberg, Iowa.

ALEXIS BARBOUR FLORCZAK (06MHA) is system vice president of specialty and surgical services at AMITA Health in Downers Grove, Illinois.

ANN BOBST (14MPH) is legislative liaison, health care administration, at the Minnesota Department of Human Services in Minneapolis, Minnesota.

MICHAEL D. BOYER (92MS) is an environmental health and safety specialist at Ball Aerospace in Broomfield, Colorado.

JACE BRADY (17MHA) is director of imaging, quality and ambulatory operations at Sentara Careplex Hospital in Virginia Beach, Virginia.

TIMOTHY CHWIRKA (12MHA) is an associate consultant at Huron in Des Moines, Iowa.

LANCE A. CLARK (15MHA) is administrator, hospital medicine, at Emory Healthcare in Atlanta, Georgia.

EMMA COLE (19MPH) is a health policy analyst at LMI in McLean, Virginia.

WILLIAM CYRS (09MS) is an industrial hygienist at Tesla in San Francisco, California.

BECKY DEBUS (97MS) is a statistical programmer at medical device maker Medtronic in Minneapolis, Minnesota. She was recently appointed a Technical Fellow in recognition of significant and consistent contributions to the technical and scientific goals of Medtronic.

JOHN DIEDERICH (93MA) is president and CEO of Rush Copley Medical Center in Aurora, Illinois.

24 INSIGHT SPRING 2020

ANNA HERRING-VANRYSWYK (05MS) is an epidemiologist and ELR project manager at the North Carolina Department of Health and Human Services, Division of Public Health, in Raleigh, North Carolina.

LEI HUA (10PhD, 07MS) is director of biostatistics at BeiGene in Cambridge, Massachusetts.

JORGE GALVA (04MHA) is executive director of the Puerto Rico Health Insurance Administration (PRHIA) in San Juan, Puerto Rico. PRHIA is the public corporation in charge of Plan Vital, the Puerto Rico government health insurance plan.

H. LESTER KIRCHNER (99PhD, 96MS) is professor and chair, Department of Population Health Sciences, at Geisinger in Danville, Pennsylvania.

NICHOLAS LENARD (14MHA) is director of strategy and business operations at Delta Direct Care in Vancouver, Washington.

CORY MEAD (13MHA) is chief operating officer of HCA TriStar Southern Hills Medical Center in Nashville, Tennessee.

LESLIE MCCLURE (97MS) is professor and chair at the Drexel University Dornsife School of Public Health and is featured in a March 1, 2020, American Statistical Association’s AMStatNews profile celebrating women in statistics. The profile also highlights her role as a mentor and her commitment to advocating for women and underrepresented minorities in the math sciences.

JEREMY MURDOCK (15MHA) is chief operating officer at Presbyterian Hospital, part of Presbyterian Healthcare Services in Albuquerque, New Mexico.

SAMUEL PANG (19MPH) is a food safety specialist at State of Iowa Department of Inspections and Appeals in Iowa City, Iowa.

RAVISH PATEL (16MPH) is a health analytics developer at Blue Cross Blue Shield Association in Chicago, Illinois.

DOMINICA REHBEIN (14MHA, 14MPH) is group practice director for the Joint Replacement Program at Henry Ford Health System in Detroit, Michigan.

AARON REINKE (19MPH) is an epidemiologist at Black Hawk County Health Department in Waterloo, Iowa.

MALLORY SNYDER (14MPH) is pharmacy business manager at Children’s Minnesota in Minneapolis, Minnesota.

SHARESE VAN SLOTEN (15MHA) is operations director, Cardiovascular Service Line, at UnityPoint Health in West Des Moines, Iowa.

QIAN WANG (06MS) is senior manager at Abbott Laboratories Trading Company Ltd. in Shanghai City, China.

NI (JENNIE) ZHANG (12PhD, 11MPH) is an assistant professor at the Department of Public Health and Recreation in San Jose State University in San Jose, California.

SHARE YOUR NEWS Have you started a new job, received an honor or award, or achieved a noteworthy milestone or accomplishment? Share your professional news and updates with fellow College of Public Health alumni! Submit your news to tara-mckee@uiowa.edu with Class Notes in the subject line.

Be sure to include your year of graduation, department or program, and contact information so we can follow up with any questions.

GALLERY

One WORLD One HEALTH hazi Kayali, PhD, MPH, is one of the dedicated scientists around the world researching novel viruses transmitted between animals and humans. He earned his doctorate degree in epidemiology from the University of Iowa College of Public Health in 2008. He is the Chief Executive Officer of Human Link, a Lebanese-based non-governmental organization with the mission to design and conduct scientific research and projects in the fields of bio-medicine, public health, environment, economy, and human development aimed at improving global knowledge and enhancing local population livelihoods. He is also an adjunct assistant professor in the Department of Epidemiology, Human Genetics, and Environmental Sciences at the University of Texas Health Sciences Center.

Human Link is contracted by the U.S. National Institutes of Health to conduct influenza and coronavirus research in the Middle East. The NGO collaborates with the World Health Organization Collaborating Center on the Ecology of Animal Influenza Viruses based at St. Jude Children’s Research Hospital in Memphis, Tennessee. Human Link currently conducts influenza and coronavirus research in Egypt, Lebanon, Jordan, and Tunisia.

Kayali’s work was recently highlighted in the prophetic pre-COVID-19 Netflix docuseries “Pandemic: How to Prevent an Outbreak,” and he was featured in a segment on the ABC news program 20/20 that profiled experts who identify the source of an outbreak, determine its transmission, and work to stop its spread.

His career exemplifies One Health, a framework recognizing that the health of people, animals, and the environment are closely intertwined.

“All my research is focused on the human-animal interfaces where virus transmission can occur,” Kayali says.

“There have been several global efforts to enhance and adapt One Health on national levels. Almost everyone, whether

Researchers led by Ghazi Kayali (left) take samples from poultry in Egypt.

scientists or policymakers, believes in One Health and its importance in preparedness for pandemics.

“However, countries struggle in implementing One Health due to lack of resources, or resistance of some of the sectors involved,” he says. “The way forward is to stop discussing One Health as a philosophical or an academic notion and start institutionalizing it.”

The Netflix docuseries “Pandemic” focuses on numerous health experts and investigators who are dedicated to researching and preventing outbreaks. Now that the world is experiencing a global pandemic, Kayali hopes that viewers can take away several valuable lessons.

“One is that pandemic preparedness requires efforts from several disciplines,” he says. “The series shows the roles that researchers, clinicians, policymakers, first responders, and NGOs play in preparing the world for a pandemic. Also, we all have a role to play in preventing outbreaks of infectious diseases by at least following simple hygiene rules and getting vaccinated when a vaccine is available.”

25 INSIGHT SPRING 2020

145 N. Riverside Dr. 100 College of Public Health Bldg., Room S173 Iowa City, Iowa 52242-2007

SPARK Recent events have brought the intersecting issues of racism, police brutality, and health inequities into sharp focus. The relentless litany of violence against Black lives has ignited global protests and demands for justice. At the same time, the COVID-19 pandemic is disproportionally impacting Black communities and people of color due to longstanding health and economic disparities. These are public health crises that demand action—speaking up, engaging with communities, changing policies— as we work toward an equitable society.

People place flowers at a memorial to Breonna Taylor during a protest against police brutality and in defense of people of color at the steps to Old Capitol in Iowa City, Iowa, on June 5, 2020. Taylor was shot and killed by Louisville Metro Police Department officers March 13, 2020.

JIM SLOSIAREK/REPUBLISHED WITH PERMISSION © 2020 THE GAZETTE, CEDAR RAPIDS, IOWA