"76 Days" w/Epidemiologist Eileen White, Part 2
Epidemiologist Eileen White
An epidemiologist and nurse with a background in acute care, Eileen White worked as Chief Nurse Consultant and Epidemiologist at the Indiana State Department of Health in Genomics and Newborn screening. She managed the stroke and cardiac systems of care at the Minnesota Department of Health, working in policy and program management and clinical program development. She now works as a freelancer in public health, and manages a Facebook page called "Public Health is Your Job, Too," reviewing COVID-related public health and clinical information and research, and educating the public on valid and non-valid forms of data and evidence in support of an informed public. She believes in making decisions based on data, not politics.
Eileen is a former epidemiologist with the Fishers (Indiana) Health Department. She tendered her resignation after being asked to make a political decision that contradicted what the data suggested.
In addition, Eileen survived a bout with COVID in April 2020.
Joe and Eileen watched the documentary "76 Days," and discussed it and its impact afterward. Covering the first days of the COVID-19 outbreak in Wuhan, China, the film goes inside a front-line hospital that struggles to handle the outbreak of the disease. "76 Days" is screening at Heartland Film Festival Friday, Oct. 9 at 9:15 at Tibbs Drive-In (480 S. Tibbs Ave., Indianapolis). Read our review of "76 Days" here, and buy Heartland Film Festival tickets here.
In Part 2, Joe and Eileen discuss how cultural differences and a lack of leadership contributed to a more severe outbreak, her own experiences with COVID, and what our country can learn from this documentary and the responses of other countries.
Joe: You're bringing up good points, about having strong leadership and decisive action that is trusted and followed, and especially having a populace that has experienced pandemics and large-scale outbreaks before. You had a pretty bad experience with your own government--how did those differ from what is shown here, even sometimes just hinted at here, and what can we as a society learn from watching a film like this?
Eileen: I think in the United States, most people don’t know how much public health does everyday to keep their water, air, food and infrastructure safe. I know in Indiana, people don’t generally grasp what public health is. I know in Fishers, no one does. The Mayor started a health department during a pandemic to get funding for a testing site, and to allow him to have a bit more control since Hamilton County Health Department would never respond to him and certainly owed him nothing. But he did not understand public health mandates, and he didn’t realize he was now required to do all the things public health departments do. This includes water sampling and immunizations and infectious disease mitigation and public safety work and education and data collection and analysis and submission etc.
Joining a fledgling department during this chaos was what I thought needed to be done, and boy did they ever need an epidemiologist. But there was never any buy-in for the independence a health department requires, in order to collect, analyze and communicate public health data to the population, and to be trusted to do so without political interference. I realized very quickly that while the department was there in name, it was merely an extension of the mayors arm, and he now had the power, sitting on a board of his own making full of people with zero public health background, to recommend and instruct the health department to operate and do what he wanted. This is not the usual relationship between politicians and health departments. County health is usually not “owned” by anyone, and they go about their normal business, doing their best to protect and implement public health measures. Marion County consults with the mayor often, but he most definitely does not control Dr. Cain.
In a state with really poor public health metrics (we consistently rank in the bottom 10), it’s no wonder people don’t know what public health does. We don’t fund it, and therefore we don’t have it. My experience working in Minnesota Department of Health was a complete 180, because not only is their state consistently ranked in the top in the nation for public health and safety measures, but they are also more aware of the things that contribute to that. People know that their money goes to support work they see every day in their clean environment and their well-designed cities that encourage physical activity through making biking/running/walking/kayaking incredibly easy and accessible. They fund public health grants, and receive far more grants they apply for than other states because they have folks with PhDs leading most areas at the state health department (that’s incredibly rare in Indiana where the starting salary for an epidemiologist is $40,000 a year).
In China, they’ve seen what outbreaks look like, they know the impact of living in cities with many millions of people and that their collective health is dependent on everyone doing things to keep transmission down. They wear masks even indoors, with family. They locked down hard. They have a different relationship with their government than we do, but they also have an appreciation for what it looks like to have a lethal disease run rampant. SARS and MERS were much less transmissible but incredibly deadly, something like 10% of SARS patients and 40% of MERS patients died. They have an appreciation for what they can and must do to protect themselves and everyone around them. They know their health is dependent on their neighbor, but we haven’t seen that in our country. Neither SARS nor MERS took the foothold that COVID has. Ebola came and thanks to a pandemic group of experts who had prepared and run simulations on how to respond to a lethal viral outbreak, there was a strategy and a plan in place. But that group was disbanded when our current president took office. The playbook was shelved. The approach of denial has led to a lack of cohesive national strategy and it’s allowed misinformation to spread, its compromised public health agencies that were world renowned (CDC has always been seen as a world leader, all the other countries call their public health agencies CDC for a reason) have lost credibility for very political decisions and for not following science.
Watching this movie today in the United States of America serves as a wake up call to the immense and inhuman toll it took on healthcare workers and the entire population. It’s not something we’ve been shown here, but we have lost so many. This exists here, but it isn’t acknowledged because we have a distinct lack of leadership. It also shows that the transmission was and can be stopped, if we only do the right, hard thing, the right way, in order to stop this. The whole movie stands in stark contrast to the choices our government has made: we never got control of this, and now we are where the disease has exploded and we have lost 210,000 American lives, and we will likely see a very hard fall with many thousands more dying unnecessarily, because we haven’t yet learned the lesson. We are only as healthy as our neighbors. And public health is for and about everyone, and it’s your job, too.
Joe: Absolutely. It's too easy for us to lose sight of the fact that we truly are all in this together, and people just doing their own thing necessarily affects everyone in their community, because transmission is so high. But I'm interested too in knowing about your experiences when you actually had COVID, and how you related to the patients in this film.
Eileen: When I caught COVID in April, I felt some of this terror as a patient. I knew my nurse practitioner on Telemedicine was scared. She couldn’t tell me what to expect, or comfort me at all. She just kept saying “keep breathing, rest, more Gatorade, call if it’s gets to be too much.” No one knew how to treat it, and I was a lucky one: I got steroids early, because my first symptom was sudden onset shortness of breath. By the next day I lost taste, had debilitating GI symptoms, and had a low grade fever, cycling hot flashes for a month. Even today, the heart palpitations are still here and the immune system overdrive hasn’t let up yet. I have some underlying conditions that were previously well controlled for more than 15 years, but they're now exacerbated by the virus. So I'm a "long hauler" who continues to have issues even after the virus itself is gone.
People still aren’t listening to those of us with long-haul syndrome, and it feels like some some physicians just don’t want to listen, like they stopped listening while science is still learning. We now have entire clinics in cities for long haulers, there are longitudinal studies to learn more about it, and it now seems to be following the path science took to recognize Chronic Fatigue Syndrome. And yet so many people are still being dismissed, sent home from ERs and doc offices, and they have very real cardiac and respiratory damage.
We have to be willing to listen, to follow patients, in order to learn more about this virus. We don’t want to relive March and April, or see what Wuhan did in this film. If we don’t continue to study, if we ignore what we are seeing, we won’t be able to treat effectively, and we’ll have significant long term drains on our already broken and impossibly expensive and, for many, inaccessible healthcare system.
Joe: I'm guessing you're recommending "76 Days" to people, as I am! What last lessons does this film have for us as Americans also dealing with our side of this pandemic? If, years down the road, this finally becomes manageable and a similar pandemic hits, how do we deal with it more effectively?
Eileen: This is a great question. Maybe the lesson is just that we know enough to ask it at all and to realize that we are vulnerable to disease in ways we’ve not seen in this country in generations, and that we must prepare for it as we would for any potential attack from a foreign country. It makes sense for us to prepare to defend our country by shoring up our public health resources, our capacity and infrastructure, to take these lessons now. It seems unimaginable to lose 210,000 Americans and learn nothing from It. This has to matter for us. We have to learn and teach the next generation the importance of our country's public health, so they don’t forget and repeat our mistakes. We must build not just the materials and buildings and data and IT capacity, but we must build it into our culture that we are only as healthy as our neighbors, and that we as a community must come together and realize that we may sacrifice some individual freedoms in times like this so that we may never again lose nearly a quarter million people to a virus that could have been mitigated and stopped.
This was preventable, and we absolutely have to realize another pandemic is likely in the next decade, as deforestation causes animals and humans to collide in ways they haven’t before. It’s not a question of if, it’s definitely a question of when.
We need to think about this the way Ebola was handled, with a pandemic team of experts on hand for every administration and for their expertise to guide any response to public health threats independent of the political machine, and we need them to create playbooks as they did for Ebola. And we need them to listen to science.
This anti-science culture in our country has resulted in this travesty of a lack of federal government leadership or response, and frankly we’ve seen the results of that now. They aren’t good. It’s time to listen to experts, and let them guide the country through public health disasters. Because I don’t need a thousand non-scientists and politicians yelling over experts. I frankly don’t care what their views are. Science and data need to lead our responses, and I really hope, as a country, we have learned that by now. The only way out of this is science.