EP. 126: INSIDE THE WORLD OF OUTBREAK RESPONSE

WITH SYRA MADAD

Aug 22

WITH SYRA MADAD, DHSC, MSC

A pathogen preparedness expert shares what excites her about managing infectious disease outbreaks and what we can learn from the challenges and triumphs of society during the COVID-19 pandemic.

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Episode Summary

Most people shudder at the idea of an infectious disease outbreak — patients stricken with a mysterious illness, hospitals overflowing, and cities going into lockdown. But for Syra Madad, DHSc, MSc , MCP, rushing into such a scenario, donned in a hazmat suit, to control the chaos has been a dream since childhood. Today, she is an epidemiologist, biosecurity advisor, and a pathogen preparedness expert who serves as Senior Director of the System-Wide Special Pathogens Program at New York City Health and Hospitals, which operates the municipal health care system of New York City.

Over the course of our conversation, Dr. Madad shares what excites her about the work of infectious disease control, why she believes we have emerged from the Covid-19 pandemic worse prepared for the next pandemic, how scientists and doctors can better communicate with the public in the absence of clear data, the importance of utilizing trusted messengers in the community to fully deploy the power of public health, and more.

Syra Madad, DHSc., MSc, MCP, CHEP is an internationally recognized public health leader, science communicator, biosecurity advisor and epidemiologist in infectious disease and special pathogen preparedness and response. She serves as the Senior Director of the System-wide Special Pathogens Program at New York City Health + Hospitals, the nation’s largest municipal healthcare delivery system. She also serves as the Co-Principal Investigator of NYC Health + Hospitals Institute of Diseases and Disaster Management. In addition, Dr. Madad is Core Faculty at the National Emerging Special Pathogens Training and Education Center (NETEC), and affiliate faculty at the Center for Emerging Infectious Disease Policy & Research at Boston University. Her work focuses on the prevention, preparedness, response, and recovery from infectious disease outbreaks with an emphasis on health care and public health biopreparedness. She has led and responded to multiple outbreak responses including Ebola, Zika, Measles, COVID-19 and MPox.
In this episode, you will hear about:
• 2:09 - How a movie led Dr. Madad to become an infectious disease preparedness expert
• 6:54 - An overview of Biosafety levels (BSL)
• 9:30 - Moments in Dr. Madad’s career when disease containment went well and moments when it did not.
• 12:27 - How Dr. Madad mentally and emotionally manages the heavy weight of often-lethal infectious diseases
• 18:05 - Dr. Madad’s opinion on how COVID-19 policies were handled
• 24:02 - Dr. Madad’s personal thoughts on the potential origins of COVID-19
• 26:55 - What concerns Dr. Madad most about future pandemics and how we can make positive steps toward recovering trust in science
• 35:40 - Dr. Madad’s advice for those considering a career in public health or infectious diseases
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and healthcare executives those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:01] Most people would shudder at the idea of an infectious disease outbreak. Patients stricken with a mysterious illness. Hospitals overflowing and cities going into lockdown. But for Doctor Syra madad, rushing into such a scenario donned in a hazmat suit to control the chaos has been a dream since her childhood. Today, she is an epidemiologist, biosecurity advisor and a pathogen preparedness expert who serves as the senior director of the system wide Special Pathogens Program at the New York City Health and Hospitals Corporation, which operates the municipal health care system of New York City. Over the course of our conversation, Doctor Madad shares what excites her about the work of infectious disease control, why she believes we have emerged from the Covid 19 pandemic worse prepared for the next pandemic. How scientists and doctors can better communicate with the public in the absence of clear, absolute data. The importance of utilizing trusted messengers in the community to fully deploy the power of public health and more. syra. Welcome to the show and thanks for being here.
Dr. Syra Madad: [00:02:06] Thanks for having me on. It's a pleasure to be here with you both.
Henry Bair: [00:02:09] So first off, I have to say your job title as a pathogen preparedness expert has quite the ring to it. How does one become interested in this line of work?
Dr. Syra Madad: [00:02:20] Well, believe it or not, what inspired me at an early age to pursue, you know, a field in high consequence infectious diseases or special pathogens or serious communicable diseases, whatever you want to call it. Right. If that's that, you don't you don't want to get. So surprisingly, it was actually Hollywood. And I remember I was maybe 9 or 10 years old and I, my older siblings were watching the 1995 movie outbreak. Again, as someone in that age group, it's not appropriate. Do not advise kids to watch that movie if they're in that age group. But because I had older siblings, you know, you just kind of watch what they're watching. And I just sat there and I was just fascinated by this invisible world of microbes and the profound impact they were having on human health. And in that particular movie, it was showcasing, you know, a viral hemorrhagic fever, zoonotic transmission from monkey to humans. And then you're seeing this city in California get impacted, you know, massive number of individuals getting quarantined, isolated in these makeshift health care facilities because they were getting overwhelmed. And it kind of goes on from there. Beyond just the fascination that this microbe, this invisible microbe that you couldn't even see with their naked eye was causing this much chaos and havoc. The other thing that caught my eye and being, you know, nine, ten years old at that time was they were wearing the hazmat suits. And I'm like, that's amazing. I want to wear a hazmat suit. That's exactly what I want to do. So I turned to my mom and I told her I was like, that's what I'm going to do.
Tyler Johnson: [00:03:52] No way. Did you really do that?
Dr. Syra Madad: [00:03:55] I swear. And she turned to me and she's like, yeah, that's not happening. You know, my parents are. I'm first generation American. They came to this country. My mom, still 40 plus years in this country, has very limited English proficiency. So, you know, she doesn't really understand, you know, what it was like growing up here. But she said, yeah, that's not that you're not going to do this, that that field doesn't exist and that's the end of it. And so that was kind of my first kind of spark of like, oh my God, this exists. And then believe it or not, you know, fast forward whatever three decades and I'm in my own Netflix series talking about something very similar and showcasing the work that I do is it's just funny how, you know, life takes these twists and turns. But that was my first story. My first inspiration kind of went on from there. And the second part to this is I had some amazing science teachers, and I want to really give a shout out to the amazing teachers that have such a profound impact on the lives of students in high school. I had an amazing science teacher. In fact, I took all of his science courses, from microbiology to anatomy and physiology to anything he was offering. I actually still have copies of my my report card, so I can see all the classes I took, because he was just so inspirational. And in high school and senior year, he gave the class a book to read and it was The Hot Zone by Richard Preston. And the Hot Zone is another really big novel in my field because it talks about Ebola and it talks about, you know, what it is, and the military response and the cases that we had, you know, in the United States within, um, animal species and the like.
Dr. Syra Madad: [00:05:30] And so I was fascinated. And then in grad school, I had the privilege of actually going to Usamriid. I was living in Maryland. That's where my parents are from. That's where I'm from. And Usamriid is the United States Army Medical Research Institute for Infectious Diseases. And, you know, they have from BSL two to BSL three to BSL four facilities. And I was actually able to get a tour of it. I was able to meet with scientists and researchers. I was able to kind of view people completely suited up researching these really bad bugs, these these hot viruses and these BSL four laboratories. So obviously it didn't go in, but I was actually able to see them through a glass window. And then they took me to what they call the slammer. And it was a two bed biocontainment unit. And this is, I think, the first biocontainment unit in the entire United States. And so if a researcher or scientist got infected with any of these infectious diseases out there, we're working with accidentally, they would place these patients in the Biocontainment unit because local hospitals wouldn't be able to care for these types of patients. And so at that time it wasn't decommissioned yet. It is now. It actually it's unfortunately now it doesn't exist. But they called it the slammer because the door shut so loudly that it would slam. And that's how it got the name. And that's, you know, again, all of these small things were like, you know what? This is what I want to do. And so these were kind of the, the little stepping stones that brought me to where I am today.
Henry Bair: [00:06:54] Just want to clarify one thing, because a lot of our audience members are in various levels of training, including people who are not in medicine at all. What does BSL stand for and what are the different levels?
Dr. Syra Madad: [00:07:04] So BSL stands for biosafety level. And so when we talk about like for example, laboratory research, there's everything from BSL one to BSL four. So BSL one is like, you know, the lowest where you're working with infectious diseases. Like for example, in BSL two, you can work with E.coli and other types of infectious diseases that are not necessarily known to cause serious illness in humans. And then it kind of goes up an escalation. So BSL four is like dealing with those infectious hot agents that may not have a vaccine or therapeutic can cause a lot of, you know, morbidity and mortality if someone's infected. So think of Ebola and other viral hemorrhagic fevers. They have to be studied. And basically, if you're working with them, have to be in these BSL four facilities with high level PPE. And I actually have experience working in these BSL facilities, everything from 2 to 3 plus one of the jobs that I held previous to the current position I'm in was I was part of the Biothreat team in the At in Texas, at the Texas Department of State Health Services, where, you know, I was the state trainer and I worked in these BSL three plus environments.
Tyler Johnson: [00:08:06] So a couple of things. First of all, just regarding your origin story, I just have to say two things. One of which is that from one to another, I have to lovingly say that that is one of the nerdiest origin stories I have ever heard that you like, see the people in the hazmat uniforms and they go, that's clearly what I need to do. The second thing is that I could still remember when I was a teenager, there was a little bit of a scare. I'm from Utah, and there were some cases of hantavirus infection in humans that were confirmed. And I remember hearing about that and just being terrified of mice for like many years afterward because, you know, and this is a thing that happened, like, I don't know, four times in the 1990s or something, but the fact that you would, like, go to the Biocontainment unit and then see the place where the people who got accidentally infected with some hemorrhagic fever virus get quarantined from everybody else and then think, oh yeah, that's clearly what I want to do. That's just a little bit of a different wiring.
Dr. Syra Madad: [00:09:06] 100%. You know, it's funny. When I left Texas in the Biothreat team, you know, they threw me a farewell party. And in the card, I just remember the team leader writing, you know, people run away from fires, you run towards them like you're crazy. Like, what is wrong with you? So that just always stuck with me. Like, I was like, to me, it's normal. Like, I love this. This is like my adrenaline rush. But the fact that, you know, normal people are like, yeah, we really don't want to go near this stuff, so.
Henry Bair: [00:09:30] So to get more specific about moments in your career, can you talk about a time when you were in charge of managing an outbreak and it went well that you can point to and say, that's exactly what I came here to do. And conversely, can you share about a time when things didn't go So according to plan and what you learned from it?
Dr. Syra Madad: [00:09:51] Yeah, absolutely. And I love that question for a couple of different reasons. I think it highlights the successes as well as the challenges in the field that we're in. In my current position as the chief fire preparedness officer at New York City Health and Hospitals, I don't actually have the opportunity to work with these live agents or actually work with patients in my previous positions where I was actually working, you know, with hot agents and supporting the Biothreat team. One example I can give you in that regard was when I was part of the Ebola search team. So, you know, when the outbreak of Ebola was occurring in 2014 through 2016, in West Africa, and it was really expanding quite significantly, it was the worst Ebola outbreak in the history of Ebola. You know, we've here in the United States had a total of about 11 patients. Most of them were medically evacuated. And the three cases that were in Texas happened in Dallas. And it was actually the Biothreat team that I was part of that actually received the specimens and diagnosed all three cases. And so it wasn't just those three cases that were tested for Ebola. There were a number of actually additional patients that were tested for Ebola, both that met the case definition for exposure as well as those that we called compassionate testing. Meaning we knew that the risk was low because there was low exposure history. But we wanted to test anyways because, you know, that's what was decided between healthcare and public health. And so I was part of that team at that time. It was very chaotic.
Dr. Syra Madad: [00:11:13] We were constantly getting calls to test specimens. And so I was part of the surge team, and I was called upon a few times to support the team, the Biothreat team. And, you know, when we were getting these samples, we didn't know whether it was containing the Ebola virus or not. And so obviously you're wearing full PPE, you're going into the lab. I would text my husband to say, hey, I'm suiting up. I'm going to be offline for the next 4 to 6 hours. So if you don't hear back from me, I'll text you when I'm out. And so that entire process went really well. We had a buddy system. We went in with a team of people. We had a protocol in place. We did what we had to do. We deaconed, we doffed our PPE, and then we kind of went on our merry way. And it was just even though we were working in a high risk environment, you're working with other people that also may be nervous. You know, given the fact that, you know, you're dealing with Ebola. It was successful. No one got infected, right? That's the success story. Nobody got infected or processes worked. And at the end, you know, while we learned a lot the Ebola outbreak in the United States, there's lots of lessons learned, lots of things that actually didn't go well, but a lot of things that did go well. And to me, that's one of the success stories, is that we were able to follow protocol, work together as a team and be able to come out of this victoriously.
Tyler Johnson: [00:12:27] So can I just ask a question? I have to admit, I mean, I was sort of half joking before about my teenage self and let's be honest, adult self being afraid of mice and hantavirus. But when you're clearly I've never taken care of a patient with Ebola virus. Right. But from my.
Dr. Syra Madad: [00:12:43] I haven't either. I'm not on the patient side, so.
Tyler Johnson: [00:12:46] Fair enough. But even as someone who hasn't cared for one, I have read enough about it. And I have, you know, and as a doctor, have a, let's say, a realistic imagination that is strong enough of what it would be like. Let me back up for one second and say this. So I took care one time of a patient who had acute leukemia, which is a only important test context. The person developed a sort of a combination of a viral infection and then a hematologic consequence of her leukemia that made her very prone to bleeding. And the point is to say that her presentation, in many ways, from sort of what I can gather, mirrored that of a hemorrhagic fever virus in the sense that she was bleeding from just about every orifice and then just went into this kind of multifaceted, multi-organ, cataclysmic failure and then died. And I can still remember very distinctly like where the room that she was in, in the ICU and where I was sitting in the ICU at the nurses sort of computer bay there, basically keeping vigil through the night because we couldn't figure out what was going wrong and then couldn't figure out how to stabilize her and whatever. And then she eventually died. But all of this is to say that that was one of the most harrowing things I have ever seen as a doctor. And while I recognize that you don't directly care face to face for patients who have those viruses, nonetheless I still have to wonder just, you know, with containment units and with pandemics being sort of your specialty, like how do you mentally and emotionally deal with the kind of specter of communicable illnesses in the background of so much of what you do for your day job?
Dr. Syra Madad: [00:14:34] I won't say it's not easy. And you know, the work that I do and the team that I have, we're constantly monitoring what is happening all around the world. In fact, you know, being now on the hospital preparedness side, one of the resources that my team produces that we're constantly on top of is we are looking at all the different outbreaks happening all around the world, and we distill it down into a couple of pages of what a healthcare systems need to know, what do they need to be looking out for, you know, if these diseases come knocking on our doors, for example, in New York City. And so that just goes to show you we're constantly monitoring the situation. We're constantly assessing what is the risk of one of these infectious diseases getting, you know, for example, imported, whether it's through global travel, through food, through trade, whatever the case may be to New York City. And so to highlight a couple of different outbreaks that we're monitoring right now in this moment, we're looking at impacts, not just the classic impacts that, you know, we've experienced in the last couple of years, which is mpox the late two. We're also monitoring mpox clade one, which is actually much more severe, both in terms of the infection and as well as the case fatality rate. We're also monitoring Lassa fever in Nigeria. We're monitoring the H5n1 bird flu epidemic happening both in our backyard and locally, you know, in the United States as well as internationally.
Dr. Syra Madad: [00:15:52] And I can name off, you know, 6 or 7 other outbreaks. And so in my mind, I'm constantly thinking about these different outbreaks, and we're constantly developing protocols and processes. We're constantly educating our workforce, building in different decision support tools, because you can't rely on that astute physician to be able to think, oh, this patient may have lots of fever because they have this travel history and they're coming with these signs and symptoms. And so how can you take out that guessing game and provide tools to clinicians that will enable them to provide, you know, safe and appropriate patient care without having them memorize the 20 different outbreaks happening in any given time. And so we're constantly thinking about that. And to me, knowing that these outbreaks are constantly happening all around us just makes me that much more vigilant and that much more aware that we are living in a world and we're living in a time of epidemics and pandemics. That's not to say that, you know, in the past century, we weren't living in the age of epidemics and pandemics, but now it's much more accelerated. It's much more advanced. And you may think that, well, we live in a much more modern world, and it's better now because, you know, we have public health that helps make sure that we the air that we breathe is clean, the water that we drink is safe, and food that we eat is safe as well.
Dr. Syra Madad: [00:17:08] And that's all true. But the fact is, we live in a globalized world, and the more that we advance and the more technology we have and the higher the population grows and the more people move into cities. As you can just look at the urbanization rate or the over 50% of the the world lives in, in a city environment. And that's actually projected to go up to 68% in 2050. These are all factors that facilitate the spread of infectious diseases that can ignite outbreaks And epidemics and pandemics. And so we're going to, unfortunately, experience more of these outbreaks, more of these epidemics, and potentially even more of these pandemics. You know, if we don't prevent them, which we can. But I think the reality is we need to prepare for them because we can't prevent all of them. And so this is kind of the world that we live in. And so these are the things that are constantly in the back of my mind where I just need to, you know, when I work with a team, it's seeing what is the threat right now and what can we do to ensure that we mitigate this threat.
Tyler Johnson: [00:18:05] So can I ask two questions related to directly to Covid? First one is, you know, I feel like, um, when the pandemic first began, there was, as I think was appropriate, there was a great deal of public debate about how strictly should society quarantine itself. Right. And this spread in all kinds of different directions. Right. What stores should be open and closed? Should the local playground be roped off? When should kids go to school? How old of kids should go to school? Should they have, you know, have to be wearing masks all the time? Anyway, we could go on and on and on. I feel like much of the popular reaction at the beginning was that, if anything, we were being too lackadaisical. And I know that, you know, some people would look at places like New Zealand or other places, which obviously is a totally different thing, and not nearly as many people in the population density is lower and everything else, but still would look at those and say, well, look at their their fatality rate is so much lower and we should be stricter. And. Et cetera, et cetera, et cetera. But then I feel like in the wake of the pandemic finally receding, a lot of people more recently have, broadly speaking, gone in the other direction and said, well, no, the biggest problem is that we didn't open schools sooner or that we kept people socially isolated and therefore exacerbated their underlying mental health conditions for too long, or, you know, those kinds of things. And so I know that this is an impossible question to answer in any sort of, you know, general one size fits all sense. But I'm just curious as a sort of on a on a big picture scale, do you have a sense that we were either too strictly quarantined or not strictly quarantined enough? Looking back in retrospect, or where do you think we fell on that spectrum?
Dr. Syra Madad: [00:19:50] Well, there's a couple of things, right? It's it's easy to now go back and say, okay, this is where we went, right? And this is where we went wrong. And we need to do that. Right, because that's how we better ourselves and improve our response. And so I think it behooves us as a nation, as healthcare systems, as public health entities to look back and do an after action report. Right. And figure out what are our areas of improvement. I will say, as somebody that has played a role at the local, at the state, at the national and even international level when it came to the Covid 19 response, it's much easier to now go back to say, well, we should have done this and we could have done less of this, but in that moment, I can tell you that you are working with imperfect data. Sometimes that data doesn't exist. You are working with a virus that you have no idea a initially how it's spreading, and that's where we didn't realize it was. Was it airborne or was it droplet? Right. And that's where we didn't know whether a mask was would be beneficial for all or for a certain number of people, for example, those that are in close contact.
Tyler Johnson: [00:20:50] Can you explain for our listeners what the difference is?
Dr. Syra Madad: [00:20:52] So airborne is, for example, the virus is airborne, where it's like when you think of like smoking a cigarette and that smoke is just, you know, spreading everywhere. Anybody can breathe it in, for example, and get infected. Droplet is if you're, for example, within six feet of an individual, the virus particles are basically laden in basically this, this bubble of water. And it drops to the floor after a certain period of time. And because it's heavy. And so, you know, when we were still trying to figure out, is this airborne, is this droplet, you were trying to make policy and guidance and give direction to the American people with the best information that you had. And so you are working with imperfect data, sometimes impartial or no data at all, and are making policies and guidances that are impacting the lives of millions of people with that imperfect data. But you're trying to do the best you can. And I have been in that seat. I have made policies at all levels with imperfect data and trying to do again what is best for the American public, because at the end of the day, the goal was to save lives, right? We don't want people to get infected because we were seeing what this virus was doing to individuals. We didn't know whether everyone was at risk or whether a certain population was at risk. And so at that time, you're going to take the most conservative measure when you don't know and you don't know what you don't know, you're going to take the most conservative measure and you're going to implement different strategies. And that really is a lot of what was happening. And as we were learning more, you were seeing different strategies being pulled back or being pushed forward. And here in the United States, it's not public health, unfortunately, that is in the driver's seat.
Dr. Syra Madad: [00:22:27] It's politics that's in the driver's seat. At the end of the day, a lot of this is politics. And in the United States, we don't have a national public health system. We have CDC. We don't have a national public health system. We have a state public health system. Every state owns their own public health system and owns how they're going to react or how they are not going to react. And a lot of it's governed by politics. So, for example, we have over 6000 hospitals in the United States, and we have over 3000 local health departments. These local health departments are located in localities, tribes, states and the like. And they're governed by, you know, their governing body of that state. And each one was responding differently. Hospitals, local health departments and the policies that were coming out was very different. And so you had 50 different states with 50 different responses, and nobody was really figuring out in that sense the best way to move forward. So there was a lot of chaos. And one of the things that I would love to see. Now, you know, being four years out is we really do need a national after action report. How did each state perform? What did they do? What did they get right? What did they get wrong? And how can we improve? Because as I mentioned, we are living in the age of epidemics and pandemics, and we can bank on these outbreaks constantly happening and threatening our livelihoods. And if we didn't learn from Covid 19, then shame on us, right? Because now, if we embark on another outbreak, whether it's now or in the future, then we're just going to be flat footed again.
Tyler Johnson: [00:24:02] Okay, so we don't usually ask hot button questions, but I have to admit that I have read for, I mean, probably literally years now, editorials battling back and forth in the New York Times, The Wall Street Journal, The Washington Post, and other places about the origins of Covid. So as a person who actually knows a lot about this, do you lean one direction or the other or do you I mean, if I say that as if there's two simplistic options, but let's just say that right? So the two broad theories are one possibility is that there was like work being done on gain of function mutations and viruses in a lab near in China, and that it jumped from that, you know, because of poor containment policies or whatever. It jumped to a human and then spread from there. And then the other one is that it was some kind of animal to human transmission from bats or whatever. That weird animal that I don't remember the name of. It is called whatever in a market near Wuhan. Do you have a take? I'm genuinely curious.
Dr. Syra Madad: [00:25:00] Yeah, I actually I did a segment on MSNBC not too long ago on this particular topic as I talk about the origins of Covid. Well, first, it's a very hot topic, highly politicized, as you can imagine, and it is extremely polarizing, unfortunately. And it's important to understand how epidemics and pandemics start. It's really important because a that's how we know to prevent them and to know what we can do to make sure it doesn't happen again. As we talk about the Covid 19 pandemic being, you know, a scientist, a my brain is wired towards looking for evidence and science based reasons. And when I look at the current evidence that we have on the origins of Covid 19, everything points to a natural origin in that sense. And when I say natural, you know, a zoonotic transmission from animal to humans, not necessarily intentional or manipulated in a lab, that's not to say that we have 100% solid answer right now. I think the large majority of the evidence certainly goes under the natural kind of phenomena here, like most outbreaks and pandemics. In fact, since 1918 to now, we've had six viral pandemics in mankind. Four were of flu origin, HIV, and then the Covid 19 pandemic. And, you know, as I mentioned right now, since ample evidence is, you know, pointing towards a natural kind of origin of Covid 19. All six of these pandemics have been zoonotic in nature. These events happen all the time when fortunately, now I don't know for ever get a smoking gun to give us evidence and information to say, hey, this was manipulated in a lab. This was a lab leak. I think I'm open to the idea. I think we live in a world where there's multiple different possibilities. But again, my brain is wired from a scientific standpoint, and I will go with the side of evidence and science and what actually makes sense and where we have evidence. And right now that is where it's pointing towards.
Henry Bair: [00:26:55] Right. Thanks for offering your your perspectives and take on that. You know, going back to the the Hollywood thing that we started off this episode with. Sure. You're aware of this movie contagion from 2011.
Dr. Syra Madad: [00:27:08] Oh, yeah. That was another one of my favorites.
Henry Bair: [00:27:11] Yeah, I during Covid, I rewatched that movie. And I mean, I think most people who rewatch it are absolutely mind blown by how much it predicted of the events and the conversations we'd be having. Right. This movie came out nine years before Covid, but they were talking about a respiratory infection of zoonotic origin that went from bat to pig and then crossed over to humans. And in the context of the movie, they were talking about how there was no cure. All you could do is social distancing. They use that term. They were talking about r-naught. They depicted the chaos of coordinating all the fragmented public health departments across the United States. They talked about trying to rush a vaccine, which in the context of the movie, I think came about in about a year as well. And then they depicted the ethical challenges of equitable distribution of the vaccines. And then they talked about the public disinformation and the conspiracy theories, all of which are just shocking that this happened right in real life. When I watched that movie, I remember thinking a little bit with a twinge of disappointment at the general state of affairs, like, we knew these things, right? These were I mean, they were filmmakers, but I know they consulted a lot of experts in infectious disease to make this as accurate as possible. But all of which is to say, none of this stuff is new. Social distancing, school closures, the effectiveness of PPE. Like, we knew about all of this already, and yet the same things, the same mistakes that were depicted in the film happened in real life. And I'm wondering now that we've all lived through this, you from the perspective of someone who was trying to manage all of this, this chaos. What most concerns you about the future, if this were to happen again, and how would we mitigate that?
Dr. Syra Madad: [00:29:00] I would say we have left the pandemic less prepared than we did entering it. And if we were to face another Covid 19 like pandemic, we would do far worse than we did during the pandemic. And my single reason for that is because we have left the pandemic with less trust in science than we did entering it. And that may not mean a whole lot at face value, but that translates into significant, significant issues because you could say anything and everything from a public health perspective, we're dealing with another new virus. We don't know how it's spreading. Oh, we do know how it's spreading. And we want to make sure people are protecting themselves by wearing a mask, by getting vaccinated. If you don't have the trust of the American people, they're not going to follow that guidance. They're going to put themselves and their families and their communities at risk. They're going to get infected. They're going to be hospitalized. Hospitals will get overrun, and then you're going to see mass death. And so since the Covid 19 pandemic and now even after the pandemic being declared, public health has faced significant demoralization, the relentless spread of misinformation and disinformation, conspiracy theories.
Dr. Syra Madad: [00:30:18] All of this has eroded public trust in science and health institutions. Public health officials and scientists who were once seen as trusted sources of guidance and information, just like clinicians. But they have now been subjected to unprecedented levels of skepticism, criticism and death threats. And I've gotten my fair share of all of that. And so this decline in trust, you know, has hindered our efforts and ability to manage the pandemic effectively when we were facing it. And it's going to continue to do so in all the outbreaks that we're going to face in the future. And if we don't rebuild trust back in science, if we don't rebuild trust back in our public health institutions, then anything and everything that we do is going to go on deaf ears and all these outbreaks that have responded to what makes or breaks it is if people understand the threat and follow the guidance. If they don't follow the guidance, they don't believe in the threat, then you know it's going to be a perpetual cycle of chaos and infection and hospitalizations and deaths.
Tyler Johnson: [00:31:23] So, you know, there's very well documented evidence from virtually every aspect of American society over the last 20 or 30 years that shows that, in effect, we as at least as citizens in the United States or people in the United States don't trust anything anymore. We don't trust the news. We don't trust the president. We don't trust Congress. We don't trust the Supreme Court. We don't trust, as you put it, quote unquote, science. We don't trust the media. We don't I mean, we don't trust almost we don't even trust each other in many cases anymore. And so I completely agree with you that short of some kind of authoritarian regime where we're foisting things on people that they don't want, really what you're left with in effect is persuasion. But in an era of corroding trust in virtually all public institutions, do you have any three point plan for how public health can try to foster an environment of trust in a place where people don't trust almost any large institution anymore?
Dr. Syra Madad: [00:32:28] Yeah, absolutely. And I would say, and you've heard this from, you know, probably at all levels of government, right, is we really need to work boots on the ground. We need to have trusted messengers in the community. Gone are the days of trying to hear a doctor at the podium to say, hey, this is what we should do and this is what I advise. Right. You can't just rely on that one physician or that one public health figure at the podium, giving advice and thinking everyone's going to listen. You know, we are a very diverse society. We need to make sure we have diverse voices and voices that people actually trust, not some person that they saw for the first time on TV that they've never seen before. Right. Many individuals have never seen public health officials. The first time they see them is on a TV saying, hey, there's a measles outbreak, or you should get your flu vaccine, or you should get your Covid 19 vaccine. That's sometimes the first time they've seen some of these individuals. And so you really need to go back into the community and see who are the trusted messengers, and how can we educate them, and how can we give them the message that we have of it's flu season? You should get your flu vaccine.
Dr. Syra Madad: [00:33:33] And when you do get your flu vaccine, this is how it's going to benefit you. If they are listening to these individuals, then they're more people actually accepting the guidance and actually accepting or changing the behavior, whatever the case may be. And so we really need to work hand in hand, you know, with the community. And we need to educate the community and make sure we're working with these trusted messengers. And so we can't just work, you know, at the high level public health institutions, we really need to work with community based organizations. With nonprofit organizations, you need to work with the primary care physicians that, you know, work down the street and these primary care clinics because that's that's where people are going to trust. And so you need to make sure they're getting the resources and information they need. So that way they can educate the masses. In addition to that, besides, you know, working in the community and getting these trusted messengers, I think we also really need to do a much better job educating the American public. Most Americans have a hard time reading and comprehending English, and that may sound surprising, but when you look at the proficiency of the reading level of most Americans, it's sometimes that fifth grade.
Dr. Syra Madad: [00:34:39] And even lower than that, when you talk about scientific literacy, some of the stats that I've seen is, you know, only about, you know, less than 40% of Americans are actually scientifically literate. And so we really need to do a much better job of constantly educating the American people to understand this is what science is, and this is how science works. And so we need to do a much better job, right at young age and middle age and older age to make sure that we are educating our workforce, not the workforce, not the workforce, but obviously the American people on what is science. And and, you know, just making sure we have that public education available. And that includes multiple different interventions, right? Starting at an earlier age, having free programs, starting in elementary school, starting in middle school, fostering that all the way up to high school and the like, and making sure that these educational materials are available and in multiple different languages, and using trusted messengers to make sure we're spreading that word. So there's lots that can be done. There's lots that is being done, but I certainly would want to see more of it.
Henry Bair: [00:35:40] I'd like to end on a note that we often end on, which is some advice you might have. You know, over the course of this conversation, we have explored a lot of the more disheartening aspects, shall we say, of public health. Earlier, you shared your opinion that you felt as if we had emerged from the Covid pandemic less prepared than we were going in. Right. Which is which is quite the blow.
Tyler Johnson: [00:36:01] Yeah.
Dr. Syra Madad: [00:36:02] I will say, you know, we probably are more prepared in certain aspects, right? So we're not less prepared as a blanket statement. I think we're less prepared in certain aspects, like from a social and behavioral standpoint, which really are the underpinnings of a pandemic or an outbreak response. But I do think we're more prepared from other aspects, like, I think we have better pipelines of vaccine development and manufacturing, and we have better processes in place to have contracts in place and, and things like that. So I think we we have strengthened many surveillance systems and we've implemented many different shortcuts that have taken away the red tape. But there's still a lot that we still need to do. And where rubber meets the road is, is with people, starts with people, and it ends with people. And if we're not there yet, from a preparedness standpoint, from a behavioral and social science standpoint, then everything else may fail.
Henry Bair: [00:36:49] Yeah. Yeah, absolutely. I mean, during the pandemic, I saw the development of a lot of technologies that were absolutely mind blowing, and I was happy to see that this was an impetus. The pandemic was an impetus to to spur the development of these things. And I worked with the CDC to analyze the effectiveness of Apple and Google's exposure notification technology, which was very interesting, And it works right for the for the communities that actually implemented it in the proper way. And again, the problem was that each state sort of had their own free reign on how they wanted to implement it, which didn't go so well. But for the states that tried their best to to do it comprehensively, it worked. The contact tracing was quite effective nonetheless. Right. So, you know, you've shared with us ways that things didn't go so well. And just now you also talked about all the the massive number of ways that we can improve how we do things. I also know people personally who have who had wanted to go into public health, who had wanted to go into infectious disease because they loved the science behind it. But then now during the pandemic, they see that the science isn't enough. It's not enough just to point people to what the facts say. We can't even agree on the facts. We can't. We can't agree on what science is. We can't agree on the process of science. There's so much psychology going on, not so much about facts anymore. What advice do you have to someone who is still interested in going to public health and infectious disease, on why this is a rewarding career and an exciting career besides the cool yellow hazmat suits.
Dr. Syra Madad: [00:38:19] Well, the field that I'm working in, there's never a dull moment. And as I mentioned, we're constantly tracking multiple different outbreaks, multiple different epidemics. And to me, it's a thrilling feeling. No day is the same. And that's actually what I tell my team members. Anytime we're actually even hiring a new person, they often ask, well, what's the typical day like? You know, working in your team? And I'm like, it really just depends, you know, and it keeps it interesting and innovative and and challenging. And so, you know, a couple of pieces of advice that I love to give to students and those that may be interested in public health is public health is such a dynamic and growing field. There's so many different types of fields within public health. There's the one that I'm in, which is bio preparedness and special pathogens. There's a field with environmental science, you know, maternal health, you name it. Right. It's such a diverse and dynamic field. So whatever your specific interest is, there's probably a specific field in public health that is dedicated to that. And so what you want to do is you want to build strong networks. You want to find good mentors that can provide guidance and support to you. That's actually one of the reasons why I started the Special Pathogens internship program at our healthcare institution about 6 or 7 years ago. It's probably the first in the nation that was specifically geared towards special pathogens, and it's been growing phenomenally ever since. We now have a new fellowship program that's specific to climate, health and special pathogens. And so you want to look out for these specific internships and fellowships and gain that experience and knowledge, and then to reach out to mentors.
Dr. Syra Madad: [00:39:48] You know, there's just so many amazing people out there that are working in public health that are eager to educate, that are eager to give back to society and to speak to students. So build that network, reach out to mentors. And really importantly, public health is not just about the science, it's about the people. And so you want to make sure you understand the community that you're looking to serve. You want to develop strong communication skills. You want to make sure you have a good sense of empathy, because people are coming from all walks of life. You really want to understand both sides of the argument, both sides of the aisle, if you will. If you really want to make sure that you're understanding the core issues of what's impacting that particular society. No two communities are the same or no one community is the same. And so you really want to understand some of the dynamics of what makes this particular community. You know, whether they are versed in public health and they have a high vaccination rate, or they're have a low vaccination rate. And each community in the United States is so different and diverse, right. So you really want to understand who you're working with. You want to adapt. You want to think creatively, really, and you want to have fun. Public health, honestly, is such a it's a fun field. And the work that I'm doing, which is at the nexus of public health and healthcare, it's thrilling. If I could summarize it in one word, it's honestly it's thrilling.
Henry Bair: [00:41:03] Well, with that, we want to thank you so much, syra, for taking the time to join us in conversation and for sharing your your unique insights and stories. Thank you so much.
Dr. Syra Madad: [00:41:12] Yeah, absolutely. Thanks so much for having me.
Henry Bair: [00:41:18] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the doctor's Art.com. If you enjoyed the episode, please subscribe, rate, and review our show available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:41:37] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient, or anyone working in healthcare who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:41:51] I'm Henry Bair
Tyler Johnson: [00:41:52] and I'm Tyler Johnson. We hope you can join us next time. Until then, be well.