Disease Detectives Tackle COVID: Reports from Around the Globe

Africa experienced a  43% jump in COVID-19 deaths this month as infections and hospital admissions continue to rise and medical supplies fall short, according to the WHO; while the death toll in Myanmar reaches daily records; and India and Indonesia see an increase in cases.

Around the globe, field epidemiologists and laboratory technicians are the first line of defense in public health outbreaks and serve as “disease detectives.”

In December 2019 in the sprawling city of Wuhan, China, an unusual number of people were falling ill with what seemed like pneumonia: a weakening fever, nagging cough, and unrelenting headache. The cause of this unknown illness was a mystery for which the detectives tested samples, identified microscopic agents, and traced the trail of transmission in the community back to its cause: the SARS-CoV-2 virus.

The Task Force’s Training Programs in Field Epidemiology and Public Health Interventions Network (TEPHINET) supports trainees and graduates of national Field Epidemiology Training Programs (FETP) through knowledge and resource sharing in an effort to build global field epidemiology capacity to detect and respond to public health threats.

Below are stories from a few of the 19,000 TEPHINET epidemiologists trained in more than 100 countries who are strengthening the world’s ability to prevent and respond to outbreaks.

Brazil

As frontline workers during an outbreak of a virus that spreads easily, field epidemiologists have to overcome personal fears of contracting and spreading the disease. For Brazilian FETP (also known as EpiSUS) trainees Ana Júlia, Ewerton, and Nathalie, this took a lot of courage while conducting a COVID-19 outbreak investigation.

“During the investigation, the constant fear of falling ill due to COVID-19 was recurrent, even when wearing protective equipment,” said Ana Júlia.

A recent spike has devastated Brazil, which currently hovers around 19.7 million cases and nearly 550,000 deaths according to Johns Hopkins COVID-19 Dashboard. EpiSUS field epidemiologists Dalva, Fernanda, and Ruanna described  how they consoled mourning families during home visits in Amazonas.

“These families presented us with the opportunity to be useful within our craft and to bring a little warmth to those who lost a piece of their family,” said Dalva. During their work in communities, the team realized that while  understanding the epidemiology behind an outbreak is important, being sensitive to the pain of others at these times is even more important.

Photos courtesy of EpiSUS.

With 32.3% of the Brazilian population vaccinated according to the Bloomberg Vaccine Tracker, public health officials are working hard to increase vaccination rates. Field epidemiologists like Ewerton, Dalva, and Ruanna are supporting this effort by investigating reports of adverse events, like allergic reactions that were reported after vaccination in regions like Parana, Goias, and Bahia. Field epidemiologists have a unique set of skills that allow them to swiftly identify and capture evidence, assimilate into a community for further investigation, and generate hypotheses to help countries like Brazil protect their communities from COVID-19 and vaccine-related anomalies.

Pakistan

On February 4, 2020, Pakistan Field Epidemiology and Laboratory Training Program (FELTP) fellow Sara Saeed and her team received a call from the Islamabad International Airport’s air traffic control tower notifying them that a flight would be landing from China carrying a passenger with fever.

“Being an airport health officer, I am looking after all agencies, airlines, and cargo, along with passengers,” she said. “Since [February 4], my team and I have screened more than 390,000 passengers at Islamabad Airport arriving from different countries. I experienced a lot of problems due to meager human resources and the irrational and uncooperative behavior of some passengers due to their fear of quarantine.”

Point of entry screening is essential to disease surveillance efforts during a pandemic so that a country can be aware of new cases entering the country and take preventative measures before the sickness spreads.

Two days shy of the anniversary of the declaration of the pandemic, Pakistan began its COVID-19 vaccine roll out. Fellows and trainees like Saeed have provided technical support to Disease Surveillance and Response Units throughout the vaccination process, helping to administer 25.4 million doses so far.

Photos courtesy of Pakistan FELTP.

Additionally, they continue to help Pakistan conduct surveillance and track vaccinations by supporting the establishment of a vaccine management information system, a surveillance system to monitor adverse events following immunization, and district vaccination centers.

China

The challenges of a global vaccination campaign are well-illustrated by the world’s most populous country, China. Reaching a billion people takes a dedicated network of skilled health professionals and an understanding of how people are feeling about the vaccine. Thankfully China’s FETP (CFETP) has built a strong field epidemiology workforce.

Across 27,000 vaccination sites, field epidemiologists developed online registration and inquiry platforms that have helped get vaccines administered swiftly. These platforms have been utilized to develop an app that transfers the Electronic Vaccination Certificate received post-

vaccination into a user-friendly health card. Building these integrated information systems provides China with a clear picture of their vaccine campaign’s progress and ensures that the vaccine supply stays on track.

To better understand sentiments toward receiving the vaccine, current CFETP trainees administered a rapid survey in three districts of Beijing among people 60 years and older. Going door-to-door to capture as many responses as possible, the surveyors collected evidence on factors affecting vaccine uptake, including community support and awareness of the nearest vaccination site. These results are helping China better protect its citizens due to a better understanding of citizens’ concerns.

Photos courtesy of China FETP.

Papua New Guinea

With only 0.4% vaccination coverage and around 1.1 million cases of COVID-19, Papua New Guinea is working diligently to protect their island communities. The Papua New Guinea FETP is supporting the COVID-10 response, including the national ‘Sleeves Up’ vaccination program.

Photos courtesy of James Flint, Papua New Guinea FETP.

The FETP conducted a national vaccine hesitancy survey to understand and address major concerns among global communities.

“Vaccine hesitancy and apathy remains high in Papua New Guinea,” said epidemiologist James Flint, FETP Program Coordinator. “We are proud of our FETP graduates, fellows and faculty who are working hard to understand and address these barriers and support the overall response. Almost all of Papua New Guinea’s 96 FETP graduates are involved in the national response, many in leading roles.”

These stories were originally published by TEPHINET on their website and in their 2020 Annual Report. Check out the full stories.

Header photo: People wait outside the Likia CDF Dispensary in Njoro subcounty, Nakuru county in Kenya. Photo courtesy of Reyoh Photography for PIVI.

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