Public Health and the Coronavirus: We should be pointing fingers at ourselves

When Congress reserved hot seats last week for two of our nation’s top health officials regarding the coronavirus epidemic in the US, it came as no bombshell revelation to my fellow public health colleagues to hear our system described as a “failure” during the testimony of the NIH’s Dr. Anthony Fauci. In truth, our situation in public health is akin to the same bad joke that keeps on being told: we are chronically underfunded to do the work we do to keep the public – Americans – healthy and safe. This unfortunate circumstance is well-known across public health circles; we talk about it as part of our schooling, discuss it at conferences, and cope with it in our workplaces. We in public health have become accustomed to doing more with less and being regarded as the step-sibling to our brothers and sisters in the medical profession. In some ways, we public health professionals can be understanding. Afterall, we recognize that it is difficult to perceive the fruits of our labors: prevention efforts keep people from getting sick (how really does one quantify the absence of disease?). We get that it is much easier to grasp what our medical counterparts do when a disease is treated and cured. Here my public health training prescribes that I point out how preventing disease is generally less costly than treating disease. Prevention approaches – be they vaccinations for infectious diseases, educational programs or anti-smoking policies – are some of the most effective interventions we have available, and they save lives. Prevention also means readiness; insufficient funding over time has had impacted our ability to anticipate, prepare and respond quickly and nimbly to threats such as natural disasters or novel viruses, such as is apparent today with COVID-19.  The reality is that we need public health more than ever: we will face new challenges with continued population growth, global travel and migration, and changing habitats due to climate change.  To succeed, our priorities need to shift as a nation. We need to support funding for public health. We need to vote for elected officials who value public health and advocate for public health with those in office.  Public health is, at its core, just that – the health of the public. We all play a role in our public health, highlighted by the coronavirus epidemic. Otherwise, we can’t fairly criticize our public health professionals and need to save the finger-pointing for ourselves.

Staying abreast of the coronavirus situation

The novel coronavirus is a rapidly changing situation for public health. I personally have found that some of the information I read in the morning newspaper may already be outdated by the time I am driving into work and listening to news coverage on the radio. This, coupled with the sheer number of sources of media can inevitably be confusing and difficult to follow. It is good to stay updated on the situation in order to be informed of recommendations by public health professionals. Pick a few sources that are trustworthy and check them regularly.

For example:

The Los Angeles County Department of Public Health has a webpage dedicated to the novel coronavirus: as does the Riverside University Health System: and the San Bernardino Department of Public Health

One of our local public radio stations, KPCC 89.3 FM, is regularly broadcasting live updates from the Los Angeles County Department of Public Health.

Or you can follow the Centers for Disease Control & Prevention (CDC) @CDCgov or the World Health Organization (WHO) @WHO on Twitter which both offer daily briefings on the coronavirus.

Why the public health response to the novel coronavirus may be shifting

The term “community transmission” is being used to describe what public health officials believe is the likely way a Northern California resident became infected with the COVID-19 virus this month. This description refers to the fact that the infected woman had not traveled internationally, had contact with anyone who had, or with anyone who was known to be infected with the virus. As such, it is possible that she was exposed to the virus through someone else who didn’t know they were infected.  A problem with emerging infectious diseases such as that caused by the novel coronavirus, is just that – they are not known to us and the unknown inevitably can cause some to fear the worst. What will help to shed light on the situation is more information and good quality information. International data on the COVID-19 virus thus far seems to suggest that approximately 80% of people who become infected do not develop severe illness. We still have more to learn about COVID-19 and public health officials are planning to expand testing for the virus. What we do know is that COVID-19 causes respiratory illness; as with other respiratory viruses, the best prevention still relies on simple steps like covering coughs and sneezes, washing hands, staying home when sick and avoiding contact with others who are. So, yes, we should be taking this new virus seriously and taking precautions, but we also should direct our fear energy to preparedness efforts.  

Fear the coronavirus… or the flu?

The media plays an important role in public health: communicating information, educating the public, serving as an avenue for discourse on a given topic. At worst, reporting by the media and particularly social media may fuel xenophobia as described in this February 3 LA Times article. While we don’t know yet the scale and magnitude of the novel coronavirus globally and in the United States, it is likely that the fear of the unknown is contributing to our perception that the risk is greater than it actually is in the US. This January 31 LA Times article nicely points out what we do know, which is that our annual influenza epidemics a.k.a. “flu seasons” are more cause for concern among Americans. The flu may be “old news”, requiring effort by public health officials to remind people every year to get the flu shot, cover coughs and sneezes, wash hands and stay home when sick.

A new virus?

A newly identified coronavirus, which was first detected in Wuhan City, Hubei Province, China in late 2019, has begun to sicken people in China and other countries including the United States. Coronaviruses are a large family of viruses named for the crown-like shape of spikes on their surface. Seven coronaviruses including the newly identified virus, SARS, and MERS, are known to infect humans, primarily causing respiratory illnesses. Other coronaviruses circulate among animals, and rarely do animal coronaviruses evolve to be able to infect people. In the case of the newly identified coronavirus in China, health authorities suspect a large seafood and animal market was the origin of the outbreak, which suggests that at least initially there was animal-to-person transmission. However, a growing number of patients reportedly have not had exposure to animal markets, indicating person-to-person transmission. At this time, the CDC reports that it is unknown how easily or sustainably this virus is spreading between people.

Why worry? Outbreaks of new virus infections among human populations are always of public health concern. At the outset of an outbreak, much is unknown and remains to be discovered. How many people will be infected? How quickly will the outbreak spread? How sick will infected people become? Will there be deaths associated with the infection? Many answers to these questions depend on characteristics of the virus, and many will depend on and the medical or public health interventions available to control the impact of the virus (for example, vaccine or treatment medications).

As of January 24, the CDC and other international health authorities are continuing to monitor the situation and updates are likely as more information is collected.

Think twice about that Caesar salad?

It’s happened again – Romaine lettuce grown and harvested in Salinas, California is getting people sick from foodborne illness caused by E. coli bacteria contamination. As of right before Thanksgiving on November 26, the CDC reported that 67 cases had been reported in 19 states, leading to 39 hospitalizations, but fortunately no deaths. A nationwide recall of Romaine lettuce grown in this region is in force. Sound familiar? That’s probably because less than a year ago, there was an outbreak caused by the same bacteria which was also associated with Romaine lettuce grown in the same region of California.

What is E. coli infection like?

  • People usually get sick from Shiga toxin-producing E. coli (STEC) 2 to 8 days (average of 3 to 4 days) after swallowing the germ.
  • Some people with E. coli infections may get a type of kidney failure called hemolytic uremic syndrome (HUS).
  • E. coli infection is usually diagnosed by testing a stool sample.
  • Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out. Some studies have shown that administering antibiotics to patients with E. coli infections might increase their risk of developing HUS, and a benefit of treatment has not been clearly demonstrated.

For the latest information on the outbreak, check the CDC website at:

Keeping our food safe

When I think about the scope and scale of our food system, it is impossible not to get a sense of the enormity of the tasks involved in keeping our food safe to eat. The reality is that many products are distributed far across the country (and world), far from where they originated. When a contaminated product enters the food system, the potential reach of the problem could be vast. Think back to a recent example that made news headlines of romaine lettuce grown in California which sickened people in 16 states. In that outbreak, it was the bacteria, E. coli O157:H7, which had contaminated the lettuce and was causing infections. Many other things can get unintentionally get incorporated into our food: plastics, metals, animal parts, insects… not very appetizing, right? For people who have allergies, foods that unexpectedly contain allergens such as nuts, can pose health risks. I saw that a batch of peppermint patty ice cream made by one of my favorite creameries was recalled this last week due to the potential presence of peanuts.

How is our food kept safe? One entity responsible for food safety is the US Food and Drug Administration. The FDA protects the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation’s food supply, cosmetics, and products that emit radiation. Curious about current foods that are the subject of recalls? Check out the “Recalls, Market Withdrawals & Safety Alerts” issued by the US FDA.

A Finnish take on food waste

Do you often wonder where salable food ends up when it “expires” and can no longer be officially sold? Maybe you suspect that you already know (the garbage). Yet it pains you to think of all the waste, particularly when food is still plenty edible and so many people go hungry?

A recent New York Times article reported on a two-year campaign in Finland to reduce food waste in which supermarkets slash the prices of food items every evening at set hours. The campaign hopes to draw “regular” customers to snatch up the items at a fraction of their regular cost, avoiding otherwise their dumpster fate.

The article pointed out the consequences of food waste from a climate change perspective, including the percentage of greenhouse gas emissions associated with food lost during harvest, production or consumer waste, as well as the methane emissions from rotting food in landfills.

Ideally, one would avert food waste by purchasing less in the first place. However, this campaign attempts to stem losses by incentivizing consumers to purchase food that then needs to be eaten relatively soon. Novel idea or nonsense?

farms around the world

One of my favorite things to do when I travel is to visit local farms and check out what people are growing to eat. It seems that no matter where I am in the world, setting foot on a farm provides me with a sense of grounding and nourishment. This summer I had an opportunity to visit Caoba Farms in Antigua, Guatemala where, in addition to growing fruits and vegetables, the farm has a cactus garden, birds, butterflies, animals and educational areas for children.