The Sher­lock Holmes of emerging epi­demics

Pop­u­lar Science, United States of Amer­ica, 21 Septem­ber 2020,­­ti­cle/2815265234­64443

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alma mater, Michi­gan State Univer­sity, while he ap­plied to med school. But this project— in­ves­ti­gat­ing how a sense of com­mu­nity in­flu­ences well­ness —in­trigued him in a way a clinic never could.

Within the heaps of pa­per­work, he un­cov­ered a com­pelling com­bi­na­tion of science and ser­vice. “I didn’t re­ally un­der­stand any­thing about the field,” Pevzner says of his first foray into pub­lic health. By unit­ing dis­parate fields like psy­chol­ogy and eco­nomics, he and his col­leagues were find­ing ways to im­prove peo­ple’s lives.

Pevzner never did end up in med school. In­stead the re­search led to a fel­low­ship at the U.S. Cen­ters for Dis­ease Con­trol and Preven­tion (CDC), which in 2005 ush­ered him into a more mys­te­ri­ous side of medicine: com­posit­ing scat­tered pa­tient sto­ries into de­tailed por­traits of dis­ease. He’s spent his ca­reer as a sci­en­tific sleuth, and now serves as chief of the CDC’S Epi­demic In­tel­li­gence Ser­vice (EIS), an elite post­grad pro­gram pro­duc­ing the world’s best health de­tec­tives.

Founded in 1951 to ad­dress the threat of bi­o­log­i­cal tactics in the Korean War, the EIS has trained more than 3,800 of­fi­cers, Pevzner in­cluded. Epi­demi­ol­o­gists, doc­tors, nurses, and even vet­eri­nar­i­ans learn to chart the chain of trans­mis­sion through peo­ple who have been ex­posed to a pathogen and those they may have in turn in­fected. Of­fi­cers tap pa­tients’ mem­o­ries, doc­u­ments like pay­roll logs and flight man­i­fests, and tech­nolo­gies like cel­lu­lar lo­ca­tion data and com­puter mod­el­ing. With each new link, EIS ex­perts re­fine their an­swers to the big ques­tions: how con­ta­gious a dis­ease is, who’s at risk, and what poli­cies might help to curb its spread—from so­cial dis­tanc­ing to fund­ing vac­cine de­vel­op­ment.

EIS of­fi­cers and alumni have tack­led every ma­jor modern pub­lic health cri­sis, in­clud­ing va­p­ing, HIV, and opi­oid ad­dic­tion. Pevzner, who took over the pro­gram in 2017, still heads into the field—though day to day he fo­cuses more on de­vel­op­ing course­work and swap­ping in­sights with sim­i­lar pro­grams around the world. In 2006, for ex­am­ple, he in­ves­ti­gated an un­usual tu­ber­cu­lo­sis out­break among metham­phetamine users in Washington state. By pok­ing through health records, his team de­ter­mined the cases were all linked to an ear­lier out­break in the 1990s through an in­fected woman who didn’t com­plete her an­tibi­otic reg­i­men. The in­ves­ti­ga­tion also re­vealed a larger pat­tern: A lack of trans­porta­tion and hous­ing kept many peo­ple from fin­ish­ing treat­ment. Pevzner sug­gested pro­vid­ing pa­tients with tem­po­rary shel­ter and fi­nan­cial sup­port, mea­sures that helped pub­lic health of­fi­cials stem the bac­te­ria’s spread.

In 2020, COVID-19 has pre­sented EIS with one of its trick­i­est factfind­ing mis­sions, and a new pri­or­ity for Pevzner and his col­leagues. With lit­tle warn­ing and no prior knowl­edge of the dis­ease, which emerged in China’s cen­tral Hubei prov­ince in late 2019, the EIS has had to de­velop ex­per­tise on the pan­demic in real time.

Pevzner, along with seven past and present of­fi­cers, be­gan trac­ing COVID-19 on the ground this past March, af­ter an EIS alum work­ing in Salt Lake County, Utah, in­vited them to visit. They went from house­hold to house­hold, gather­ing data via sur­veys, swabs, and blood sam­ples to cal­cu­late the virus’s “at­tack rate”—the per­cent­age of an ex­posed pop­u­la­tion that con­tracts the dis­ease in a given pe­riod. Tal­ly­ing this within fam­i­lies can help es­ti­mate com­mu­nity spread and guide health­care sys­tems as they stock sup­plies and ramp up ser­vice. To evade nosy neigh­bors, the team donned their per­sonal pro­tec­tive equip­ment stealth­ily in back­yards and garages. “Many peo­ple have never seen some­one in full PPE, ex­cept in movies like Con­ta­gion or Out­break,” Pevzner says of the anx­i­ety-pro­vok­ing com­bi­na­tion of gowns, face shields, gloves, and masks.

As new clues sur­face, the team’s prac­tices change too. For in­stance, when re­ports emerged cit­ing loss of smell and taste as symp­toms of COVID-19, Pevzner’s crew mod­i­fied its sur­veys and cir­cled back to pre­vi­ous in­ter­vie­wees. With­out this tid­bit, the in­ves­ti­ga­tors might have over­looked some pa­tients, al­low­ing the in­fected to un­know­ingly con­tinue trans­mit­ting the dis­ease.

The constant dou­bling back can be frus­trat­ing, Pevzner admits, but the de­tec­tives train to keep up. Whether it’s the present pan­demic or the next novel dis­ease, the best way to track and stop a pathogen is to adapt along­side it. “We have to be nim­ble,” he says.

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