San Antonio Express-News (Sunday)
ALL YOU NEED TO KNOW ABOUT THE PANDEMIC.
For the past 15 years, former Metropolitan Health District epidemiologist Cherise Rohr-Allegrini has studied and planned ways to prevent infectious diseases from spreading in
San Antonio and the rest of South Texas.
She began her tenure at Metro Health in 2005 then quickly became the department’s first person in recent decades to oversee pandemic flu planning. After that, she oversaw the region’s communicable disease division for the state health department during the H1N1 pandemic.
Today, Rohr-Allegrini works as the San Antonio director for The Immunization Partnership, a nonprofit dedicated to eradicating vaccine-preventable diseases. We sat down with her to understand how the city’s pandemic flu position came to be, how funding cuts got us to this state and what obstacles we face moving forward.
Tell me about how you started with Metro Health 15 years ago.
There was a lot of Homeland Security funding, and they were investing a lot in doing research on potential bioweapons and preparing for outbreaks of diseases caused by bioweapons. They brought me on for that in the public health emergency preparedness division. That was the year of Hurricane Katrina. About two months in, I got thrown into Katrina’s response. It was crazy for everybody — nobody had ever done anything like that.
As that started to wind down, there was a large investment nationally in pandemic flu planning. And our health director said to my boss, “Who’s our pandemic flu person?”
And he said, “Cherise is!”
And I was like, “What?”
I had a lot of virology classes in graduate school, I felt fairly confident that I had at least a firm understanding of the
basics, but I had never studied respiratory diseases before that. I was not an expert on pandemics or flu before that. But I had to become one.
I quickly became the local expert, not just in influenza and all the different epidemics we’ve had but in contingency planning. What I ended up having to do was work with all sorts of entities — city departments, local businesses, big businesses like USAA, school districts and universities — to help them come up with plans for, what would you do if 30 percent of your workforce was out? I don’t think we honestly ever talked about a full shutdown of the economy like we have now.
When you were working in that role, did you ever expect something like the COVID-19 pandemic to happen?
Yes and no. We expected the pandemic to be flu. We know a lot about influenza, so that helps us. This is a virus that’s got a lot more unknowns than influenza virus. The incubation period is longer for COVID-19. We don’t fully understand the transmission dynamics, so that’s different.
We didn’t anticipate a whole shutting down of the economy. It was more measured, like, if we have to close schools, how would your business stay open? A lot of focus was on how do you keep your economy, including your schools, functioning at a time when you don’t have your workforce fully available, assuming they would be sick. We actually expected a lot more people to be sick in the process.
So there are differences, but there are also a lot of similarities. We always would say it’s not if, but when.
We did have a pandemic in 2009. At that point, I was working for the state health department in Region 8 and we had the first cases of H1N1 that were identified here. But that pandemic ended up being not nearly as bad as we expected. It was pretty significant, but it wasn’t having the broad impact that this is having. And I think that’s a little bit part of the perspective because people mostly remember H1N1, but they don’t remember it as a big deal.
But memories are short. Then the funding went away. I don’t think any health department still has that level of staff or pandemic preparedness we had in 2005.
This is a very, very common problem in the history of public health. When you do things well, you prevent disease. Preventing disease is not sexy, and it’s really hard to show how many lives you saved … by prevention. When you have a fire and you put it out, you can show what you did. But when you prevent the fire from happening, it’s hard to say, “Well, we prevented all this stuff.” So the money goes away, there’s not even resources for it, and you shift priorities because it’s not what’s happening right at that moment.
It was mostly federal funding, right?
It was then — that was the
Homeland Security funding that went away slowly over the years. And that’s a big deal. Everyone wants to blame certain political leaders for it, but really, I blame us as a society, regardless of my opinion of certain political leaders.
I think, as a society, we had decided that funding these efforts was not important so Congress cut funding to it over the years, and certain executives made other decisions making it worse. That was something that I think we all share responsibility in. We stopped caring about it as a society, until it’s in your face. We’re not alone in that, I think worldwide that’s an issue. Again, it’s easier to see the need to put out the fire than to prevent the fire from happening.
Considering those things, what are going to be our biggest obstacles to recovering from this pandemic?
In this way, COVID-19 is very different from flu because we were able to get a vaccine pretty quickly for flu. That is a lot of what kept H1N1 from spiraling out of control: We had a vaccine within about six months. That’s not going to be the case at all for COVID.
So what’s going to be really hard is getting — I hate saying, the new normal or getting back to normal — but it’s figuring out how to move forward in a way that continues to be safe.
There’s a great article by a woman from Harvard. She compared it to abstinence. Basically, abstinence-only doesn’t work, and in this sense, she’s referring to the physical distancing. Telling everybody to not go outside is essentially saying, “You can only practice abstinence.” We know that that’s not practical. So how do we adapt to limiting our social interactions so that we’re not spreading disease in a really problematic way? I think we’ve done a really good job up until now, but we can’t continue to live like that.
You brought up the future COVID-19 vaccine. To what extent do you think the anti-vaccination movement will threaten our recovery?
It’s a huge threat. In Texas, they like to say they’re not antivaccine, they’re pro-personal rights. It’s a huge problem because they already are not just opposed to vaccines, they are opposed to anything the government tells them to do. The movement in Austin a month ago when they had the big rally at the Capitol by the people demanding reopening the state, it was the same people. They overlap.
It’s going to be a problem because they spread misinformation constantly. We’ve been dealing with that. We already have an issue with being at risk of a measles outbreak. We always have pertussis — it’s going to get worse. There’s a few other diseases that if kids aren’t vaccinated more, there’s enough lurking out there that it’s going to be a problem. They haven’t gone out of control yet, because we do have good vaccination rates overall. But we do have pockets of people who aren’t vaccinated, and all you need is one person in that population.
That scares me that we’re going to be at higher risk of diseases that we do have vaccines for, on top of COVID-19. And that community is already fighting against a vaccine that doesn’t exist. They’re already saying, we will not get vaccinated, you can’t force us to get vaccinated.
That part I’m not worrying about yet. Because the reality is, even if we get a vaccine, we are not going to have enough vaccines for everybody for a number of years. We’re going to start off with high-risk groups that get vaccinated first because it takes a while to manufacture, and this has to be worldwide. The biggest problem with (the anti-vaxxers) is they are spreading misinformation already.
What other efforts will be critical moving forward?
Anyone who knows me knows I talk about contact tracing excessively. Contact tracing is something that is not new. It has been done since John Snow, the founder of epidemiology in the 1800s. Contact tracing is how he was able to understand the source of a cholera outbreak.
It’s always what we’ve done. Using new technology is all the rage right now, and certainly having a good database to enter this information is useful. However, an app doesn’t replace that human interaction because you get so much more from human interaction. And in the U.S., we respect people’s privacy. We have HIPPA for a reason.
When I call someone to say, “You’ve been exposed to COVID-19. You need to get tested,” the source of that exposure is never named. I’m not using cellphone tracking data. Our society is such that we use a lot of resources so I might go through Facebook and look for that person and go, “Who are those people there?” But it’s not anything beyond what people are already sharing.