Putting the pandemic in perspective
Photo by Ashley Barnas March 31, 2020
UD epidemiologist Jennifer Horney explains social distancing, testing rates and more to a global audience
In just one month, the COVID-19 coronavirus pandemic has upended how we live, work, learn and play. It has raised myriad questions about individual and governmental responsibility, allocation of medical resources and long-term impact, especially as rates of infection continue to rise.
Whether explaining U.S. coronavirus testing rates, noting the need for caution in using computer models to predict patient care or stressing the importance of social distancing, University of Delaware’s Jennifer Horney has been a voice of authority in the national media, answering pressing health questions and putting the issues related to the COVID-19 pandemic in perspective.
This is an area that Horney — the founding director of the Epidemiology program in the College of Health Sciences — knows well. She has trained rapid response teams around the world to respond to outbreaks of novel and re-emerging diseases, such as Influenza A H1N1.
In addition, Horney’s research focuses on the impacts of natural disasters on public health, as well as linkages between disaster planning and the actions communities and individuals take to prepare, respond and recover. She is also core faculty at the Disaster Research Center.
“Dr. Horney has been an excellent addition to the College of Health Sciences and the University of Delaware for the expertise she brings in epidemiology,” CHS Dean Kathleen S. Matt said. “Her facilitation of the translation of research into models can then inform a more scientifically based approach to our response to health challenges such as the one we are experiencing now with COVID-19."
Horney recently answered questions about COVID-19 and her experiences as an epidemiologist.
Q. How does the coronavirus pandemic compare with other issues you’ve tackled before?
Horney: I was part of the teams responding to avian influenza (H7N9) in Southeast Asia and pandemic influenza (H1N1) in the U.S., Central America, and Russia. That was different, as those outbreaks did not impact the U.S. to such a large extent. In the case of H1N1, there were a large number of cases in the U.S. in the spring of 2009, but relatively quickly we were able to see that most of the cases were mild, and the antiviral Tamiflu was available and effective at both reducing the severity of infection and shortening the course of the disease.
I also have been part of public health teams that responded to a number of major hurricanes, including Katrina, Irene, and Harvey. I think that natural disasters are somewhat different as they, at least for the most part, encourage a sort of social cohesion where people tend to come together. With a communicable disease where we are being asked to socially distance ourselves from our friends and neighbors, that type of social support is missing and that loss is being felt by individuals and communities.
Q. What kind of efforts help people to take their role in reducing the spread of the pandemic seriously?
Horney: Several things are happening simultaneously this week that will define the shape of the epidemic in the U.S. over the next several months. As more states implement closures of non-essential businesses, the case counts will also increase as testing becomes more widely available. This may lend additional support to those who are criticizing the large-scale social distancing measures and advocating instead for focusing these efforts only on those over age 60 and with comorbidities that may complicate infection with novel coronavirus.
However, there are early signs that social distancing is starting to work. The number of days that it takes for the number of cases to double has been slowly increasing, with some models showing it reaching four days just in the last 24-48 hours.
Q. How does testing factor into this?
Horney: Even as expanded testing becomes available in the U.S. this week, we are still not in a position to test everyone, like the approach in the small Italian village of Vo, or to respond to the test results as stringently as Singapore has to quench the outbreak there. This makes it essential to expand testing in ways that continue to focus on those with symptoms and those at highest risk and to test those for whom a positive result would change the course of treatment. As we have more data from testing, we will be better able to use our tried and true skills in public health surveillance to improve our understanding of how COVID-19 is spreading in the U.S.
Q. How can people learn more about what’s going on around them?
Horney: One of the most interesting things recently is the launch of COVID NEAR YOU, which lets you enter your own information about how you feel and track activity by ZIP Code. As states are ramping up testing, there are more positive cases being reported and more pressure from the public and the media to release identifying information about those cases, which of course is not possible due to HIPAA and other privacy regulations. For those interested in seeing more granular information about infections, this site may be of interest. It is based on an online tool that has been used for several years to track the seasonal flu.
Q. How has the COVID-19 pandemic changed the way people perceive public health?
Horney: We usually say when public health does its job well, it is invisible. No one talks about all the cases of measles that are avoided through vaccination, public health education, surveillance and partnerships with health care providers. At the time of the first coronavirus infection in Delaware, public health was conducting several other important outbreak investigations, including an outbreak of mumps in a local school district. The investigation of outbreaks is one of public health’s core functions, but usually we are dealing with a disease that is more familiar to the public and therefore garners less attention.
Q. What’s the media attention been like?
Horney: I used to feel nervous talking to the media, but you get used to it as you do it more. I’m happy to take the time to do it because there is so much misinformation out there — particularly on social media — that if the interview just gets factual information in a few people’s hands (or inboxes) then it’s worth it.
It’s one of the things I teach in my outbreak investigation class – which I’ve been busy putting online for the rest of this semester. One of the key steps of an outbreak investigation that is tempting to skip is the communication aspect. We have to communicate aspects of the investigation not only to public health and other governmental officials, but also to the public, who need to understand the control measures that are being put into place, the risk of infection and the reduction of risk that may be associated with those control measures, and how to protect themselves. This communication also helps to ensure that similar outbreaks are avoided in the future.
Q. Will this pandemic lead to more people being interested in epidemiology and public health?
Horney: During my career, I’ve pretty consistently been asked if I study the skin (epidermis) or hormones (endocrinologist), so one silver lining would be if the public in general — and students interested in a career in public health or health care — get to see firsthand what epidemiologists do.
It can be hard to explain what epidemiology is since it is a broad field, but we’ve seen contributions from those in applied epidemiology (outbreak investigation), epi modeling and health care epidemiology (trying to understand the surge capacity of the healthcare system and get us to take actions that can “flatten the curve”), infectious disease epidemiology, chronic disease epidemiology, the epidemiology of aging. So there’s a role for most people with knowledge of epidemiologic methods to play in the response to novel coronavirus.