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Alexandra Arriaga: Hello everyone and welcome back to I AM GPH. In this episode, our faculty member, Dr. Robyn Gershon, uses her perspective as a clinical professor of epidemiology to moderate a discussion about coronavirus with NYU graduate Dr. Rachael Piltch-Loeb and second year MPH student Suiyue Cui. They discuss the most current figures for the virus, the different ways in which media are portraying it, and the danger of misinformation. We also get the unique perspective of Sui who has stayed at the forefront of the epidemiological events of the virus thanks to her relatives who live in China.
Robyn Gershon: Hello, my name is Dr. Robyn Gershon. I'm a clinical professor in the School of Global Public Health here at NYU. I'm here today to talk to two of our fabulous students. One recently graduated with her doctorate. The other in the second year. We've been talking back and forth amongst ourselves about this terrible coronavirus outbreak. Now, at the School of Global Public Health, we have a brand new certificate program in disaster science. You might say, "Well, why do we need such a specialized certificate program?" But sadly, the fact is that the fastest growing job in the US right now outside of IT jobs is emergency management and public health disaster preparedness. Those two areas, emergency management and disaster public health preparedness, are fast growing because sadly because of climatological change, we are seeing an uptick in all kinds of natural disasters, including outbreak such as this. I have with me here today first our recent doctoral student, Dr. Rachael Piltch-Loeb, and she'll be talking a little bit about some of her fascinating work that she conducted looking at how people perceive threats and whether or not how they get that information about threats impacts whether or not there's going to be uptake on certain interventions that will help address those threats. She'll tell us a little bit more if I've done that correctly. We also have with us Suiyue Cui, who is a second year epidemiology major student here. One of the things I'd like to highlight here is the fact that at NYU we are teaching our students and they are studying things that have direct applicability in the real world. What could be more real than addressing an outbreak that may impact not just China, but the whole world? They're taking epidemiology, statistics, public health policy, global health, and now of course, all these disaster courses, three of which I direct myself in an online forum. Let's start first, if we would, with Rachael and ask her, how does the work that you did, your fabulous doctoral work, how does that inform your view of the situation that's now unfolding in China and of course throughout the world?
Rachael Piltch-Loeb: Hi, everyone. Thanks, Robyn, for that introduction, which I think you did do justice to. Again, I'm Dr. Rachael Piltch-Loeb. I am a postdoctoral preparedness fellow at the Harvard Chan School of Public Health in their Emergency Preparedness Research Response and Practice program or EPREP, it's a mouthful in and of itself, and affiliated here still with the program on population impact recovery and resilience. Thinking through my dissertation work and what's really relevant here is how/where information comes from really influences how that information is to be perceived. For example, for those of you who are following the news, perhaps you're getting information about coronavirus from typical sources you go to, whether that's The New York Times, The Sun, The Daily Mail, the BBC, your family, your friends. There's a lot of different resources that maybe you go to for your news. Maybe it's just Twitter or Facebook. What you're seeing on all of those different news sites really depends. The content of the information really varies from site to site. Some places you'll see sensationalized images or messages that are perhaps intended to instill some level of fear or scare in you related to coronavirus. That's not to say that the virus isn't scary or unknown at the moment. There's a lot that scientists, epidemiologists are still trying to figure out about coronavirus, but the coverage of the virus itself really varies from publication to publication. In contrast, in some other places, you might be getting more factually based information that's talking about the statistics or the number of cases we're seeing, which I think as of this morning is 6,000 cases, approximately. The number of deaths that have occurred, which I think again as of this morning or today is 132 deaths, which have all been in China. The material is really focused on kind of just stating the facts and what's still to be determined by WHO and the global health community. How you're probably perceiving and feeling, maybe that level of anxiety related to the virus, is likely tied to where you're getting your information. I think that that's really important to keep in mind. For those of you who may be having sort of this level of concern related to coronavirus to perhaps think about seeking information from another place just to get a little bit of a reality check on what's the content that you're getting and how consistent is that with what all various news sources are reporting. Because I think in terms of coronavirus in particular, this level of unknown currently related to the virus is really allowing the news coverage to be so varied in comparison to something like the seasonal flu, which in this country has already affected 15 million people and actually killed over 8,000 people. Typically, we see 30,000 deaths or more related to seasonal flu. When you put that in perspective, you're kind of reminded that the information that's coming out about coronavirus is intended to sort of stoke our fears about something that's unknown, new, and challenging. But yet when you contextualize it with something like flu, which we see every year, and I'm guessing some of you probably haven't gotten your flu shot, it sort of puts it in perspective.
Robyn Gershon: For sure. But one of the things that for me, and I am a specialist in this area, that even has me concerned is every day when I look at the news and I typically look at The New York Times or The Washington Post, I keep seeing more numbers. I see cases in other countries. I see person to person spread. I think you brought up a great point about influenza, of course, has been around for a long time. Every season it could be quite bad. This one particularly bad, but here is a brand new agent. We don't even know the source of it yet. For me, it sounds like the drum beats are sounding every day the news gets worse and worse. Furthermore, today for the first time, I read that there is a rumor mill going about that in this particular province, in Wuhan in particular, there is a high level bio containment facility and there's a rumor going around that this was an engineered bio threat that somehow got loose. Of course, there's no real documentation to that effect, but it's a whisper that's posted in the UK Mail, which is a UK publication. Kind of like a second tier, yeah, tabloid. Okay. That's a good way to put it. They're spreading it and apparently it's getting picked up all over the US in all kinds of blogs and websites. I'd like you to speak a little bit because I know you've thought a lot about this about these kinds of rumors and misinformation, disinformation. How do we counter that and how do we as public health professionals deal with that?
Rachael Piltch-Loeb: You bring up an excellent point, Robyn, and the challenge of dealing with conspiracy beliefs or misinformation, which means a kind of direct information that's counter to what we know versus disinformation, which is sometimes based in truth but spun a little bit differently. The terms are sometimes used synonymously. We won't get into a literature lesson too much, but I think that again, when there is a gap in scientific knowledge, there is an opportunity for kind of these counter narratives or beliefs to spread. As soon as there is information, or excuse me, a news story that may be picked up that has seemingly information that others have maybe missed or that plays to kind of the belief system that governments are not always transparent with populations, with the people, there is a real virality to that. It goes viral relatively quickly, sort of by creating a vacuum of information. Public health officials, government officials in some ways allow this opportunity for alternative facts, theories, et cetera, to fill that void for people. Because as we were just thinking about, we're talking about before, there is a search for, for information related to coronavirus. People are fearful. They're scared. They want to know what's up to date. If they're not getting that from their government or from public health officials or perhaps from a more trusted source and they see something out there that kind of can fill that void, that information becomes something that they latch onto and something that can be spread really rapidly, especially through online news sources. There's actually a very, very thin line between conspiracy beliefs and facts in the sense that people who are seeking information, people who want to find out more about a given topic will oftentimes go to as many sources as possible. When they find a piece of information that is perhaps distinct from what they're seeing on all these other places, that resonates with them. That news story that sticks out or is maybe different sometimes sticks more than the other kind of repeated facts and information. That's something that public health and governments need to be really conscious of when communicating is not leaving that void for people to go seek information from other places to try and avoid the spread of these perhaps counterfactual information.
Robyn Gershon: Let me play devil's advocate for a second with respect to the measles vaccination debacle, you might call it. There was not a void in terms of measles vaccine works. It protects lives. It saves lives. Yet, we had this terrible, terrible, I guess conspiracy theory about measles vaccine causing autism and other kinds of health problems. Now, that's a different kind of situation than what you're referring to right here, which is a void, there's info coming, it's incomplete info. Here we had a long history of knowing how well that vaccine worked, yet there was a space in the public's imagination to be able to believe that in fact it was dangerous and that has created, of course, horrible consequences. What do you think is behind something like that when the facts are already out there and the government's making a good effort to communicate that?
Rachael Piltch-Loeb: That's a great question and I think that there's a few different kind of factors at play. One, I think in 1997 when the Andrew Wakefield story came out, which was this news story that was published in a very respected journal, The Lancet, that basically linked to the vaccine to autism. We knew vaccines worked, but there certainly was not an ongoing effort necessarily to encourage parents to make sure that they were getting vaccines to kind of re-emphasize the purpose of vaccines. Perhaps there was a little bit of complacency in the risk communication world underlying prior to 1997. However, once this bell was rung, so to speak, once the story got out there that this one clinician believed that vaccine could be linked to autism, for parents who perhaps had a child with autism or who had concerns about vaccines in general, this was the proof that they needed, that there was kind of this problem and that now there was scientific evidence to back it up. There was a reason perhaps why their child was experiencing these symptoms that were different from other children on the form of autism spectrum disorder. Now, I think where we're at now is in a little bit of a different place and perhaps this existed in the mid to late '90s as well, but there are actually several belief systems or reasons why people are vaccine hesitant now. The concerns related to autism are certainly I think get the most air time, but there's plenty of parents out there who believe that they should be the ones to make medical decisions. They shouldn't be being told by the government what decisions to make for their children, or who believe that sort of in an organic parity argument that any medical intervention kind of isn't right for their kids certainly believe that, sort of have skepticism related to the adverse consequences of vaccines. I think one of the challenges of where we're at now is the information provided by CDC or by the government really only focuses on the fact that vaccines do not cause autism. But what about all this other stuff related to how if one parent chooses to not vaccinate their child, they can have an effect on children in their entire community. We rely on something called herd immunity, which is the fact that most children in a given particular area have the vaccine, so that can kind of provides coverage for the entire group without getting too technical around epidemiologic terms. Yet there's not really this focus on why it's important for all children to be getting vaccines, for example, or on countering any belief system besides this fact related to autism. I guess this is a long-winded way, which we're good at being in academia, way of saying that there are a variety of beliefs related to vaccine hesitancy. Without countering or providing information that speaks to all of those beliefs, we're not filling the gap that people need in order to potentially think about shifting their behavior and getting their kids vaccinated.
Robyn Gershon: Thank you. That was long, but well worth it because it's so fascinating. Even though that Lancet article was retracted, the whole theory has been debunked, it's amazing how persistent those false beliefs really are. But let's turn to Suiyue who has very close contact with people in Wuhan area and has some I think important insights about the risk communication that's been going on in that part of the world from the Chinese government and how do you think that's working for the better, greater good, or is it making things worse? Is it exacerbating the fears and concerns of the population?
Suiyue Cui: Thank you, Robyn. My name is Suiyue Cui. I am a second year master of public health student in epidemiology, and I am originally from China, so I have been closely following the coronavirus since it broke out. In my perspective, at the first one, we first heard of the coronavirus, it was in mid-December. The government had posted a public statement on a possible pneumonia-like symptom, but it didn't enclose anything that's in my opinion is essential to the public, including the case number or the symptoms. Then on December 31st, it was the first public notice of how many cases has there been and how many people had developed symptoms that's related to the coronavirus. At that time, there was no clear evidence of human to human transmission, so everything seems pretty chill. There has been many epidemics that's being contained at a small scale. At that time, there hasn't been any public concern on how big this epidemic would turn out as it's today. In my perspective, the situation really went down on January the 20th where it has been confirmed that the virus is capable of being transmitted from human to human. At that time, the rumors had spun that the Hubei government is going to put Wuhan City on lockdown. It was also at the time where the Chinese New Year is coming. There has been millions of people who had planned to go back home out of the province or going abroad at that time.
Robyn Gershon: Are you saying that the rumors started spreading... It was just a rumor at that point, January 20th, that they weren't going to put the city on lockdown, but people were getting ready for the Chinese New Year, so they left the city potentially infected. Is that your understanding that that was a mistake? If they were going to put it on lockdown, they should have been. We're not agreeing that that was the best course of action, but what happened was people got anxious that they wouldn't be able to go travel during the Chinese New Year, so they quickly left the city potentially taking the virus with them. Is that your understanding?
Suiyue Cui: Yes. I think the rumor had potentially worsened the situation. Millions of people had I would say fled the city. I had a number that's 5 million of people.
Robyn Gershon: 5 million people fled the city. Here's a case where in the absence of good information or good intel, there was space for rumors to form, which inadvertently led to potential spread of this disease. Now, do you feel, Suiyue, that people in that province and maybe perhaps through China, do you feel that they trust the government to give them true information in general about things like this, like outbreaks?
Suiyue Cui: I think they trusted the government until one point when they don't trust the government anymore.
Robyn Gershon: Now they have lost the trust. The last I heard that people are being put into at least 14 day quarantines in their homes if there's any suspicion that they may have been exposed and they are delivering food. I think I sent you the link to this fabulous little video about they're using robots in certain cases to deliver food to people's homes. Interesting use of robot technology. But where do you see things ending? How is this going to play out in terms of the population? I mean, in today's times, they talked about is this going to be the Chernobyl moment for the Chinese leadership. Chernobyl, of course, led to the downfall of USSR, part of the downfall, because there was complete distrust of the government. Do you think this is of that kind of magnitude where it can actually take down a government?
Suiyue Cui: I don't think that'll be to that magnitude because there has been a city level government, there's provincial government, and there's the state level government. I think when the people didn't feel like the city government is updating the news that they expected or apply procedures or intervention to contain the current pandemic, then they might say for the upper level government to justify the errors being made or to contain the current coronavirus situation in general. From what I've seen, people generally have confidence in the higher levels of government, but not the Wuhan City government.
Robyn Gershon: Now today I heard that they will definitely let in WHO, whether or not they let CDC come in with them, which we hope and pray they actually do is up to... We'll see if they do that. But perhaps now that they're going to involve the international public health communities, people will feel even more reassured and more willing to stay in quarantine and not travel and follow the prescriptives of the government. Suiyue, you told me that your mom actually works in a hospital in that area. Is that right?
Suiyue Cui: Not in Hubei, but in Beijing.
Robyn Gershon: In Beijing. She has had some patients that may have the coronavirus?
Suiyue Cui: They have cleared the patient two days ago, which is like it's good news. Very good news. But she had shared something about how to test the patient. It requires very meticulous procedure. There has has to be trained personnel to sample the patient from deep in the-
Robyn Gershon: Lung tissue? I thought they took a blood test?
Suiyue Cui: Not just blood test, but also a sample from the lung.
Robyn Gershon: They're having trouble doing testing at least on these potential cases.
Rachael Piltch-Loeb: I was reading one thing in the United States at least is that it's a preliminary chain reaction test, but only the CDC. There's only one lab currently in the United States at least that had the test in order to do it, which was leading to some delays in confirming whether some of the patients who have returned to United States, whether their samples are being tested and whether or not they have the virus. But it's fascinating to hear you talking about kind of this distinction between local, provincial, national government and the coordination with the healthcare system because one of the adages in public health emergency preparedness is all disasters begin locally, right, which is something that's taught in our courses here at NYU and is sort of an ethos for the field. I think that this is quite an example of how local and other levels of government really have to coordinate well together and be able to ask for help and sort of sound the alarm in order to get the resources that are necessary and to respond to an emergency. That's true regardless of country.
Robyn Gershon: Absolutely. We're so lucky here in the US not just because of our local departments of health and here arguably the New York City Department of Health is considered number one in the nation. I say that very humbly. Of course, CDC is the world's leader. We're very, very fortunate, but even our resources can be stretched. I heard that Bellevue is going to be the facility. Bellevue Hospital in New York City will be taking the first patients that come in, and they say it's inevitable that they will come into New York City, but Bellevue actually only has two or three beds available. There are very few other hospitals that have that high level of containment that we might need. Even in the US, we could be stretched by these outbreaks. But before we end and our time is running out, I would just like to ask our two wonderful students, one who received her doctorate here and one who's almost done with her MPH, how did your educational experience at NYU help you to view the way the world is right now, the changing fast-paced world? Since the last few decades, we've had over 80 brand new, absolutely brand new, pathogens that have led to outbreaks, think of MERS, SARS, H1N1, Ebola, so many, Zika. The world is changing. It's getting closer. We're global. How did your training at the School of Global Public Health prepare you to be such educated citizens, in some cases, citizen scientists? How did that impact you? Let's start with Suiyue.
Suiyue Cui: I think my education I got from Global Public Health had helped me to think ahead of time. When I perceive one policy on control or response to epidemics such as coronavirus, I will think like the policy, whether it is dragged by the current outbreak, trying to catch up with it, or I try to go ahead of the outbreak to try to contain it and provide preventive procedures, and also to think in a global scale. It's not just the flu outbreak in the States or the coronavirus outbreak in China, but like how we as global citizen would deal with such outbreak that may have influence on the global society and how the global cooperation between nations will help us put an end to the current outbreak.
Robyn Gershon: Critical thinking skills, for sure. Now, when you graduate, Suiyue, what do you plan to do?
Suiyue Cui: I plan to work in research lab too as a data analyst.
Robyn Gershon: Very nice. Okay. Rachael, I know you're in your first year of your postdoc at Harvard, which is fabulous, where do you see your career headed after your postdoc is done?
Rachael Piltch-Loeb: I'm interested in continuing to pursue an academic career at the intersection of public health emergency preparedness research and practice to continue to work at this intersection of risk communication and practice improvement, thinking through many of the issues that we've talked about today. I think that the School of Global Public Health is really at the forefront of the public health community in providing opportunities to students to craft their educational interests while here, to develop critical thinking skills, and to focus on topics that are really at the forefront of the news, our minds and public health as a growing field.
Robyn Gershon: Absolutely. Do you know that I bet you they are not more than 250 people in the entire United States in academia who are at this space that you are now moving into, the intersection, risk communication, public health practice, public health risk. There are very, very few people who are actually doctorally prepared people in that space. You are a rare, rare breed and so are you, Suiyue. I guess we better stop now. I want to thank all of our listeners and we'll end it here. Thank you so much.
Rachael Piltch-Loeb: Thank you, Robyn.