Coordinating Coronavirus Response Across Africa

3Qs with Dr. Maryse Simonet, MD, MPH ’93, MSc ’03

A woman with glasses and a dark shirt
Dr. Maryse Simonet, MD, MPH ’93, MSc ’03

International Public Health Consultant, Health Systems, Expertise France

A physician and public health consultant, Dr. Maryse Simonet works with Expertise France, a technical assistance agency operator of the French Ministry of Foreign Affairs, to support coordinated and informed coronavirus responses in Guinea and other sub-Saharan nations. She steered development of a technical support platform to assist national response and adaptation of health development and other long-term projects through networks of field-based experts.

Q1: How has coronavirus progressed in the countries you’re working with, and how is that shaping the response?

The onset of COVID-19 required us to adapt our technical assistance activities, in terms of preserving essential health services and responding to the additional needs arising out of this pandemic. Not many African countries are without impact, but the full extent is not yet known. Most of the cases and the responses have remained in capital cities, yet rapid tests are now coming to rural settings.

In a lot of African countries, teleworking is only available to an elite minority. People need to maintain informal activities and businesses to survive. Like France, Guinea has used hotels to isolate asymptomatic people, but until recently only in the capital. Now Guinea is experimenting with mandated institutional confinement throughout the country, although this may cause objections to testing.

Q2: How do recent Ebola outbreaks impact the way sub-Saharan Africa approaches coronavirus?

Ebola helped develop and strengthen health security in most countries and through regional and sub-regional organizations. Initially, this created an advantage in reacting to COVID-19. However, the transmission is much faster and invisible with COVID. A “copy-paste” response, from the Ebola experience or from Western world strategies, is inadequate.

Ebola also led to increased malaria death, maternal and child death because of the low utilization of essential services. In rich countries, crisis management means reallocating routine health care resources towards emergencies and essential services. In Africa, there are very few non-essential health services. There’s a need now to protect all health workers, but how do you implement prevention measures when families have to feed and care for hospitalized patients and when protective equipment is only available for COVID-dedicated health care workers? What is left for essential services if you concentrate resources on COVID-19 management?

Q3: What are some of the major lessons you’re learning in coordinating coronavirus response across Africa?

At this point, I think lessons are still in the pipeline. I’ve heard about some initiatives using community health workers who have been working on HIV/AIDS or TB, trying to organize them to contribute to case tracking and to collective confinement. Stronger health security authorities could help find a middle ground between no confinement and full confinement. Institutional or community based collective confinement is something we could learn from Asia.

Our efforts must go beyond finding cases and treating them; there’s a need to focus on anticipating and preventing the spread. There’s a need to support African health authorities in documenting and implementing creative solutions, rooted in context—including gender sensitive approaches. In spite of trained technical assistance, it has still proved difficult to rapidly reorient development aid toward national health systems’ response to COVID. Many donors seem to prefer sending humanitarian actors, rather than funding national health systems initiatives.

At the Center of Federal Public Health Response

3 Questions for Claire Perkins, SM ’14

A woman in a black blazer smiles.
Claire Perkins, SM ’14

Senior Policy Analyst and Health Finance Specialist, Assistant Secretary for Financial Resources/Office of Budget/Division of Health Benefits and Income Support, U.S. Department of Health and Human Services

In her role at the Department of Health and Human Services (HHS), Claire Perkins, SM ’14, works to manage the new resources and responsibilities given to HHS by Congress through legislation like the CARES Act, in addition to maintaining the ongoing work of major health care programs like Medicare.

Q1: How has your work at HHS changed since the coronavirus outbreak in the United States? What’s the atmosphere like?

A lot of HHS has pivoted towards thinking about immediate response. COVID-19 impacts basically every part of our work. Immediately folks at HHS started thinking about, “Okay, what do we need to be doing differently?” I work on financing and policy for Medicare, but it’s an all-hands-on-deck approach here, whether it’s FDA thinking about protocols for approving a vaccine, or NIH thinking about researching a new test or treatment option, or CDC rolling out public health campaigns, or the work I do with CMS and the Medicare and Medicaid programs, or HHS working with lawmakers so that they can make changes through legislation. We’ve been working on a lot of technical assistance for the Hill, but we’re also asking: “Can we change the regulations under our current authorities? What can we do to create the flexibility the health care community needs right now?”

Q2: How does your office work with Congress on legislative or regulatory solutions?

It’s an advisory role, but it’s also making Congress aware of best practices or standards within the health care domain. When senators or house members or their staff have ideas, they often pass them to us and ask for feedback. So it’s a two-way back and forth between HHS and the Hill. They’re very actively soliciting our ideas. “FDA or CMS, you all are the experts. What do you need right now to be able to effectively address this pandemic?”

In addition to the large amount of funding and various important provisions of the CARES Act and the two pieces of legislation that preceded it, one key piece of the legislation that’s passed already is that it includes provisions to require private health insurance providers (or allow for our programs like Medicare and Medicaid) to provide an eventual coronavirus vaccine and coronavirus testing without cost sharing, so that it’s not a barrier for people to access those services.

Q3: What are some of the related health economics issues your office is looking at going forward?

This is definitely a two-part crisis. We can see the immediate effects right now. The unemployment rate is catastrophic and we’re in a place economically that looks like the worst it’s been since the Great Depression. One thing we’re thinking about a lot is how the economic stability of the country and the ability to pay for health care services are tied together. A lot of people in the U.S. get their health insurance through their jobs. So if they’re losing their jobs, they’re losing their health insurance. We’re thinking about how that impacts people, and where they can turn to get health insurance.

Another coming crisis that’s definitely going to be exacerbated is the stability of the Trust Funds that pay for the Medicare program. A huge portion of the Medicare program is paid for from payroll taxes. That’s something we’re going to have to think really critically about as we come out of this crisis.

Responding to COVID-19 in the Filipino American Community

Photo of Antonio Moya with mask on delivering boxes

3 Questions for Antonio Moya, MD, MPH ’13

Photo of Antonio Moya

Neurologist and graduate of the UCLA National Clinical Scholars Program

Antonio Moya, MD, MPH ’13, is a Los Angeles County neurologist who recently served as a National Clinical Scholar at UCLA and is active in the Filipino American community’s response to COVID-19 in Los Angeles and nationwide.

What specific challenges does the Filipino community in Los Angeles face when it comes to COVID-19?

Oftentimes, Filipino families in the U.S. comprise a lot of members in one single household, and we’ve seen that spreader events in the United States have been linked to getting exposed to the virus inside a single household.

There have also been incidents of racism during this pandemic, whether it’s Filipinos being attacked by people saying, “Go back to China,” and “Bring your COVID-19 back with you,” or Filipinos themselves placing blame for COVID-19 on people of Chinese descent.

Filipinos also represent a large number of those on the frontlines. One out of every five nurses in California and many nursing home caregivers are Filipino or of Filipino descent. They’re the workers that have the most exposure to COVID-19, and unfortunately that’s the risk with being a huge part of the U.S. health care workforce in the United States. We even have a website of all the Filipino health care workers who have passed away, showing the faces of people who have died in our community. Yet rarely are Filipino Americans shown on the T.V. screen, rarely given due credit for being on the front lines.

How are you involved in Filipino community response efforts to COVID-19?

BalikBAHAY project logoThere are two projects that I’m working on. The first one is the BalikBAHAY Box project, which equips people who are especially vulnerable in the community to be ready for this pandemic. Boxes of healthy Filipino food staples have been distributed in target areas of Los Angeles. We also worked with local Filipino cloth mask makers to procure masks for the boxes. And we also have a pamphlet with key information in English and Tagalog about preventing the spread of COVID-19, especially dispelling the myths that are circulating in our community—for example, the myths of using garlic or vitamin C to prevent coronavirus infections. We wanted to create these packages using materials from Filipino restaurants, Filipino groceries, and have all the information come from Filipino health professionals within the community.

I’m also working with one of my best friends that I met at Harvard, Dr. Angelico Razon, on the Filipino American Health Forum on COVID-19: a series of talks about COVID-19 in our community in the United States given by Filipino American medical professionals, mental health professionals, and experts in many different fields related to COVID-19.

Why is it important to adapt public health communications to specific cultural groups?

Successful public health outreach is very dependent on having the cultural humility to truly understanding a community.

Some older Filipinos do not use English as their primary language, so information that we share must be in both English and the Filipino language. Filipino Americans statistically have higher rates of insurance than other Asian Pacific Islanders, but there’s a reticence to seek medical care because of different cultural understandings—one of which is this kind of spiritual fatalism, “Bahala na,” the idea that “If I get a disease, that’s God’s will.” This sentiment is entrenched in our culture. So there have to be effective ways to use this type of idea to our advantage, perhaps by saying, “God has given you the opportunity to learn more about COVID-19 or access medical care by having insurance, so you need to meet Him halfway.”

My other outreach has been related to stroke in the Filipino community. After doing qualitative research within the community, we created a soap opera-like episode, a teleserye, about stroke and what needs to be done during an acute stroke, specifically calling 911. That video was taken up by The Filipino Channel and has been seen by more than four million viewers globally.

Photo of Antonio Moya and team posing with boxes of provisions

Leading Hong Kong’s Response to Coronavirus

3 Questions for Sophia Chan, MPH ’07

Sophia Chan, MPH ’07, is Hong Kong’s Secretary for Food and Health. In this position, she works in the Chief Executive’s cabinet, overseeing departments related to food safety, public health, and environmental hygiene. She has been at the center of coronavirus response in Hong Kong since December of 2019.

Q1: How did the virus arrive in Hong Kong, and how did it spread?

If we look at the confirmed case numbers, over 60% of them are imported cases from the rest of the world, not from China. Initially, we had some imported cases from Wuhan, but that was a very small number. Later on in March, we had a large surge of imported cases coming back to Hong Kong from elsewhere in the world. We have now stabilized our situation and have sporadic imported cases every now and then. Because we have so many imported cases, our primary strategy is to prevent the imported cases from coming in, and our secondary strategy is to prevent the spread of the infection in the community. Through our positive cases, we were able to find some high-risk places. For example, there were clusters of infection from bars and also karaokes in March, leading us to close those businesses temporarily because we feel that the behavior that actually happen in those premises is high-risk. 

Q2: As of late May, Hong Kong has had just over a thousand coronavirus cases and only four deaths. How have you been able to control the situation so successfully?

After SARS, we built our equivalent of the CDC. We call it CHP, our Center for Health Protection; they are responsible for all infectious disease response. We have also put in a lot of resources in infectious disease research because we know this is something that is very important in public health. When the coronavirus hit us, we were very quickly put into a very high level of vigilance. Even before we had any confirmed cases, we immediately went into the “serious” response level whereby the entire government is alerted. Once we had the first confirmed case, we raised the level to “emergency,” not waiting for the pandemic.

We have always been very vigilant at border control. We have to first minimize the mobility of people coming into Hong Kong to prevent the spread of the infection by the imported cases. At some points we’ve denied entry to people who had been to certain places experiencing a very severe epidemic.

Testing and contact tracing are also key measures. We have been expanding our surveillance in terms of testing, not only for cases coming back from other countries, but locally as well. For example, we have asked both the public hospital system, as well as the private GPs, to try to collect samples for high-risk occupational groups to detect the asymptomatic cases in a community.

Q3: What economic toll has the virus taken in Hong Kong?

Hong Kong has never had any city lockdown per se. We have been exercising social distancing and mask wearing, way back to very early on during the epidemic. In terms of social distancing measures, we started very early on, and people have been wearing masks and remaining very vigilant. Probably because they have gone through SARS, everybody is very vigilant about their personal hygiene, as well as environmental hygiene.

Of course, the economic situation is challenging because we know that with all these measures, there are business who are about to close down. Our unemployment rate has also increased. The government has put in place two rounds of anti-epidemic funds and related relief measures, representing about 10% of our GDP to tide people and businesses over in these difficult times.

Emergency Care During a Pandemic

3Qs with Dr. Alie Scholes, SM ’12

Dr. Alison Scholes is an emergency medicine physician and board member at Saint Luke’s Health System in Kansas City, MO. Throughout the pandemic Dr. Scholes has been working within her health system and physician group to create pandemic response measures, while continuing to serve as an emergency room physician.

Q1: How has COVID-19 changed day-to-day emergency department work? Have you reorganized in order to treat COVID patients and non-COVID emergencies? 

When COVID arrived, we started right away with some pretty aggressive measures. We immediately started a no-visitor policy at all our hospitals, we shut down all of our elective surgeries. Our clinics were ramped up to go to telemedicine. We had a screening area right in the front where you came in, you got your temperature taken, and were given a mask.

We turned our decontamination shower area into a COVID ER. Anybody who had to be admitted who was a COVID PUI [persons under investigation] would go directly to the COVID floor from there, bypassing the ER completely. By doing this, we limited exposure for everybody. Our hospital alone has 6,500 employees. In our entire health system, we’ve only had one staff member become positive. I think the lack of sick people on the staff speaks volumes to the way our preparation went and because we did it so early. We did it long before anybody was doing anything in town. They all thought we were crazy.

We also shut down all the ORs except for emergency cases. We also took all of the anesthesia machines that have ventilators on them, and moved them so the anesthesiologists could work in tandem with the intensivists and school them on how to use the anesthesia machines as ventilators. That more than doubled the number of ventilators available.

Q2: Are you seeing the resumption of non-COVID ER duties? Are you concerned about delayed fallout in terms of people’s health?

Our emergency room volumes are going back up. Right now, a lot of that diagnosis and care of COVID is happening more on a community basis. I think for the ER, it’s just important to keep up our vigilance. Our city has opened up. You can go to a restaurant now—which I find shocking—but you can’t visit your family member who’s got appendicitis at Saint Luke’s Hospital. We’re not changing any of those policies until we have a couple of weeks of decreasing death rates. So I think these rules are going to be in place awhile, probably the remainder of the summer.

Because of the thrombotic nature of COVID and how it affects vasculature, we have definitely seen increased numbers of stroke in people who shouldn’t have stroke. We’re seeing that, and we’re seeing people who delay: people who when they get chest pain are too scared to go to the hospital. We definitely saw increased numbers of delayed presentation for stroke, heart attack, and appendicitis. 

Q3: How do you and other emergency staff deal with the mental strain of this work?

Well, I’m a really social person, and I have an incredibly close family. My sister lives across the street from me. I actually diagnosed the first person in Jackson County with COVID. When that happened, I was like, “You know what? I should probably not be around the family because I might be the vector.” So I shut down all of our family gatherings, which has been really, really hard. Every week we have at least three family Zoom calls. That’s really been super important for me.

The only other people who know exactly what I’m dealing with are the nurses that I work with, the other doctors that I work with. We have a group text with all the women physicians in my group. The conversation on that has ramped up quite a bit because everybody’s not only a doctor and doing this but they’re also moms, and so we have all these mom issues. My younger colleagues have had to be homeschooling on top of all this, which would be insane to me.

As an ER doctor, I don’t feel like this was as big an ordeal for me maybe as it would be for physicians in other fields of medicine. We’re sort of expected to adapt to weird, wacky situations. It seemed like, “Well, this is what I’m supposed to do.” I definitely am weirded out by all this “health care hero” thing. Well, of course, I’m working during a pandemic. I’m a freaking ER doctor! That’s not heroic. That’s my job.

Long Term Care on the Frontlines

3 Questions for Katherine Almendinger, SM’10

Katherine Almendinger, SM ‘10


Research Director, American Health Care Association

Katherine Almendinger, SM’10, heads the research team at the American Health Care Association, a trade association representing 14,000 skilled nursing facilities/nursing homes, assisted living centers, and intermediate care facilities. The AHCA’s COVID-19 response team provides communications, emergency response, education, and technical assistance to skilled nursing and assisted living facilities across the country.

How is your research team supporting members in the context of COVID-19?

All of our projects are focused largely on COVID now, from interpreting clinical guidance, to looking at survey changes, to trying to help coordinate with federal agencies and getting funding. We interface with our providers, but also with the CDC and CMS, with the White House, with FEMA—just trying to make sure that we can provide as much information to parties who need it as we can, especially since this is an unprecedented thing for most of our providers.

Something we’re working on now is looking at why infections happened. Survey and regulation are supposed to be encouraging certain behaviors, but if it’s something that a provider has no control over, then punishing them does absolutely nothing for keeping people safe and preventing the spread of COVID. We’re also trying to establish what’s true, and what’s helpful. For example, a piece in Kaiser Health News that was trying to draw correlations between CMS quality rankings and COVID cases, but if you use a larger sample than they looked at, the two are not actually related.

We have also been working to lobby Congress to include long-term-care facilities in the bills that they’re passing to cover the increased costs [of caring for COVID-19 patients], trying to get us prioritized in the testing queue. Trying to overturn state requirements to accept people from a hospital without testing. So, it’s a pretty broad spectrum.

Why is it so important to address COVID-19 in long-term-care facilities?

The average age of our residents ranges from the high seventies to mid-eighties, depending on the facility. Most people have multiple underlying comorbidities, so they’re the hardest-hit group if they are exposed to this virus. We’re providing care for the people who have the most significant consequences of getting infected.

Many people who arrive at hospitals needing to be on ventilators are coming from nursing homes. At the same time, we need to take people from hospitals, but if we bring people from hospitals who have COVID infections into the building, that produces additional people who need to go to the hospital. Hospitals and skilled nursing facilities need to be able to partner to manage the flow of patients back and forth.

How has AHCA recommended that nursing homes/skilled nursing facilities protect patients and staff? What is still needed?

It’s been a mix of cohorting, requesting testing, and then restricting interactions and making sure that facilities and staff follow protocols for infection prevention and control. We’ve been trying to focus on getting resources to help them identify individuals who have the infection quickly, whether or not they’re symptomatic, and cohort them away from others who are vulnerable to that infection.

There were orders to divert PPE to hospitals, and so a huge number of facilities have not been able to get protective equipment for their staff. We worked with the CDC to put together crisis management guidance on how to use and conserve PPE. Our members have struggled with shortages of staff because they don’t want to come in when there’s not PPE. We think that we have [now] been heard, that it’s vital that we have PPE, but then whether the supply chain can keep up is a question.

Right now, nursing facilities need help and support the way hospitals are being supported.

Helping Rural and Indigenous Australians Stay Safe from COVID-19

3 Questions for Dr. Lucas de Toca

Lucas de Toca wears a blue jacket and white shirt
Dr. Lucas de Toca, MPH ’13

A/g First Assistant Secretary, Australian Department of Health

Dr. Lucas de Toca, MPH ’13, leads the Australian Government’s Primary Care Response task force for COVID-19, reporting to the Chief Medical Officer of Australia. He has direct responsibility for the rollout of 150 primary care-based respiratory clinics nationwide, as well as for the rural, remote, and Indigenous health aspects of the government response.

What is Australia’s approach to limiting the spread of coronavirus to remote and Indigenous communities?

In early March, we established a national task force to bring the Aboriginal-led health services and the government together to mount a response [to COVID-19]. We’ve developed a whole range of policies to ensure that remote communities and Aboriginal communities are protected from introduction of the virus. That included listening to community calls for restrictions on travel. By March 26, we essentially had a quarter of the Australian landmass under [Biosecurity Act] restrictions. As of today there have been only 60 cases of COVID-19 in Aboriginal and Torres Strait Islander people, not a single one of them in a remote community. This is an excellent result compared to how many First Nations communities have been affected by this virus worldwide.

Every decision was made in true partnership with the Aboriginal health sector. If you don’t do that, then there’s a potential of these measures being perceived as reminiscent of the darker times of Australian history where governments were imposing limits on movement for Aboriginal/Torres Islander people. This time, the communities themselves were asking for the federal government to use its powers to limit access, and we responded to that request.

How else is the Australian government protecting people in remote and Indigenous communities?

We’ve worked to strengthen all the other aspects of our health system that relate to COVID-19. We’ve strengthened the capacity for aeromedical retrievals and medical evacuations, so that if there was a case in a community, the system is ready and agile to respond. We’ve also rolled out point-of-care tests across 85 remote communities for diagnosis of COVID-19 in the primary care setting using the same technology that is used in laboratories, but in a more compact desktop platform, which in some cases will cut the time from specimen collection to diagnosis from nearly two weeks in some of the more remote communities to 45 minutes. I’ve also been involved in the broader health approach, including rolling out nearly 150 respiratory clinics to ensure that the health system capacity is preserved while we have a specialized pathway for COVID-19 care.

Tragically, 103 people have lost their lives, but compared to what an uncontrolled outbreak would have been, we think Australia’s response to date has been extremely effective.

What are your next steps (and challenges) in coming months?

In the next few months we maintain the current approach as some of the movement restrictions are relaxed. But we keep ensuring that we have the capacity to rapidly identify, contain, and respond if an outbreak occurs.

It’s always the irony of specialties like public health that when we do our job well, no one notices, or people start to say that we exaggerated and we over-reacted. We are starting to see some public commentary along the lines of: “Well, we clearly went too far. We didn’t need to do this. The virus wasn’t that bad.”

We are on a winning path, but we haven’t won yet. We’re still in the midst of it. This is not going to be a sprint, it’s going to be a marathon. So we’d better stay prepared to keep talking about COVID-19 for quite some time.

COVID-19 and Children

3 Questions for Dr. Nipunie Rajapakse, MPH ’16


Pediatric Infectious Diseases Physician, Mayo Clinic, Rochester, MNNipunie Rajapakse wears a yellow shirt and blue sweater

In addition to helping the Mayo Clinic Children’s Center prepare to care for children with COVID-19, Dr. Nipunie Rajapakse, MPH ’16, works with the Mayo Clinic News Network to create and disseminate accurate information to the general public. She has been consulted and interviewed by local, national, and international media outlets including NPR and USA Today, and you can watch her Mayo Clinic videos on YouTube.

What are some of the most common questions you’re getting from the public?

As we were learning about this virus and pandemic in the medical and public health arenas, the general public was learning about it right along with us. Everyone’s gotten a crash course in public health very quickly. In the beginning, there were a lot of basic questions: What is this virus? How does it spread? What are the symptoms and what should I do if I think I’m sick? In this current phase, most of the questions that we’re getting are around reopening: What can I do to protect myself as we start moving towards going back to work or opening up businesses?

What are we learning about COVID-19 in kids?

We know that kids tend to have mild or moderate symptoms, if they develop symptoms at all; few require admission to a hospital. We’ve also learned about kids who are presenting—usually a few weeks after infection with SARS-CoV-2 virus—with what can be a severe, life-threatening illness characterized by inflammation that affects multiple organ systems in the body. Thankfully it appears to be a very rare complication.

Multidisciplinary collaboratives have been quickly set up to figure out how best to treat children that become critically ill with COVID-19. Most of the current clinical trials have excluded pediatric patients, so it is important that we work together with other children’s hospitals in the United States and around the world to collect and share knowledge.

What other issues is this pandemic bringing up among children?

The impact of the pandemic on mental health in children has been huge given how much it has disrupted their daily lives and routines. We’ve seen increases in symptoms of anxiety and depression in kids. Parents are also struggling with immense pressures associated with loss of income and jobs or trying to work from home while also homeschooling their children. Kids and families who depend on schools for some of their meals have experienced food insecurity. Seeing schools and communities rally to help meet these needs has been heartwarming.

One of the big concerns for pediatricians has been the interruption of routine childhood medical visits. We really don’t want to start seeing outbreaks of preventable diseases like measles due to kids falling behind on their vaccinations. It is understandable that parents may feel nervous about taking their kids in, but clinics around the country have now had time to put measures in place to protect kids and families. We want to encourage parents to get their kids’ vaccines updated, and also to continue to get routine care to avoid issues down the road.

We have also been seeing delayed presentations for illnesses that could have been less severe if a child was brought to medical attention sooner. We need to get the message out that if your child is sick, if you are worried, please do call your health care provider or seek medical care sooner rather than later.

A Global Approach to Vaccines

3 Questions for Natalie Dean, PhD ’14

Natalie Dean wears a white and black shirt
Natalie Dean, PhD ’14


Assistant Professor, Department of Biostatistics, University of Florida

Dr. Natalie Dean specializes in infectious disease surveillance, survey design, clinical trials, and vaccines. As well as consulting on other pandemic-related projects, Dr. Dean is working with the World Health Organization to design strategies and protocols for testing COVID-19 vaccine candidates in large-scale clinical trials.

Why does it take so long to develop and test vaccines? Where are we in that process for COVID-19?

There are a lot of steps, and all the steps are very important. We start off in highly controlled environments, making sure the products are safe, figuring out the dosing, looking at the immune response, looking at safety, and gradually stepping up to bigger and bigger numbers. In the Phase 3 trials that I work on, thousands of participants are involved to test whether the vaccine protects them from disease.

The paradigm for the pandemic has been trying to overlap steps. You’re taking on a lot more financial risk because you’re basically starting the next step before you even know if you’re going to proceed to it. But it saves a lot of time if it does work. Right now there are a mix of vaccines that are in pre-clinical phase and those that are in Phase 1 or Phase 2 trials—they’re looking at the immune response, they’re looking at safety. Some early candidates are starting to move into Phase 3 trials, with more throughout the summer.

How can the clinical trials timeline be accelerated during a pandemic like this?

After I graduated, I got involved in a Phase 3 Ebola vaccine trial in Guinea. Traditional trials struggled because Ebola spread is very unpredictable. Our trial used a more flexible strategy, ring vaccination, that was very targeted and followed the epidemic as it occurred. Mobile trial teams would drive out to affected communities and enroll people there. We were able to establish that the vaccine was highly effective. After that, the WHO formed the R&D Blueprint for Action to Prevent Epidemics. I’ve been involved in the clinical trials working group, focused on how we evaluate vaccines during outbreaks.

We had a paper come out recently in the New England Journal of Medicine about having a flexible trial structure that allows you to add in new sites as the epidemic evolves and moves.

We’ve been working on a strategy for a multi-country COVID-19 vaccine trial that uses this sort of flexible approach. It’s really emphasizing collaboration. If all these different sites are contributing information to the same trial, then you can get big numbers quickly. It’s those types of adaptive strategies that will shave off time.

You’ve been called upon a great deal to speak with the media about COVID-19. Why is the biostatistical perspective so important?

I have experience with survey design, including designing serosurveys. What does it mean when you hear that some percentage of people in an area test positive for antibodies? I can explain the strengths and limitations of these studies, and I’ve written about how to interpret the results. I’ve spent a lot of time explaining to reporters test sensitivity and specificity and concepts that I teach in some of my biostats courses.

I’m also trying to help people interpret messy data and these complicated, very incomplete pictures of what’s going on. We know that there’s a lot of under-reporting of COVID-19 cases. We know that there hasn’t been enough testing. We know that we’re missing people who don’t have any symptoms. Once someone shows up in the hospital, they were infected as long as two weeks ago, so there are all these lags in reporting. I specialize in emerging infectious diseases, so I’m used to viewing this type of data with caution, but others aren’t.

International Collaboration Against Pandemics

3 Questions for Elena Savoia, MPH ’04

Elena Savoia wears a brown jacket and white shirt
Elena Savoia


Dr. Savoia is Senior Research Scientist, Department of Biostatistics, Harvard T.H. Chan School of Public Health and Deputy Director of the Emergency Preparedness Program with the Division of Policy Translation and Leadership Development

Elena Savoia, MPH ’04, is working with FEMA’s Region I Recovery Task Force facilitating New England’s response to COVID-19. Trained first as an MD in her home country of Italy, Dr. Savoia attended the Harvard Chan School and now serves in the School’s Department of Biostatistics and as deputy director of the Emergency Preparedness Program in the Division of Policy Translation and Leadership Development. She has been applying evaluation and survey methods to her work in emergency management with U.S. and Italian colleagues.

How has coronavirusimpact in Italy informed your work with FEMA?

When the outbreak started in February, I was in Italy visiting my family. One of the first cases emerged in the small town where I was born and where my father still lives. I connected immediately with colleagues in the region. The first issues that were evident were lack of access to and training in the use of personal protective equipment among health care workers. I started to support them in trying to understand the different types of equipment that were available and appropriate, and the level of training of hospital personnel. We were able to quickly develop and launch a survey and make the results of the survey available to hospital management to inform policies and training.

It really helped me to visualize what could have happened here. Right now I’m serving on the FEMA Recovery Task Force and I’m continuously in touch with my colleagues in Italy to understand how the reopening is going, and trying to transfer that knowledge to planning efforts here in the United States. Even if they’re two very different realities, there’s still a lot of opportunity for us to learn from each other.

What does your work with FEMAs coronavirus response look like?

FEMA creates an inventory of resources and continuously checks in with the states to understand what theirneeds are. There is great collaboration and great communication, from what I can see here in Region I [states in New England]. My role is facilitating discussions on topics that are important to consider during recovery efforts. Some of these calls help local officials ask questions of the federal government and brainstorm what their next priorities are. They really have to think ahead, because in preparedness, you’re working today, but you’re thinking about what is the system going to look like in three weeks, in six weeks, in three months.

How will COVID-19 change the way public health professionals collect or use data?

There’s been a great collaboration between epidemiologists. People have shared data like never before, making data publicly available very quickly. I have also seen great collaboration between alumni. There are alumni in Italy from the Harvard School of Public Health whom I speak to at least twice a week in regards to COVID-19, and it’s been incredibly helpful. In the future, there’s definitely going to be a need to collect more data on ethnic disparities and to have systems in place where data collection is easy. We collect information about age very quickly. We are not as good in getting data about race and ethnicity as effectively as other variables. This is probably something that epidemiologists can work together on to make sure that, at the state and the local level, these data are collected, because they’re extremely important.

In the future, we’re going to leverage all this knowledge about how to quickly share information with each other even more effectively.