Harvard Chan School graduates from across a spectrum of public health careers have been working to contain COVID-19. These are just a few of their stories.
MAPPING THE SARS-COV-2 GENOME
Jessica Manning, SM ’14
Last fall, Jessica Manning’s infectious-disease lab in Cambodia booted up a small, white gene sequencer. With it, through a grant from the Bill & Melinda Gates Foundation, came access to IDSeq, a global software platform that helps scientists identify pathogens through their telltale genes in sequencing data. At first, Manning identified viral microbes that were causing undiagnosed fevers in the country, part of her ongoing work to develop a universal vaccine for all mosquito-borne infections. But just a few months later, she added a new pathogen to her search list: SARS-CoV-2, the agent behind today’s coronavirus pandemic.
Manning, SM ’14, knew the pandemic was coming. A clinical researcher at the U.S. National Institute of Allergy and Infectious Diseases’ malaria and vector research lab in the Cambodian capital, Phnom Penh, she vacationed with her family in China during the December holidays. She had disconnected from email for two weeks, figuring that she wouldn’t miss anything. But when she returned to the airport for her flight back to Cambodia on January 3, she was met by long lines and full-body scanners. Suddenly, every-thing had changed. Less than three weeks later, Cambodia saw its first confirmed case—a Chinese man from Wuhan. A sample from the patient was sent to Manning’s lab.
Two hours after his genetic data was loaded into IDSeq, the program displayed a heat map showing a close but not exact match to SARS—the coronavirus that had set off an epidemic in 26 nations in 2003. The sequence was later confirmed to match the SARS-CoV-2 Wuhan strain now entrenched around the world. Manning uploaded the data to the global collaborative database Nextstrain, contributing one of the first 20 SARS-CoV-2 genomes to a collection that now includes thousands. This information is being used to track the virus’s spread and mutations and provide clues for vaccine development.
“I’m grateful to be able to add a kernel of knowledge to this great collaborative network,” Manning says. She notes that the protocol she developed in Cambodia to test the sample was used in California weeks later to test hundreds of samples at a time.
As an infectious-disease physician, Manning also works with the U.S. Embassy in Phnom Penh, where she is science attaché and occasionally sees patients. In February, she was called to help when a Holland America cruise ship docked in Phnom Penh after being denied entry in five countries. All of its 2,400 passengers and crew wound up needing to be quarantined and tested. Over a whirlwind five days, Manning helped coordinate testing—receiving samples flown from the ship by helicopter—while also overseeing the medical needs of the mostly elderly passengers. Starting this fall, she’ll be using roving mobile units in Phnom Penh to conduct serosurveys—blood tests that can determine whether a person has been infected with the virus.
Manning hopes that the COVID-19 pandemic will serve as a wake-up call on the importance of funding global health and ensuring that systems are in place to respond to the next pandemic. But she worries that with time comes complacency. “We have to stay vigilant,” she says. “I hope that in 30 years, I’ll be looking back on these events and remembering when we got it right.”
CELEBRATING SMALL WINS WITH BIG RAMIFICATIONS
Mike Grant, SM ’13, SD ’16
While on a routine phone call one day in April, Mike Grant, SM ’13, SD ’16, received an instant-message notification. It was from his division director, requesting that he hang up immediately and get in touch. As an industrial hygienist with the National Institute for Occupational Safety and Health—part of the U.S. Centers for Disease Control and Prevention (CDC)—Grant was used to getting called to take on new projects and field assignments, but this urgency was unusual. Hours later, he was on a plane to South Dakota, leading a team of epidemiologists and other specialists investigating an outbreak of COVID-19 at a meat processing plant. At the time, it was suspected to be one of the worst hot spots in the country’s rapidly spreading pandemic.
Smithfield Foods, in Sioux Falls, South Dakota, handles 5 percent of U.S. pork production. By late April, 929 workers at the massive plant had tested positive for COVID-19 and two had died, prompting Smithfield to close it down. During the two-week assignment, Grant and his colleagues toured the plant, scrutinizing work areas from the warehouse to the slaughterhouse floor. They issued more than 100 recommendations, including installing plastic barriers between workstations on production lines and providing educational materials in multiple languages.
The plant worked with the state’s department of health on implementation and reopened in May. According to news reports in June, workers are still getting sick, although new cases are significantly lower than at their peak.
“There’s no such thing as a perfect safety program,” Grant says. “I’m from Massachusetts originally, so I have a very healthy New England cynicism about many things. But I’ve always been very optimistic about my work. Every small change improves conditions for workers. And if you can build up enough of those little changes, people see that it can make a difference.”
The guidelines Grant developed for Smithfield Foods informed broader CDC guidance for the meat and poultry processing industry. When a new group in the CDC response was launched to focus on meat processing, Grant was put in charge—a jump in three job levels for the self-described “worker bee scientist.”
The weeks that followed were exhilarating and exhausting, as Grant set up a system for virtual and field consultations with health departments about dozens of plants around the country. He recalls days filled with end-less phone calls, including with members of Congress. “I actually developed a sore throat one day after talking for hours at a time,” he says. “I worried I was becoming symptomatic.”
Grant has assumed several other roles since then, and as of August oversees health and safety assistance to states, including for the meatpacking industry. He sees his work as a marathon, not a sprint, and believes in celebrating small wins where he can find them.
During his first COVID-related assignment in February, he helped the quarantine station at Dulles International Airport, near Washington, DC, with COVID screening. Most airports had little experience with screening potentially contagious passengers, but Dulles, which had received passengers from African countries that experienced the Ebola epidemic, was a little better prepared. Still Grant had work to do when he arrived. High on the list: training staff, replacing expired personal protective equipment (PPE), and getting a clear mental map of the ventilation system.
“We were having trouble figuring out the correct air-flow configuration. When we finally fixed the issue, it was such an exciting moment,” he says. “It seems insignificant in the context of the rest of my work, but I think it’s important sometimes to just take a second to appreciate what you’ve accomplished.”
LEADING A STATEWIDE FIGHT
Monica Bharel, MPH ’12
In early July, as cases of COVID-19 began to decline in Massachusetts and the Commonwealth began to reopen, many citizens were breathing a sigh of relief and returning to old habits. Monica Bharel, commissioner of the Massachusetts Department of Public Health, wished it really were time to celebrate. But the threat of a new surge remained all too real.
For Bharel, MPH ’12, COVID-19 has brought seemingly endless days, stretching from early-morning Zoom meetings to public news conferences with Governor Charlie Baker to late nights reading the latest scientific findings about the virus.
“I have been so incredibly fortunate and humbled to be able to be a part of the response to this pandemic,” Bharel says. “It feels like the right place to be in this moment in time.”
A general internal medicine physician, Bharel has spent more than five years overseeing the department and taking on health challenges including the opioid epidemic, the vaping crisis, and outbreaks of mosquito-borne Eastern Equine Encephalitis. Previously, she had served as chief medical officer for Boston Health Care for the Homeless. Throughout her career, she says, she’s been driven by a mission of fairness and justice in health.
Her work fighting COVID-19 comes with an additional layer of empathy for suffering patients—she’s been one herself. In March, as viral transmission began ramping up in the state, she started feeling muscle aches and fatigue. She dismissed the symptoms and pushed on with her work until her daughter came down with a fever. Bharel and her husband, a physician, took coronavirus tests. Both tests came back positive.
For the next three weeks, Bharel continued to work daily, as she and her family isolated at home. It was a rough ride as she progressed through fevers, severe exhaustion, eye pain, and loss of sense of smell. But she counts herself lucky that they all recovered without hospitalization.
“I developed a really new and profound respect for what COVID-19 could do to an individual and how difficult it could be,” she says. “But it also gave me strength and focus to continue our work.”
Bharel is guiding the state’s response with data. Each afternoon, her department releases an in-depth report including cases broken down by county, gender, and race/ethnicity, and another comprehensive Weekly Public Health Report. Watching the trends over the summer, Bharel worked to expand free testing in the hardest-hit communities. And seeing that Black and Hispanic residents have been getting sick and dying from COVID-19 at much higher rates than white residents, she convened a Health Equity Advisory Group to develop recommendations.
For Bharel, the most difficult part of the pandemic has been the stories of those who have died and the loved ones unable to visit them in the hospital. The dedication of her DPH and health care colleagues—and the impact their science-driven efforts have made—keeps her going, as does the resilience and community spirit of so many Massachusetts residents.
“I don’t think there’s anybody around the world whose life hasn’t changed radically. It’s quite remarkable to have every single individual on our globe impacted by something at the same time,” she says. “A silver lining that may come out of this devastating time is that people are remembering what’s important in life. It’s really about the connectivity that we have with each other.
SEIZING THE PUBLIC HEALTH MOMENT
Jacob Ankeny, MPH ’18
As the USNS Comfort arrived in New York City on March 30, Lieutenant Commander Jacob Ankeny, MPH ’18, watched the people waiting to welcome the ship to port. It was there to take on non-COVID-19 patients, providing relief to the city’s crowded hospitals. For Ankeny, it seemed like a moment of potent symbolism.
“It brought back a feeling of American unity similar to post-9/11,” he says. “I think people needed a reminder to stay strong and resilient.” But these thoughts were also mixed with concern for the health of his crew as they pulled into what was then one of the nation’s pandemic hot spots.
Ankeny, an occupational-medicine specialist, serves at the Navy and Marine Corps Public Health Center in Portsmouth, Virginia. Its work is primarily policy-related, so his deployment as the USNS Comfort’s preventive-medicine physician—which came with 24 hours’ notice—was a shock, Ankeny says. “But you go where the military tells you to go.”
As part of the ship’s infection-control committee, Ankeny pushed for safety standards that went beyond CDC recommendations. When the ship began taking COVID patients at the city’s request about a week into the mission, Ankeny’s team led the effort to implement red and green zones to separate them from other patients and the crew as much as possible. This task wasn’t easy in the inflexible layout of a former oil tanker.
Initially, persuading the ship’s leadership to accept a mask mandate was also challenging, Ankeny says. There was concern about inciting fear in junior sailors. However, once Navy policy and guidance on face coverings was released and the mission shifted to taking COVID patients, the mask mandate quickly became a matter of no concern.
Of the 182 patients cared for during the ship’s month in port, about 70 percent had tested positive for COVID-19. But ultimately, only 13 crew members became infected, and all recovered. Ankeny sees a lesson in this success: Even in extremely close conditions, teamwork and basic precautions can help stave off the virus. He says, “It was satisfying to know that I had a large role in protecting the ship’s crew. Whether they knew it or not, we were keeping them safe.”
Ankeny doesn’t foresee the need to redeploy the Comfort, given that knowledge about the virus and mitigation factors has improved significantly. Now back at the Navy and Marine Corps Public Health Center, he’s working with colleagues on Navy-wide policy responses to the pandemic. As he sees COVID-19 spreading around the country, he’s particularly frustrated that the message that masks work is still not sinking in with some people. “I have four children,” he says. “The last thing I want to do is pass a potentially deadly virus to them when I could have done something as simple as wearing a mask.”
He adds: “As a nation, we need to establish a culture where we do the right thing for each other and not just focus on self-interest. That’s what public health is all about. Maybe this pandemic will be the inciting incident that moves people in that direction.”
TURNING HEALTH INFO INTO RHYME
John Clarke, OEMR certificate, ’18
It started with a video titled “Asthma Stuff.” As a young physician in Jamaica, Queens, in the late ’90s, John Clarke watched an ominous rise in asthma among children in the community. He wanted to find a way to communicate vital information about managing the disease in a form that would resonate with these kids. So he tapped into his love of rap music, wrote a song, and created a video. It proved to be a hit with young asthma sufferers. “Health-hop,” as Clarke coined the new genre, was born.
“We’ve found that kids retain health information from songs better than from a lecture,” says Clarke, who in 2018 earned a certificate from the Harvard T.H. Chan School of Public Health’s Occupational and Environmental Medicine Residency Program. “Rhythm and rhyme stimulate memory.”
Now director of occupational medicine at Cornell Health, in Ithaca, New York, Clarke has been writing rap lyrics since he was 8 and combined premed studies with music and sociology as an undergraduate at Columbia University. He has recorded dozens of health-hop songs, including a 2009 rap on H1N1 “swine flu” safety, which won a contest sponsored by the U.S. Department of Health and Human Services and was distributed as a public service announcement. When the COVID-19 pandemic exploded in late February, he pored over the latest scientific evidence and fired up his home recording studio.
Donning a white doctor’s coat and sunglasses for “Stop Corona”, Clarke advises on prevention basics such as hand hygiene and staying home when sick. His 14-year-old son John Jr. raps the catchy verse that starts: “Stop corona, don’t be a case/Be careful who gets in your personal space,” and Clarke’s three younger children are extras. The song has been played in schools and viewed more than 10,000 times on Clarke’s YouTube channel.
The video ends with another family connection—a poignant tribute to Clarke’s in-laws, Joseph and Sandra Clements, who died in April from COVID-19. Clarke’s wife, Elizabeth, a nursing director, had driven to see her parents in Queens when she hadn’t heard from them in a few days. She found them in respiratory distress and rushed them to a hospital. But despite their both testing positive for the virus, they were forced to wait in crowded, chaotic conditions for care. For the next week, Elizabeth kept a lonely vigil from a nearby hotel, while Clarke stayed home with their children. When the Clements’ conditions turned critical and there were no intensive care unit (ICU) beds available, Elizabeth arranged for them to be airlifted to her hospital in Ithaca. Two days later, they died. Clarke honored the care they received by working with his wife and her colleagues to create a video called “You’re a Hero”.
The deaths in his family made very personal for Clarke the reality that African Americans have been disproportionately impacted by COVID-19. But health inequity is not new for his family, Clarke says. “I have had several personal experiences where only after I identified myself as a physician was the appropriate care and attention granted.” He’s certain that both of his parents would have died had he not been present to advocate for them during hospitalizations. Age or socioeconomic status doesn’t matter, he says. “What matters is being Black. For change to occur, empathy is essential.”
PLANNING FOR THE WORST CASE
Eric Dickson, SM ’07
Just one more patient would have been too many. All ICU beds at UMass Memorial Health Care hospitals were full of COVID-19 patients, despite the addition of dozens of beds across its central Massachusetts system. CEO Eric Dickson, SM ’07, stared at the numbers during the first week of May and held his breath. The emergency medicine physician and Army veteran admits that for once he was “frazzled.” But then, something unexpected happened—cases plateaued and declined.
Even though the hospital system avoided the worst-case scenario, it still weathered weeks of intense pressure. On Sundays, Dickson took off his CEO hat and donned PPE to work alongside his staff in the COVID treatment areas. “I’m not going to have the caregivers here to do anything that I wouldn’t do myself,” he says.
It was also good for his own morale. “In the end,” he says, “I’m an ER doctor. I thrive in trying to organize chaos and figure out what the most important thing is—always focus on the most important thing, the sickest patient.”
For weeks, the most important thing had been avoiding the nightmare scenarios unfolding in overwhelmed New York and New Jersey hospitals. Dickson describes himself as an optimist, but he also believes in being prepared for the worst. The heat of battle is not the time to wish you’d spent more time practicing on the firing range, he says.
A point of pride for Dickson was the pop-up field hospital—the first in the state—deployed in just eight days in Worcester’s convention center by members of the Federal Emergency Management Agency and the National Guard. The massive main floor supported a tidy warren of 216 black cubicles, each furnished with a bed, a table, and a hookup where patients could charge their phones and connect to loved ones on social media. Stocked with a state-of-the-art IT system and a suite of mobile medical equipment, the facility also boasted a trailer for patient showers and robotlike mobile units topped with video screens for telehealth appointments with specialists and to connect non-English speakers with interpreters. A particular challenge was erecting a complex infrastructure of copper tubes to pump in oxygen to each patient.
The pop-up hospital served 270 patients—160 of whom required acute care—before it closed on May 20. It remains intact so that it can be deployed even more quickly if another COVID-19 surge arises.
Should this situation occur, Dickson says, one thing will be different: The system won’t stop seeing non-COVID patients for cancer screenings and other lifesaving care. During the spring, many appointments were canceled, and other patients chose to stay away. Dickson was dismayed to hear stories of patients who delayed care until the summer and missed a vital window for treatment. Now, he says, providers know how to see these patients safely.
Another lesson he’s taken from this difficult time: “You can’t lead by being silent. Whether it’s speaking out against racism or educating people about how to stay safe,” he says, “as a doctor leading a health care system, I need to be out there.”
FINDING STRENGTH AND HOPE
Khama Ennis, MPH ’02
In 18 years as a physician, Khama Ennis, MPH ’02, had stayed home sick from a clinical shift exactly once. The idea of calling in because she was under the weather had always seemed unthinkable.
“It’s just not done,” she says. “You go in and do your job. It is not a healthy aspect of medical culture, but often, you suck it up.” But in March, Ennis, then chief of emergency medicine at Cooley Dickinson Hospital in Northampton, Massachusetts, thought she might have COVID-19. She reported it, took a test, and stayed home to wait for what proved to be a negative result. (Ennis is now associate chief of emergency medicine and will also become president of the medical staff in October.)
“I feel much more vulnerable as a health care provider than ever before,” she says. “The process of realizing that I actually could be doing more harm to my patients, my community, and my team by coming in rather than staying home was humbling and difficult.”
As COVID-19 spread in New York and Boston, Ennis and her colleagues prepared for the worst. But while her ICU briefly maxed out, the hospital never had to move to the next level of expansion. A second respiratory emer-gency department set up for suspected COVID cases never reached full capacity.
“There was a lot of fear and anticipation,” Ennis recalls. “In medicine and public health, we derive a lot of comfort from data and evidence. And we had none.”
The unknowns made conversations with COVID-19 patients who did not need to be hospitalized difficult. “Early on, many patients thought that a positive test was a death sentence,” Ennis says. She recalls sending home a woman who was part of a family of six living in two rooms. “How was she going to sequester herself and protect her family? I could feel her fear, but all I could tell her was to do the best she could.”
Ennis says that while she initially did “a terrible job” dealing with the stresses of the early days of the pandemic, tending to her young daughters’ needs “pulls me out of my own head on a regular basis.” Exercise, strict limits on media consumption, and a daily dose of the New York Times crossword puzzle also helped.
By mid-June, even as she planned for a possible future COVID-19 surge, cases were low enough in Massachusetts to allow for moments to breathe, like a socially distanced drink with friends on the porch. She also took time to reflect on the movement for racial justice that grew out of the killing of George Floyd by police, writing several op-eds for the Washington Post about her experiences as a Black parent and physician in the current political moment.
“I think I will look back at this time as an opportunity to make real change toward racial justice in a way that we haven’t had in a few decades,” says Ennis. “We also have an opportunity to recognize that our collective success and survival really does depend on all of us caring about each other. The groundswell of the movements that are going on right now gives me hope.”
Amy Roeder is associate editor of Harvard Public Health.