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Careers in Public Health
Public Health on Front Burner After Sept. 11

Reproduced here with permission from USA Today. Original article by Anita Manning, December 26, 2001.

The doctors, nurses and lab scientists who labor, often underpaid, in underfunded public health departments suddenly find themselves in the limelight.

Once the poor relations of the medical field, now they're cast as a kind of medical Delta Force standing between unknown microbial threats and an anxious nation.

The deadly anthrax mailings that followed the Sept. 11 attacks on New York and Washington, D.C., put a bright spotlight on the importance of a strong public health system, health officials say, moving it close to the top of the national priority list.

They pray it will stay there. "Maybe, maybe it won't just be our 15 minutes of fame," says Mary Selecky, secretary of the Washington State Department of Health. "This country can't afford to walk away from public health. We must be prepared to identify new and emerging diseases, and if we can do that, we will be prepared for a bioterrorist event."

Public health is a network of government-funded and non-profit services that monitor the health of the population, watch for emerging diseases, establish medical policies and practices, and make sure all citizens, rich and poor, have access to medical care. Except when there's a shortage of flu vaccine or a new disease, such as West Nile virus, public health rarely hits the national radar screen. Terrorism has changed that.

Now, "we've been discovered," says Scott Becker, executive director of the Association of Public Health Laboratories. Lab scientists have been "thrust onto the public stage. They're under the klieg lights, and they've performed amazingly well. They are every bit the American heroes as the others heralded over the last months."

Those lights also have illuminated serious cracks in the system. Some health departments function in outmoded buildings with no computers or fax machines to speed communication of crucial information. They're plagued by high staff turnover and funding shortages. Many states had begun thinking about a response to bioterrorism, but in most cases, planning was incomplete.

For those in all facets of the public health system, a vast network of some 3,000 federal, state and local health departments and labs, life since Sept. 11 has meant long hours and a new sense of the urgency and importance of their work.

Stephen Morse of the Centers for Disease Control and Prevention's Laboratory Response Network says that since early October, nearly 70,000 samples suspected of anthrax contamination have been tested—including 45,000 in states that had no anthrax incidents.

"It has been very intense," says Katherine Kelley, director of the Connecticut Department of Public Health Laboratory in Hartford. Hers is one of the few labs in the country that detected a positive case of anthrax. A 94-year-old woman in a rural Connecticut community died in November after being exposed to anthrax, possibly through contaminated mail.

The event brought together local doctors, public health and law enforcement, she says. Lab scientists "were seeing a lot more police cars. The FBI were here. These were new partners we didn't see on a regular basis."

Kelley has been putting in 80-hour weeks, along with a dozen scientists in her lab assigned to test hundreds of samples as part of the investigation. All have been on 12-hour shifts, seven days a week, since early October.

But nobody's complaining.

"I think they're very proud of the role they're playing," Kelley says. "We're the public health lab, and now we're the first-response lab. This is a new role for us, but we've been training for this. We can do it, and do it well."

Leslie Beitsch, Oklahoma health commissioner, says she now sees "colleagues in our system are accorded a much greater amount of professional respect."

Public health in America may well emerge from the tragedy of terror stronger than it ever has been, officials say.

"This unprecedented attack on the nation has gotten everybody's attention and allowed people to focus on issues and concerns that weren't high on priority lists in past years," says James Hughes, director of the National Center for Infectious Diseases, at the federal Centers for Disease Control and Prevention in Atlanta.

Tops on that list are two items that previously induced nothing but boredom, despite the best efforts of public health agencies: the need to shore up the public health infrastructure and to prepare for potential disaster.

Some health departments lack the technology needed to access information quickly. The need for more lab workers, lab space and hospital capacity is clear, officials say. In a normal winter, hospital emergency rooms overflow with flu sufferers. Imagine, they say, what would happen if smallpox broke out.

The federal government seems to be thinking about that. In mid-December, Congress passed a $2.9 billion bioterrorism bill that includes more than $1 billion in grants to state and local health agencies to improve preparedness and lab capacity, $450 million to the CDC, and more than $1 billion to pay for expansion of national stockpiles of drugs and medical supplies, including more smallpox vaccine.

President Bush is expected to seek at least $15 billion in his 2003 budget proposal for domestic security needs, including funding for communications equipment for public health agencies and hospitals so they would be better able to deal with a terrorist attack.

"That we are no longer immune to the threat of bioterrorism is abundantly clear," Rep. Billy Tauzin, R-La., said after the bill he co-authored passed 418-2. "In a post-Sept. 11th world, it's critically important that Congress strengthen our public health infrastructure at the national, state and local levels."

To many in public health, these words signify a sea change.

"The 'new normal' is that public health is now on everyone's mind," Selecky says. "For me to hear someone in Congress use the phrase 'public health infrastructure,' which used to be a fall-asleep phrase, is just amazing."

Infectious-disease specialist Rathel "Skip" Nolan of the University of Mississippi Medical Center in Jackson sees the change in his daily work. For months, Nolan had been offering a series of lectures on bioweapon exposure to medical personnel, under contract from the CDC and the state health department.

"The response was lukewarm," he says. "My audience was polite, but they thought, 'This was pretty silly, it's not going to happen here.'"

Then came the first case of inhalation anthrax, which killed a photo editor in Florida on Oct. 5. A week later, an NBC employee tested positive for the skin form of anthrax.

"The phone began ringing off the hook," Nolan says. Suddenly, his lectures were full, and he became "the anthrax poster child." He has given 20 lectures since early October. Now, he says, "The urgency is there."

Getting out the information

Physicians are on high alert and hungry for information about agents of bioterror that might show up in hospitals and doctors' offices. Now that doctors better understand the urgency of reporting diseases to state health departments, CDC officials and state health directors say they hear daily from doctors who wonder whether what they're looking at is chickenpox or smallpox, a respiratory virus or inhalation anthrax.

"We're looking at adult chickenpox and young people with pneumonia more closely," says Mississippi state health officer Ed Thompson, who has sent information packets on biowarfare agents to hospitals, clinics and doctors throughout the state. "Every one of us has had to increase the awareness of our primary-care doctors, emergency room doctors, those on front lines who would be the first to see any of these diseases."

Information flows more freely from public health agencies to the front lines than it did in the first weeks of the anthrax incidents, says Robert Carr, a family doctor in Washington, D.C.

Tying in to family doctors

"What we didn't have early on was specific information. The public health people were responding and learning as they went along," Carr says. "They did a good job under the circumstances, (but) it may not have been apparent early on that we were the people who would be seeing the vast number of patients. Television was saying, 'If you're concerned, see your family doctor'—and we didn't have the information."

Efforts are being taken to improve communication between public health and private practice doctors, says the CDC's Hughes. "The cultures are different, and there have always been communication issues, but these gulfs have to be bridged. When you get into state and local preparedness, the clinicians and public health community have to be at the table."

And time is of the essence. Georges Benjamin, president of the Association of State and Territorial Health Officials and secretary of health for Maryland, says, "We're functioning on a much faster turnaround time for a whole range of things. It used to be that our epidemiologists did their work quietly. That's not true anymore. They're truly functioning in a fishbowl."

The "sudden marriage between the public health community and the acute-care medical community will persist," Benjamin says. "It's almost a dependency. The need to work together on this crisis was so apparent that I think the relationship that has been fostered will strengthen our ability to respond to this in the future. The recent terrorism has pulled us together in new ways. And I think we're better for it."

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This page last reviewed November 17, 2004

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