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DHS news release

Sept. 23, 2004

This guest opinion is by Mel Kohn, M.D., state epidemiologist in the Oregon Department of Human Services. For a photograph of Dr. Kohn, call Bonnie Widerburg at (530) 731-4180 or email at bonnie.l.widerburg@state.or.us

New TV series glamorizes medical investigations
In real life, it’s carried out by unassuming epidemiologists who monitor disease transmission on a daily basis

Length: 582 words

This fall, NBC launched the "Medical Investigation" series. The first episode was based on a true investigation into a baffling case of 11 New York residents, sickened with food poisoning, who literally turned blue.

It’s a thrill to see public health getting high profile attention. But the work of preventing disease is carried out in smaller, less dramatic ways every day.

In the series, the investigators are rather unlikable daredevils who move at an action-packed pace to track down strange illnesses. They come from an elite unit within the federal National Institutes of Health.

In real life, this work is carried out at the federal level by the Centers for Disease Control and Prevention (CDC). But rarely does CDC get involved in an Oregon outbreak. Most often it involves local public health nurses and sanitarians who aren’t focused on the newest exotic bug on the block. They’re looking out for threats around us every day, like E.coli O157, meningitis and hepatitis.

State law requires all health care providers and medical labs to report 50 diseases and conditions to local health departments. Reporting is also required for other suspicious disease clusters, the cause of which might not be known. The health departments forward all reports to public health officials in the Oregon Department of Human Services.

County and state epidemiologists receive an average of more than 200 reports per week in Oregon. If they detect a cluster of illness, they don’t hop into a helicopter and swoop off to a busy restaurant or a hospital as depicted on television.

Instead, they reach for the telephone and begin a meticulous, methodical process of collecting information to try to find the cause of the illnesses or a common exposure. They’re searching for a clue as to how these people all acquired the same illness. Did they all eat at the same restaurant, shop at the same grocery store or attend the same event?

In addition, those in close contact with the sick people have to be identified so they can be told how to avoid becoming ill, too. This is critical to stopping further disease transmission.

Collecting all this information is very labor-intensive. Heavy-handed tactics won’t work; it requires persuasion, diplomacy, the cooperation of the public–and sometimes, a bit of luck.

Sometimes public health workers go offsite to personally interview cases and contacts, or to collect blood or tissue samples for testing. But usually they huddle over telephones and computers, acting as a team. They put in long hours, working urgently, because the information they gather is what will stop a disease epidemic in its tracks.

As data are compiled, they are analyzed to identify the common exposure and likely disease transmission route. Once that is identified, control measures are quickly instituted. Examples include pulling a food or product off the market, such as Costco’s recent voluntary removal of salmonella-contaminated almonds from store shelves, or advising certain groups of people to take medication or recommending changes to state policy.

The chase to find the source of a disease outbreak is high drama because how quickly and how well it’s done affects real people. The epidemiologists and public health workers who do it find it to be very satisfying work. I’m glad it’s getting prime time play, but the real story is that this work goes on every day in Oregon. This year, to date, public health has detected 137 communicable disease outbreaks in our own "Medical Investigation" drama–and without a single helicopter ride.

Dr. Mel Kohn is state epidemiologist in the Oregon Department of Human Services. He oversees statewide prevention activities for communicable diseases as well as other health threats.