Lunar New Year kicked off last week as millions of Chinese people left the cities they live for the homes they grew up in. For many, their trips coincided with the outbreak of the coronavirus, an epidemic that the government has responded to with intense travel restrictions in Wuhan, the city of 11 million, that’s ground zero for a disease that’s killed more than 100 people.
The intensity of the quarantine has raised questions from outside observers like Emory University School of Medicine microbiologist Elaine Burd, who worry about the unintended consequences of the government’s move. As the government has “essentially ordered” the people in Wuhan to wear protective gear, it’s caused a shortage of equipment for those actually treating patients, she says.
“The biggest problem is that health care workers, who are taking care of sick patients, don't have enough protective gear, and this puts them at greater risk of catching the virus while they're taking care of patients,” said Burd. “From reports that I've seen, that seems to have created some panic among the group we call the ‘worried well.’ These people without symptoms but now don't have access to the protective equipment that the local government and public health officials said they should have. And so they feel vulnerable, maybe excessively vulnerable. So I think all of that really, it can create chaos.”
Burd joined digital media producer Morgan Lee and CEO and president Tim Dalrymple about what people should know about the coronavirus, God’s call for her to become a microbiologist, and how her experiences working with an Ebola patient inform how she understands China’s current crisis.
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The transcript is edited by Bunmi Ishola
Highlights from Quick to Listen: Episode #197
Why don't we start with you telling us a little bit about your background and your training and your experience with disease outbreaks other than the coronavirus?
Eileen Burd: I got my doctorate degree actually at the Medical College of Wisconsin in Milwaukee, and after that, I worked for 12 years at Henry Ford Hospital in Detroit, Michigan, and then about 12 years ago, moved here to Atlanta, Georgia to accept the position I'm currently in.
As part of the position I'm currently in, Emory has the Serious Communicable Diseases Unit. It is important for someone in my position to be on the staff of that unit. So that provided me a really unique opportunity, especially in the Ebola patients that we cared for back in 2014-2015.
You know, ever since I arrived here at Emory, we did drills and training and the Serious Communicable Diseases unit so that we would be in a state of preparedness should this a situation arise where we would have to activate the unit.
You do the drills and you feel pretty comfortable, but when we actually got the call to accept our first patient who is being flown back to the United States with Ebola, it caused a little bit of angst. We had a couple of days to prepare, and I think when all of the unnecessary people kind of got out of the way, and let the people who were trained to do what they needed to do, it fell into place fairly smoothly. I was actually very proud of how all of that worked out.
For me, it was quite different from my day-to-day work. I didn't actually do any laboratory testing in the unit until the patient had been here. It was the third day that I was doing testing and so I was in full personal protective gear, which is a little different to work with that kind of equipment on. The lab was also right next to the patient's room. That was one thing that was different for me because usually I'm quite in the background and don't get to see the patients that we're doing testing on. But the patient was in the room right next to me and it was very visible how sick the patient was.
I'll have to admit, it caused me a moment of pause when I held that first tube of blood, knowing that the Ebola virus was in there and what it was doing to the patient. But also knowing that I had full protection with my protective gear and confidence in my ability to do my work, you proceed.
That first day, once I got the test set up, some of the tests were done fairly quickly, in 10 or 15 minutes, but another test that I was doing took about an hour here. I was in a biocontainment lab, and no one was going to come in, I wasn't going to leave. So I had really protected quiet time, which doesn't really happen, you know? I thought for a moment, what do I do with this time? I could have done some work, but it took me just a moment to think that really what I needed to do was pray for that patient in the room next door. So that's what I did. It was a great exercise in relieving some of the fear and also just connecting me to that patient.
In those types of testing scenarios, what is it that you're hoping to learn? And what role does that play in gaining a better understanding of the disease or better treating the patient?
Eileen Burd: Some of the work is just basic chemistries—sodium and potassium and glucose and things like that—numbers that we need for the immediate care of the patient, to determine how much fluid the patient needs and that sort of thing. And then because it was Ebola, and we really didn't know much about it, some of the testing we did was just to determine how widespread this virus was in the patient's body and as a kind of learning, as treatment went along, how things were progressing. So it was just to better understand the disease process
The testing I do in my clinical lab all day long, every day is to diagnose infectious diseases. And the basic chemistries are done very, very routinely. But this was definitely high stakes testing just because of the nature of the virus.
Let’s talk about coronavirus. Could you explain what it is and how it's transmitted?
Eileen Burd: There are four common human coronaviruses that are found worldwide, and they really cause the common cold along with vinyl virus[9:38]. So a lot of us have been exposed to coronaviruses in our life, but recently there are three other human coronaviruses that are the exception. They're limited in their geography and they produce really life-threatening illnesses.
These are the SARS coronavirus that emerged in 2002/2003, then the MERS (Middle Eastern) coronavirus that emerged in 2012, and now we have the Wuhan pneumonia syndrome coronavirus that just emerged in December of 2019.
These newer coronaviruses really originate in animals, and either because humans come into contact with these animals that they normally wouldn't or because the virus has mutated to be able to infect humans from animals, humans are exposed. What we know about the Wuhan pneumonia coronavirus is that it is transmitted is that there was this market in Wuhan that sold kind of some exotic type animals that were used for food consumption. But I don't think that they've identified the actual animal source.
When a new virus like this is found in a population that hasn't seen it before and especially in such a high-density population—you mentioned 11 million people in Wuhan. This is a lot of people who are not immune to this virus—they found very quickly that the virus could be spread person to person. The spread is by droplets, which means by coughing or sneezing, or by something called fomites, which just means contact with surfaces that become contaminated.
We're still learning a lot about this new virus. I don't think we know exactly like how long it stays on surfaces and is viable, but it appears to be for a period of time.
How worried do you think people should be? And where in the spectrum, between the fatality rates not so high versus this is a new disease and we don't really know what's going to happen to it yet, is the right place to land?
Eileen Burd: It's no mistake that this outbreak is a public health emergency in China. It is true that it seems to be highly infectious—we have a new virus in a high-density population, it's spread easily from person to person—but you're right, it's not considered to be as virulent as the virus that caused the SARS outbreak in 2003. Some response is certainly necessary, but I also think that we need to keep things in perspective.
In the United States, we've been told that risk is low, and I think that this is true. Influenza is a far graver health threat in the United States that the Wuhan coronavirus. In fact, the last numbers that I saw were since October, about 20,000 Americans have died of the flu this year. So that's a really huge number.
Could you talk to us about the idea of quarantines? How and why are they being used with the Wuhan coronavirus?
Eileen Burd: Quarantine is an interesting concept. Its purpose is to restrict the movement of people who may have been exposed to an infectious disease so that it doesn't spread.
I think some of the response of the Chinese public health officials and government has been appropriate. This limiting the mobility of the population and really shutting down all forms of public transportation—buses, berries, trains, airplanes, even putting up roadblocks to restrict private cars—is quite extreme. Especially at the beginning or right at the outset of Lunar New Year when people are really wanting to be with their families. There may be some component of legitimate rationale, but I think that it’s really extreme.
What you really want to focus on are the people who are sick and people who are healthy should be vigilant about potentially developing symptoms. I think part of this big quarantine comes from the suggestion that even healthy people can transmit this virus. If they're not symptomatic, yet they've encountered the virus, they can transmit it to others. But there are international investigations trying to really explore that a little bit further, including researchers at the CDC. If that notion was the premise for the extreme quarantine, it's really not evidence-based at this point.
From your perspective as a member of the scientific community, how does the international medical community mobilize when something like this happens? How is information shared internationally?
Eileen Burd: Knowing the genetic makeup and the identification of this particular coronavirus came quite quickly. That can make such a huge difference in developing diagnostics.
Right now we have this new virus and we have people getting sick. We have to be able to be tested, but there weren't existing tests and so they had to be developed very quickly. Also for vaccine preparation, which can take many months and you may or may not be effective, but just to be able to work on a potential vaccine, you need to know the sequence of the virus. China has very good centers for disease prevention like we do in the United States. And so a lot of the work for sequencing this virus was done there. And then the World Health Organization and other groups play a role in making that information available to people who are developing tests and vaccines and treatments and.
But that doesn't always happen, and it doesn't always happen that quickly. I think we are much better resourced now in that regard than we were a while ago. But for outbreaks that happen in developing countries, where those kinds of resources aren't available, patient specimens have to get to places like the Centers for Disease Control, where that kind of testing can be done and so there can be delays.
Outbreaks like this, and the measures that are taken to contain them, can have a real economic impact or political impact. And so before we transition and start talking about some of the spiritual dimensions of this story, what about the unintended political consequences and economic consequences? Is this something that you've had an opportunity to think about?
Eileen Burd: I actually have thought about this a little.
When you talk about quarantining 50 million people in the center of China—and this has been going on for about a week or so—what happens to the country? How does it keep functioning in the throes of a pandemic when everyone is quarantined? If travel's disrupted, if trade is disrupted, how does the economy continue to function?
And when people are held up in their homes and information may not be so forthcoming, I think there starts to be a certain degree of lack of public trust. There needs to be some credible, transparent, honest communication. And I'm not sure how much of that is happening.
Even things like the local government and public health officials in China have essentially ordered people to wear protective masks and even suits as a preventive measure. I mean, they had to know that for a population of this size, that was just not sustainable. Now there's a situation of shortage, right? And so the biggest problem is that health care workers, who are taking care of sick patients, don't have enough protective gear, and this puts them at greater risk of catching the virus while they're taking care of patients.
From reports that I've seen, that seems to have created some panic among the group we call the “worried well.” These people without symptoms but now don't have access to the protective equipment that the local government and public health officials said they should have. And so they feel vulnerable, maybe excessively vulnerable.
So I think all of that really, it can create chaos.
Can you explore more deeply about the types of apprehension or fear that you and your team members felt when you found out that an Ebola patient was going to be brought back to the U.S.? What type of conversations did you have with your colleagues and how did you work through that from a faith perspective?
Eileen Burd: My colleagues in the Serious Communicable Diseases unit were not really fearful because we had been trained and the processes were in place. There was a little angst surrounding whether that would all flow as easily as we thought it would. We didn't know what kinds of near misses or things like that would happen.
We did have what we called family meetings twice a day—where you could either call in if you weren't physically in the unit, or if you were in the unit attend the meeting—where the patient's condition was reviewed and the plan for the day was laid out so that everyone knew what was going on. And I think that kind of communication helped keep things going smoothly and transition from shift to shift for the continuous care of the patient.
A lot of the fear happens outside of the unit and even in the community. There were signs going up in the area, press were camped out on the lawns of Emory University. We were on information blackout, so we couldn't really convey anything about what was going. It fascinated me how much fear there was in the community.
It amazed me also that even months later, one of my staff in the unit went to get their teeth cleaned and they were refused treatment by their dentist because they had been involved in the work in the unit. One of my other colleagues went to give a lecture at a university and was refused. People's fears are really unwarranted, and some of that was really quite surprising to me, having actually been in the unit with the patient, with the patient's blood and feeling comfortable in that setting.
In our society today with so much uncertainty, there's kind of an underlying noise of fear. And so the temptation is to be afraid. I think the Christian response to that is to be aware and informed and know the facts. To get your information from credible sources. Another sort of component of the Christian response would be not to buy in to or spread misinformation. It amazed me how quickly in this current coronavirus outbreak that fabrications surfaced pretty fast.
The other thing that I've thought about also, just because of some of the situations back in Ebola days, is not to exclude anyone from activities. And we certainly should not generalize so that any person of Chinese heritage who happens to cough, we think “Oh no.” Those kinds of panics really cannot happen.
Back in the Ebola days, I think it was even hard for my kids to send me off to the Ebola unit. They were young, but they kind of knew what was going on and I had to assure them that I personally was not at risk because of the personal protective equipment that I had and because of my abilities and the confidence I had in my abilities.
I did have conversations at our neighborhood pool. My neighbors knew the kind of work that I did, and they would ask questions. I think people are curious and in the thick of it, it can be a little scary. And I think knowing the facts, not letting things get blown out of proportion, is really important.
Can you talk about the screening process and how accurate it is? How comfortable can we be that people who may have returned from the affected area are healthy?
Eileen Burd: One of the United States’ responses to this outbreak is that the CDC looked at airports who received direct flights from Wuhan. They identified only three—San Francisco, Los Angeles, and JFK in New York. They focused on those three airports with direct flights from Wuhan and started monitoring at those airports. So people getting off the airplanes would have their temperature checked and then there was a symptoms-monitoring questionnaire that they would fill out. And anyone who wasn't feeling quite right or who had a fever would then be referred to appropriate health care workers who were in those areas. O'Hare and Hartsfield Jackson in Atlanta were added to that list, just because of secondary flights.
Those screenings are not 100%, but I think they're pretty good though. I think there were five cases that have been identified in the U.S. that way and patients were appropriately isolated and treated in hospitals. There haven't been secondary cases in the United States, so the virus hasn't gotten out or spread. So I think those measures, as simplistic as they are, can be very helpful.
I don't know what you dreamt of being when you were little, but God has placed you in a really unique position. How do you think about God's purpose in your life, through your work, and how you live out your faith in the workplace, given what you do?
Eileen Burd: When I was really young, I thought I would be an ambassador to France because I love the French language. When I got to college, and even just as I was graduating from college, I was going to study cardiac physiology. But I wound up graduating a semester early, and so I was looking for work. There was an opening at the Medical College of Wisconsin in Milwaukee for a microbiologist.
My degree is in biology, not specifically in microbiology, but I'd taken all the microbiology classes I could take, and I really did enjoy it a lot. But I didn't quite have the qualifications for this position. I ran it past my mom, and I remember her saying, “Just go ahead and apply because you never know who else might be applying and what their qualifications are.” So I applied for the position and much to my surprise, I got the position. And so I found myself working in microbiology, which was not my original intention, but I loved it.
I remember when I said, “I'm going to study microbiology and infectious diseases,” being one of my mentors told me, “You’re going to be out of a job in a couple of years because they're going to find the magic bullet antibiotic, and everything is going to be treated and you're not going to have work.” But of course, that has not been the case.
That first job that I had after I got my bachelor's degree, I worked at for a while, and then it became really clear that I needed an advanced degree. And so I got a master's degree and then a doctorate, and worked in a clinical laboratory medicine and hospital setting, which I loved. It's funny how doors open and doors close and the path that you follow.
I was not necessarily a deeply rooted Christian at that point, but you'd try to live in the center of God's will and follow where God wants to take you. If someone had told me, even when I was a practicing clinical microbiologist, that I would be treating Ebola patients in Atlanta, I would not have imagined that in my wildest dream.
You be faithful and, and go where it takes you.
To close, what are one or two specific ways that our listeners can pray for people that are either currently afflicted by this coronavirus or who are at risk of contracting it?
Eileen Burd: I find myself in my own prayer life praying for three major things surrounding this outbreak.
One is for the government of China, that they make well informed, evidence-based decisions for their population. I know in their heart of hearts they're trying to prevent the spread of this virus, but I'm not sure that the methods they're using are necessarily the best. That they continue to be or are transparent with people. That they react at an appropriate level.
I pray really hard for the healthcare workers in China. I know they haven't been well-resourced.
And I pray for the general population in China. The mortality rate is low, which is good, but still, the speed at which people are getting sick is unsettling.
I really pray for those three things. The government, the health care workers, and the population in China.
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