Blue Promise: Are We Ready for the Next Big Outbreak?

Do you remember the Ebola outbreak that started in Dallas? Five years ago, the deadly disease made its way to America and landed in our own backyard. Find out more about the impact of highly infectious diseases in this episode of Blue Promise, featuring Dr. Philip Huang, Director of Dallas County Health and Human Services. 


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Blue Promise is a podcast and online video blog that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas. 

Show Transcript

SHARA: Do you remember the Ebola outbreak that started here in Dallas, five years ago? This deadly disease made its way to America and landed in our own backyard. Find out more about the impact of these types of highly infectious diseases in this episode of Blue Promise. 

SHARA: Thanks for tuning into Blue Promise, where we're committed to addressing complicated health care issues with candid conversations from subject matter experts. I'm Shara McClure, Divisional Senior Vice President of Health Care Delivery at Blue Cross and Blue Shield of Texas. I'm sitting in for our host and President, Dr. Dan McCoy. Joining us today is Dr. Phillip Huang, Director of Dallas County Health and Human Services. Thank you for being here today with us, Dr. Huang.  

PHILIP: Thank you for having me.  

SHARA: So, a little over five years ago, Ebola struck right here in Dallas. And I believe at the time, you weren't here. You were in Austin, is that correct?  

PHILIP: Right. Right.  

SHARA: So, tell me a little bit about what it was like to work in public health at that time. 

PHILIP: Sure. I mean it was a crazy time. And even though we weren't the epicenter, like Dallas, I mean it had a ripple effect and certainly affected I think every community in the country in terms of you know the fear, the concern, and we were all evaluating patients that were persons under investigation. You know, people who were traveling from Africa and you know being evaluated and monitored for symptoms during that time. So again, I think it was very interesting, sort of wild, but we all were affected. I mean one thing I remember, in particular, I think it was around the time of the state fair so in Austin I'm getting these questions from people: should we go up to Dallas for the State Fair?” Because of these cases up there. But that was a lot of the types of questions and concerns that were being heard around the country. 

SHARA: I remember and actually, I was new to Dallas at the time because this was 2015 and I do remember it being around the state fair and also the area. I remember no one wanted to go around the area. People didn't want to be at the hospital. It was just getting a ton of public attention at the time. And I'm certainly sure that I remember health care workers being very concerned and we were caught off guard. We were kind of ill equipped. So, infectious diseases like Ebola can have some major consequences. So, we talked about what it was like to go through it. What do you think the impact has been to the community and the nation from that outbreak? 

PHILIP: You know, one of the things I mean I think it was heightened awareness of how we do need to be prepared. I mean, the initial thoughts were any hospital in the United States was ready for this and we could handle it. But then, when there was transmission within the hospital, you know recognition. Hey, we really need to be very diligent and be prepared for some of the personal protection equipment, all of those sort of aspects, as well as you know making sure and ask the questions on travel history. But then, you know, other things in the community just that you know, well okay, in the hospital laboratory. I mean, they were worried about having specimens go through the lab systems and then if there were contamination, shutting down hospital labs. There was even from the community level, you know, who was willing to clean a house of someone who was diagnosed and then what mortuary services were even willing to deal with, you know, any deceased bodies. So, it was pretty dramatic the level of sort of the issues that came up that we didn't really necessarily expect. 

SHARA: Yeah that's extensive and there's a lot of fear there. And it was certainly contained. I don't think we've seen anything here in America at least to that extent since that time. 

PHILIP: Although yeah, you know. But you look back and the early days of HIV had some of those same sorts of fears that were out there. I mean, people were not wanting to run HIV tests and you know laboratories things like that. So, there was some prior experience similar to that 

SHARA: I think that's a very good point. So fast forward to 2020 and there are still Ebola outbreaks going on in the world, especially in the Democratic Republic of Congo. What do we know now that we didn't know then? 

PHILIP: Well, again I think that the in terms of being prepared, you know having the personal protective equipment, and the diligence that needs to be applied to those situations. But there's also now vaccine development that has made great progress. So, that's a game changer for some of that. But then still, the implementation of these control measures is affected by many different aspects. 

SHARA: And has the vaccine reduced fatalities? 

PHILIP: It's been shown to be effective. So again, it's a new tool to address this. 

SHARA: Well that's certain certainly good news. So, we've talked about Ebola. Give me some examples of other infectious diseases that could be threats to our community. 

PHILIP: Well you know, one of the things that we deal with every year and we're dealing with now is just influenza. And people forget, I mean, the severity and the magnitude of what influenza can cause. I mean you know, with Ebola we had just a handful of cases in the entire United States. I mean, but with you look at the pandemic flu in 1918, there were 500 million people worldwide. I think it's estimated you know, a third of the entire global population that were infected. I think there were 50 million deaths globally. You know, it's just, those are things that are still present dangers as well as many others. 

SHARA: So that's a little over a hundred years ago. So, what's a modern outbreak that you remember going through that's really impacted communities? 

PHILIP: Well, I mean we actually dealt with H1N1. Not too many, within the last decade.  

SHARA: I think that was what, 2009? 

PHILIP: Yeah, right. So, that was almost a dress rehearsal for some pandemic flu situation because that's really what that was it was. And I know being in public health we were going through all the movements and all the you know but it was real. But fortunately, it wasn't as severe as it could have been. But there were, you know, that was still a very real time experience that I think we dealt with. 

SHARA: So, you describe these outbreaks but it's kind of come from somewhere, right? How do you, there are diseases that are going on all the time in our communities that are being treated by hospitals, that are being treated by physicians, and other professionals. Describe exactly, how does this work? How does a potential outbreak get on the radar of the Dallas County Health and Human Services Department? 

PHILIP: Well, that's one of the core functions of what we do in public health and the health department, is monitoring that assessment piece. And so, having the data systems where we're monitoring is there a spike in increase in the number of deaths due to something or you know illnesses. And we work very closely with the physicians, other health care professionals, the laboratories, on getting those reports. You know, so those early reports are some of the ways that these are initially identified. And so, when we get something of concern, then the epidemiologists, the disease detectives that we have in public health, are the ones who will interview those initial cases. Again, if it's a brand-new thing, to do some hypothesis generating. You know what are the, what was this person exposed to, and get very thorough histories. Try to find linkages and connections between cases, identify you know mode of spread, and what treatment, all these sorts of things. And then part of our messaging is, you know, get the information out to the health care community and physicians, if we know here's how to treat it, here's how these should be assessed, here's what laboratory specimens need to be collected for these things. All of that is part of what we do in public health as part of being prepared and then the intervention activities. You know, what control measures do we need to implement and how do we work that. How do we work with the pharmacies? How do we work with distribution of vaccines? Things like that are, you know, part of that response. 

SHARA: So, that's a pretty important role that Health and Human Services plays. And are you comfortable you're getting all the information that you need from the medical community? 

PHILIP: You knowwe're trying to build the data systems so that we can get the best information we can. In Dallas, we have a great working relationship with our physicians, with our medical community, the county medical society. So, we get excellent reporting. I think that, in some of the issues, sometimes the numbers even come out higher in our area. Like for instance this latest, the vaping respiratory illnesses related to that, we have higher numbers here and we really attribute it because we have such a great working relationship with the community and we get these reports very quickly very comprehensively. 

SHARA: That's good news. So, you've got a lot of people. I think you said about 500 professionals, who work in Dallas County Health and Human Services and some of them are what we describe as disease detectives. Tell me about a day in the life of a disease detective. 

PHILIP: So again, I think it's looking at some of the data that we're collecting, seeing, assessing if there's any trends, any particular populations that might be affected by something that's sort of showing up, evaluating. We have reportable conditions that are systematically reported to the health department. And then, following up with those investigations. So, we have, you know, those who do those interviews with people, see what, you know, for instance for other issues like sexually transmitted infections, HIV. We have staff that go out and interview them and identify contacts. Then we notify those contacts that, hey, you may have been exposed, please come in and get tested. So, there are you know various control measures. Tuberculosis, another area where we follow up if there's a TB case and we assess exposures and contacts. And then you know, that starts a whole cascade of okay, who was exposed to this person that has active TB? Doing this skin testing, or the testing to see if any of them convert, and then getting those people on preventive treatment, and getting the you know the TB case treated. So, all of that's part of the public health response. 

SHARA: So, you've talked about many different diseases. I mean from HIV to flu. We've talked about Ebola. All these different diseases that you're monitoring. Is there anything else that's on your radar? 

PHILIP: You know, we never know. I mean, you know, five years ago we weren't thinking about Zika, and then that popped up. So, there's, you know, Dallas has also been a center for the West Nile virus and the mosquito issues. And you know, the mosquito borne diseases. So, those are something every year, we are you know 365 days a year. I mean, we are monitoring and collecting mosquito specimens and testing them and you know watching for that. So, there's so many different things. But those are just a couple of other things that we think about. 

SHARA: You've got a pretty broad range of diseases that you're monitoring and many of which we thought were actually eradicated. We had a measles outbreak. Can you comment, a little bit, about how important vaccines are? 

PHILIP: Yeah, I mean that's a great point that you know vaccines are really one of the greatest public health accomplishments of the last century. And this is tragic that we're having to re-assess and think about problems like measles, that are vaccine preventable. Things that we had declared eliminated in the United States you know previously that now are popping back up. And so, you know the vaccines again, we're really a victim of our own success with that. Now health care professionals, they haven't taken care of you know people with. I mean you look at those pictures of the iron lungs, you know, rooms with that, from polio. And you know that there used to be you know 5 million cases of measles a year in the United States each year. And things like that, that we've essentially eliminated and been successful with. And so, it's because people don't think about it and because they don't see it anymore, they forget about the success. And sothat's tragic that we're having to still deal with it. 

SHARA: agree, and I think that it's important and I'm glad that you emphasized the importance of vaccines and how it's been such a such an important public health advancement that’s prevented diseases. And some say, of other diseases, it's not a matter of if, but when. And I think you've given our listeners advice around vaccines. Is there any other public advice that people can do to avoid diseases? 

PHILIP: Oh, you know one of the best things: wash your hands. That's, you know, with the flu, we say that all the time. Wash your hands for so many different transmission of disease, whether gastrointestinal or respiratory, you know. And for the flu, I always say, you know, wash your hands, get your flu shot, don't rub your eyes, nose, and mouth with your hands. Cough and sneeze into your crook of your arm, or into a Kleenex. And if you're sick, stay home. 

SHARA: Thank you for your advice Dr. Huang and thank you for being here.  

PHILIP: Thank you.  

SHARA: Thanks to our listeners for joining us for this episode. Don't forget to subscribe to the podcast or videos from wherever you listen or watch. You can also leave a review, which will help people like yourself find this content. Thanks for tuning into Blue Promise.