Diane Gross

How do you handle an epidemic unfolding on-the-ground, and how do you handle cultural and language barriers? How do you know when an epidemic starts to wind down?

Diane Gross, PhD, adjunct professor in the Department of Epidemiology, was on-the-ground in 2015 in Sierra Leone during the Ebola outbreak. She’s also served as a senior epidemiologist in the High Threat Pathogens unit for the World Health Organization (WHO), and works with the Monongalia County Health Department to support its response to the COVID-19 pandemic.

Below are excerpts from her interview on the “WVU and the Coronavirus” podcast, where she shares information about the role of public health experts in tackling pandemics, working on the ground during an outbreak, and the vital work being done to keep communities safe during the COVID-19 pandemic.  

What is public health’s role?

We've been working to ensure public health for hundreds of years. Actually, the idea of public health and the health department go back to the plague and trying to prevent disease from spreading within population.

In the United States, some of the first public health officials were involved in doing surveillance on ships, coming into port in the coastal cities, to make sure they didn't carry diseases in from other places. From that, we've developed health departments. We know Centers for Disease Control and Prevention is kind of the national health department, but then we have them at the state and local level.

Now, we think of the health department as doing disease investigation, quarantine, isolation, but we also do all the sanitation inspections, restaurant inspections, making sure that swimming pools are healthy. So, we do quite a large range of activity.

What was your experience like working in Sierra Leone during the Ebola outbreak?

They shut down the country for months and people had to go back to their house, they couldn't leave their villages or province. We had people who walked through the villages every day looking for cases. Sadly, they have very few healthcare workers or healthcare facilities for the population. So, we couldn't rely on people going to the doctor or showing up to get tested because they just didn't have those facilities. We had trained just community leaders, people in the community on how to walk through and look for signs. If they identified anyone, we would take them to an Ebola testing site and test them and put them in isolation until they tested negative and were released.

How did cultural practices influence the response in Sierra Leone?

The first step when you're dealing with having to modify cultural practices to try and prevent spread of infection, is you really need to have good understanding of the issues at the community level, their concerns, their fears, their motivators and really good communication.

And with the 2014-15 Ebola, groups there worked to determine what cultural practices and what about them, these burial practices, were helping to allow what we would call super spreading events, where a large number of people were becoming infected. And then the other thing was because particularly a burial of someone high in the community or a patriarch of a family, you would have people coming from lots of various places together for the event and then spreading back to many places across the country, which of course made it much harder to track. So, working with community and religious leaders, they found ways to modify burial practices that still respected the culture and the community, but also tried to mitigate or stop the spread of infection.

In Sierra Leone, we had a lot bigger job of trying to educate people on what was going on in viruses. The average person in Sierra Leone didn't have as much of a science background as people in United States have in their routine education. In crisis communication, you have a clear, consistent message to try and make sure that you are not causing confusion.

We had issues with people not wanting to have the burial team, they wanted to do the burials themselves. So, we were, communication-wise, still fighting the same fight, different circumstances, but a lot of the kind of same issues that you could see with COVID as with any other kind of major disease outbreak.

How does a disease get classified as a pandemic?

To become a pandemic means it's spreading around the globe. And not just that a traveler went here and a traveler went there and brought it, but it actually gets into another area and then starts spreading locally within that area. And then it goes somewhere else and spreading locally. Now with air travel and as mobile a population we are around the world, it's much easier for a disease to spread from Africa to Asia to Europe to the U.S. to South America.

In disease reporting, the World Health Organization (WHO) is the body of the U.N. that works to promote world health and also promote countries working together when there are these types of events.

All the countries in the U.N. that have signed on to be part of the World Health Organization have agreed to a set of rules called the International Health Regulations – they will track certain diseases and they will share that information to other countries in the WHO in a timely manner…so the countries of the world can track this.

If they have a disease that they are tracking, that they think might be a pandemic, they have these emergency committee meetings where they will bring together all the experts for this disease from around the world to discuss what's going on. Where is this disease? How serious is it? Where is it spreading? And they will then make the decision that gets referred to the head of the WHO. Under the current public health system that we have globally right now, it's the director of the WHO who declares when it has become a pandemic.

How does an outbreak get reduced to the all-clear?

It kind of depends on which type of disease you're talking about. For Ebola, we worked to get it eliminated so that we had no cases that we could find in the country in the area we were working. So, when they declared the outbreak over for Ebola, that meant they watched for a set period of time, which is basically the incubation period, meaning the time between someone gets infected and when they could become ill with it. So, you take two incubation periods and if you've had no new cases during that time, you declare the outbreak over. For Ebola, the goal was to get to zero because Ebola is not a disease that we would normally see spreading even at low levels in a population.