Steven Shelley, Cornell MPH ’19, Maine Center for Disease Control and Prevention
After graduating last year from the Infectious Disease Epidemiology Concentration, Cornell MPH alumnus Steven Shelley moved to Augusta, Maine for a position as Tuberculosis Epidemiologist for the Maine Center for Disease Control and Prevention (MeCDC). Recently, he has also been supporting COVID-19 efforts with the MeCDC. According to Steven, Cornell’s MPH Program helped him feel prepared for the current crisis through classroom discussions of global wet animal markets, zoonotic disease, and emergency preparedness.
In his role with the Maine CDC, Steven supports tuberculosis (TB) case investigations and coordinates collaboration between epidemiologists and public health nurses across the state of Maine. Though TB poses a major threat worldwide, it is less prevalent in the United States, with a total of 9,025 TB cases reported in the U.S in 2018, and a national incidence rate of 2.8 cases per 100,000 population. Maine’s incidence rate is lower, at 1 case per 100,000, and the state investigates about 15-20 TB cases per year. Importantly, 90-95% of people with TB never have active TB. Instead, the disease can lie dormant, and may become active if the immune system becomes suppressed.
According to Steven, significant resources are required to conduct screening and contact investigations for every case in Maine, since TB is such a complex disease and infection—it can take up to 18 months for someone exposed to be infected and develop active TB disease. Contact investigations can be small, but they can also be much larger, depending on how many people someone with TB has been in contact with. Steven says that some of the most vulnerable populations in Maine require the largest investigations, often because they live in close contact with many others, as with homeless shelters or “New Mainers” living in congregated housing after moving to the state. Also, unlike with most other infectious diseases in the U.S., a strategy called Directly Observed Therapy (DOT) is essential for ensuring that active TB patients follow 6-9 months of treatment with 4 different medications while managing side effects. Public health nurses who make home visits are essential for DOT, and the Maine CDC coordinates much of this across the state.
Of course, the COVID-19 pandemic has changed business as usual for the Maine Center for Disease Control and Prevention. According to Steven, emergency plans set in place across the country during the H1N1 outbreak in 2009 have helped agencies prepare for the current crisis. In Maine, as with many state and local health departments, they are implementing a “Continuity of Operations Plan” that goes into effect in emergency situations such as this, so that all staff can take on more tasks directly related to the crisis. For example, Steven reviews electronic lab reports to help to assign COVID-19 investigations to field epidemiologists. Already, there has also been a notable impact on the MeCDC’s Tuberculosis Control Program. Public health nurses have been rerouted from some TB control duties to responding to COVID-19 calls from the public and conducting COVID-19 investigations. Of course, this and other fallouts from the pandemic impact resources available to care for TB patients, conduct contact investigations, and even to collect samples to test for suspected active cases. Since TB typically attacks the lungs, TB patients are at high risk during the COVID-19 pandemic, and the most vulnerable populations, such as the homeless, are at highest risk.
The MeCDC is also using digital technology to help address some of the gaps during this crisis. Since COVID-19 has come to the U.S., the Maine CDC has aimed to move as many TB patients as possible to Directly Observed Therapy over FaceTime or WhatsApp, or what they call Video DOT. This helps address some of the reduction in public health nurses for TB cases, but of course, some of the most vulnerable are also least able rely on electronic devices for digital therapy. As the pandemic continues to play out, Steven and many others at the MeCDC will need to strategically balance available resources to respond to COVID-19 while maintaining other essential programming like the Tuberculosis Control Program.