Us, Empaths: Diseases Are Bad
Two icons in conversation ft. me
The fact that this piece is going on live on the second anniversary of The Day Covid Became An Official Thing was entirely accidental… or was it?1
As we all know because we have all read every single E4P and have loved every second of it, I have been incredibly frank about how absolutely little I know about science and math. While you may think I’m being coy and am secretly really amazing at everything, there is a long-winded story to tell about how I never even learned how to light a Bunsen Burner.
But I don’t need to be good at science because I have smart friends who can explain it all to me!!! Which is what I did this week!!! I talked with two actual science icons, Arthur Menezes and Eleni Kokolakis about what it’s like to be brilliant (what they’re studying), what needs to be fixed regarding America’s approach to public health (a lot), and what we can all take away from their research on infectious diseases and apply to our own lives (main character syndrome, very contagious).
Arthur transitioned from spending time in a mascot suit to spending time in a lab, both of which brought sweat and tears. He wishes his TikTok career took off so that he wouldn't have to still be in school at 24 years of age. But alas, here he is, still wearing a backpack every day. In fact, he is starting to believe that he was actually born with a backpack on. When not in the office pretending to be productive, you can find him on Broadway (in the audience of course— remember the TikTok career didn't take off!!).
Eleni is a pre-med dropout finishing her Master’s in Public Health at NYU. She aspires to help women access reproductive healthcare, cure COVID-19, convince every man to get a vasectomy, and save the world, all while denying her parents the pleasure of saying their daughter went to medical school. In her free time, she spends many hours on BookTok, yelling about the state of Florida, watching The Marvelous Mrs. Maisel, and crocheting in straight lines. Her current mottos include “ask not what the patriarchy does to you, but ask instead what it can do for you” and “it’s good for the plot.”
It’s Giving Bill Nye Saying “Science Rules”
Once again, I find myself in the presence of spectacular humans who have decided to continue going to school.
Emily: What are you studying and why did you decide to pursue it?
Arthur: I'm currently a 2nd year PhD student in an Ecology and Evolutionary Biology program [side note: at Princeton University!!!!!!! Flex this more, Arthur!!!!] focusing on infectious diseases. I have always loved math, science, and public health and this field is a perfect combination of all 3.
Eleni: I am a current Master of Public Health candidate at New York University pursuing a concentration in Global Health, and will be graduating this upcoming May. I will also be receiving an additional advanced certificate in Health and Human Rights from NYU.
I decided to pursue public health when I was at Emory for my undergrad, and I had a breakdown at 4 am while studying for Organic Chemistry and decided that I actually didn’t want to become a doctor. I spent the next two hours until 6 am researching the field of Medical Anthropology and Public Health. By 6:30, I had called my parents and changed my major and minor, and now I am here.
The core reason as to why I decided to pursue the field is that I became incredibly frustrated by the fact that no matter how many people a doctor treats, the population will just continue to get sick unless as a society we focused on preventative measure rather than just treatment. That’s where Public Health steps in, getting at the root of the problem.
Of course, choosing to return to school is already a massive feat in itself if you are not someone who, when the pandemic hit and you were thrown into multiple weekly existential crises, wondered if you should go back to school simply because you suddenly could not conceive of anything that made up your identity other than “being good at school.” Or so I would imagine.
Anyway, I asked Eleni and Arthur:
Emily: Unabashedly hype up your research or studies in 5 sentences or less.
Arthur: As we all know by now, predicting and preventing future outbreaks is PRETTY important and one way we can do this is by assessing the landscape of immunity to pathogens of interest. One way to uncover the landscape of immunity is through serological surveys which provide direct measures of antibody titers within individuals.
Typically public health officials assess the levels of immunity with vaccination coverage data but that's not always the best measure because doses delivered do not always equal the number of individuals immunized. I'm currently working on new analytical methods to extract more information from serological surveys to better define the landscape of immunity to vaccine-preventable diseases in order to uncover pockets of susceptibility and better inform future vaccination campaigns.
Eleni: Public health is literally the coolest science to study ever. If I could marry it, I would. There is no other study that dedicates so much time, resources, and research to bridge the gap between science and directly applying that to solely benefit people and their health.
Emily: What are you most proud of yourself for achieving academically?
Arthur: Honestly just getting into grad school!
I did 6 grad school applications during senior year while also doing an honors thesis, working a work-study job, occasionally being Swoop (our school's mascot), and other extracurriculars. Oh, and I took a full course load too! So yeah, juggling a chaotic senior year and 5 grad school interviews and still managing to get in somewhere is probably what I'm most proud of.
Eleni: On a micro level, getting into grad school and graduating top 20% :) On a macro level, actually understanding what im learning and applying it practically! My father will be so proud that his hard earned money is being put to good use.
Arthur: Wait never mind, I just remembered that somehow I got a 92 on an organic chemistry exam. That was my peak! It's truly been downhill since then.
If you’re wondering what qualifies me to talk to such brainiacs each week, don’t worry— I am, too.
Real-Life Science!!!
While I can hype up Eleni and Arthur like Lil’ Jon in an Usher song all day, we should probably get into why we’re all here—our collective burning passion for love for infectious diseases and public health. Rest assured, I asked them all of the most pressing questions:
Emily: What's your favorite infectious disease?
Arthur: Oof this is a tough one! I think I'm going to have to say measles but I'm slightly biased because this is one of the diseases I work with. The
coolscary thing about measles is that it's the most contagious disease known to circulate humans and it deletes your immune memory to past infections. SCARY!!Emily: What is your beef with America's public health spending?
Eleni: We have so much beef. America doesn’t know we have beef yet, but I talk mad shit about her and her spending.
Healthcare as a market commodity is incredibly inefficient leading to higher costs in care with poor outcomes. What’s the point then in healthcare if no one can access it and when they do it’s not what they need? That’s dumb. We have some of the highest healthcare spending in the world, and we are an outlier in out-of-pocket spending. This means that the way our system is organized, we shift the costs onto individuals and employers to access care.
Again, this directly impacts quality and access to care. Those who can pay get it, those who cannot don’t. My absolute life motto that I will live by until I die is that when governments invest in the health of their people, there is a direct positive impact on the economy as a whole. When you work to keep people healthy, they are more likely to remain in the work force, more likely to be productive, and can increase GDP by at least 0.7% annually. Research has shown that poor health reduces global GDP by 15% each year, which is devastating.
By working to create efficient spending in preventative care *cough public health cough* we can decrease health costs, provide equitable care, and improve the economy.
The National Health Expenditure Accounts (NHEA) estimated that “U.S. health care spending grew 9.7 percent in 2020, reaching $4.1 trillion or $12,530 per person. As a share of the nation's GDP, health spending accounted for 19.7 percent.” Even scarier? Measles cases are never at 0, with 49 cases being reported in 2021 and fortunately only 2 being reported so far this year.
However, 2019 saw the highest number of measles cases since 1992 on account of people not getting vaccinated against the disease. More conversations are popping up about the end of Covid (or, more accurately, Covid’s endemic era), but it’s still not clicking to some people that the only way for the disease to become endemic and for life to return to whatever today’s definition of “normal” is through vaccinations.
While there are valid reasons to have concerns over the vaccines (notably the history of medical racism, intentional violence against already marginalized groups, and the fear of how it could be used against undocumented immigrants), enough time has gone by that many of these problems —as well as the bad faith myths anti-vaxxers have come up with— have been addressed or disproven. Still, according to the CDC, 76.7% of the total American population has received one dose of the Covid vaccine while only 44.3% have received all three recommended doses. Covid can’t go endemic—or become something we just learn to live with—until the infection rate becomes more stable.2
Because I’m bitter, a bitch, and am still mad that I have had violent reactions to all three doses of Miss Dolly Parton’s Moderna Vaccine (but will still continue to get them for as long as is needed to protect myself and others), I had to ask:
Emily: From a public health standpoint, why are bitches dumb? Like why do people say "they're going to do their own research" but then don't or do and cite WebMD?
Eleni: From a public health standpoint, bitches do be dumb, but it’s not always their fault. The idea of researching both sides and then making your own decisions sounds fair enough, but as we’ve learned recently with COVID, is that not everyone is a scientist (obviously).
People usually lack the understanding to properly read and comprehend dense research papers and then extrapolate the data to determine their own perspectives on it. I mean, even I have a tough time doing that and I’ve spent the last 6 years doing it!! When people do their “own research,” it usually includes people searching on Google, or Facebook, or whatever biased news channel they follow for information that confirms or supports their previous beliefs or values. This is called a confirmation bias. Research in itself should be unbiased and peer reviewed. Most people who are doing their own research are not looking for peer reviewed articles, nor is it likely that they have the capacity to even comprehend what these articles are explaining.
This leads to an insane amount of misinformation that can cause irreparable harm and even death in dire situations. And just to be clear, Joe Rogan is NOT an unbiased or peer reviewed source. When I had both the time and emotional energy, I spent a lot of time responding to peoples posts on Instagram to clear up mis information and fielding all the questions my mom had about articles that her wacky friends would send her about some new conspiracy theory about COVID-19. Now I am tired, so I just field my mother’s questions.
One of my professors said an interesting thing in my Emergency Communications class. He said that the way media presents facts and truth is by presenting both sides equally no matter what they are. The science community presents facts as one singular peer reviewed truth, in which all other options have been eliminated over time. That is why there is such a discrepancy in how mass media presents scientific facts, they work in fundamentally different ways.
In conclusion, bitches be dumb and the science community needs to work better in producing communication and presenting information to lay people who may not understand all the jargon.
Emily: What can the global response to other infectious diseases tell us about the longevity or future developments for Covid?
Arthur: There was some talk about eliminating COVID once the vaccines were developed but that did not track given the global response to other vaccine-preventable diseases. We have only been able to eliminate one human disease (smallpox) thanks to vaccination and unfortunately, many vaccine-preventable diseases are a big public health concern in many countries.
Given all of this, one would believe that COVID is here for a long time— unless we can get our act together.
Emily: Based on your respective fields of research, are we doomed if we ever have to face another pandemic? Are we doomed by Covid?
Arthur: I don't really have a good track record answering these questions. When I applied to grad school, I wrote that my goal for my PhD was to help predict and prevent outbreaks and during my interview, in February 2020 I was asked if I thought SARS-CoV-2 would become a pandemic and I said "no."
However, like myself, I think that the science community and the world have learned some super valuable lessons which will be applicable to future pandemics. So hopefully we aren't doomed but this is all dependent on the characteristics of this new pathogen.
Eleni: I think it is incredibly likely that we will experience another infectious respiratory disease like this in the near future.
As we continue to destroy the planet, and climate change decimates entire ecosystems, there is an increase likeliness of zoonotic diseases making the jump from animals to humans. Zoonotic diseases include Ebola, HIV/AIDS, MERS, West Nile Virus, and now COVID-19. This is not the first pandemic, and this will definitely not be the last. The science is very clear and has been warning us for years, we’ve just been turning a blind eye until its knocking at our doors.
Investment in planning for these diseases, like with the Coalition for Epidemic Preparedness Innovations and the COVAX program, and mitigating the stress we as humans place on the environment is key to preventing more pandemics.
Because you know what this on-fire trash can was missing before? Climate change!!!
We saw as early as December 20203 how the initial shortages of PPE and the immediate overwhelming of our health institutions during the pandemic came right back around to bite us in the ass. But just because the messaging was wrong at the height of widespread global panic (and widespread coronavirus) doesn’t mean that all messaging is wrong… even if the CDC’s mask messaging was also all wrong…
You know what? Fuck it—drink your bleach!!! Is that what Arthur and Eleni want me to say? Definitely not. But if you’ve gotten exactly to the two-year mark of the pandemic and for some reason think you’re smarter than everyone then, by all means, live your truth. Though maybe stop reading here because next, we’re talking about empathy and how essential that is for public health, which might not be something you’re willing to talk about.
E4P Readers Can Have a Little Hope, As a Treat
So the window to save the planet is shrinking, zoonotic diseases are spreading, the measles are back, I’m yakking up a storm just thinking about my second booster… is anything good going on here???? Is there anything we can take away from these very serious conversations to hopefully become better people??
Emily: Is there any insight from your research on serological surveys in Madagascar that can be extrapolated to offer insight into the global approach to public healthcare?
Arthur: There are so many factors (immunological, environmental, etc) at play determining vaccination coverage in a specific region and it is important to understand how all of these interact in the context of the disease you are studying. All this to say, the global approach to public healthcare cannot expect one solution to work in every area without understanding the mechanisms at play in that area.
Public health measures need to be re-evaluated and tailored to the target population!!
Emily: What have you learned during your time surveying individuals on various public health matters?
Eleni: People are just scared really. No one is just a blank slate when you tell them to do something or listen to you, however, most people are willing to learn when their own health is on the line.
Most of this stuff is gibberish to many people, and fortunately I’ve been blessed enough with an education that allows me to understand and navigate this information when many cannot. As public health professionals, the best we can do is inform them and ease their fears the best we can by providing clear and effective communication.
Emily: What role does empathy have to play when studying and producing communications about public health?
Arthur: I believe empathy is one of the critical tools needed when developing new projects, especially when conducting research in other countries to help prevent parachute science.
Parachute science is when researchers drop in from the wealthy Western world into a foreign community for fieldwork and then leave as soon as they get their data without acknowledging or engaging with local researchers. I think all scientists should approach these settings with empathy to help them connect with the locals in order to achieve meaningful and impactful collaborations and outcomes in the community they are working in.
Eleni: I think it has everything to do with it.
When studying anthropology and public health, one of the key pillars in our lessons is an understanding of cultural relativism and how it impacts how people understand their own health. Cultural relativism is the ideal that people’s beliefs and practices are understood based on their own cultures and that we can only best provide care when it is within their context of understanding. That means NO participating in modern day colonialism like mission trips that only provide care when the population converts. That’s icky.
Instead, try to have empathy and understanding of the cultural contexts in which people live in and provide care accordingly. The idea of cultural relativism doesn’t only apply for global care. When producing communication in the face of public health emergencies, like COVID-19, one of the foundations in Crisis and Risk Communication training is to “be empathetic.” This means both culturally and to their situations. Risk communication messages can and should be crafted to match audience needs, values, background, culture, diversity, health literacy, and experiences.
Only in this way can people best understand their risk and alter their behaviors as necessary.
As crazy as it sounds, people are naturally empathetic… albeit primarily only towards those they feel a sense of familiarity with but we’ll take what we can get.
Think back to where you were exactly two years ago today. I flew home (on an airplane!!!!) wearing latex gloves and packing an aggressive amount of Clorox wipes to clean everything off with. There were literally people hacking up lungs but my main concern was sanitizing my front table.
I defended my thesis on Zoom as my professors and I learned how to use it in real-time. My family went for therapy walks and pulled our sweatshirts up whenever we passed a neighbor doing the same. We tried to support local restaurants and did birthday drive-bys and sat six feet apart while outside just to see other humans.
We cared about people in a different way in early 2020 before the sun came out and we all got a little serotonin boost and then were baffled that we still had to think about one another the second we realized the worst wasn’t over. But the same people that were living and dying back then are living and dying now, and no one deserves to die without a fair shot at living. (Was that poetic or just a ramble from my tiny pea brain?)
I asked:
Emily: What is the greatest barrier to providing equitable public healthcare in America? Is there a way to overcome this?
Arthur: POLITICS?! Deferring this question to our public health queen, Eleni.
Eleni: Healthcare is an extremely lucrative industry, and the US spends the most on healthcare than anywhere else in the world. To put it into perspective it’s an $8.3 trillion industry (which is about 8% of the world’s GDP), and the US spends about $3.5 trillion (17.7% of our GDP). However, despite this insane investment in health, we have some of the worst health outcomes of developed countries. A lot of this is due to the fact that we spend so much on treatment and administration rather than preventative measures that PREVENT populations from getting sick to begin with. Within health spending, only about 3% is dedicated towards public health in the US.
Our system is basically incredibly inefficient with spending leading to high costs in care overall with poorer outcomes. We spend a lot of money on administrative costs, technology (that most people don’t know how to use since training takes time and money), diagnostic tests are expensive, prices aren’t sensitive to costs (meaning that there is no downside to doing things that cost a lot), there are no social supports to support good health outcomes, the population as a whole is very old so we spend a lot of money treating chronic illnesses, people aren’t getting care earlier enough, and there is no single standard of care between providers.
And that’s just off the top of my head. Our healthcare system is just so disorganized and fragmented—not even considering how insurance plays into this— that to really provide equitable and efficient care, we would need an overhaul of the entire system. Which is incredibly unlikely to happen anytime soon.
Ok so!!! Not the resoundingly optimistic conclusion we’d like but the reminder many of our institutions don’t actually do the things they’re supposed to do that we deserve.4 While Eleni and Arthur are on their way to genuinely change this world for the better, unfortunately, they can’t do it overnight (their only flaw, truly). But for the sake of not sending everyone back out into the world shaken to their core, I asked Eleni:
Emily: Who is your science crush?
Eleni: Arthur Menezes every day, all day, 24/7.
Thank you to Eleni and Arthur for actually being gems of humans, both in their professional lives and as really cool people I have the pleasure of knowing and going to see Broadway shows using lottery tickets with!!!!! Follow Arthur’s TikTok!!! Respond to Eleni’s screening phone calls if she calls you!!! Tell them you love them!!!!
It was but how convenient is that???
This discussion largely pertains to the US. Only 18.5% of the global population has received their booster.
No one say a word about the A*drew C*omo compliment in that article. Those were the days of yore when the Cuomo Brothers Power Hour was something to gather the family for.
Another week, another reminder that 2022 means midterms!!!! Start researching who's going to be on your ballot and if they stand for the same thing you do vis-à-vis public health and climate change. And then maybe, just maybe, find a way to get involved with their campaign to help give them the best shot they can get in November.