The night I wrote the last blog post, a call from my father interrupted me. He screamed in agony into the phone that something horrible had happened…
… I met Andrés when he was eight years old. My father was dating his mother, and Andrés latched on to my dad as his own. Little by little, the kid became a permanent fixture around my dad’s shop. Like any other child in that little town in Mexico, he got in plenty of trouble. He preferred running around and playing instead of school, but he showed how smart he was by how quickly he grasped the concepts dad taught him. Like dad did with me, he poured his entire knowledge of machines into Andrés.
Every time I visited dad, Andrés would beg and plead with his mom to let her go to our little town and hang out with us. We would get into the car and drive off into the mountains, going to the waterfalls, the rivers. My other brother would also join us. Slowly but surely, we became family. We called each other “brother.”
I’m not going to lie to you. It wasn’t easy to accept him into the family. He came into our lives at a time when things were strained between dad and I, so I saw Andrés as dad’s attempt to replace me. Nothing could be further from the truth. He was not replacing me. He was adding to our family. Dad did what he did with me and my other brother. He took another young man under his wing and did his best to teach him about life and how things are supposed to be. For all his faults, dad is an okay guy.
Last year, as the pandemic slowed down just a little between the Alpha and Delta waves, I traveled to Mexico to check on dad. Andrés had joined the state police, first as a forensic scientist and then as an officer on patrol. He took time off from the job to spend a few days with dad and I. We traveled to a canyon, ate Mexican food from a roadside stand, and just chatted the day away. He told us how much he loved his job, and how he felt like he was doing something good in the world.
Later in the year, a group of Central American immigrants were kidnapped by a criminal group near the border with Texas. Andrés and his team were the first to get to the warehouse that housed well over a hundred men, women, and children. He said the conditions were deplorable, and many people suffered from dehydration and diarrhea. The criminals held them there for ransom, calling their relatives in the United States and not releasing the kidnapped people until a hefty ransom was paid. Many people were not released. Some died in the warehouse. Some were found in the desert, killed in cold blood even after a ransom was paid.
Andrés told me his unit was told not to go into the warehouse immediately, because it might be booby-trapped. He said they didn’t care and grabbed a ladder to jump over the fence. It affected him because he spent a few months as an undocumented immigrant in Texas, before returning home and going to a school of forensic sciences. He told me how lucky he was to not be in their position, or to put us through what their families went through.
His work with the police went from working with the forensic scientists to grabbing a weapon and heading out on patrol. He bulked up and grew up a lot, from when he was admitted into the force to when I saw him next. He was older, wiser. He wasn’t like the brazen, cocky young cops I’ve encountered so many times. He had nothing to prove, and all he wanted to do was do good in the world…
…Dad cried into the phone with a heartbreaking wail. “He’s dead,” he said between sobs.
“Who?” I asked, feeling my chest tightening, readying myself for whoever it was that died and broke dad’s heart so badly.
“Andrés,” he said. “Andrés is dead.”
I jumped on a plane on Monday morning. We left BWI Airport a little late because a flight attendant was delayed, and that would set up a whole series of events for the day to come. Instead of arriving in Chihuahua City in the evening on Monday, I would not arrive until the evening of Tuesday. The flight from Baltimore to Austin was delayed, then the pilot tried twice to land in Austin in a bad rainstorm. He went around twice and then diverted to Houston.
Once in Houston, a crew member said people going to El Paso (where I was going) could deplane. He said a direct flight from Houston to El Paso was about to leave, and we could jump on it. Well, by the time I got to that gate, the flight was already full. They asked me to return to the original plane and wait for it to leave for Austin again. After a few minutes back at the plane, they called me by name and said they had found another flight for me. The thing was, that flight was from Houston to Las Vegas, then I would catch another flight to El Paso, arriving around midnight. I didn’t care. I said I’d do it.
After an hour of waiting to be re-ticketed, the airline representative told me the flight to Vegas was now full. There were no other flights. I found a flight on another airline in Houston’s other airport, so I booked that flight and caught an expensive Uber ride over. Things were not better at that airport. The weather from Austin had drifted into Houston, and now no flights were landing or leaving Houston. The flight at two in the afternoon was delayed to four, then six, then eight. By nine that evening, we were told the plane to take us to El Paso had landed, but the crew for it were late on another flight… As a result, that flight was cancelled.
By then, I had been in communication with my dad, texting him updates as I went. I had also been texting and calling my wife. She talked me off the ledge several times as the travel ordeals piled up. I was feeling helpless and alone, and incredibly sad. When the flight was cancelled, I broke down crying in front of everyone, and I did not care. I cried and cried as I booked a hotel room for the night and another expensive Uber ride. I didn’t sleep a wink for the second night in a row.
Tuesday’s weather was far better. It was still cloudy, but there was no rain. Flights were leaving Houston with no problem. I jumped on a plane at noon local time, and I was in El Paso less than two hours later. When I got to the car rental place, they told me they had no cars to rent, but they did have a pick-up truck. I didn’t care. I took it, and I started the four-hour trip to Presidio, like I have done so many times in my life. Except that I did it — yet again — because of an emergency or tragedy.
The little town of Juan Aldama, in the mountains of Chihuahua, had always been a refuge for me. I grew up splitting my time between there and Ciudad Juarez, where I was born. Juarez was busy, hot and dry. It was ugly and gray. It was where I went to school, so I did not like it. Aldama was green, with the alameda lined with big oak trees planted by my grandfathers and their fathers. The weather was hot, yes. But it would cool down in the evenings, and the rainy season was fun because we got to play in the irrigation ditches and streams. It was a place that used to be safe for kids to be kids. (The wars between cartels has changed all that.)
Both my parents’ families lived in Aldama, though they had moved there from other regions of the country. It was close enough to the state capital (Chihuahua City) for people to work there and live comfortably in Aldama. It was also a center for raising and selling cattle and many agricultural products. As the years went by, some family members moved north to Juarez. Some moved across the border into Texas. But we all returned to Aldama… The joke is that if the world ends, we’ll all rally back at Aldama.
Traveling to Aldama from Juarez meant jumping on a bus or a relatives’ vehicle (or my own vehicle once I had one) and making the five-hour drive from Juarez to Aldama on a two-lane highway. You’d often be racing the buses and tractor trailers, driving by memorial markers on the side of the road where people died in car accidents.
Eventually, you’d arrive in Aldama and let the fun begin. My cousins were there. My friends were there. Summers were some of the best times I had. Christmas was also good, but just a bit cold with short days. There were no deadlines, no real work to be done. Our parents and grandparents took care of everything. Even in our young adult days, it was all about having fun and living without a care in the world. Aldama was our refuge.
“This seems very familiar,” my dad said. “Like I dreamed this would happen to Andrés.”
“It’s not that,” I replied. “It’s nine years to the day since my uncle…”
The weather gets hot during the day starting in April. At night, the temperatures can dip into the forties, but the temperature then rebounds quickly during the day. Sometimes, daytime temperatures can get into the nineties. It’s not too bad, though. There is no humidity to speak of. The sweat evaporates off of you quickly, cooling you off. You get a hell of a tan, though.
Back in 2013, when I was accepted into the “best public health school in the world,” I traveled to Aldama to celebrate with my dad. I had struggled the year before to get in, so we were all quite happy that I finally made it. The years ahead would be rough, but at least I was in. To add to the celebratory mood, one of my cousins had returned from the United States after several years of working there. His father — my uncle — was happy to see his oldest, just like my dad. My uncle threw the biggest party for him, and everyone was invited.
The party was great. There were mariachis, great food, and lots of alcohol. My uncle got sloshed, and his kids were all happy to be back together. Dad and I sat back and watched with joy how happy he was, especially after dad mentioned my uncle had been sad lately. The rest of the weekend was more catching up with everyone, sharing in my recent acceptance into the school of public health, and celebrating the return of my cousin to his hometown.
By Monday, it was time to head back to El Paso. I had left a rental car in Presidio, Texas. The plan was for dad to drive me there, and I would then drive to El Paso and fly home. That morning, we visited my uncle before I left. He seemed sadder than usual. My cousin had left to go back to the United States. He would be gone for a while again, and my uncle missed him dearly.
Even as I write this, it is very hard for me to write a detailed account of what happened. Suffice it to say that my uncle attempted suicide that Monday. By Tuesday night, he would be on a ventilator after emergency surgery. I would return to El Paso on Thursday. He would die about a month later. That Monday, dad and I drove the same road on a similarly hot day while chasing the ambulance carrying my uncle.
“If you don’t die a Christian, you won’t get to see him,” she said as my dad looked at the floor and cried.
“I know… I know that,” he replied and cried some more.
The two families that make up my relatives have always been quite religious. The Najeras are Catholic, and devout ones at that. Several of them would take a pilgrimage to Mexico City to visit the basilica there. When Pope John Paul II visited Mexico, it was the highlight of many of their lives. The Padillas are Protestant, belonging to several denominations that span the spectrum of fanaticism. Some are more reasonable than others. Some I like. Others, well…
Protestantism in Chihuahua took time to grow into its own. It had to compete with a very traditional and strong Catholic presence. At first, it attracted the more liberal people who wanted to stray from the strict teachings of the Catholic Church. Later, it began to attract the more conservative folk who thought the Catholic Church was not strong enough to protect certain traditions. This became especially true when Pope Francis took over. He became too liberal for the taste of many, so they flocked to the more conservative Assemblies of God churches which started to pop up.
Andrés’ mother and sisters belong to such church. Apparently, his mother had been pressing my father for years to convert away from Catholicism. She sent preachers to his shop to talk to him, and in his words, “pray away his sins.” This confused dad. He had never been religious, but he thought that being a Catholic — and a good person with good children — was enough. As we sat at the funeral home, Andres’ mother came over and told dad Andrés was in heaven. She then added to my grieving father that he would not see Andrés unless he converted.
There were two religious services for Andrés. The first one was led by a female pastor. She read seemingly at random from the Bible, talking about how Andrés was in heaven… The usual stuff. A male pastor led the second service, and he was the more palatable of the two. He talked about comforting the grieving family, and comforting no matter their beliefs. I thanked him for his message. As a lapsed Christian myself, I needed to hear his words of encouragement and comfort.
I don’t blame Andrés’ mother. She was incredibly angry and sad, heartbroken, you name it… She had lost her oldest boy, a wonderful young man who was good in every way. She was telling my father the best way she knows to see Andrés again. And I don’t blame the religious people for wanting to “save” my father. It’s their whole purpose, to spread what they feel is the best way to live forever. Their timing could have been better, though.
“I’m going to take the long way to El Paso, dad,” I said to him. “I need to clear my mind.”
I’ve always loved the drive from Presidio to El Paso. It’s a hot, dry climate, but the low traffic and pretty vistas help it go by quickly. As I left dad to head back to El Paso one more time — and certainly not the last time — I decided that I was going to mourn Andrés in my own way and drive while thinking things through. I didn’t have my camera with me, so the iPhone 12 camera would have to do.
From Presidio, I went north on Highway 67 to Marfa. Along the way, I took pictures of Elephant Rock and the Profile of Lincoln. I then continued on Highway 17 to Fort Davis. I wanted to visit a roadside reptile museum that has many rattlesnakes inside. I hate snakes, but I wanted to just get distracted. It was closed, so I went west on 118 to the McDonald Observatory. There was a festival going on, so I just used the facilities and jumped on the truck on west to Highway 166 south. That was the most beautiful part of the drive. A gorgeous rock formation goes along for the drive for most of the length of the highway until it meets Farm Road 505 toward Valentine, Texas. I then stopped at the Marfa Prada art installation. Then it was time to drive to El Paso and get some sleep before my flight back to Baltimore the next day.
I told dad we would be back as a family (my wife, my daughter, and myself) this summer to pay him a visit. My daughter is five, and he has not met her yet. The distance and the pandemic got in the way, and I’m hoping it doesn’t get in the way again. We probably will fly into Chihuahua City and not El Paso. My wife doesn’t like long drives. Back when we were dating, we drove from San Antonio to Presidio, crossed into Mexico at the Ojinaga border crossing to have lunch with dad, and then drove to El Paso. That was the first time we ever saw the Marfa Prada. She didn’t like the long hours in the car.
I don’t blame her. Texas in general and West Texas in particular are acquired tastes. The dry desert air definitely takes some getting used to after the humid air of the mid-Atlantic region of the United States. But it is all pretty, from a certain point of view.
Andrés and another state police officer died in a vehicle rollover between Ahumada and Juárez, Chihuahua. Two others were transferred to a hospital in Juárez. Andrés was in his third year of service to his city, his state, and his country. He always said he wanted to contribute just “a grain of sand” toward peace in a region torn by wars between drug cartels and decimated by organized crime. And he did.
Posted on April 25, 2022
Did you miss me? I know I haven’t been writing here as much as I should, but I have been writing. I’ve been writing over at Medium, and I’ve been trying — trying hard — to keep it professional. It has been hard to keep it professional with so many attacks on public health. From so-called “pro-life” policymakers being okay with LGBTQ+ children dying by suicide, to women not having access to reproductive care… To an unqualified judge lifting the mask requirement on public transportation, thus handing the perfect play to our enemies (foreign and domestic) on how to make Americans roll over and show our collective bellies.
Things have been going well, though. The History of Vaccines project is humming along and undergoing a major renovation soon. My teaching is also going well, with a successful spring semester at Gorge Mason University, and a good third term at Johns Hopkins. The students I’ve taught this semester all give me hope for the future of the public health profession. They’re young, headstrong, reckless, creative… Just the kind of people we need.
Work at the health department is mixed, though. On the one hand, I work with an amazing group of people. There is no one there that I avoid or even cringe when seeing. From where I stand, we all get along well. On the other hand, there isn’t much appreciation for the work that so many people there do. Public Health Week came and went, and there was not much fanfare other than what a couple of us at the office did for everyone: pizza, donuts, coffee, and some random goodie bags. Unless I missed it, we didn’t really hear much from the leadership in the C-suite.
What is really grinding my gears there recently is the number of people looking for work elsewhere. Not much is being done to retain them, and they’re good people. Good, bright people. Little by little, we seem unable to fill some spots, while other spots are opening. I worry about the division that was at one point expanding beyond infectious disease and into what we call “population health” will end up stuck at infectious disease, and the epidemiology and public health work that should go into population health will continue to be split between different agencies.
So that’s where that is…
I’ve been working on several side projects as time has allowed. I made a radio out of a Lego alarm clock for my daughter. I put together a pi-hole server to get rid of advertisements coming into the home internet network. (Yes, it works. And, yes, the traffic is faster.) And I also made this…
I got it in my head that I wanted to play Super Mario Brothers 3 one night, and I looked around for way to play it. There were some ways to play online, and others called for buying some machine off the internet that was not guaranteed to work. I ended up doing some research, and I bought the template for making this online. Then I bought all the components, and put it all together over a long weekend. Not bad for the first version, right?
Now that the weather is better, it’s time to get off the soldering station and outside. So I took out the bicycles, cleaned them, lubed them, and made sure everything was working well. I’ve given up on taking them to the local bike shops. Maybe the owner or one of the guys know what they’re doing, but the rest of the staff don’t. And I’ve ended up having to do additional work on them at home. After I took one of the bikes to a shop, the guy told me to “just keep pedaling” if I noticed the chain suddenly became loose. It turns out the rear freewheel was locking up. When it did, it would start turning even as I was not pedaling. That set the chain in motion.
They could not fix it! Their best solution was for me to “just keep pedaling”? They said they could not find a flywheel to fit my bicycle, but I knew that was bullshit. It’s an old steel bike I bought and put together myself from Target. It’s not special in any way. So, after finding the freewheel on Amazon of all places, I replaced it myself.
Anyway, that was last year. Since then, I’ve decided to do all the work myself. Sure, I had to buy some tools, and it’s probably slower than what they can do at a bike shop, but maybe not. I think there has been much turnover at those shops, and few people who actually know bicycles are working. Me? Dad made sure I knew tools and how things worked on my bicycle whenever he fixed it. And that is something I hope to pass on to Kindergartener Ren.
Speaking of Kindergartener Ren, she is growing like a weed. She is learning so much, and challenging us as parents so much. But it is lots of fun. Some of the best days are…
Oh, dear God… No!
The horror of that night and why the abrupt end to the blog post are here: https://epidemiologist.blog/2022/05/03/lets-get-caught-up-continued/
Posted on January 18, 2022
And, by “non-believers,” I mean the ones who don’t believe in science.
Growing up in northern Mexico, I had to deal with the two sides of my extended family disagreeing on different matters. The N’s were devout Catholics and militant partisans of the National Action Party (PAN), a right-wing party by Mexican standards. The P’s were devout Evangelicals and militant partisans of the Institutional Revolutionary Party (PRI), a left-of-center party by Mexican standards. Interestingly enough, the politics of those who migrated to the United States flipped when they crossed the border. The Catholics became Liberal, while the Evangelicals became Conservatives.
Mom and dad saw in me the ability to learn difficult scientific concepts with ease, so they went out of their way to help me learn about science. Catechism school and Sunday school were secondary to the aims of my education. Although I learned much about Christianity and identify as Christian, religion did not become part of my identity. I don’t really place myself in a religious category, though, choosing instead to put myself in a category of scientist: I am an epidemiologist.
When my cousins were being schooled on the different dogmas of their respective branches of the Christian faith, I was getting a children’s encyclopedia. When they were told their normal body functions were amoral and sinful, I learned to understand the intricate functions of the human endocrine system and its control over much of what we do. And when they were getting pregnant as teenagers — because you’ll be shocked to find out that abstinence-only sex education doesn’t work — I was graduating high school at sixteen and enrolled in the medical technology program at the local university.
I write all this not to say that I’m better than them in any way. In many ways, I wish I were more like them. I wish I had started a family early, because my daughter will be in early college when I plan to retire. I wish I could have started working a job and saving for said retirement early, instead of getting myself in student loan debt. And I wish I could have stayed in my culture, because diving head-first into living and working in south-central Pennsylvania — as a Mexican born and raised — threw me for a loop.
Nevertheless, the life I chose and the career I followed have allowed me to see complicated processes better. I understand science in general and biology, virology, pathology, epidemiology… Many “ologies” better than they could. And, at this point, ever will. (Maybe the young ones, the next generations, will know better. But, from what I’m seeing, they’re being indoctrinated into worshiping social media stars just as badly as their parents.) This is why I am superbly frustrated by the Evangelicals and their weirdness when the pandemic struck.
Suddenly, they became experts in everything, from virology to constitutional law. Not happy with getting things wrong, they started spreading their errors of logic on social media to the point where I had to block them. I would have said (or written) the wrong/angry thing had I continued to allow their algorithm to meet with mine. Sadly, I miss them. I miss the jokes and the good times we had as kids, but they’ve turned over to the dark side of science, so to speak. They’ve made homeopathy their thing. Supplements, complementary and alternative medicine (S.C.A.M.) are what they use for any ailment.
Worst of all, they have lately become influencers in these things, far more influencing on these matters than I ever could be… Mostly because I have ethical and moral standards. I can’t lie and tell people that homeopathy prevents and cures diseases. I can’t drive myself to Mexico and get hydroxychloroquine to sell to people who test positive for COVID-19 in my church. And I can’t claim the COVID-19 vaccine as the “mark of the Beast.” (Because it is not.)
Or, rather, I could, but I have an oath to public health and science to keep. I’ve also read the Bible, not as a work of literature, so I don’t take it literally. If you read the history of how the Bible was written, you know that the Book of Revelations was written in coded language to early Christians living in Rome. The “Antichrist” in that book was Nero, who was hunting down Christians and killing them. It’s all clear once you read the evidence.
Other evidence I’ve read talks about the difference between viruses and parasites. The novel coronavirus causing the pandemic? A virus. Lice and worms, and malaria? Parasites. So how could anti-parasitic drugs shown in clinical trials work on viruses? Also, there is no good evidence that anti-parasitic drugs work on the novel coronavirus. Someone just told people that, and people like my cousins believed so much that they’re quick to make a buck by hauling in unregulated medicines from Mexico.
I’m sure that plenty of you reading this have friends and relatives who are the same. They don’t hold degrees. They never cared about scientific concepts. But then the pandemic struck, they fired up their phones and tablets, and now claim to be top-notch virologists.
Others among you might laugh and think that this silly, that family should not break up or stop talking because of these issues. But you’re not in my position, where I am a public health practitioner with the responsibility of serving up facts and making public health recommendations that affect entire populations. It gets exhausting to see and hear them go on and on about how my colleagues and I engineered a pandemic for money, or how I’m getting rich from pharmaceutical corporations blocking the sales of ivermectin or hydroxychloroquine. (I have zero relationship with any pharmaceutical companies, by the way.) And they waste no time questioning my current accomplishments by reminding people around me about my missteps in my youth.
It’s been 30 years since I drove without a license. Let it go. (I’ve done nothing illegal since, to the best of my recollection.)
As those who work in healthcare and science continue to fulfill our sense of duty and continue to work in this pandemic to keep people safe and save lives, we will face opposition from people and groups with a warped sense of liberty. (It’s Life, Liberty, and the Pursuit of Happiness… In that order. Life above all else.) The last thing we need is our own family getting in our way and complicating things. We need you, dear family, to either help or get out of the way, but do not oppose us. If you disagree with us, stay quiet, especially if you are not experts. Just walk away.
There has been too much disease. Too much pain. But I have an honorable compromise. Just walk away. Leave the science to me. Leave the medicine to the experts. Just walk away, and we’ll give you a safe passageway into the back of our minds. Just walk away, and we’ll hang out again when there is an end to the horror.
A previous version of this blog post was first published on my Medium.com page. Go over and check out some of the other stuff I’ve written: https://epiren.medium.com
Posted on January 16, 2022
Public Health practitioners keep forgetting to talk about and teach the most important lesson of all.
Humans are notoriously bad at assessing risk. In 2019, aviation authorities around the world grounded the Boeing 737 MAX class of aircraft because of two accidents that occurred in 2018 and 2019. The accidents resulted in 346 deaths, a small proportion of the estimated 8 billion passengers who flew commercial airlines in those two years. (That number includes duplicates, or people who flew multiple flights in those years.) Nevertheless, plenty of people became apprehensive about flying. Even after the investigations into the flights, and the return of the airplanes into service, there are still people out there who do not want to fly in general or in those airplanes in particular.
Instead of flying, people who are looking to travel but fear flying will instead turn to driving or riding a bus. The risk of fatal accidents on the road is larger than flying by orders of magnitude, but being on the ground seems safer than flying. We could extensively discuss the psychology of this. Instead of discussing psychology, I’d rather discuss how to explain risk to a person as if they were five years old… Because I just did it with my own preschooler.
“Safe or Unsafe” Is an Imaginary Binary Option
First, let us understand that risk is not a binary thing. An activity should not be classified as safe or unsafe and then left at that. An activity should be classified along a continuum of risk. For example, drinking water is one of the safest activities you can do. Nevertheless, there are instances in which people choke or drown while drinking water. It does not happen very often, and that is why we see drinking water as safe. Running a marathon is much safer for your overall health than sitting on the couch all day. Nevertheless, training for and running a marathon incurs risks of traffic accidents, injuries, or cardiac events. You can’t tear your hamstring while sitting on the couch, can you? So, there is some risk to running a marathon, but it lowers the risk of other outcomes that are more common in our society, such as overweight, obesity, diabetes, and lung and heart disease.
For many years, smoking was seen as a safe activity until we understood its strong association with lung disease. Then it became risky, but that risk hinged on when you started smoking (lifetime exposure) and how much you smoked. This is the same concept with other activities that are harmful, like using injectable substances, but we in public health seek to reduce harm by recommending that a person who injects substances use clean needles, has naloxone nearby if they’re using opioids, and does it with someone nearby if they overdose. Again, these activities are on a continuum of risk.
Everything Is Absolutely Relative
Next, let us understand the difference between absolute and relative risk. If I tell you that your risk of a blood clot will double if you start using a medication, you might be less inclined to use the medication out of fear of getting a blood clot. But what if that risk was 1 in 1,000,000, and then your risk goes to 2 in 1,000,000 once you start taking the medication? That is a relative increase in risk of 100%, or doubling. Your absolute risk went up by 1 in 1,000,000. Furthermore, you have to look at the other side of the equation: How much is the medication lowering your risk of a bad outcome because you take it? In most cases, medications are licensed for use if the benefits outweigh the risks. In the example above, your risk of a bad outcome should go down by as much as your risk of a clot goes up, or more.
Finally, we need to understand that public health interventions aim to change the dynamics of risk, often without eliminating risk entirely. This is mostly because nothing in the known universe is 100% safe or effective. Vaccines lower your risk of infection, or — if you get infected — will likely lead to a milder course of the disease. (This is true for most people; your mileage may vary.) Other interventions, like needle exchanges or safe injection sites for injectable drug users, are also aimed at reducing risk and not having the user quit completely (though, it would be nice if they did).
Vaccines Will Save Us, but Not All of Us
Many of us who work in public health mistakenly said the vaccines against the novel coronavirus that is causing the COVID-19 pandemic were some sort of panacea. I know I did. I said the vaccines would bring about the end of the pandemic faster than anything else. While that may still be true, it has not been true so far. With the Omicron variant doing what it is doing right now, plenty of people have the right to question the efficacy of vaccines. However, it is my sincere opinion that they are questioning more because we held vaccines to a very high standard a year ago. Had we properly explained that vaccines lower the risk of infection and severe disease if the infection happens, we could have managed the expectations of the public much better than we did.
Perhaps it is time to include a dedicated curriculum on risk in our schools. I’m certainly trying to teach my preschooler about risk by asking her what is the most probable outcome of some of her decisions. “If you fall and are not wearing your helmet, would it be more painful than if you wore your helmet? Yes? So then wear a helmet, please.” Or, “we have gotten up and looked under your bed for monsters many times. What is the probability that we’ll see a monster this time?” We’ll discuss more advanced concepts later.
Program Our Autopilot to Account for Risk?
At the end of the day, we do what we do without thinking most of the time. People who are afraid of flying have an irrational fear of it, so it is difficult to try and rationalize things to fight that irrational fear. Teenagers with raging hormones hand over control of their actions to the more “autonomic” part of their brains. And people for whom life hurts will seek a way to ease that pain. What we do to respond to those fears, those urges, and that pain — and how we do it — will determine the level of harm we cause ourselves and each other. Without understanding the risks of the actions we take to do harm — and especially to reduce it — we will continue to make the same mistakes that end up hurting us.
A previous version of this blog post was first published on my Medium.com page. Go over and check out some of the other stuff I’ve written: https://epiren.medium.com
Posted on November 15, 2021
The preschooler wanted to do something fun tonight, but the weather wasn’t collaborating. So we set up the projector and screen and watched Cruella. For those of you who are not initiated, Cruella is the story of the villain in the 101 Dalmatians film(s). It is a prequel that tells the story of how she became evil, explaining to the audience that she is a mix of unfortunate circumstances in her life as an orphan and the genes she carries. I won’t spoil it for you, but it a fun character study of why bad people do bad things, and why we label them as “bad” when we don’t know the whole story.
Disney has been doing this lately with other villains in other stories. My wife and I went to Baltimore to watch Wicked, the story of how the “Wicked Witch” in The Wizard of Oz got her bad reputation. Spoiler alert: It was all a misunderstanding, and the witch’s origins (biological and circumstantial) have a lot to do with what happened. It is much the same way with Cruella, where “Estella” becomes evil to get back at the woman who victimized her. Along the way, we are given a glimpse into how people’s actions in public label them a villain while their private lives are just a little more complex than that. If only life was like that.
Or is it?
There are plenty of people in my life who have this weird idea of me. Because of my (pseudo) oppositional defiant disorder, they think that I am a jerk. They base that opinion on a few interactions, not really knowing all of the stuff that goes on in the 99% of the time that I’m not around them. The people who really know me understand when I’m grumpy and leave me alone, or they confront me on my grumpiness and tell me to cut it out. The people who don’t know me just get all weird and form their opinions. To some, I end up being a bad guy. To others… Well, I hope that I’m not living rent-free in their heads.
Anyway, back to the villainy.
I could probably count on one hand the number of villains in my life. There are even fewer of them whom I’ve never met in real life. The others, the bullies, probably do remember me because I’ve probably been one of the few people to stand up to them. In case you don’t know me, I don’t take kindly to bullies. I either metaphorically or physically punch them in the mouth, and that sends a clear message that their bullying will not work on me. They then leave my life, and then I don’t have to count them as villains anymore. They become nobodies.
Similarly, all the rhetoric we’re seeing right now from anti-vaccine forces make it seem like they’re a bunch of people who have some sort of real power. They don’t. They claim that “millions” are behind them when it’s maybe tens of thousands. They claim that “thousands” will show up to demonstrations when it’s maybe hundreds. This doesn’t surprise me, of course. They’re so bad at measuring risk that they’re just as bad at comparing proportions. Unfortunately, too many local and state governments fall for that trap and end up acquiescing to the demands of the loons.
When public health and other authorities acquiesce to the demands of the loons, we end up swinging the pendulum completely the other way in a reactionary way that benefits no one. The loons become the establishment, and then the fight is on to remove them. Democracy turns into a joke, and a revolving door of government officials who get nothing done become the norm. It’s basically the Trump administration in miniature and all over the place.
On the one hand, I feel pessimistic about where public health is going. But that pessimism is replaced with a certain kind of excitement because these kinds of challenges have always brought public health and science out of the other side with a renewed sense of purpose. When hundreds were dying of cholera in the mid-1800s in England, John Snow didn’t back down from the science, even when going against the established paradigm of his day.
Vaccines have always had people claiming all sorts of bad things about them, yet we eradicated smallpox, polio hasn’t been transmitted in the Americas in 30 years, and only a handful of people have died of rabies in the United States in this century. It’s almost as if vaccines were good and people saw it. It’s almost as if the grown-ups in the discussions did what they had to do and ignored the children throwing temper tantrums. Almost.
Anyway, back to the villains… It’s hard to hate people when you realize what went horribly wrong to make them so angry, so hate-filled. There is this one antivaxxer who tragically lost his wife to cancer. Right around the same time she died, he became ardently anti-medical. He started writing about how hospitals were made to kill people, about conspiracies on organ trafficking, and about vaccines being made to make people sick. When you peel away the crazy, you see a heartbroken man who lost his wife of many years. I can’t say that I wouldn’t lose it like he seems to have lost it if my wife died on me in a horrible way.
I also frankly believe that antivaxxers who became anti-vaccine because their children have a developmental delay legitimately love their children — and all children — but they harm children by maligning vaccines because they’ve been convinced that what “hurt” their children are vaccines. Peel away that crazy, and you have a parent who is reacting to a perceived wrong done to their child. Again, I can’t say that I would become like them if I thought — for some reason — that vaccines hurt my child.
We are all complex creatures, made to be the way we are by a wealth of experiences from even before we were born. It is hard to say that someone is created evil, though there is no doubt in my mind that some monsters are out there who just want to watch the world burn. As part of this realization, I’ve taken more time to understand the people who oppose me, who threaten me because of my public health stances, and the people who just don’t like me. There is much more to them than just being evil for the sake of evil. Similarly, there is much more to me than just the me you get to read about… And a lot of it would not surprise you.
Posted on November 5, 2021
The only thing that I remember from that day is the letter P sitting on the floor next to the grating that ran at the bottom of the fridge. It was the same refrigerators that I had with me through college, a refrigerator that was gifted to my parents by my paternal grandfather when they got married. It was a yellow, old refrigerator that did its job but required frequent defrosting sessions when the ice in the freezer got out of control. As dry as El Paso was, there seemed to be plenty of humidity for the freezer to grow huge layers of frost.
The rest of the story, as told by various people throughout my lifetime, comes down to something like this… Every morning, for many mornings, my grandmother would sit me down on the high chair and feed me breakfast. As she did so, she would also show me every letter of the magnetic alphabet set she put on the refrigerator’s door. She started off with the vowels, then the consonants, and then the alphabet forwards and backwards. One day, the letter P fell off the fridge, and I said to her, “Ay, abuelita. Se cayó la P.”
Grandma said she was stunned because I was just a few days from turning two years old, and she didn’t really expect me to learn the alphabet. She did it just to keep me entertained, she said. But, once I told her the letter P had fallen, she started asking me the names of all the other letters. I had memorized them all, and she was ecstatic.
When mom got home from work, my grandmother did not wait in telling her what happened. Mom pretended not to be surprised. “He is my child after all,” she said. But she was surprised. Like my grandmother, mom didn’t think that the morning ritual would lead to me learning the alphabet at that age. In the part of the world where we lived, children learned the alphabet in first or even second grade. Some didn’t even learn it at all and still managed to get good jobs that paid enough to raise a family. So, it wasn’t a concern that I excel at anything.
I was also just two years old.
Upon hearing the news, grandpa grabbed me and took me to the town pharmacist, who happened to be one of the most educated men in town. Grandpa held me in his arms as he asked me to “read” the letters on the different advertisements around the pharmacy. I have a memory of a glass stand full of bottles with a small sign on it, and grandpa’s hand pointing at the letters one by one as I told him what letters they were. I just don’t remember the words because putting the letters together to read words would not happen until I was three years old.
By the time I started kindergarten, I was reading. It wasn’t fast reading or anything like that, but I did read the comic strips on the newspaper, and occasionally articles themselves. Mom bought me a children’s encyclopedia that I absorbed from A to Z, and dad would take me to a book store every weekend to buy magazines and books. They were not at all afraid to let me learn, and they pushed me to learn more and more as I consumed all the materials they gave me to read.
This would come in handy about 20 years later, when I met my wife. Our first date was at a bookstore, and we sat there while sipping on chai tea and talking about the books we had picked to look over and buy. It was a great conversation that led to a great relationship and to us being the parents of a bright little girl who herself is finding the love of reading…
All because grandma wanted me to learn something while eating breakfast.
Posted on November 3, 2021
I went to sleep early the night of the presidential election of 2016. I was in Atlanta, training on what I needed to know before being deployed to Puerto Rico for 60 days of chasing Zika. I had been in training most of the day, and then I took a long walk to the hotel from CDC headquarters. Once at the hotel, I grabbed some food and tuned in to listen to the news and see the early returns. Everyone was convinced that Hilary Clinton would win, and a Donal Trump presidency seemed like an unfathomable nightmare. As the night wore on, I stared to watch stock futures fall as other parts of the world looked at the returns. But I was too tired to think, so I decided to go to bed.
In the middle of the night, my wife called me. She seemed very upset, and I asked her what happened. She told me that Donald J. Trump had been declared the winner. It seemed like a dream, and I got up to look at the returns. It was true. The dude who had mocked immigrants, people with disabilities, women, and just about any group that was not white and filled with anger… That dude was going to be president. And he was going to put members of his own family in positions within the White House. And people would be okay with that so long as he hurt the “others” and not the small and vociferous base of the Republican Party.
Back at CDC, the woman who was in charge of training me was very happy the next day. She said she was happy because “something would finally be done about the immigrants.” She said this with all sorts of seriousness on her face. Whether or not she was aware that I was one of those immigrants, given that she had access to my bio and curriculum vitae, is beyond me. But it did help me realize that it was the beginning of at least a very long four years. Nevertheless, I was not discouraged.
Tonight, it looks like Glenn Youngkin is going to win the governorship of the Commonwealth of Virginia. Mr. Youngkin, a Republican, has come out in opposition to reproductive rights, to books about slavery being read by school students, to vaccination mandates, to making mandates, and to public health recommendations during the COVID-19 pandemic. He has also been friendly with groups that are anti-immigrant and borderline racist in their xenophobia. And he’s not afraid to double-down on lies and misrepresentations by his campaign — or himself — when asked to account for those statements.
Here we go all over again.
While I’m not a resident of Virginia, I do work there, and my work is entangled with the public health work of the Virginia Department of Health, a department that will be staffed and functioning at the pleasure of Mr. Youngkin if the results from tonight hold. The policies that he has advocated for as a candidate will have a great impact on public health of Virginians. And, since few if any public health problems respect political boundaries, they will likely have an impact on the state where I live.
While I am disappointed, I am not going to lie to you and tell you that I’m not somewhat excited. I am excited because I am my grandfather’s grandson. Grandpa was a member of the opposition in Mexico during that country’s Perfect Dictatorship. He and his friends made a lot of trouble for the federales in the Mexican north. He was a poll worker, an activist, and an outspoken critic of the status quo. I got to see a lot of that in my youth, and I got to hear how much people admired him for all he did. Even the people who disagreed with him politically respected his commitment to standing up against the authorities.
I, like my grandfather, am a trouble maker.
There’s this scene in Battlestar Galactica where the humans who are fleeing the murderous robots out to get them are trapped in a settlement as the robots arrive. One of the humans asks one of the main characters, “What now, captain?”
“We fight them. We fight them until we can’t,” she responds.
Because the only thing to do is to keep fighting and not be discouraged in the face of adversity. You walk up to bullies and push them back, maybe even punch them in the mouth. That’s what those who cannot defend themselves need from us.
And that’s just what I’ll do… Until I can’t.
Posted on October 28, 2021
It’s the hot summer of 1997, and I’m running drills with the club soccer team as best as I can, given that I was up very late the previous night and had managed to forget to hydrate. The heat and altitude were getting to me, and I was definitely not giving my all. I worked through the cramps and managed to sneak some water here and there between running after the ball to the sidelines near my gear. This was the 1990s, and coaches used keeping water away as a punishment and allowing you to drink water as an incentive.
I was also the tallest kid in the bunch. I didn’t really stand head and shoulders taller than everyone else, but I was 5’11” and bulky. And, by “bulky,” I mean fat. Well, not “fat” fat, but certainly carrying around more weight than I should. It wasn’t too much weight to slow me down, though. It was enough to push people around and not be pushed, so every cross into goal was mine. Every high pass was mine. Any kid with any kind of ability to dribble the ball was no problem if they could be shoved and tackled into submission.
One day, the coach brought on a new kid. He was slightly taller than me and slimmer. We called him “el galgo,” the race dog. Tall and slinky as he was, he could jump higher than me and run faster on those long legs. He wasn’t muscular, though, so he was handled easily by the more sturdy-yet-smaller players around him with better centers of gravity. Slowly and steadily, though, he started to make gains on the field and become one of the best players.
At that point, I could have done one of two things. On the one hand, I could have up and quit the team and go find somewhere else where I was still at the top and feeling good about my position on the team. On the other, I could make the best of the situation and help El Galgo be a better player, thus improving the team and thus being a part of a really good team. I chose the latter. That season with El Galgo, I fed him so many passes for goals that I led in assists. I also dropped back from playing forward all the time and being blamed for not scoring to playing in the midfield and having free rein to defend with all my… uh… “heft.”
I don’t know whatever happened to El Galgo, though. I never saw him in the big leagues. ¯\_(ツ)_/¯
This early decision to not take all my toys and go home when someone better than me showed up on a team helped me a lot. As I grew older, I began to realize that all that competitiveness that testosterone causes in young males is wasted energy that could be used to make teams — and societies — better for everyone. There were other ways to stand out. Or why stand out at all? Why not work at keeping “the back channels open in hopes of staving off disaster” instead of being baddest motherbleeper in the room? It gets tiring, especially when you get little to nothing in return…
Several weeks ago, a position within the division where I work opened. I applied for it and thought that I was a shoe-in. After all, I had been doing the jobs of that position de facto for a while, during the pandemic response. I went into the job interview with confidence, and I think I did well in it. The problem was that there didn’t seem to be much attention paid to my CV. It was later relayed to me that I lacked experience in managing people — which I had been doing through my participation in the pandemic response, which I did when working in the lab and managing the phlebotomy staff, which I did when teaching and being lead TA for several classes at Hopkins, and which I did when taking on new challenges in my different positions as epidemiologist starting in 2007… 14 years ago.
I guess they just missed those things, or I didn’t make them clear in my CV. That, and one of the interviewers was surprised to find out that I was a Doctor of Public Health days after the interview.
They did ask two candidates to return for a second round of interviews, however. To make things more interesting, I was asked to sit down with those two candidates for a half hour interview/chat. Yep, that was very weird. “We won’t give you the job, but we trust your opinion on who should get it,” they seemed to say. (This infuriated my wife, by the way. She really wants me to leave.) I agreed to the sit-downs, and at least one of the candidates is a strong candidate for the job. I can see myself working with them to make things better within the division. There is a lot of work to be done on many things that the pandemic revealed.
Who knows? I might find myself feeding him so many passes on goal that I am the one who ends up getting credit for the wins even though he’s the one scoring. I mean, it does happen:
In coaching, you want to put together the best team you can. You probably want to have nothing but all-stars at every position, but then the egos get in the way and ruin things. Nah, man… You want good players. You want people who jive well together and get the job done, people without egos (or with normal-sized ones) who will come together when things get rough and get through adversity together. You want them to compete not with each other but with the people on the other teams.
As a player, you want good players around you. You want people you can rely on, and — if possible — you want them to not be the kind of people whose hand you have to hold the whole time as you work together. You want them to be independent, but still depend on you. You want them to be dependable.
The best thing about this current situation, and the situations I find myself in lately, is that I am old and experienced enough that I’m not sweating it. If it becomes absolutely clear that the opportunities for advancement are not there, I have options. (I have a doctoral degree from “the best school of public health in the world.” That ought to count for something, right?)
Now, if you’ll excuse me, there’s a job offer I need to tend to.
Posted on May 26, 2021
A little over a year ago, after it became clear that the coronavirus had escaped from China and was coming our way, I was asked by the director of our division if I was willing to be activated into the emergency response. He didn’t have to ask. I would have found a way to collaborate to the response even if I had not been part of it. A few days later, I was made the chief of the outbreak team.
Ever since, we have responded to outbreaks in congregate living facilities like skilled nursing facilities, assisted living facilities and independent living facilities. Our team consisted of public health nurses, environmental health specialists, data analysts and epidemiologists. We all worked some very long days when the pandemic began, easing a little over the summer before picking back up again in the winter.
This week marks the end of my time as the chief of the outbreak team. The positivity rate in our health district is now at 1.25%. In Maryland, it is at 1.98%. In Washington, DC, it is at 1.5%. The number of cases from congregate settings has dropped precipitously as vaccination uptake reached well over 90% in most facilities among their residents, though it could be better among their staff. Overall in the communities, more than half of eligible adults have been vaccinated, with many parents taking their younger kids to get vaccinated and younger adults also participating (thanks in part to schools and universities requiring vaccination before returning to in-person teaching).
Things are looking up, though we need to continue to be vigilant. I’m personally not taking off the mask in the office until all three jurisdictions I mentioned above reach less than 1% positivity. I just don’t want to catch this and give it to my preschooler. Because of the epidemiological transition from the vaccine, children are now the group contributing the most to the overall number of cases in the country, so I want to keep her safe. The pandemic is definitely not over.
Starting next week, I will go back to working on population health epidemiology, looking at diseases and conditions like opioid overdoses, suicides, and mental health. I’m also adding some new people to my team, bright epidemiologists who are starting out in the profession and have much to learn. I’m planning on getting a lot done in the next few months, things that will hopefully make countering most of those diseases and conditions a little bit easier.
It’s the end of a chapter, and it feels weird. Sure, I’ll probably still need to support the activities of the team that is taking over COVID-19 investigations, and there will be plenty of “How did the pandemic affect X or Y?” questions. As one of the few people who speak Spanish — and the one epidemiologist who does so fluently — I’m sure there will be still some media requests about COVID-19 that I will have to answer. So, there is certainly a lot to be done to bring it all to a close… And I’m ready.