An Open Blog Post to My Non-Believer Relatives

Clothes hanging from a line outside a building
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

We Have to Explain Risk to People as if They Were Five Years Old

Image of a man on a tightrope walking across a chasm
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

“Cruella” and the Complexity of Being a Villain

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.

Image of a white cloth screen onto which a movie is being projected. The movie frame shows a woman with half black and half white hair looking away from the camera and to the left. She looks haggard.
Good, old-fashioned evil.

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.

Some loons are better than others. (Photo by Gio Bartlett on Unsplash)

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.

Look at how long we went without a Secretary of Homeland Security. Securing the border was never going to happen with a decapitated security apparatus.

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.

He knows ten thousand ways to kill you if you so much as look at his child the wrong way.

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.

Se Cayó La P

Image of pink letter magnets. Some are magnetized to the white surface while others are on the floor.

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.

Featured image by Jason Leung on Unsplash

Until We Can’t Fight Anymore…

Men and women at a protest holding a sign in Spanish that reads "let's not give up. Let's keep fighting."

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.

The Teams You’ll Play and Work With

Image of eight young men in front of a soccer goal. Four of then are kneeling on one knee and the other four are being the first four, standing.

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.

I Get It. You’re Scared.

I had a most interesting encounter with a dude on Facebook. Said dude decided that a few hundred deaths from COVID-19 each day are acceptable for several reasons, the most important of which — in his opinion — was that we could not lose our freedoms for the sake of saving the lives of people who are going to die anyway… Or the people who lived lifestyles that lead to their demise.

Just for the record, we’re all going to die. My job in public health is to delay that death as long as possible while maintaining the health and productivity of populations as we all march together toward the inevitable.

When I asked him why so many preventable deaths were acceptable if they were preventable, he responded with foul language and accusatory “questions.” He wanted to know why I was worried about COVID-19 deaths and not worried — in his opinion — about deaths from things like Alzheimer’s or heart disease.

Now, the answer to that is easy. I’m also worried about those things, but few of them are as preventable as COVID-19. Two doses of the mRNA vaccine or one of the viral vector vaccine, and your risk of dying from COVID-19 plummets to near zero. That’s it. You don’t need to do much other than get the vaccine, and the vaccine is safe. Period. End of story.

To get rid of deaths from the chronic and acute conditions the dude asked about requires more work. Alzheimer’s itself is still quite the mystery, and the medications available for it right now are no where as effective against it as the vaccines are against COVID-19. Preventing Alzheimer’s is quite a task that involves modulation of genetic and environmental components.

It’s not like I wake up in the morning and rank the top ten reasons people die and then decide what to attack. Instead, I go through my personal and professional life weighing risk as best as I can. Right now, avoiding COVID-19 is my top priority because the risk to myself is huge. With my overweight/obesity and history of asthma, catching COVID-19 could kill me. Now that I’m fully vaccinated, I can still catch it and give it to my unvaccinated daughter, or to someone who could really get sick and even die from it. Multiply this to the population level, and you can see why I’m so goddamned worried about it.

I mean, if we could all get vaccinated in the next year, then I could worry about Alzheimer’s in 2023, maybe.

But I get it: the dude is scared. He is scared because he seems to know very little if anything about biology and science, and not knowing those things right now makes the flood of information (and misinformation) on COVID-19 too much to handle. It’s like people running around with fire extinguishers during a house fire and leaving you in the middle of a room while telling you not to catch on fire, or go towards the fire, or go away from the fire. Just stand there. It’s scary.

He is also apparently scared that the interventions being put into place will somehow erode the freedoms he has been privileged to have as a white, straight, American male. Things like putting on the mask or not going to crowded places are scary to him because he’s never had to do it before. (And, from his ad hominem attacks and apparently allergic reactions to any kind of request to be civil, it must also be scary to be nice.)

I’ve seen this before in people who believe that everything is a zero-sum game. They feel that if someone gains something, they must be losing something by default. Give people a chance at surviving the pandemic? Well, that must mean that they are having some of their chance of surviving being taken away. And that is scary.

Tell them to put on a mask, and that must mean that someone less worthy than them is not wearing a mask, so why should they wear one?

No, don’t try to reason with it. It’s that unreasonable. It’s really that weird.

So, what do we do? We ignore. We block on social media and ignore in real life. Some people are too far gone to be dealt with in any kind of way. They move goalposts. They launch personal attacks. They go to your social media accounts and make intimidating comments. But you ignore them, and then life rent-free in their heads for years.

Header image by Jasmin Sessler on Unsplash

The End of a Chapter

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.

Maybe.

The Trauma of Your Ancestors

I listened today to a seminar on transgenerational trauma. The theory of such trauma boils down to a couple of basic things. Number one, someone in your lineage suffered trauma of some sort. Number two, they displayed that trauma and their children followed suit. Number three, you also display that trauma because that is how you’ve been raised. Essentially, what happened to your ancestors some generations back is having a strong influence on your health and wellbeing — especially your mental health — today.

In the United States, this kind of trauma can be seen in members of groups of people whose ancestors have been traumatized by forces bigger than them. In Native Americans, the legacy of conquest, colonization, relocations, forced assimilation and outright inequitable treatment continues until now. And what can we say of slavery? Those effects can be seen every day in how Black people, especially young Black men, interact with authorities who see them as inherently violent.

This all got me wondering if I am experiencing this kind of trauma in any way, and it also made me wonder if it compares in any way to the trauma others feel. My identity is one of an immigrant, born in Mexico, coming to the United States as a child. I’ve experienced racism from people telling me to go back to my country or to not speak Spanish in front of them. I’ve experienced hardship from not having any family wealth to help me begin my own financial history. I’ve been stopped at the border or at airports at the border on numerous occasions to be “randomly checked.” I’ve been pulled over by police who later send me on my way with not even a warning after they check my name and personal details against their databases.

But I also have a doctoral degree, a master’s degree, and a bachelor’s degree. I live in a nice development and in a beautiful home. I drive a good car. I have a great job that has afforded me the luxury of not being jobless during economic slowdowns and during this pandemic. And I have great friends who are phenomenal sources of support.

And what can I say of my wife and daughter, my siblings, and my mom and dad? They’re all alive and healthy, and there for me, if I ever need them. So, in many ways, I’m okay, and I’ve been okay awhile.

However, my ancestors were not that lucky. Mom had to make the hard choice to buck family and societal pressures and go to college, all while being a single mother at age 17. Dad worked from sun up to sun down at all sorts of jobs in all sorts of places to help me financially while I was in college. My paternal grandfather was a political activist in Mexico during “the perfect dictatorship,” and that brought with it many challenges. My maternal grandfather was a mailman, a musician, and died an early death from cancer.

The women in my extended family have had to endure a lot of hardship from abusive relationships, misogynist work policies, and the realities of having to work to make ends meet while also having to raise children. Some of those children, my cousins, have had horrible things happen to them because of the color of their skin, the place where they lived, and/or their gender. Female cousins of mine have repeated the missteps of abusive relationships, forced marriages and forgone educations and professions because tradition or society dictated other paths for them.

So, here I am. I am the product of over 40 years of my history and probably hundreds of years of the history of men and women who’ve done things that set the reality I live in into motion. At some point, the Najeras left Spain and arrived in Mexico. So did the Padillas. And the Herreras, the Armendariz. Others came from other places in Europe, and others have lineages that have been in the Americas for centuries. They all did stuff, lived stuff, suffered through stuff that is echoing in me today.

The question is what to do about it all? I choose not to be a victim of all those past lives, but to learn from them, grow, be better. I choose to stop the transmission of trauma at me, as good as I can, to keep it from traveling further down to my toddler. The Toddler Ren has things to do, man, and they can’t be bothered with trauma. I’d rather that Toddler Ren be bothered with wisdom, from learning of all those things that happened then so that the wisdom can prevent things now and in the future.

You see, I am painfully aware of the association between how girls are treated by their fathers (or how they see their fathers treat their mothers) and the behavior that those girls-turned-women will exhibit. I’m also aware that this kind of influence is not exclusive to girls and their dads. Boys also follow the lead of their fathers. As a father, I need to make sure that the trauma of past generations stops with me in both my behavior from it and my behavior toward it.

It’s hard, though. Some things have more control over us than we think. Some cop can wake up tomorrow with a grumpy mood and pull me over and end my day in quite the literal sense. Same for an alcoholic who gets behind the wheel of a car and drives straight at me. Or some weirdo politician convinced enough people that my toddler is not enough of a human being for their life to matter… Or someone eats a bat in some other part of the world and a pandemic with 30% mortality rate rolls around. (That would be an extinction-level event, by the way.)

Nevertheless, there are things that I can control, and things that I cannot, and that is what I learned from the seminar. There is a lot of that trauma going around, and people are still being hurt by the institutions put in place by the majority to grab and keep power or to keep the “others” held down in what is, honestly, indentured servitude. Yet, there are things we can do. We can stand up, help others stand up as well, and make a change. We can ourselves be the lights that shine on the darkness and end the trauma, especially if we realize that we are not alone.

The Stories You Need to Hear/See/Read and Understand

I was reading Runner’s World Magazine the other day when I noticed a theme in the stories they were telling in that issue. Most of the runner’s being showcased were LGBTQ+, a racial/ethnic minority, or a combination thereof. Their stories were very similar in that they grew up in the United States, isolated and lonely because of who they were. They faced different challenges because of their respective identities, many times having to explain their existence — or, worse yet, justify it — to the people around them. On the one hand, it made me sad to see such a level of misery in their existence solely because of who they were and the lives they wanted to live. On the other hand, it made me realize that there are far too many stories that need to be told to fully understand the richness and variety of human existence.

When we talk history, we often talk about the victors, the old (mostly) white men who conquered the world and controlled the narrative of how they conquered, who they conquered and why they conquered. Indeed, for many years in my childhood, we were forced (as in, it was not optional not to) to revere and celebrate Christopher Columbus’ arrival in the New World, Hernán Cortés’ triumph over the Aztecs, and the conversion to Christianity of the American continent. It took a long time for me to learn of the atrocities — the genocide — committed upon the Native peoples living in the Americas. Basically, it took me having access to alternative points of view, alternative voices, and books.

Then I came to the United States, and I was made to pledge allegiance to the Flag, to defend the names of old (mostly) white men who were referred to as “Our Forefathers,” and to fight anyone who would dare say that the United States was not the greatest nation in the world. Even though I saw so many things wrong around me, I couldn’t say anything about them, lest I am labeled a traitor or — most often than not — be told to go back to my country. Because that’s how it works, I guess… You give up and quit on something or someone if they are not up to the standards of Truth and Justice. Maybe?

Among the many things that this country does have going for it is the free and open access to most of the information in the known universe. Once in school, I could go to a library and find books and magazines on a variety of topics. With the advent of the internet, I could log onto the World Wide Web and meet and debate with a great variety of people. I listened to stories that were different from my own after an entire life of listening to experiences that were just like mine. And then came satellite radio and internet radio, and podcasts. I was taking in stories about all sorts of people from all over the world. I learned of their struggles, and I was inspired by their successes.

One of the big reasons why I ended up on the East Coast after college — and the only one in my extended family who lives east of the Mississippi — is because I met people online and in person who were from over here. They told me all about their lives in cities like Washington, DC; Baltimore or Philadelphia. I wanted that. I wanted to live like they did, in a place full of other people and culture, and with plenty of things to do. (The only fun in El Paso was to go across the border to Juárez and party, or to play soccer in the many parks.) When they told me that I could drive from one big city to another in a matter of minutes or hours, I was hooked. I wanted that for myself, so I moved out here. I am not disappointed.

Of course, these stories sometimes come with sadness, too. Some storytellers do an excellent job of tugging at my heartstrings and getting me to do something about the injustices they identify. Others fill me with hope when things are looking dire. Most of them entertain me and allow me to forget about the real world for a while. Because that’s what we need.

When I talk to my friends, I am always interested in listening to their stories, be they good or bad. I love listening to how they see the world because I don’t think that how I see the world is necessarily the best way to see it. Sure, I may shake my head in disbelief at the things that they’ve done, but I still find them interesting. And it’s kind of the same with strangers. I’m always willing to stick around for a good story.

As the world becomes smaller and smaller because of mass communications, I’m curious to see how stories will change. Will they retain their essential elements of introduction, presenting the conflict, the climax of the story, the resolution and the end (or a cliffhanger)? Or will we see more stories that are less personal and less entertaining as people without any kind of talent dominate social media?

Who knows? Whatever happens, though, I hope the stories are diverse and tell the stories of not just the conquerors, but the survivors… Not just the (mostly) old white men, but the young voices from far and wide of all colors and flavors.

Featured image by Seven Shooter on Unsplash