Reflections from 40 Years Fighting International Epidemics

Module One provides you with an introduction to the context and perspective of Dr. Lucey. He is a public health and infectious disease physician and epidemiologist who has helped fight epidemics around the world beginning in 1982 in San Francisco before the HIV virus was discovered but long after the virus discovered us. This module offers a chronology of his field experience in over 10 epidemics in 5 regions of the world. A Medical Humanities perspective is included using his own list of 40 one-phrase reflections on epidemics, distilled from 1982-2022, and the first of several narrative stories from the 2014 Ebola pan-epidemic in West Africa. These stories in module 1 and module 4 illustrate some of the 40 one-phrase reflections and their origins. A summary is also provided of the exhibit (2018-2022) proposed in 2014 by Dr. Lucey at the Smithsonian National Museum of Natural History on viral epidemics that originated in animals, using the “One Health” approach that integrates human, animal, and environmental health.

Module Two provides six examples of epidemics that began months, years or decades before they were first recognized or their viral cause “discovered”. These include HIV-1 (< 1959-1983), Nipah (1998-1999), SARS (2002-2003), MERS (2012-2013), Ebola in Guinea (2013-2014), and Zika clusters of neurological diseases (2014-2016). The unifying theme of this module focusing on past epidemics is: “What’s next is already here, we just haven’t recognized it yet” (refection # 40 of 40). One key objective of this module is to lead the learner to ask what epidemics are already here today in the world, but have not yet been recognized or their cause “discovered”.

Module Three focuses on the theme of “anticipate, recognize, act” to build on the previous module with its six past examples of epidemics that were not recognized quickly. Examples are provided of the process and policies whereby the World Health Organization (WHO) evaluates recently recognized epidemics to determine if they should be declared a “Public Health Emergency of International Concern" (PHEICS). Two examples of potential future epidemics and information that should be anticipated and that will be important on Day One (1) are presented. These examples, of the many potential ones, are (1) A Nipah virus epidemic outside south Asia and SE Asia where all past Nipah outbreaks have occurred (e.g., China, Africa, Europe, or the Americas); (2) A multidrug-resistant anthrax epidemic due to the Bacillus anthracis bacteria. In addition, links to over 10 additional outbreaks around the world that have occurred in 2020-2023 are provided in blogs written by the instructor on the “Science Speaks” website of the Infectious Disease Society of America (IDSA). Examples are analyzed from the contextual framework of “anticipate, recognize, act”. They include mpox (many nations), melioidosis (USA), Langya henipavirus (China), H5N8 avian influenza (Russia), unexplained pneumonia (Argentina), unexplained hepatitis (Europe and USA) and more.

Module Four focuses on Medical Humanities and literature regarding both patients and healthcare providers. Several sources of such information include writings by Albert Schweitzer (“Reverence for Life”) Alexander Solzhenitsyn (“Cancer Ward”). In addition, some of the 40 reflections regarding both patients and healthcare worker colleagues from Liberia and the USA. Lastly, a general reference is made to an ongoing 2-volume ‘library collection’ of over 180 medical wisdom stories shared by alumni from the instructor’s Geisel School of Medicine at Dartmouth with its graduating medical students each year beginning in 2017.