sophia.drewry – Sophia Drewry Portfolio

Week #8: 7/26/2021

My final week has been a bittersweet one. My duties were remained as usual, rotating between COPA and COCOVID and working on the CDCD literature review during my free time. To spare my loyal readers, I will not provide another recap of my work with COPA and COCOVID but instead, focus my last blog post on what I learned during my 9 weeks here.

In Georgia, I am constrained by our state’s own privilege when it comes to understanding Arboviruses on a macro level, being that Georgia does not have the need for a large-scale arboviral surveillance network. While my professors spent time trying to find case studies and teaching about zoonotic disease, I was learning about the tree of knowledge when I could be eating the fruit. In Puerto Rico, I was given the opportunity to see how a country handles endemic diseases like dengue, Zika and Chikungunya. While I worked with the CDC on this project, the real public health work is done by the citizens of Puerto Rico. Mosquito control can and has become political in ideal conditions, and to understand how a government-run program can work, you have to inadvertently learn about the political history between a government and its citizens; something I did not expect to be studying.

In summary, this is only the beginning of my scholarly arboviral career with various Spanish-speaking nations. When studying arboviral prevention, surveillance, and treatment, I learned just how important the government’s role plays in overall effectiveness. This variable alone will always be accounted for wherever I end up working with whatever country I work with. You can study the most effective treatments and solutions, but if there is no money, will, or government sentiment, all it is just an idea at the end of the day. Luckily this was not the case in Puerto Rico as at the end of the day it operates under the US public health network. This summer alone was the second annual release of Wolbachia released mosquitos. But other countries do not have this same will or luxury. Once again the word sobering comes to mind when realizing all the forces that come to play with successful mosquito control. I must reemphasize, sobering in this case will result in a more mindful future epidemiologist with hope for what can be working within what is.

Well that’s all folks! I have attached a couple of photos below for your viewing pleasure.

Week #7: 7/19/21

This week marked a transition towards the end of my internship. I have continued my usual duties with COCOVID and COPA. I have also been putting more effort into the analytical portion of my internship working on a literature review and thinking critically about the difference between a passive and sentinel surveillance system. In a way, I include cohort studies such as COPA as an interesting variable in the mix of case identification. It could be said that the cohort studies, while spall, yield the clearest picture of arboviral infection in Ponce. Since so many cases are presented as asymptomatic, a large portion of passive and Sentinal surveillance do not pick up such infections.

My humble exploring of Puerto Rico has also shed light on the ongoing fight against mosquito breeding. Post-hurricane Maria, many buildings are still abandoned which leaves plenty of time and room for mosquitos to grow. Trash disposal is an issue on the island, and I have seen firsthand large areas where used tires are dumped, the perfect breeding ground for mosquitos. The amount of wild dogs and cats also makes me wonder from a veterinary perspective the rates of animal to human transmission of various diseases.

Week #6: 7/12/21

By this point in my internship, I have become familiar with all the programs and can somewhat expect a routine. This week I evenly balanced doing all three programs. In COPA, there was a push for recruitment of participants in neighborhoods where there was a significant loss to follow-up. In COCOVID there was the usual pick up and drop off of samples, although being able to go out into town never gets old. In SEDSS, I am still dressing up with full PPE to go to the ER, interestingly there are still a handful of COVID patients that often have overlapping symptoms with the dengue symptoms we look for. In other exciting news for this week, I will start to work on a lit review looking at symptomatic dengue cases picked up by surveillance systems. I am interested to see if the inclusion criteria is the same as the one used in the SEDSS program I work with.

While not much new has been happening this week here in Puerto Rico, I cant help compare the almost 66.5% vaccination rate and end of strict regulation to the state in which Cuba is in. Though both islands are in the Caribbean, they could not be any different. It has really given me time to reflect on how important government structure is to successful public health practice.

Week #5: 7/5/2021

After taking a relaxing week off with friends and exploring the island, I started the week off strong helping with a busy week in COCOVID. Because of the holiday, the pickup and drop-off schedule was a bit muddled and it was all hands on deck collecting and picking up samples. This week was pickup shift after pickup shift and I really got to learn the intricacies of participant management. We had to juggle giving out incentives with schedules and coordination with the main cohort study, COPA. This week I also got my CDC laptop up and working and continued to do file conversion for CDC headquarters in San Juan.

Since I am looking at the data as it is collected and the questions used in the survey, I have been thinking about possible research questions to ask. The art of finding an interesting research question is often rushed and given a deadline. With this long-term project, I am able to marinate about what data is collected and involve current events, such as the Denguevaxia rollout and Covid into the situation. Pictured below are the other interns I am working with.

Week #4: 6/21/2021

After a relaxing 3 day weekend at the beach, I started my week working remotely for the San Juan CDC HQ helping with file conversions using a program created by one of the data scientists there. From an epidemiological perspective, it was interesting seeing how the data was stored and what goes into understanding the codebook used to decipher it. I personally have never dealt with such a large and intricate data set, so seeing the internal organization of it all makes it easier to exercise my epi-trained brain on how it is analyzed. I have also enjoyed collaborating with the other interns and have learned about some valuable resources they use in their programs. I have also taken it upon myself to start on an introductory modeling course in preparation for next semester when I have free time in the office.

For the rest of the week, I ran routes for sample pickups for both COPA and COCOVID. I still enjoy interacting with the residents of Ponce and seeing the city. In other relevant news, as of June 24th, a committee met to present and vote on the usage of the dengue vaccine, “Dengvaxia”. It was passed 14-0 by the Advisory Committee on Immunization Practices (ACPI). Have done a little research about the efficacy of the vaccine, I found it interesting the majority opinion is pushing to accept the vaccine here considering its flaws.

Week #3: 6/14/2021

This exciting week was concentrated on working with COPA. My main takeaway from this week was understanding all the community partners that were involved in making these programs run. I started out the week working with the recruitment team. Meaning we would go in the 14 different neighborhood zones and try to enter families in the study. This is tedious work and sometimes not fruitful, however, it is crucial for longitudinal studies. I also continued my normal 12-month COPA participant visits and even got to interview a child. During one of the visits, a next door neighbor had a mosquito trap, having done previous work with these traps last summer I could easily identify it. After a bit of question, I learned a little bit more about PRVCU, or Vector Control Unit. PRVCU is the government program that is involved in putting down these traps. To my surprise, the next day someone from PRVCU came in and did training on how to sample and look for larvae as well as inspecting porches. Turns out PRVCU data on mosquito traps are used in conjunction with the COPA study, making them an incredibly important partner.

Week #2 6/7/2021

The majority of this week was spent working with COCOVID. On Tuesday, I attended a training to go over patient communication and the ethics of both the COCOVID and COPA study. Having learned about the IRB approval process and HIPPA requirements in the past, everything was as expected when handling sensitive health data. Consent and assent from both children and adults are important, especially when handling a biological sample. Interacting with the community is a major part of this job considering that with COCOVID there are weekly visits and sample collections and with COPA there is a yearly visit. All patient communication is done in Spanish, so for now I do not interview patients, just help with paperwork and sample processing. I am still in the process of picking up Puerto Rican Spanish and especially focusing on medical terminology.

During the COCOVID program routes, not only did I get to inadvertently explore the city of Ponce and get to know the community, but I also got to understand the people and their reaction to the COVID pandemic. For starters, masks are still worn by a majority of the population and there is little pushback compared to what I was seeing when I left Georgia. Part of the COCOVID questionnaire is to see if the participant has been vaccinated or not. To my surprise, almost all participants we visited were vaccinated and supported vaccination without hesitation. As of June 7th, the mask mandate has been dropped but I have not noticed a difference in mask usage.

Week #1: 6/2/2021

I landed in Puerto Rico on May 26th, since then I have been completing a slew of paperwork and checking in with the CDC main office in San Juan. I traveled to Ponce and explored the city before starting my first day on the 2nd.

Upon the arrival on my first day, I was given a tour of the office in the medical office of the Centro Médico Episcopal San Lucas. I will be working on 3 different projects and shadowed all three the past week. Below is a brief overview of my understanding of each program.

Day 1 & 4: COPA program: This is the long-term longitudinal study that involves going to recruited members houses to take blood samples and interview for mosquito exposure and perception.

Day 2: COCOVID program: This is a nested cohort study within the COPA program adapted for the COVID-19 pandemic. This involves the weekly collection of nasal swabs of participants.

Day 3: SEDS program: Symptomatic surveillance within the hospital. Patients with arboviral symptoms are identified and recruited, Blood samples and nasal swabs are taken.