When Germs Travel - Coronavirus, Quarantines, and Contagious Crises

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University of Michigan Department of Emergency Medicine

This document discusses Howard Markel's expertise in the history of epidemics and pandemics. It outlines a 4-act model of how epidemics typically unfold, with act 1 being progressive revelation of the disease, act 2 managing the randomness of spread, act 3 managing public response, and act 4 being subsidence and retrospection. It also lists major themes and factors that shape epidemics, such as how societies understand diseases, economic impacts, media coverage, poverty, quarantines, and amnesia between outbreaks. Specific examples discussed include Markel's op-eds on the early COVID-19 outbreak in China and quarantines, and a quote expressing uncertainty around predicting future pandemics.

Health & Medicine

When Germs Travel
Coronavirus, Quarantines, and Contagious Crises
Howard Markel, M.D., Ph.D.,
George E. Wantz Distinguished Professor of the History of Medicine
Professor of Pediatrics and Communicable Diseases
Director, Center for the History of Medicine
The University of Michigan at Ann Arbor

4-Act Model of Epidemics
Act I: Progressive Revelation
Act II: Managing Randomness
Act III: Managing Public
Response
Act IV: Subsidence and
Retrospection

Major Leit Motivs of Epidemics and Pandemics
Pieter Bruegel the Elder
Triumph of Death (The Black Plague), 1556.

Epidemics are
framed and shaped—
sometimes advanced,
and sometimes
hindered— by how a
given society
understands a
particular microbe to
infect and spread to
others.
"Doktor Schnabel von Rom" ("Doctor Beak from Rome").
Engraving, Rome, 1656.

The economic losses associated with epidemics can
have a strong influence on public response.

The potential for the concealment of an epidemic,
delays in reporting one, or their severity being
ignored or underestimated by the world at large.

The movement of people and other living beings
and the speed of travel are essential factors in the
spread of infectious disease.

Widespread media coverage of epidemics is hardly
new and an essential aspect of any epidemic.

Our fascination with the suddenly appearing microbe that
kills relatively few in spectacular fashion often trumps our
response to infectious scourges that patiently kill millions
every year.

Markel, H., Doyle S., Epidemic Scorecard. (Op-Ed Page) The New York Times, April 30, 2003.

 Poverty. and its attendant evils, often fuel
the fire of an epidemic

Scapegoating or blaming individuals or social
groups for the importation of infection.
Judge, September, 1892

 Laws Governing Migration, Individual Liberties, and
Movement to Contain the Threat (real or perceived) of
Contagion

The Birth of the Quarantine
In response to the “Black Plague” pandemic of 1347- 1348, Venice
founded the first quarantine island, Lazaretto Vecchio, Santa Maria di
Nazareth Island. In 1485, in response to a successive wave of plague,
Venice adopted the rule requiring that all vessels coming from infected
ports be detained for 40 days, (Quaranta giorno).

 Internecine Rivalries and Disputes Between
Local, State and the Federal Government

What is the most dangerous response to a
recent epidemic or pandemic?
Profound Amnesia

Lead Op-Ed, Sunday, January 26, 2020
Why we should be skeptical of China’s
coronavirus quarantine
“As a historian of epidemics, I’m not
optimistic it will turn out well.”

Op-Ed, January 27, 2020:
Will the Largest Quarantine in History Just Make Things
Worse?
“The dirty history behind isolating the sick...
With the Wuhan coronavirus, as with other epidemics past,
quarantine measures may be too much too late.”

Time Magazine,
November 7, 2005
Q: What will be the next deadly pandemic
and how will it unfold?
A: “No one really knows what's going to
happen. Anyone who says they do is either
a fool or lying."
---Howard Markel, M.D., Ph.D.

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Fishing for treatments for human sepsis: lessons from a zebrafish model of en...

University of Michigan Department of Emergency Medicine

The zebrafish endotoxemia model can model specific features of human sepsis pathogenesis. Both in human sepsis patients and zebrafish exposed to LPS, genes involved in cholesterol metabolism are significantly upregulated, including DHCR7. Inhibition of DHCR7 through use of an inhibitor protected zebrafish from endotoxemia-induced death. Next steps involve investigating how DHCR7 inhibition provides this protective effect and determining if DHCR7 inhibitors could be repurposed to treat human sepsis by testing their effects in mouse models of endotoxemia and sepsis.

Acute Management of Pediatric Epistaxis in the Emergency Department

University of Michigan Department of Emergency Medicine

This study investigated characteristics of 809 children presenting to the emergency department for epistaxis (nosebleed) between 2013-2022. The majority (92.7%) were treated medically with nasal compression or intranasal medications. Older age, bleeding duration over 30 minutes, and antiplatelet medication use were associated with the 6.3% who received procedural intervention like cauterization. Procedural control led to higher rates of transfusion and admission. The results provide guidance on pediatric epistaxis patients needing emergency referral.

Tale of Two Cities: Cardiac Arrest Outcomes in Flint and Detroit, Michigan

University of Michigan Department of Emergency Medicine

This study compared cardiac arrest outcomes between Detroit, Michigan (DEMCA) and Genesee County, Michigan (GCMCA) from 2017-2021. DEMCA had significantly higher rates of poverty, unemployment, and African American patients compared to GCMCA. While bystander witnessed arrests and CPR rates were higher in DEMCA, survival rates were significantly lower - only 1.9% survived with good neurological outcomes in DEMCA compared to 5.5% in GCMCA. Socioeconomic factors likely contributed to the differences in outcomes between the two regions. Further work is needed to improve cardiac arrest survival, especially in communities with higher poverty and unemployment.

Reflections on a Research Career in Academic Emergency Medicine

University of Michigan Department of Emergency Medicine

This document summarizes the career of Dr. Rebecca Cunningham in academic emergency medicine and injury prevention research over nearly 30 years. It describes her progression from emergency medicine residency training in the late 1990s to becoming Vice President for Research. As an emergency physician, her research initially focused on preventing firearm injuries and violence among youth. This expanded to larger community-based intervention studies and developing emergency medicine training programs in Ghana. Her current role continues to support injury prevention research and new initiatives in areas like hydrogen energy and bridging the funding gap for university startups.

StrokeNet RCC-17 - Successes in Changing Stroke Care… And Future Opportunities

University of Michigan Department of Emergency Medicine

The document provides information about the University of Michigan StrokeNet Regional Coordinating Center #17 (RCC-17). It discusses the origins and growth of StrokeNet and RCC-17 over time. Currently, RCC-17 coordinates clinical trials across 17 counties in Michigan and Kentucky, enrolling over 270 sites on average. RCC-17 runs both prevention and treatment trials, enrolling nearly 500 subjects total. It aims to improve enrollment diversity and provides fellowships for training in stroke research. RCC-17 also develops new clinical trial proposals and represents the region in national StrokeNet committees.

A Comprehensive Experience Contesting COVID-19: Perspectives from a Universit...

University of Michigan Department of Emergency Medicine

This document summarizes the experiences of a university-based critical care EMS service in transporting 127 COVID-19 patients between March and December 2020. Key findings include that patients were often severely ill, with most requiring intubation and interventions like nitric oxide. Over 40% of patients died, with mortality higher for those needing more respiratory support or vasopressors. Transports were lengthy, especially for patients receiving multiple interventions. The pandemic challenged procedures but the EMS service was able to adapt and provide high level critical care during transport.

The Adult ICECAP trial - Early, High Quality, Hypothermic Temperature Managem...

University of Michigan Department of Emergency Medicine

The document discusses the Adult ICECAP trial, which aims to study early, high-quality hypothermic temperature management for out-of-hospital cardiac arrest. It notes that no devices are FDA-approved for inducing hypothermia in adults, so the trial is using an investigational device exemption. The goal of the trial is to take better care of patients through new knowledge and design future trials to accomplish this. It then provides rationales for inducing hypothermia to 33°C rather than just controlling fever, and argues for cooling patients early and deeply to give them the best chances of survival based on previous study results.

Focused Cardiac Ultrasound (FCU) Findings of Fluid Tolerance are Associated w...

University of Michigan Department of Emergency Medicine

1) Focused cardiac ultrasound findings suggestive of a patient's ability to tolerate fluid (fluid tolerance) as defined by a normal left ventricular ejection fraction, absence of dilated inferior vena cava, and absence of decreased respiratory variation in inferior vena cava size were associated with greater compliance with administering 30cc/kg of fluid within 3 hours per the SEP-1 sepsis bundle. 2) Patients found to be fluid tolerant on FCU received more fluid within 3 hours and were more likely to meet the 30cc/kg fluid target amount compared to those found to have poor fluid tolerance. 3) The association between FCU findings of fluid tolerance and increased fluid administration was strongest in patients with pre

Impact of a Medication for Opioid Use Disorder Curriculum for Emergency Resid...

University of Michigan Department of Emergency Medicine

The document describes a study that provided education on medication for opioid use disorder (MOUD) to emergency residents and found it increased their comfort and confidence in offering treatments like buprenorphine. Clinical process measures showed more patients were offered buprenorphine and referred to outpatient addiction treatment after the educational intervention. The authors conclude targeted education for residents on MOUD and harm reduction holds promise for improving care of patients with opioid use disorder in emergency departments.

First Responder Experiences with an EMS “Leave-Behind Naloxone” Program

University of Michigan Department of Emergency Medicine

This document summarizes the results of a survey of first responders regarding their experiences with a "leave-behind naloxone" program. 56 first responders from EMS and fire departments completed the survey. Key findings include: 23% had previously distributed a naloxone kit, common barriers to distribution were forgetting, patients refusing, and lack of someone to leave the kit with. Most respondents understood the program's purpose and had received related training. Around half expressed interest in additional continuing education on harm reduction and addiction. The study provides insight into facilitators and barriers to naloxone distribution programs from the perspective of first responders.

Hemodynamic impact of aortic balloon occlusion combined with percutaneous lef...

University of Michigan Department of Emergency Medicine

This study evaluated the impact of combining aortic balloon occlusion with a percutaneous left ventricular assist device (pL-VAD) during cardiopulmonary resuscitation (CPR) in a swine model of cardiac arrest. The addition of transient aortic occlusion to pL-VAD support during CPR led to synergistic improvements in coronary perfusion pressure and cerebral perfusion pressure compared to pL-VAD alone. This enhancement was associated with improved cardiac function recovery and cerebral oxygenation. Post-resuscitation, coronary and cerebral perfusion pressures as well as cardiac function improved more rapidly in groups that received continued pL-VAD support. Further research is needed to evaluate potential long-term benefits

Harm Reduction for Substance Use Disorders

University of Michigan Department of Emergency Medicine

This presentation discusses harm reduction approaches for patients with substance use disorders in emergency departments. It provides background on the opioid epidemic and overdose deaths locally. It describes current harm reduction services at the University of Michigan emergency departments, including social work consultations, syringe access, naloxone distribution, and medication for opioid use disorder initiation. It outlines two research projects - one training emergency medicine residents on medication for opioid use disorder and one evaluating a first responder naloxone leave behind program. It introduces the project team members, which includes house officers, medical students, faculty advisors, and other collaborators from various departments.

Detection of Hemodynamic Status using an Analytic Based on an ECG Lead Waveform

University of Michigan Department of Emergency Medicine

Recent Applications of Machine Learning to Life-threatening Infection

University of Michigan Department of Emergency Medicine

1) The document discusses recent applications of machine learning to predict life-threatening bacterial infections, specifically Staphylococcus epidermidis bloodstream infections. 2) Phenotypic measures like antibiotic resistance, biofilm formation, and growth fitness, as well as virulence genes, were used as predictors in machine learning models to classify S. epidermidis isolates as pathogenic, contaminant, or commensal. 3) The best performing model was a conditional inference tree model that achieved 82.4% accuracy in classification.

Emerging Technology Platforms in Health Care

University of Michigan Department of Emergency Medicine

The document summarizes emerging technology platforms in healthcare, specifically the Mayo Clinic Platform. It discusses how healthcare is transitioning from reactive to preemptive care using molecular data and early detection. The Mayo Clinic Platform aims to discover, develop, validate, and deliver insights and algorithms through collecting, harmonizing and storing diverse data sources. It provides examples like using machine learning for ejection fraction detection in cardiology. Advanced Care at Home is highlighted as a virtual hospital ecosystem to provide 24/7 medical support to patients at home using technologies like mobile imaging and labs. The document emphasizes data transparency and population representation in algorithms.

"I don't want these to be my people": Understanding Women's Experiences in Em...

University of Michigan Department of Emergency Medicine

The document summarizes perspectives from medical students on the culture in emergency medicine (EM). It finds that EM culture includes behaviors perceived as exclusionary and that beliefs about ideal EM physicians have a gendered character. It also discusses distressing patient encounters and unprofessional behaviors witnessed by students, as well as how access to mentors and representation in EM affected their interest in pursuing the specialty.

Impact of COVID-19 on High-risk Conditions and Associated Complications in a ...

University of Michigan Department of Emergency Medicine

Multi-site External Validation and Improvement of a Clinical Screening Tool f...

University of Michigan Department of Emergency Medicine

This document summarizes a project aimed at developing and validating a clinical screening tool to predict risk of future firearm violence. The project is led by Dr. Jason Goldstick and involves researchers from Harborview Medical Center, University of Pennsylvania, and Hurley Medical Center. So far, baseline surveys have been completed by 601 participants across the three sites. The team is using various machine learning methods like elastic net regression, random forests, support vector machines, and boosting to analyze the data and develop the screening tool. The ultimate goal is to provide a way to identify individuals at higher risk of firearm violence during emergency department visits to guide intervention efforts.

Caring for Diverse and Vulnerable Populations

University of Michigan Department of Emergency Medicine

This document summarizes Dr. Adrianne Haggins' presentation on caring for diverse and vulnerable populations. The presentation covered two main domains: delivering care, including discussions on COVID vaccination studies, facemask policies, and caring for diverse patients; and the physician workforce, including strategies to promote belongingness for underrepresented groups and the value of near-peer mentorship. The presentation also listed collaborations Dr. Haggins has been involved in regarding developing health equity dashboards and understanding root causes for leaks in the career pipeline for women in emergency medicine.

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