94: ProPublica’s Syphilis Investigation – Part 1

ROBERT JOHNSON:

This is Public Health Review Morning Edition for Monday, January 10th, 2022. I'm Robert Johnson.

Now, today's news from the Association of State and Territorial Health Officials.

CAROLINE CHEN:

My name is Caroline Chen. I'm a reporter at ProPublica, which is a nonprofit newsroom that focuses on investigator reporting and deep-dive journalism, and I've been covering healthcare for about eight years.

JOHNSON:

If you work in public health, we don't need to tell you how awful syphilis is for people who suffer from the disease. We also don't need to tell you that it's making a comeback. What journalist Caroline Chen will tell you is the story of syphilis through the eyes of a local public health investigator trying desperately to find and to help a woman who's homeless, pregnant, and infected.

Here's the first of our two-part morning conversation with Caroline Chen.

Syphilis is making a comeback, even though we once thought it was on the brink of elimination. What happened?

CHEN:

Yeah, so, one of the things that drew me to reporting this story was realizing that so many people didn't even know that syphilis was still around. You talk to people—you know, lay people—my friends, they'd be like, "Wasn't that a thing in the forties?" You talk to people in public health, and they're like, "Oh my gosh, this is such a big problem." I'm like, there's some huge gap here.

And so, you know, it's been a disease that has come in waves. The U.S. has come really close to eliminating it a couple times, and then it's always come back—and the factors are obviously complicated, there are a lot of different reasons why cases are rising right now.

And what I focused on in this story was the question of public health resources and sort of our cyclical nature of paying attention and then losing interest, and paying attention and losing interest.

JOHNSON:

And you play that out in a story that follows a public health worker and a pregnant homeless woman that she's trying to get into treatment. You get the sense when you read it that this is happening all over the country every day. Is that accurate?

CHEN:

Yeah, so, I think the story that I wrote—you know, where I was focusing on congenital syphilis, specifically—we know that there are a couple areas in the country where this is truly playing out daily, particularly in the south and the west. You know, there states in the northeast which are not seeing as many cases, where this is not probably a daily reality; but cases are rising everywhere and it is running in more and more states.

So, really what I was trying to do with this story is not just tell a story about congenital syphilis; I was trying to tell a story about public health. So, you know, the panic and neglect cycle that I described in this story is something that happens for a lot of public health issues. And so, in that regard, I would say this story is happening everywhere.

JOHNSON:

You mentioned federal money—you talk about that a little bit through some of the comments that you get from people you spoke to—and there was indicated a sense that five years of promised funding is great, but we're not really sure if we'll get all of it. Talk about that for a minute.

CHEN:

Yeah, so, one of the things—that, in retrospection, I've been surprised by—but as I, when I was first starting to do some reporting, I was a little bit surprised by, was the extent to which a lot of the public health money in this country is determined by a bunch of politicians and how political that process can be.

So, specifically with federal dollars in the CDC, you know, this is determined by an appropriations committee in Congress. And I talked to a number of people who have had a lot of experience with lobbying; and, you know, they say, you know, there are a couple of months where lobbyists descend on Washington and you can't help but end up in a position where the people with the loudest voices, with the biggest contingents end up getting the most attention.

And I was talking to folks who represent STDs, and they talk about trying to bring up the issue of congenital syphilis, and sometimes politicians will say, "Oh, we heard from the HIV people earlier, you know, just send us an email. We are not going to meet with you," and sort of that struggle for attention and how that drives money was actually pretty surprising to me.

And so, when you mentioned the five years, the reference to the Biden administration sort of realizing, because of the pandemic, that we hadn't paid enough attention to public health and setting aside money for five years, which includes funds to hire DIS—disease intervention specialists. And, you know, that's a great thing. A lot of the public health departments I talked to were very excited about this and sort of wondering, you know, how much of that pie they'd be able to get.

The flip side is I talked to some experts who said, you know, this is a five-year commitment—you know, what's going to happen after that five years? 'Cause we've done this before, you know, where after Ebola, you know, a bunch of money came in, and then it ran out and it wasn't replenished.

JOHNSON:

Yeah. There's definitely a roller coaster cycle when it comes to funding that essentially reacts to a crisis for a while, until we move on.

CHEN:

Yeah. That's exactly sort of what I was hoping to show in the story. And I think one thing that really struck me as I was reporting is the complex nature of some of these public health challenges. You know, the main story I followed here—which is of a DIS in Central Valley, California, looking for a private woman who is homeless—sort of represented to me a lot of these factors.

You know, you might have people who live in rural areas who don't have great access to healthcare, who might have had trauma with the healthcare system, who are homeless, who just have other things on their mind, where getting syphilis treated—no matter how dangerous it is for their baby—if they don't have symptoms right there, it's just not going to be priority. And the resources you need for a complex sort of chronic preventative campaign has to be a long-term, sustained commitment because, otherwise, you're just going to lose the most vulnerable people.

JOHNSON:

And the sense from reading the story is that tracking down one woman takes a lot of time.

CHEN:

Absolutely.

You know, I followed Mai Yang, who works for the Fresno Department of Public Health, and she ultimately—as far as I know, at the point of publication—had gone six times to this tiny town an hour drive away; and a few times she managed to meet this woman. A couple of times, she couldn't find her and was driving around trying to look for her, and that's just an enormous amount of resources for one person.

And then, you multiply this by—you know, at that point in time I met her, she had 30 cases going; but, at the height of the pandemic, at some points it was 60 or 70 because so many contact tracing folks—you know, DIS people who have these skills—were pulled off to do COVID.

JOHNSON:

We'll have part two of our conversation tomorrow. You won't want to miss it.

Extreme weather continues to batter the U.S., bringing rain and mudslides in the west and crippling snow and cold in the east.

For the past year, ASTHO and the CDC have provided funding for 19 disability and preparedness specialists to help jurisdictions better meet the needs of people living with disabilities during emergencies and disasters.

ASTHO has a new blog article on the topic. It offers ideas and guidance for planners looking to do more for this important population during times of crisis. There's a link to the article in the show notes.

Finally today, the CDC will take applications starting January 18th for people interested in its Public Health Associate Program. Candidates will spend two years working alongside professionals in a public health agency or NGO. The paid training program gives participants the experience they need to get a job in the field.

There's a very short window to apply. Learn more by clicking the link in the show notes.

That'll do it for today's report.

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I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.