95: ProPublica’s Syphilis Investigation – Part 2

ROBERT JOHNSON:

This is Public Health Review Morning Edition for Tuesday, January 11th, 2022. I'm Robert Johnson.

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

Callers to C-SPAN's Washington Journal Morning Show had a lot of questions for Louisiana state health officer Dr. Joseph Kanter on Monday. They wanted to know about testing antivirals, hospital crowding, and changes to Omicron messaging.

1. JOSEPH KANTER:

You know, things have been changing so quickly that it's sometimes tough to get a clear message out, and there's no doubt that there's confusion. We try and give feedback, we try and help craft the message; but I'll tell you it is challenging with the speed with which things have been changing and moving the past few weeks.

And certainly—about the new CDC guidance—the quarantine and isolation guidance has been confusing. It's new guidance, there's always some confusion. There's been confusion about the monoclonal antibodies—not because anyone's to blame, just because things are changing very, very quickly, and we're all living through this pandemic real-time.

It's messy when you live through it real-time. It takes a real concerted effort to get the message out and to do it in a way that doesn't further confuse people.

JOHNSON:

While Omicron dominates headlines, syphilis gets far less media attention even though the number of infections is growing. The sharpest increase is among newborns suffering from congenital syphilis, cases quadrupling between 2015 and 2019 according to the CDC.

ProPublica journalist Caroline Chen writes about this public health crisis, telling the story of a Fresno County disease intervention specialist who tries to help a woman who's homeless, pregnant, and infected. Here's part two of our conversation with Caroline Chen about her story and whether it's made a difference.

What has been the reaction since the story broke? Have you heard from anyone who said this is right on or you're way off?

CAROLINE CHEN:

Yeah. I've heard from a lot of folks in public health who are like, "Yes, wow. This is our reality. This tells our story." And I've been gratified to feel like I've gotten that right.

There's been a lot of just, like, shock from the general public where they're like, "How is this possible, that babies are dying of syphilis? You know, like, why does this happen in America?" And like, you should not be surprised.

You know, this story, in many ways, was not surprising to me because, you know, I've covered other public health issues before; and that's kind of what prompted me to be like, "You know, it isn't just COVID, guys." Like, this is sort of a narrative that we see often in public health, but I think a lot of people don't know that.

And I think the other thing I really hope came across was what the work is of public health. Like, actually where I started with this reporting was people keep saying, you know, "Fund public health, fund public health." This has been a sort of common cry we heard during the pandemic. And I thought, do you actually know what that means? Like when you say fund public health, what is the day-to-day work? And so, I hope that did come through in this story.

JOHNSON:

Other than funding, during your reporting did you detect any other needs that have been going unmet, that maybe will be addressed as part of this response to COVID that continues here in Washington and around the country?

CHEN:

Yeah, and certainly, of course, it is not just funding.

I think something that was really interesting to me—I was talking to Jo Valentine, who works at the CDC, and she was the program coordinator for the last campaign to eliminate syphilis. So, I was very eager to talk to her because I wanted to know why it wasn't successful. You know, at that point, the case rates were basically as low as we've seen it in the country. What happened? How did we miss the boat?

And something she said was public health tends to have a very short-term, parachute-in-and-fix-this-thing mentality, and that doesn't work for sort of a chronic issue like syphilis. And we need to be working sort of across departments, that sometimes public health can get a little siloed. You know, like the STD division is doing its own thing, but you're not talking to people who have mental health resources or who work with, you know, drug abuse. And a lot of the hardest-to-reach folks might have a lot of complex issues that they're juggling.

And so, she said, you know, you have to get out of this mindset of like, "I'm going to parachute in and fix this thing," because that maybe works when you have, like, a food poisoning outbreak—an acute situation—but it's not going to really work with preventative issues. And you need to come in as a public health officer and know that people just see you as public health, and they're going to want help with many things; and staff on the ground need to be equipped to actually do that, and to know how to refer people, and to sort of help the health of a whole human being.

And so, you know, my story was focused on congenital syphilis. And I remember her telling me, "You know, if you have healthy men and woman, you will have healthy babies, and you can't just myopically focus on, 'I've got to get my case rate down on congenital syphilis.'"

JOHNSON:

There's a lot of talk about breaking down those barriers within programs inside departments, big and small.

When you were following this public health worker around and doing this story, did you get the sense that the talk is turning to action at all on the ground? Is it happening yet, or are we still discussing the policy nature of it?

CHEN:

I think it is starting to happen. I think that the movement is slow. So, in Fresno—which is where I ended up focusing on—they've just been working more closely with their mental health services. And I did talk to one DIS who told me a story of looking for a pregnant woman—you know, particularly with cases that involve pregnant women, you know, there's a bit of a ticker, you know, a timer going on those, so there's an urgency—but that woman was so deep in the throws of the drug addiction.

You know, she was able to refer her to treatment that she wanted, and that was sort of the important first step for her to get the trust of this woman. And, you know, she went back multiple times, and she ultimately was able to get her treated for syphilis and also to get her a referral. You know, she literally physically drove her to a treatment center, you know, and I think that was what she needed to do to get through to this woman and help her get to a better place. So, I think it is happening. I think it is slow though.

The other thing I haven't mentioned, I talked to a number of OB-GYN and pediatricians, and I think that's another bridge that needs to make sure that that's, you know, really super tight.

You know, I talked to a maternal fetal specialist in Houston and she said too often you have OB-GYNs that don't have the treatment in their clinic because it's expensive or they aren't confident in testing. And so, they'll just tell a woman or a patient who comes in, "Oh, go to the health department." And for somebody who maybe is a single parent, who doesn't speak English, who's kind of had bad interactions with the healthcare system before, it's just another point, you know, another gap in where they have to bridge it. And it's so easy to lose someone when you say, "Oh, I can't help you, go to the health department." They might be scared of it because they think it's the government.

So, she really advocates warm handoffs. So, she's like, "You know, I need to call somebody at the health department and say, 'I'm sending this person to you right now.' Like you got to be ready for her. You know, she's going to come at this time," and to give the patient that sense like, "You don't have to navigate this by yourself. I'm going to help get you to the right person."

JOHNSON:

Finally this morning, ASTHO continues to celebrate the work of 19 disability and preparedness specialists assigned to help address the needs of people living with disabilities in jurisdictions across the states and territories.

A blog article provides an overview of the program and examples of the work done in states like Alabama, Missouri, and South Dakota. You can read more about the project and its impact using the link in the show notes.

That'll do it for today's report.

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Be sure to join us again tomorrow morning for more ASTHO news and information.

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