Coordinating CDC’s emergency response to the deadly MERS virus


(courtesy of Dr. Lyn Finelli)
May 20

When the alarm sounded earlier this month about the possibility of the first U.S. case of Middle East Respiratory Syndrome (MERS), the Centers for Disease Control and Prevention’s (CDC) emergency response system quickly swung into action.

Led by Dr. David Swerdlow, the CDC sent a team to Indiana for an on-site investigation, confirmed the laboratory test results, worked with the hospital to make sure the sick patient was in isolation, helped identify and contact more than 500 people who might have been exposed to the patient on flights, a bus trip and elsewhere, and made sure more than 50 at-risk health care workers were quarantined. The CDC also issued numerous alerts to the public health community.

A second case of MERS subsequently was confirmed in Orange County, Florida, and the CDC followed the same script.

“We are as prepared as we can be,’’ said Swerdlow. “This is a very infectious and dangerous disease.”

That preparation began some 18 months earlier after the first cases of MERS were reported in Saudi Arabia, and when other cases began to appear in the Middle East. This raised concerns about the global spread of an illness with a high fatality rate and no known treatment. MERS attacks the respiratory system, can lead to pneumonia and kidney failure and comes with symptoms which include fever, cough and shortness of breath.

Who is David Swerdlow?

POSITION: Incident Manager of Center for Disease Control and Prevention's (CDC) MERS Coronavirus Response, and CDC Associate Director for Science, National Center for Immunization and Respiratory Diseases.

RESIDENCE: Atlanta, Ga.

AGE: 55

EDUCATION: University of California, San Diego, B.A.; Harvard Medical School, M.D

AWARDS: U. S. Public Health Service outstanding citation in 2013 for the response to influenza A infections with pandemic potential; in 2012 for providing significant relief to citizens of Haiti following one of the largest cholera outbreaks in history; and in 2011 for exemplary performance to provide public health support for the U.S. Botulism Treatment Program. He received the 2011 and 2010 National Center for Emerging and Zoonotic Infectious Diseases Awards of Excellence and the 2010 Charles C. Shepard Award for Excellence in Scientific Achievement.

HOBBIES:Photography, bicycling and traveling

Swerdlow said his team initially set up an emergency operations center in the fall of 2012, developed laboratory tests to identify MERS and provided guidance to the medical community on the symptoms and treatment options. The CDC also developed and disseminated information on how to find and notify those who may have been exposed, the ways to protect those at risk and how to conduct good infection control.

The playbook for this operation, Swerdlow said, came from the CDC’s experience in 2003 with Severe Acute Respiratory Syndrome (SARS), another viral respiratory illness that caused more than 8,273 illnesses and 775 deaths reported worldwide.

“We recognized the lessons from the SARS outbreak were really important,” said Swerdlow. “We spent a lot of time preparing for possible cases of MERS when we didn’t have a case. We feel very satisfied that all the effort we put into this to prepare was very valuable and now has paid off.”

The patient in Indiana, a healthcare worker employed in Saudi Arabia, has since recovered and was released from the hospital, but Swerdlow said the CDC remains vigilant. The second patient is also a healthcare worker from Saudi Arabia who arrived in the U.S. on May 1 and entered the hospital on May 8. A third case involved a resident in Illinois who had close contact with a patient in Indiana. The Illinois resident did not seek or require medical care and was reported to be feeling well.

Swerdlow, whose full time job is as associate director for science at the CDC’s, National Center for Immunization and Respiratory Diseases, brought years of experience to the MERS emergency response team.

He has held leadership roles during CDC emergency responses to the Haiti cholera epidemic in 2010, the pandemic Influenza A (H1N1) outbreak in 2009, Hurricane Katrina in 2005 and the anthrax bioterrorism attacks in 2001. Before that, he spent more than a decade at CDC studying the epidemiology of foodborne diseases and was involved in investigating a major salmonella outbreak that was eventually linked to peppers from Mexico.

During the H1N1 pandemic, Swerdlow was the co-lead during the field investigation to determine how the virus spread, its severity and the causes of deaths. In Haiti, he helped establish a program to get clean water to the affected population since oral hydration can help prevent cholera deaths. As far back as 1991, he worked in a Malawi refugee camp investigating the causes of a cholera outbreak in Mozambique, and helped determine how individuals were exposed to contaminated drinking water that was a major factor in the spread of the disease.

Anne Schuchat, the director of CDC's National Center for Immunization and Respiratory Diseases, said Swerdlow did an amazing job establishing the emergency response system for MERS, worked through many difficult challenges and fully prepared the CDC and public health community to deal with the potentially very dangerous disease.

“He is really good in the emergency context because he is calm, thoughtful, has lots of energy and knows how to deal with the immediate crisis while also being able to take the long view,” said Schuchat. “He does what needs to be done and thinks beyond that to what is possible.”

When he is not involved in emergency response activities, Swerdlow spends time reviewing scientific research for publication, and has co-authored over 200 peer-review articles, book chapters and government documents. He also has done a great deal of work on predictive modeling to anticipate emerging health threats and works as a clinical assistant professor of medicine at the Emory University School of Medicine and as an adjunct assistant professor at Rollins School of Public Health at Emory.

Swerdlow said coming out of Harvard  Medical School, he thought a great deal about the type of medicine he wanted to practice, and quickly came to realize that he could make a significant difference in the field of public health.

“In public health, you can really have an impact on many people’s lives and prevent illnesses and death,” he said. “It is a great opportunity to help people in the United States and around the world.”

This article was jointly prepared by the Partnership for Public Service, a group seeking to enhance the performance of the federal government, and washingtonpost.com. Go to the Fed Page of The Washington Post to read about other federal workers who are making a difference. To recommend a Federal Player of the Week, contact us at fedplayers@ourpublicservice.org.

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