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Tag: Duke Global Health Institute

Post-COVID: The New Normal in the Health Care System

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The COVID-19 pandemic sometimes feels like a problem we mostly dealt with yesterday, not one we’re still facing today. However, Duke medical anthropologist Harris Solomon had a different story to tell in the Trent Humanities in Medicine Lecture on April 9.

The transformations within Intensive Care Units (ICUs) across the globe, initially sparked by necessity, have morphed into what might be our “next normal,” Solomon said.

Harris Solomon. Associate Professor in the Department of Cultural Anthropology at Duke University

During the height of the pandemic, hospitals morphed into war zones where the frontlines became the ICU rooms. Like never before, these rooms became a no-man’s-land that few others would cross. A separation was born.

This separation, however, was beyond a physical space; it was a delineation of roles and responsibilities. Nurses often found themselves acting as intermediaries between the patient and the external healthcare team, prompting a sense of isolation and moral burden. They wrestled with their fears in solitary confinement, while colleagues relayed instructions over walkie-talkies—a stark contrast to the collaborative nature of pre-pandemic medicine. Protocols that were once straightforward now needed a touch of ‘MacGyvering,’ with clinicians making do with what was available.

The rigidity of clinical trials also faced challenges; the blinding of studies was questioned as lifesaving drugs teetered on the edge of accessibility. Solomon gave an example of what this change looked like in real life. A patient was due to be treated, and they said that they didn’t care about the details. Even if it was a placebo, they were fine with it. While he didn’t go into the specifics of what had happened, he used this story to accentuate the disparity between evidence and treatment. People don’t care about the treatment as much as they used to.

“We make decisions like we never did before. We summon the need to accept uncertainty”, Solomon said.

As the crisis was evolving, and the world was recovering from the aftermath of COVID, the fabric of healthcare work found itself to be changed forever. Processes and practices that were once considered to be stable, are now brought under a microscope in a post-pandemic world.

The pandemic has indeed been a catalyst for change, but is this change good? While there is no black-and-white answer, I left the room feeling a bit uncomfortable. Although the pandemic has prompted a reevaluation of the health care system, have we innovated, or have we just found shortcuts?

 

Big Bets on Humanity: How Rajiv Shah’s Audacity is Winning the Fight Against Pandemics

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If your community relied on COVID-19 rapid tests to reopen safely during the first year of the pandemic, there’s a good chance Rajiv Shah had something to do with it. Not just for his ambition but also for his audacity to transform the nature of our response to pandemics: Rajiv Shah, the president of the Rockefeller Foundation, played a crucial role in scaling up diagnostic testing for COVID-19.

He’s also the man who tackled Ebola with the Obama Administration. Back then, Shah and his team embarked on a “big bet” to deploy 2,500 troops to fight the disease, not on the battlefield, but on the frontlines of human health.  Much like the name of his 2023 book “Big Bets,” he embarked on a journey to change the world. 

In a Jan. 31 talk hosted by the Duke Global Health Institute, Shah discussed his “big bet mindset” when it comes to tackling public health challenges.

Bet #1 Diagnostic Testing at Scale 

For starters, what’s a big bet? 

“It’s a big bet you take on the community to help young people get opportunities. Often, when we think of charitable endeavors, we imagine that doing a little bit is beneficial because it makes us feel good. In contrast, a big endeavor means taking on something significant and engaging in the hard work necessary. It’s about going beyond just doing the best we can; this isn’t merely a charitable endeavor, it’s a strategic approach to ensure national security.” Shah explained. 

Keeping true to his word, the goal was clear: administer 30 million tests per week to preempt the need for lockdowns and enable a safer, faster return to normalcy. This was not just a health initiative; it was a socio-economic strategy aimed at averting total disaster. He took a big bet, and the numbers spoke for themselves. The Rockefeller Foundation played a pivotal role in assisting schools with their reopening strategies during the pandemic. This support included the establishment of collaborative networks, the development of resources and guidelines, and the provision of expert recommendations. Now do you get why this man probably saved your life? It’s because he did! 

Bet #2 A Memo for Bill Gates 

It wasn’t all that easy for him though. He had his haters (don’t we all?). Perhaps the difference was, his hater was Bill Gates. But he successfully proved Gates wrong too. Thankfully, Gates and Shah are more like besties than anything now. Despite the initial dismissal of his ideas as “the stupidest thing,” Shah’s persistence and innovative thinking paved the way for a groundbreaking bond structure to fund vaccinations, ultimately saving millions of children’s lives. Shah and Gates – two greats in one room – inevitability led to the production of something good: The Vaccine Alliance. This meeting set the stage for a three-year roadmap focused on a bond structure to fund vaccinations. This initiative ultimately contributed to saving 16 million children’s lives. 

The Final Bet: The Power of Experimentation. 

I’ll be honest, I was intimidated walking into this room. I was in my Duke hoodie, not expecting fancy foods, and coat checks (good news: this meant they recorded his speech and uploaded it on YouTube. Check it out!).

At the heart of Shah’s philosophy is a belief in the power of experimentation and innovation. His call to “keep experimenting” embodies the spirit of resilience and creativity that is essential for tackling the world’s most daunting health challenges. Being amidst well-suited individuals while donned in a hoodie wasn’t an experiment in the scientific sense, but it was an experience that highlighted the contrast between expectations and reality, comfort zones and the unfamiliar. It served as a metaphor for the broader experiments we’re all a part of—those that push us beyond our boundaries, challenge our preconceptions, and ultimately lead to growth.

His book was called ‘Big Bets’ because the editors thought it was catchy. They were right. But this title doesn’t just grab our attention—it invites us into a world where daring to dream big and taking calculated risks can lead to monumental changes in public health and beyond.

Post by Noor Nazir, class of 2027

The HIV/AIDS Epidemic: Revisiting the Early Days of a Global Health Crisis

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On June 5, 1981, the Centers for Disease Control and Prevention reported the first cases of a mysterious disease afflicting young, otherwise healthy men in a tiny suburb of Los Angeles, California. The disease, now known as AIDS, would go on to infect 85.6 million people around the world, sparking an epidemic that persists to this day.

On February 6, 2024, Duke’s Global Health Institute hosted a conversation with Dr. James Curran and Dr. Kevin M. De Cock, both former leaders at the CDC, about their experiences on the frontlines of the AIDS crisis in the earliest days of this epidemic. The conversation was moderated by Dr. Chris Beyrer and Dr. Nwora Lance Okeke, two Duke researchers in infectious disease.

Pictured from left to right: Dr. James Curran and Dr. Kevin M. De Cock

The Origin of the Epidemic

The first cases of AIDS were reported by Dr. Michael Gottlieb, a young immunologist from UCLA. His groundbreaking findings, published in the CDC’s Morbidity and Mortality Weekly Report, described “previously healthy gay men from Los Angeles, San Francisco, and New York, who presented with rare opportunistic infections,” said De Cock. These infections, known as PCP (Pneumocystis carinii pneumonia) and KS (Kaposi’s sarcoma), were extremely rare. Upon observation, Gottlieb identified a startling commonality among the cases: they were all sexually active gay men.

Michael Gottlieb: The Rutgers Alumnus Who First Identified the Deadly  Disease We Now Call AIDS | New Brunswick, NJ Patch

These findings “didn’t fit into any organizational unit at the CDC,” so a multispecialty task force was formed. Led by Curran, it recruited experts in STIs, parasitology, virology, cancer, and more.

Tracking the Epidemic

At the start of the epidemic, cases were phoned into the CDC by individual doctors. But this quickly became inadequate. The epidemic was growing fast, and CDC phone lines could not keep up. “The CDC, therefore, developed a surveillance case definition for the syndrome,” De Cock explained. “Cases meeting this definition were reported through health departments to the CDC.”

“I think we were able with the case definition for surveillance, to take advantage of the fact that all of these conditions were very serious and so unusual that the physician would say ‘I’ve never seen anything like it,’…,” Curran said. “The other conditions were far less specific and far less useful for tracking the disease.”

In October 1981, these tracking protocols helped identify AIDS as a sexually transmitted disease. A national case-control study found that sexual activity was a leading risk factor, and a cluster of cases in 10 US cities linked via sexual contact was discovered. “People just didn’t want to believe it,” Curran said. “They wanted to believe that it wasn’t something transmissible.” 

Expanding Epidemic

Over the next year, the epidemic expanded to include injection drug users, heterosexual partners of bisexual men, people of Haitian descent, and infants. But perhaps most surprising was the transmission occurring through blood transfusion. In December 1982, a case of AIDS-like illness was reported in a 20-month-old infant after receiving blood from a donor who later developed the virus.

“Until that December report of the infant, the mainstream media had actually paid very little attention to AIDS. But that suddenly changed,” said De Cock. “While AIDS was seen as a problem of marginalized groups… it was easy to ignore. But anyone might need a blood transfusion.”

In the following years, rumors surrounding transmission and contact sparked nationwide panic. Fear of contracting the disease caused AIDS patients to lose their jobs and housing. Although the CDC provided up-to-date information on the nature of the virus, quelling public fear was extremely difficult. “AIDS proved that you can’t separate prevention and treatment,” Curran explained.

Modern AIDS Era

As we get close… to 100 million HIV infections since the epidemic began- have we done as well as we should have?”

Dr. Kevin M. De Cock

In 1991, researchers successfully identified HIV (Human immunodeficiency virus) as the underlying cause of AIDS. Since then, scientific understanding of the disease has greatly improved. “Our success has made AIDS more normal, which has robbed the disease of some of its mystique,” De Cock expressed. However, there is still no known cure for AIDS. The disease is a lifelong battle that wreaks havoc on the people it infects.

HIV / AIDS - Our World in Data
Source: Our World in Data

De Cock and Curran’s contributions to the AIDS epidemic fundamentally shaped our understanding of the virus. Their work shines a light on the importance of frontline research and support. Their book, entitled ‘Dispatches from the AIDS Pandemic: A Public Health Story,’ is available to read here.

Written by Skylar Hughes, Class of 2025

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