Dr. Robyn Gershon, an epidemiologist and an expert on disaster preparation in the workplace, addressed students in a lecture hosted by CU Journal of Global Health.
For an event called “Pandemics and Disaster Preparedness”, there is no speaker better prepared than Dr. Robyn Gershon, who has spent her career studying epidemics such as HIV, and workplace safety in setting from labs to office spaces. Dr. Gershon is a researcher focused on disaster preparation in high-risk careers. She previously was a professor at Columbia’s Mailman School of Public Health, and now is a professor at NYU’s School of Global Public Health.
She began her talk by discussing the broad field of public health, which encompasses many areas and has allowed her a very diverse career. She brought up her time teaching Masters of Public Health students at Columbia, and that her students proceeded to law school, business school, medical school to practice or research, or directly to careers at Departments of Health in various cities. Alongside the diversity of opportunities available in the field of public health, Dr. Gershon also cited the need for public health experts, as there is an increase in both frequency and severity of disaster events in the U.S. and around the world. To this end, Dr. Gershon stated that public health is the fastest-growing undergraduate major.
Dr. Gershon explained the many facets of her career. She studied medical microbiology in her undergraduate and master’s degrees and did clinical research at Yale. She loved this work (and noted that she still does) but saw that the field was becoming mechanized and that the benchwork she loved was no longer a possibility. There was an opening in the Yale department of biological safety, and despite not initially having the training, she took on a role in this department, supporting research groups working with chemical hazards. Dr. Gershon discussed the “shortcuts” she saw during her time at the Yale lab, with horrible effects. First, she told the story about a veterinary student who was bitten by a primate infected with simian herpes, a disease with a 100% fatality rate in humans. The vet had his blood tested daily, and Dr. Gershon described how the uncertainty of his prognosis took such a toll on his mental health that even when he tested negative for simian herpes, he left the field, and Dr. Gershon has not heard from him since. She also told the story of a researcher working with glass tubes of hepatitis-B-positive blood, with no gloves (the usage of gloves was a requirement at this lab.) The researcher contracted hepatitis B through open cuts on her hands and died shortly after. When a student asked about Dr. Gershon’s inspiration, she relayed these two tragic stories, and how they might have been avoided with simple workplace precautions.
Dr. Gershon realized that she required more education about the broader field of occupational safety. In 1990, she began a fellowship at Johns Hopkins University, which offered one of the few doctoral programs in occupational safety. (At this point, she recommended to the audience to attend a graduate school that will cover tuition and a living stipend to avoid starting a career with a lot of loans.) Dr. Gershon described an influential summer she spent at Fort Detrick, a high-containment facility that processed many dangerous pathogens that was the first to develop ELISA test kits for HIV, which is a now-common test for HIV antibodies in a blood sample. She was charged with developing the safety program for the production of these kits, as production had already begun without a safety program in place. She described the moment where she looked into the production lab and saw technicians working with 400-gallon vats of pure HIV wearing only lab coats and one pair of gloves with unidentified liquid on the floor. This moment, she stated, changed her perspective on the importance of disaster science. Eight months later, the CDC released a report about HIV in healthcare workers, which noted that workers were not taking precautions because they believed they already had HIV. Gershon’s realization about the importance of protecting workers from dangerous pathogens fueled her thesis work on HIV in healthcare workers and her assistance in writing the OSHA bloodborne pathogens standard.
After completing her doctorate, Dr. Gershon was offered the position of Occupational and Environmental Health Director at Stanford University. She explained that this would have required relocation from Baltimore to California, and that she had to consider her husband’s career as well, and that in partnerships more broadly, you can never consider one career move, as it will always affect both people. Dr. Gershon joined the faculty at Hopkins, received an NIH grant, and developed a hospital safety course. She noted that as an institution, Hopkins “doesn’t want” teachers, but rather researchers, and advised the audience to consider whether they wanted to teach or to research.
Dr. Gershon stayed at Hopkins until 2000, when her husband, also an epidemiologist, was offered a position in New York City. They moved, and she became a professor at Mailman. She noted that there were many more research opportunities in New York City, namely a study of the evacuation of the World Trade Center on 9/11. This study, focusing on what factors helped or hindered people evacuating a building in a disaster scenario, informed new codes high-rise buildings in NYC. During this research, she met weekly with the New York Fire Department to discuss changes to building codes, and she described how valuable it was to have people in positions of power making changes based on her research. When asked about this study later in the talk, Dr. Gershon shared that as a result of this study, NYC high-rise buildings are required to have an Emergency Director (“not just a retired firefighter) who is trained to handle situations such as chemical terrorism, biological terrorism, fire, or an active shooter. NYC fire codes are considered the gold standard in the US, and many major cities have followed suit. As for the study itself, it has been published in a variety of sources, including fire safety journals and public health journals. She explained that it had such wide professional appeal because it was essentially about human behavior in extreme situations when people don’t have complete information but have to make a fast decision, an assessment known as risk perception.
After her time at Columbia, Dr. Gershon moved to UC Berkeley’s School of Public Health, where she taught in the two-year, online SPH program.
Opportunities again arose on the East Coast for Dr. Gershon and her husband. They re-relocated to NYC, where her husband is currently a professor at Yale, and she develops and teaches healthcare disasters courses at NYU. She related her experience with this course last spring, initially designed with many site visits, and interviews, but disrupted by the move to remote learning due to the COVID-19 pandemic. As a result, she adjusted her summer healthcare disaster courses to be much more COVID-centric and was able to provide a supportive space to her students, who were all MPHs, MDs, and RNs, who were suffering a great deal.
She closed her remarks by again highlighting the diversity of career opportunities available in the field of public health, whether that is the “shoe-leather epidemiology” at an Institute of Health (checking restaurants or water supplies, for example) or as a public health journalist, stating that what we are seeing now with the COVID-19 pandemic is what happens when people are unaware of the importance of preventative public health measures, or when public health guidelines are poorly communicated.
Dr. Gershon proceeded to take questions from the audience. One student asked how she thinks the COVID-19 pandemic will affect workplace safety policy. Dr. Gershon noted the recent trend in open office spaces is to encourage interdisciplinary work and collaboration but has the unfortunate side effect of spreading illnesses. She believed that there will be a movement away from this open plan, as well as open kitchen spaces in workplaces, where for example employees place their personal water bottles right against the spout of a water cooler. She also said that face mask use will increase, particularly in close spaces such as public transport, as well as better coughing etiquette and increased handwashing/use of hand sanitizer. Dr. Gershon expressed concern about the general lack of funding for public health measures, saying that $1 spent on preparation equals $10 saved in disaster scenarios, alongside many lives. Additionally, she noted that public health is an aging field, and hoped that young people continue to join the field, even if with only an undergraduate degree.
A student asked about other landmark studies on disaster planning. Dr. Gershon noted that in all three of the courses she currently teaches, students have to write a disaster plan for a certain building. These plans cover all manner of disaster situations, including extreme weather like summer heat and winter weather, or diseases like Ebola and Zika. Currently, her students are writing COVID-19 plans for nursing homes, dialysis centers, and other institutions that lack a specified plan, or have not updated their plan with new knowledge about COVID-19. As for landmark studies, Dr. Gershon explained that disaster science is a new field, with new theories about risk perception and risk communication, as well as how to prepare a community to be resilient. She noted the work of disaster sociologists, studying the influences of social media, religion, friends or family, and previous disaster experience on an individual’s risk perception in a given disaster situation.
There was a question about Dr. Gershon’s interactions with the US government during her HIV research. She discussed her experiences writing an HIV safety plan with OSHA and NIOSH. She noted that at the level of plan-writing, her point of contact at OSHA was not a political appointment, but was a career scientist. Dr. Gershon furthermore expressed concern about the politicization of diseases, saying “These pathogens don’t care what your political affiliation is”, and noting how quickly HIV decimated the US because politicians like President Ronald Reagan, President George H.W. Bush, and President George W. Bush were unwilling to address the epidemic, and how quickly COVID-19 got out of control for the same reasons. Dr. Gershon expressed certainty about a COVID-19 vaccine but noted that there does not yet exist a cure or vaccine for AIDS. More broadly, she contextualized both viruses in the context of the 80 new pathogens (including illnesses like SARS or Ebola) that have appeared in the past decade, and that humans are very susceptible to.
With this, another student asked how we can prepare for the future. Dr. Gershon explained the existing practice of syndromic surveillance, where the Department of Health is able to track purchases of items like Advil, thermometers, and anti-diarrheal medications at NYC pharmacies, and thus gain insight out outbreaks of respiratory or foodborne illnesses. Similarly, the DOH monitors ICU beds across the city for trends in illnesses. This system, however, is not perfect. In terms of the COVID-19 pandemic, it could not have accounted for the fact that COVID-19 is similar to the flu, and appeared in the US at the end of flu season. As a result, the outbreak spread significantly in NYC before the DOH had “situational awareness” of it. Dr. Gershon also expressed disdain for high-level politicians who knew the risks of COVID-19 and did not act sufficiently to limit the extent of the outbreak, as well as her belief that no politician should get involved in the CDC in a way that obstructs its operation.
In all, this event underlined the importance of simple workplace safety procedures, to prevent preventable tragedies, in the larger context of general preparation for disaster situations. Dr. Gershon’s expertise also contextualized the lack of preparation that has caused COVID-19 to be so deadly in the United States.
An example of workplace safety via Wikimedia Commons