Local to Global Disease Detection: Alumni in Public Health Address COVID-19 Crisis

In this Dec. 6, 2012, file photo, minks look out of a cage at a fur farm in the village of Litusovo, northeast of Minsk, Belarus. Coronavirus outbreaks at mink farms in Spain and the Netherlands have scientists digging into how the animals got infected and if they can spread it to people. (AP Photo/Sergei Grits, File)

On two different sides of the world, two alumnae of the UW School of Veterinary Medicine were just getting settled into new professional roles when the novel coronavirus struck. They rolled up their sleeves, called upon the relationships, resources and skills they’ve developed, and led efforts to address the COVID-19 pandemic – all the while advancing other public health priorities as well. For both, their work is guided by a collaborative, cross-disciplinary One Health approach, recognizing that animal health, human health and the environment are interconnected.

Below, read more about the experiences of Stephanie Salyer DVM’11 and Darlene Konkle DVM’93, MS’97.

Stephanie Salyer DVM’11

Technical Advisor, Africa Centres for Disease Control and Prevention
Addis Ababa, Ethiopia

Since completing the dual doctor of veterinary medicine/master of public health (DVM/MPH) degree program at the University of Wisconsin-Madison, Stephanie Salyer has worked for the U.S. Centers for Disease Control and Prevention (U.S. CDC) in locations ranging from the state to the country of Georgia, from Kazakhstan to Colombia, Seychelles to Switzerland, and more.

She participated in U.S. CDC’s Epidemic Intelligence Service (EIS) postdoctoral training program from 2012-2014, stationed in Haiti as part of a multidisciplinary team supporting response and recovery work following the 2010 earthquake and subsequent outbreak of cholera. There she led a dengue outbreak investigation and tuberculosis surveillance evaluation, and supported the establishment of a rabies surveillance system.

Stephanie Salyer
Stephanie Salyer

In the time since, Salyer became a staff epidemiologist supporting U.S. CDC’s global work, with special emphasis on One Health-related activities. She supported the implementation of zoonotic disease surveys and surveillance in over 15 countries. Additionally, she served as a liaison between the U.S. CDC’s Center for Global Health and One Health Office, implementing zoonotic disease prioritization workshops and contributing to the development of the Tripartite Zoonoses Guide. (Salyer has seen the world – even before graduation, she completed coursework, externships and summer programs in Ecuador, Egypt, Uganda, Kenya and Chile.)

Salyer now works as a technical advisor for the Africa Centres for Disease Control and Prevention (Africa CDC), a specialized technical institution of the African Union (AU) established to support public health initiatives of AU Member States. She began this position in September 2019 and supports the agency’s One Health program, which included the development of a framework for One Health practice in Africa’s national public health institutes. She also conducts event-based disease surveillance, monitoring news and social media for signs of a potential disease outbreak or pandemic, like COVID-19, and making recommendations for interventions that might be needed.

UW SVM: How has the COVID-19 pandemic impacted your work?

Salyer: As soon as the first cases were reported on the continent, we quickly ramped up a team within Africa CDC to start monitoring the situation across Member States, gathering aggregate reports of cases, deaths and recoveries. We have been collecting those data every day, twice a day, and reporting on them, since the beginning of the pandemic. On a weekly basis, we also monitor trends and produce outbreak briefs. We have a number of tools we’ve developed to help inform Member States’ response efforts, including interactive dashboards in collaboration with partners like ESRI and Resolve to Save Lives.

You were the lead author of a research article published in The Lancet evaluating the pandemic’s progression in Africa. What were some of the major findings?

Africa CDC COVID-19 dashboard
An August 2021 screen capture of the Africa CDC COVID-19 dashboard, which is updated daily.

Early on, the continent really clamped down. They put a number of public health and social measures in place – shutting down travel, putting in place quarantines and curfews – to decrease transmission. And it worked. Africa didn’t have as many cases early on, as compared to many other countries outside the continent.

However, the second wave of cases on the continent coincided with the emergence of new, more transmissible variants and a decrease in the implementation of response measures. These factors most likely contributed to the second wave being much more severe on the continent than the first.

The second wave occurred right around the December holiday period and at the same time the beta variant was first discovered in South Africa. Healthcare facilities were overwhelmed, with no available beds or supplies of medical oxygen. Laboratories were unable to keep up with the demand for testing. And countries were hesitant to lock down as hard as they did initially, due to the negative impact these measures had on livelihoods and the economy.

What is the current status of the pandemic in Africa?  

Now the third wave is impacting the continent, and it is much worse than the second wave. Currently, there are now three variants of concern on the continent (alpha, beta and delta). And while there are now safe and effective vaccines available to help control transmission and prevent deaths, the African continent lacks access to these vaccines.

Expanding Africa’s Vaccine Manufacturing for Health Security
Africa CDC and the African Union are working to build vaccine manufacturing and increase access on the continent. Credit: Africa CDC

As of July 2021, less than 2 percent of the population has been vaccinated. To help meet the continental goal of vaccinating at least 35 percent of the population by the end of this year, Africa CDC and the AU have put in place a procurement mechanism (AVATT) and a strategy to help build vaccine manufacturing on the continent. Additionally, Africa CDC has been working with many partners like the U.S. government, World Health Organization through COVAX (COVID-19 Vaccines Global Access) and pharmaceutical companies to increase vaccine access on the continent.

While vaccine is starting to arrive, there still is a major issue of inequity. It is a serious concern that countries are still struggling to get vaccine to priority populations like first responders.

Post-pandemic, where do you see your work heading?

Over the last six months, we’ve tried hard to start engaging again with AU Member States regarding our routine work. One of the key things I’m focusing on now is supporting Africa CDC’s One Health Programme and starting to implement our One Health framework.

We are starting to develop training materials for community-level event-based surveillance, incorporating a One Health approach to detect events as early as possible and improve a country’s early warning system. Community health workers can be trained to look for signals in the environment and animals before they spill over into the human populations. In effect, trying to get ahead of the next COVID-19.

Additionally, we are advocating for the different health sectors or ministries within a Member State to coordinate surveillance efforts and share information, especially with regard to diseases that are zoonotic or events that impact animal populations, the environment and humans.

“While vaccine is starting to arrive, there still is a major issue of inequity. It is a serious concern that countries are still struggling to get vaccine to priority populations like first responders.”

What advice might you share with students related to the intersection of public health and veterinary medicine?

For new students trying to figure out what they should do, I would suggest taking advantage of and being open to trying new things. This is how I stumbled into public health. Once you have an idea of what you want to do, find a mentor. Find somebody that you connect with, who is doing the work that you hope to do in the future, and seek out as many opportunities as you can in this area with their guidance. But also, never forget to maintain your curiosity and willingness to evolve with your career over time. (Related: View CDC fellowship opportunities.)

Darlene Konkle DVM’93, MS’97

Wisconsin State Veterinarian
Madison, Wisconsin

Darlene Konkle
Darlene Konkle

In September 2019, Darlene Konkle was named Wisconsin State Veterinarian – the state’s chief animal health official. Six months later, COVID-19 was declared a global pandemic, spurring Konkle and her Wisconsin Department of Agriculture, Trade and Consumer Protection (DATCP) colleagues into action to safeguard companion animals, animal agriculture and public health.

Konkle has been with DATCP’s Division of Animal Health since 2005, and had served as the acting state veterinarian since June 2018, preceded by five years as the assistant state veterinarian. In her time with the department, she has developed disease control methods to reduce threats to the state’s livestock sector, led the response to an outbreak of highly pathogenic avian influenza and overseen the response to bovine tuberculosis in a Wisconsin dairy herd.

Drawing on her years of experience and strong relationships established with state and federal agencies, Konkle coordinated swiftly to guide the Division of Animal Health’s COVID-19 prevention and response efforts.

UW SVM: Looking back on the start of the COVID-19 pandemic, what were some of the first issues you had to address?

Konkle: Initially, there was a lot of concern about animals. There was a lot we didn’t know – can animals get SARS-COV-2, the virus responsible for COVID-19? We didn’t know which species were susceptible, how susceptible and what role that might play for public health.

Dog owners wearing masks to help protect against the spread of coronavirus speak along a street in June 2021. (AP Photo/Burhan Ozbilici)
Dog owners wearing masks to help protect against the spread of coronavirus speak along a street in June 2021. (AP Photo/Burhan Ozbilici)

It turns out the virus is zoonotic; it probably originated from animals somewhere. And we found that people can transmit the virus to some animals. What we eventually found is that yes, companion animals can become infected. But they don’t seem to be particularly susceptible. The number of reports in animals so far is very small compared to human infections. And there doesn’t seem to be any evidence that companion animals can transmit the virus back to people.

As we learned more and information was shared between public health and animal health sources, we were able to let veterinarians and the public know that animals are not a major source of infection for people or a cause of propagation in this pandemic. So hopefully, we were able to alleviate fears in that way.

Then it emerged that mink and other animals within the Mustelidae family could be infected, and eventually, some farmed mink tested positive in Wisconsin. What course of events did this set in motion?

USDA, in collaboration with CDC, came out with biosecurity guidance for mink farmers because we knew mink were a susceptible species. A couple of veterinarians in Wisconsin specialize in mink, so we worked with them, as well as local and state public health, to disseminate that biosecurity information to mink farmers.

We then received two reports in the fall of last year of positive farms within Wisconsin in Taylor County. We quarantined those farms as soon as we were aware. The veterinarians were very quick to spot that this was something unusual and suspected SARS-COV-2 right away. They sent samples through the Wisconsin Veterinary Diagnostic Lab, so I and my state public health counterpart, Rachel Klos DVM’04 (an epidemiologist with the Wisconsin Department of Health Services), were informed quickly.

We (Wisconsin Division of Animal Health) quarantined the farm to limit any movement which could transmit the virus. We also worked through appropriate methods to dispose of any animals that had died, did follow-up testing, and developed protocols for when to release the quarantines and how to handle pelts from these farms so the owners could have some business continuity to move low-risk products.

We developed a protocol, in consultation with CDC, USDA and others, for storage of the pelts, which involves reaching an appropriate temperature for an appropriate amount of time. Then they (the pelts) could be released from quarantine. Putting our heads together and assessing the best available information, we thought this was a low-risk product and low-risk movement for public health and animal health.

Where do things stand currently with Wisconsin mink farms?

In this Dec. 6, 2012, file photo, minks look out of a cage at a fur farm in the village of Litusovo, northeast of Minsk, Belarus. Coronavirus outbreaks at mink farms in Spain and the Netherlands have scientists digging into how the animals got infected and if they can spread it to people. (AP Photo/Sergei Grits, File)
In this 2012 file photo, minks look out of a cage at a fur farm in Belarus. (AP Photo/Sergei Grits)

Those farms are nearing the end of their quarantine process. The mink have tested negative for two rounds, so they have cleared the virus in live animals and are not seeing any signs of problems currently. Vaccine manufacturers have done the initial testing on a COVID-19 vaccine for mink and other animals and now have approval from the USDA’s Center for Veterinary Biologics to market those vaccines to mink farmers in an experimental use category.

DATCP evaluated the vaccine as part of a standard process for approvals for biological products. We approved the vaccine’s use for Wisconsin mink farms and a couple of zoos in Wisconsin. We felt the vaccine was a tool that could be used for mink, much as in people, to help control the transmission of this virus in a  species that is quite susceptible.

Could you describe some of the other collaborators you’ve been working with?

The COVID-19 pandemic and associated concerns with animals has really been a One Health effort. We’ve been sharing information all along with our public health and wildlife health counterparts. The CDC One Health group, USDA One Health group, and all of the state public health and animal health officials get together on weekly calls to get updates and share information. As the pandemic progressed, we had a clearinghouse to share that information and make sure it was available to people.

When we started to see positive mink farms, the various states affected – Utah, Michigan, Wisconsin and Oregon have had positive cases – also held a weekly call with our state and federal counterparts to share information and try to be consistent in our response.

“The groundwork we’ve laid over the past few years in working with our public health and wildlife health colleagues paid off, as we were able to respond pretty quickly and work for the good of public health and animal health.”

Of course, the pandemic isn’t happening in a bubble. Amidst COVID-19, what other concerns have you had to address?

Business as usual went on as well, so we still needed to remain vigilant and work with our other disease management and control programs, including tuberculosis, brucellosis and chronic wasting disease. We didn’t have any major other outbreaks but were still working to maintain those programs for our state.

Reflecting on the past many months, are there lessons you’ve drawn from the experience?

The networks and relationships we’ve maintained helped us to deal with this. The groundwork we’ve laid over the past few years in working with our public health and wildlife health colleagues paid off, as we were able to respond pretty quickly and work for the good of public health and animal health.

Moving forward, we want to use all we learned here and continue to work on those relationships. We know we’re going to see more of these One Health types of incidents and more emerging diseases. And we know that anything we face is going to impact public health, if not directly, indirectly because of people’s relationships with their animals and their livestock, and the potential to impact wildlife as well.

Is there anything you’d want to say to students about the importance and potential available in this field of work?

I definitely think there’s a lot of potential for students to become engaged with animal health regulatory and One Health efforts. We see students coming through our office for externships and we’re happy to show them what we do and the impacts of this type of work. We’ve seen more interest in the past few years. When I was in school more than 25 years ago, we didn’t get a lot of exposure to it. I think all students should be aware of the larger impacts for animal health and public health – every veterinarian has that charge to protect animal and public health and to stay aware of emerging trends and diseases.

For those who might want to work in this field, there’s a lot of opportunities either through the SVM’s joint DVM/MPH program or working as a program veterinarian in our office or with the USDA, and we also employ veterinarians who work out in the field directly with private veterinarians and farmers.

Meghan Lepisto

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