Dr Hana Rohan is Assistant Professor in Social Science at LSHTM and a member of the UK Public Health Rapid Support Team. She completed her PhD at LSHTM in 2010 and is now supporting the Africa Centers for Disease Control and Prevention (Africa CDC) in responding to the COVID-19 outbreak.
How has the COVID-19 outbreak affected your work?
I am a member of the UK Public Health Rapid Support Team (UK-PHRST), it is one of our mandates to deploy globally to respond to public health emergencies and outbreaks. Our mandate also includes research and capacity building. My current deployment is to the Africa Centers for Disease Control and Prevention (Africa CDC). I was working at the Africa CDC headquarters in Addis Ababa with colleagues from the UK-PHRST when we had to all get on a flight to return to the UK, as it was unclear whether we would be able leave afterwards, due to the travel restrictions being put in place. All of my work now has shifted towards supporting the Africa CDC remotely with their COVID-19 response, my other work beyond that is now in a state of limbo. We are really putting all of our energy into dealing with this major event.
What does your work with the Africa CDC entail?
I have been doing a lot of guidance and policy development. For example, working on putting together community physical distancing guidelines, or a step-wise guidance for African Union Member States which gives them a template for the response to each phase in the outbreak. We have also been working on a document to help guide the exit from lockdown, as some Member States are now moving in that direction. I have also been working with the risk communications team, this has involved setting up a rumour tracking system at the continental level so that Africa CDC can respond appropriately to COVID-19 rumours and misinformation and help combat their spread.
Another very interesting and important recent development has been a real-time data collection platform which has just launched – the Partnership for Evidence-based Public Health Response to COVID-19. This brings together epidemiological data and socio-economic data, as well as information on acceptability of certain measures. We collect a range of data, including survey data from as many as 20 African countries to see the acceptance of physical distancing measures, what barriers there might be, but also the impact such measures could have. Especially in low and middle income countries we have concerns that long, or even short term, lockdowns are very difficult for people to adhere to. They will also have significant related social and economic costs, as well as indirect health effects as people may not be accessing health centres anymore.
How well equipped do you think African countries are to deal with COVID-19? How has the outbreak affected countries there?
It is hard to tell at this point, the shape of the epidemiological curve has not been quite the way we had anticipated it, not quite as acute as in European countries and in the US. We are not yet sure why that is, it could also be a question of how reliable the data are. It does however seem that the spread of infection is not accelerating as expected. This could be due to the younger age structure in African countries. On the flip side, we also know that the prevalence of certain co-morbidities is high, I am speaking about HIV, TB of course, but also malaria and malnutrition, we don’t yet know how these will come into play. In terms of response, many African countries took very early steps to close borders and institute some form of a lockdown and physical distancing.
In some ways African countries might also be better prepared, as there are other infectious diseases, such as cholera or typhus they have to deal with and the health systems might therefore be more adaptable and flexible. Of course countries with experience of dealing with Ebola have much stronger surveillance and public health capacities already in place.
How has LSHTM’s training helped you during this outbreak?
I think the educational experience that I received at LSHTM is really unrivalled. The applied way theoretical content is taught is really special. I wouldn’t say that my academic education alone prepared me for the current outbreak, of course 15 years of professional experience did more of that – and no one can be prepared for an event like this. However, LSHTM definitely set the ground work, providing me with qualitative and quantitative research skills and a strong analytical way of thinking and looking at public health which is helpful now at this time of scientific uncertainty.
Do you think public health/epidemiology and related fields will be seen as more important in future due to this outbreak?
I would like to think that public health expertise has been given a boost and a higher public standing. I am not sure whether a stronger reliance on science is really going to stay with us. I think we will have to see how everything plays out, especially here in the UK. I can say there is definitely a greater understanding of what I do for a living – epidemiology is now a household name, people no longer think I work on skin diseases! So, yes the public awareness of the discipline has grown massively.
Do you feel a sense of pride being able to support the response with your work and expertise?
It is difficult to gauge what impact my individual work will have, as the response to the outbreak is of course a collective effort. I am really proud of the work and great team that I am able to support at the Africa CDC and through the UK-PHRST. Africa CDC is really full of amazing people, but sadly quite under resourced. I also feel lucky to be able to be working on COVID-19, despite the pretty gruelling hours and lack of rest. I think it is emotionally helpful to focus on it technically, to be able to step away from the emotional response and concentrate on it through my professional lens and keep busy.
How was the outbreak affected you on a personal level?
Even for someone like me, who has worked on outbreaks before, it has come as a surprise how the current coronavirus outbreak has affected me emotionally. I think because it is everywhere and affects me directly, both personally and professionally. It takes a lot more emotional self-care to be alright. It is very intense and there is no way of escaping it. When I worked on Ebola in the past, of course it was really stressful and took its toll, however I was able to get on a plane for a few days and back home nobody was speaking about Ebola, now there is nothing else that is talked about. I keep saying it’s like looking at something familiar, but upside down.