His job as Seattle and King County’s chief epidemiologist puts him on the front lines of every scary germ and virus to hit the news.
DR. JEFFREY DUCHIN had his marching orders: grab a respirator, hop a plane to New Mexico and help find the biological agent that was killing young members of the Navajo Nation.
The public was in a panic, and members of the tribe were being shunned when Duchin, now Seattle and King County’s chief epidemiologist, flew into the center of the 1993 epidemic as a disease detective for the federal Centers for Disease Control and Prevention.
Duchin studied the medical charts of the dead while two colleagues interviewed tribal elders and collected tissue samples from autopsies for analysis at the CDC lab.
Within a week, the CDC identified the culprit: a new form of hantavirus transmitted via deer mouse droppings. By the time the investigation was over, Duchin, who had planned to be an emergency-room doctor, was charting a career path in the high-stakes world of public health.
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“It’s one of those lessons where you think you know what you want in life, but you never can predict the best course of action,’’ he says, recalling the investigation that earned him recognition for “exceptional performance” from the U.S. secretary of the Department of Health and Human Services.
Today, the 57-year-old physician presides over a core staff of about 30 as chief of the section that handles communicable disease and immunization for Public Health — Seattle & King County. The job, which he has held since 1999, puts him on the front lines of every scary germ and virus to hit the news. His areas of expertise are a word salad of unpleasantness: bioterrorism, pandemic flu, microbial threats, disaster medicine, rabies, tuberculosis, HIV, hantavirus, Legionnaires’ disease . . .
Duchin (pronounced Dew-shin) also was recently named the health department’s interim local health officer, a job that comes with the power to quarantine people, and the responsibility for developing plans and strategies to protect the public from existing and emerging health threats.
When he’s not pondering nightmarish scenarios, he’s overseeing day-to-day monitoring of infectious diseases, building networks among health-care providers, and educating a public that often lacks even a rudimentary understanding of basic biology.
IT’S A FIRE HOSE OF A LIFE. On a recent day, Duchin’s inbox of emails numbers 1,600. Towers of papers — reports and articles waiting to be read — cover his circular conference table. He’s got meetings and a planning drill for potential Ebola cases, and, at lunchtime, a radio interview explaining why this year’s flu vaccine missed the mark.
With so much doom and gloom waiting, it’s no wonder Duchin’s modest office feels more dorm room than war room. Some of his more kitschy items: a Viking helmet on a Styrofoam head, a movie poster for “A Town Called Panic,” a New Yorker cartoon showing a man swatting at flies, and a pack of dried fish Duchin calls “an outbreak in a package.”
“I picked it off the shelves so one less person gets sick,’’ he says, only half-joking.
In one framed photo, Duchin’s colleagues are wearing masks of his face, complete with the reading glasses that sit atop his bald head like mouse ears. They sent it to him via email when he was at a meeting in Washington, D.C.
“A sense of humor in this job is essential,’’ he says. “It’s a stressful environment.”
Duchin’s preferred dress — jeans or khakis and a collared shirt — give him a laid-back look. But if there were an Olympics for overachievers, Duchin would be a serious contender. He teaches at the University of Washington as a professor of medicine in the Division of Allergy and Infectious Diseases, as an adjunct professor at UW’s School of Public Health and as a faculty member at the Northwest Center for Public Health Practice. He also has served on five CDC committees or work groups, on a national forum on microbial threats, and as chairman of the public health committee at the Infectious Diseases Society of America.
“Jeff really is one of the small, elite group of outstanding public-health officers,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, who has known Duchin for about 20 years. “He thinks with his head in the clouds and operates with his feet planted firmly on the ground.”
Osterholm says Duchin’s involvement with national and international committees gives him a unique perspective that has helped make Seattle and King County’s public health department “one of the top four or five local health departments in the country.”
Swedish Medical Center’s director of epidemiology, Will Shelton, calls Duchin “a treasure” who has built strong ties with the local medical community and developed ways of communicating quickly with health-care providers on the front lines.
Communicating with the public is one of Duchin’s most important responsibilities. Occasionally, some say, he gets it wrong. He came under fire recently for failing to notify patients or the public about an outbreak of deadly drug-resistant bacteria at a hospital. The outbreak was linked to a type of endoscope that harbors bacteria even after it’s cleaned according to manufacturer instructions.
Duchin defended his failure to disclose the outbreak locally, saying there was no ongoing threat to patients and that nothing could be done for patients who had become infected. The problem, he said, was potentially inadequate cleaning standards, and he was working to address that issue at the federal level.
It was a rare misstep for a man who publicly criticized the CDC for being too pat in its answers when facing public panic last year over the death of an Ebola patient in Dallas.
“It’s just as important to say what you don’t know as what you know,’’ he says.
Talking about any outbreak always has the potential to stigmatize victims, so he treads carefully, he says. And even with the best communication, some people still are going to scare easily.
“Dealing with panic is our bread and butter,’’ he says.
JULIA BYRD comes to work every day by 8 a.m. expecting possible disaster.
Ebola doesn’t scare me, or scare me like some other things.”
“You never know what’s going to happen,’’ she says. “Every day is different.”
In 2013, the communicable disease section where she is a program manager handled more than 5,000 reports of communicable diseases, including 1,004 new cases of chronic hepatitis C, 507 cases of chronic hepatitis B, 126 cases of pertussis, 115 cases of suspected rabies exposure and more than 600 cases of food-borne illness, including 199 cases of salmonella.
Byrd has helped investigate every major outbreak since joining Public Health in 1989. When she started, record-keeping was done on paper, and it was difficult to spot connections. Today the department monitors the local prevalence of about 80 conditions, using databases that provide up-to-the-minute information.
The 1990s were marked by a wave of food-poisoning cases, including E. coli linked to undercooked hamburgers at Jack in the Box.
“I’ve never worked so hard in my life,’’ she says of the 1993 disease investigation, which required hundreds of phone calls and in-depth interviews to find links between the victims. “It happened fast, and then was just furious. There were a couple of kids in critical condition, and they were just eating a hamburger.”
That E. coli outbreak was followed by another, linked to unpasteurized apple juice made by Odwalla.
“We went from one outbreak to another outbreak to another outbreak,’’ she says. “And while that’s going on, you’ve got to keep your regular surveillance going on.”
Duchin arrived at the department in 1999 just as bioterrorism was entering the public consciousness. The riots that accompanied the World Trade Organization meeting in Seattle that year revealed the need for better responses and more resources.
Byrd says the department rented 15 laptop computers to monitor incoming patients at area emergency rooms for exposure to biological agents.
After WTO came anthrax and SARS, concerns about smallpox, and biological weapons.
Next was the H1N1 or “swine flu” outbreak of 2009, an epidemic that peaked before the vaccine was available for the public. Now, there’s Ebola and measles at Disneyland.
“We are so much better about getting on stuff,’’ Byrd says. “Ebola doesn’t scare me, or scare me like some other things.” The team’s been through the drill before, she says, and everyone knows their roles.
Shortly after Duchin arrived, he started an “emergency outbreak response group” to enable hospitals to work together during severe biological emergencies. That group evolved into the Northwest Healthcare Response Network.
The day-to-day work is “very labor intensive,’’ Duchin says. “It’s ongoing, based on building human relations. It’s not something you can do one time and say, ‘Got it!’ They have to be constantly nurtured, these relationships, and people turn over, and new people come in, and old people leave, and things change.”
Byrd attends daily meetings at 2:30 p.m. in which Public Health epidemiologists and nurse disease investigators review current cases and compare notes.
“This is where the magic happens,’’ Byrd says, as she settles into a seat around a conference table where the staff shares details and looks for trends.
On this day, cases include monitoring 31 travelers for Ebola, and tracking people with measles, influenza, and a man who is refusing preventive treatment for rabies after a bat flew into his face. Duchin is not happy about the refusal and has ordered a strongly worded letter urging the man to get recommended treatment.
The team also is wrapping up a salmonella investigation that sickened nearly 40 people in six counties.
The investigation is all but complete, but it’s clear there’s still work to do.
IN JUNE, Duchin’s team began receiving reports of salmonella, a bacteria that can spread through raw or partially cooked food. It causes bloody diarrhea and sometimes more serious illnesses.
The team interviewed health-care providers, patients and their families, and quickly deduced it was being spread through food. But they couldn’t determine how the cases were linked. The team brought in Eyob Mazengia, a researcher and supervisor in the public health section that oversees food safety.
Mazengia recognized the victims were of Ethiopian origin, so he wrote a lengthy questionnaire that addressed specific Ethiopian cultural practices, including sharing food and eating raw or undercooked beef either sliced or ground and mixed with spices in a widely consumed dish called kitfo.
The beef is so popular that when it’s delivered fresh to local markets on Thursdays and Saturdays, customers queue up to buy it, and bring it home or sit down on site to share it with friends.
Through questionnaires, interviews and gumshoe detective work, the investigators learned that cows were being purchased at a livestock auction in Chehalis and taken to off-the-grid slaughterhouses. The meat was then transported in large plastic tubs via cars and trucks to restaurants and delis in King County and elsewhere.
The purchase and slaughter methods were similar to those practiced in Ethiopia, where backyard slaughter is common and meat-handling practices vary widely.
The culprit in the outbreak, however, proved to be the plastic tubs used for transport. They weren’t sanitized properly, so contamination was a recurring problem. The team went into high gear, recognizing people were at risk for more serious food-borne illnesses such as E. coli unless handling practices changed.
Mazengia organized a meeting where owners of Ethiopian food establishments could meet with representatives of state and federal agricultural departments, and state and local health departments, to review approved slaughtering activities and safe food-handling practices.
He also asked Assaye Abunie, director of the Multimedia Resources and Training Institute in Seattle, to host a panel discussion on safe food-handling practices to air with Amharic subtitles on Seattle Community Media’s Ethio Youth Media TV channel.
The meeting and the television program got people in Seattle’s Ethiopian community talking. As word spread, one restaurant linked to the outbreak went out of business, even as its owner denied there was a problem, Abunie says.
Abunie, who trains journalists from ethnic communities, is working on a documentary about the salmonella outbreak that will air here on Ethio TV.
He says people are aware of the risk from raw beef and have curbed their consumption. Still, undercooked beef remains on the menu at Ethiopian restaurants, and people still buy fresh meat to take home and eat raw with a side of habanero peppers or ground as kitfo.
THE IMPACT to businesses and people who become ill is always a concern, Duchin says, and some people will panic no matter what.
“If you’re investigating an outbreak in a certain community, if a lot of attention is focused on that community publicly, they’re at risk for being discriminated against and having negative consequences,’’ he says. “It interferes with your ability to do an outbreak investigation. They don’t want to cooperate with you because they feel like the more scrutiny is brought . . . the more hardship they’re going to have.”
The work goes on with growing challenges.
Duchin worries about scientific illiteracy that keeps people from getting vaccinations or taking simple steps — such as washing their hands — to keep themselves and others safe.
And he worries about social and environmental ills, things like growing income disparities that make it more likely people will delay medical care in the early stages of disease, setting up possible outbreaks with more serious illnesses.
His voice drops and his brow knits as he speaks about global warming. It’s one more nightmare for him to ponder and plan for.
He points to the New Yorker cartoon on his wall, the one with the man swatting at flies.
“That’s me,’’ he says.