RESOURCES:
Washtenaw County Health Department (WCHD)
CDC: Measles Cases and Outbreaks
State of Michigan Measles Updates
TRANSCRIPTION:
Caroline MacGregor: This is 89.1 WEMU. I'm Caroline MacGregor. And today, we are discussing the outbreak of measles in Washtenaw County that has expanded into neighboring Monroe County. Michigan cases are now among 17 new outbreaks nationwide that have been reported to the Centers for Disease Control and Prevention since January. To get the latest on efforts by health officials to contain the virus and associated costs of tracking the disease, my guest today is Washtenaw County Health Department Spokesperson Susan Ringler Cerniglia. Susan, thank you so much for joining us today!
Susan Ringler Cerniglia: Absolutely! Thanks for having me!
Caroline MacGregor: Susan, I believe there have been more than 1,600 confirmed cases of measles reported this year across 32 states. That's according to CDC data. And before talking about the actual tracing and cost, would you please bring us up to speed on the numbers here in Washtenaw County?
Susan Ringler Cerniglia: Yes. We're at seven cases still in Washtenaw County. As you mentioned, there has also been a case confirmed in neighboring Monroe County. We don't have definitive connection to that case, but, obviously, since we're having an outbreak, it's suspicious. And there's concern that we may be experiencing what we'd call community spread with that case. So, in other words, we don't know for sure that the Monroe case had contact with our case but are concerned that that spread is happening. These, to my knowledge right now, are the only cases confirmed for this year so far in Michigan.
Caroline MacGregor: Now, while the outbreak that you're dealing with in Washtenaw County seems small, it's still cause for alarm because of the effort that goes into basically tracking to contain the disease. Tell me about how this is going right now with your health department.
Susan Ringler Cerniglia: So, when we respond as a local health department, that one case of measles really triggers more of an emergency response, and that's for a couple of reasons. First and foremost, measles is incredibly contagious, one of the most contagious illnesses we know about. It's also potentially very serious, and some of the consequences of that serious illness can include things like pneumonia, encephalitis, lifelong disabilities, such as blindness or deafness, and, in some cases, death. Death is, of course, more rare, but nothing anybody wants to see particularly from a preventable illness. It's incredibly important that folks that are eligible for vaccination actually do that, and it can impact this whole situation tremendously. You and I probably wouldn't be chatting right now if we had stellar vaccination rates.
Caroline MacGregor: Right. So now, as public health officials in Washtenaw County, your department included, obviously, the resources required to manage or at least contain the virus are huge and, along with those resources, the costs. Tell me about how this is impacting your health department and how it's also affecting the focus on normal services.
Susan Ringler Cerniglia: Yes. So, a lot of folks kind of became familiar with this idea of contact tracing during COVID, but it's a strategy that we use all the time, so contagious and potentially serious, and we work kind of behind the scenes to make sure that everyone potentially exposed gets whatever treatment is required. When that happens with measles, because it is so infectious, we are concerned about the airspace because this is spread through the air and, of course, direct contact or sneezing or coughing and that kind of stuff. But it stays airborne for two hours after the person was in that space. And folks are generally contagious right before those symptoms start. Well now, we have a couple of problems, right? We've exposed people in more private settings. Think of those household contacts where you have family or friends that you spend time with. Those are what we call close contacts. We typically contact them directly because we can get contact information. Then, we have this whole set of public exposures. And when that happens, it's because we don't have a way to contact all of those folks individually. So, you think about a mall, a pharmacy, often a healthcare setting because of the way there's open spaces like for waiting rooms. So, when those things happen, we have lots of exposed people, and we have to try to reach them as best we can. So, we rely on sharing public information to do that. So right now, you can see all these pieces happening. We have our nursing staff and our clinical staff that are diligently calling, texting, reaching out to folks that may have been exposed. We're working with affected institutions, whether that's a store, a school, a public building, to figure out how they can or can't contact people. In some situations, there's really good systems for messaging something out to others. In other situations, there's really not. We have no choice but to put that out publicly. If you were in this place during this specific time, then you need to do X, Y, and Z. And so, it requires a lot of time for clinical staff to follow up with people that were potentially exposed, give them instructions. Those instructions vary greatly, whether someone is vaccinated or not. And then, we can kind of narrow down to the folks we're most concerned about. There's some chance that anyone exposed can become ill, but it's greatly reduced for the folks that are vaccinated. So then, we're gonna do more intense followup with them. So, that includes like after the vaccination status is confirmed, those unvaccinated or vulnerable folks, we're going to be following up with them multiple times a day, checking on whether they have symptoms, making sure they know what to do, reinforcing that if they go seek healthcare, they should make sure to tell the healthcare provider before they go in, right? So, we can prevent additional exposures. And then, on the flip side, all those public ones, often we don't even know how many that is, but we're working very hard to push that information out. So that requires folks like me and my comm staff to prepare that information, post it across our channels, answer questions, make sure it's accurate and updated and really reach out to them. Anywhere that we can get names and contact information, there are some state systems where we can send automated messages to someone and be like, "Hey, you're exposed. Do this. Blah, blah blah." But I think we all know, in this day and age, when we get those unsolicited calls and texts that people don't always answer, there's legitimate reasons to believe it might not be true, right? We all get scam things on our phones, right?
Caroline MacGregor: Indeed, indeed.
Susan Ringler Cerniglia: But it is an option for us, particularly if we have a large group of people that are exposed, like we've had in this situation, that we can at least be reaching out to them and sending some reminders when we don't have the capacity to do direct follow-up with everyone, or it could be a subset of people that we know were vaccinated, we want them to still monitor, we want them be aware, but we don't have as high a level of concern as we do for the unprotected folks.
Caroline MacGregor: You've really explained how involved this is and how is it taking a toll on your department as far as the manpower, the effort going into this and the costs.
Susan Ringler Cerniglia: Yeah, it's a high level of effort, and right now, the situation we've been at for the last few weeks, we have, what I'd say, is a subset of people sort of pulled from their regular work. So, that includes clinical staff, our nursing staff, that is doing the follow-up, that is verifying the vaccinations. That includes my communication team, It includes people from our data or epidemiology team that are helping to track the information as well as to follow-up, and also our emergency preparedness staff who help us make connections, find resources, and then, of course, leadership to some degree, right? They have to be informed. We have to make sure other leaders are informed of the general parameters. And our medical director who makes decisions about actions given the situation and what we're going to do. So, it's not at the level where it's everyone, but it's a fair amount of staff. And we received some additional refunding to respond to this. And that was about $100,000, and we've mostly used and allocated that already. So, the next thing that we're preparing for is the current situation could go one of two ways, right? We could wrap it up and see no more cases. And once there have been no more cases for two incubation periods, then we're considered done with the outbreaks. Now, if you remember that incubation period is actually 21 days. So, we're talking about 42 days passing from the last identified case, then we can consider the outbreak over. So, obviously, we are not there yet. And hopefully, we get there. And hopefully, like all this work that we're doing helps us get there. But if it goes the other way and we do see more cases or we see a larger outbreak, we also have to be ready for that. So, part of the work right now too is thinking about, "Okay, what kind of capacity do we have to scale up our testing, to scale up our vaccination to make sure that we have things ready like tents and locations where we can do all that work?" And then, at that point, it would likely require pulling more staff from their regular roles more than we have already, calling in volunteers. We have what we call an MRC--Medical Reserve Corps--of trained volunteers, screened volunteers, that can come out and help us. We saw, again, a lot of this during COVID with our mass vax clinic. It took literally over a hundred people to run one of those large clinics, and some of that workforce was also volunteers. So, if this goes the wrong way and really expands, which, of course, we're all hoping that it doesn't, we will need some of those things to come into play as well.
Caroline MacGregor: Susan, it's been very informative speaking to you, and we'll certainly do some follow-ups on this conversation to see how things develop. But thank you so much for joining us today!
Susan Ringler Cerniglia: Absolutely! Thanks for talking with us!
Caroline MacGregor: I've been speaking to Washtenaw County Health Department Spokesperson Susan Ringler Cerniglia, and we have been discussing the measles outbreak in Washtenaw County. This is 89.1 WEMU-FM Ypsilanti.
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