Outbreak, epidemic, pandemic

PUBHLTH 405
Social Epidemiology of Infectious Disease
University of Michigan School of Public Health

Jon Zelner
[email protected]
epibayes.io

Agenda

  • What is an epidemic?

    • According to the CDC?
    • According to Rosenberg?
    • According to us?

  • Finish pathogen dossiers.

  • Dig into Rosenberg’s dramaturgical take on epidemics.

The different types of infectious disease events according to the CDC

  • Outbreak

  • Epidemic

  • Endemic

  • Pandemic

  • Take 15m in pathogen groups from last time to discuss what differentiates these from each other and how they impact your pathogen.

  • What types of social and historical factors are likely to influence each of these types of events?

  • How are they similar?

  • How might they differ in their causes and impacts?

  • Which of these is most applicable to your project pathogen?

What does it mean to take a dramaturgical perspective 🎭 on epidemics?

“A true epidemic is an event, not a trend.” (Rosenberg 2020)

1918 Influenza pandemic: An event?

Epidemic as a play in three acts:

  1. Progressive Revelation

  2. Managing Randomness

  3. Negotiating Public Response

Progressive Revelation

Only when the presence of an epidemic becomes unavoidable is there public admission of its existence. Bodies must accumulate and the sick must suffer in increasing numbers before officials acknowledge what can no longer be ignored. (Rosenberg 2020, 566)

Reuters, 12/31/2019

New York Times, 1/20/2020

New York Times, 2/20/2020

Statehouse news bureau, 3/9/2020

bbc.com, 3/11/2020

Only after cases were identified in Michigan was a state of emergency declared here. (clickondetroit.com, 3/11/2020)

Managing Randomness

Accepting the existence of an epidemic implies — in some sense demands — the creation of a framework within which its dismaying arbitrariness may be managed. Collective agreement on that explanatory framework may be seen as the inevitable second stage in any epidemic. (Rosenberg 2020, 567)

In the absence of clarity, we can end up with some strange ideas about cause and effect…

Public Response

In the stress of an epidemic…, failure to take action constitutes action. An epidemic might in this sense be likened to a trial, with policy choices constituting the possible verdicts. (Rosenberg 2020, 569)

Action - or lack of action - in an epidemic is clearly a function of the social and political environment of the time in which it takes place.

Outwardly visible signifiers of prevention clearly also have a dramaturgical element

How can we apply Rosenberg’s take to real-world problems?

  • To what extent do Rosenberg’s criteria and those of the CDC align with each other?

  • Which set of definitions is more useful from a day-to-day perspective?

  • Could we integrate Rosenberg’s ideas into a revised set of guidelines?

Revising CDC’s definitions

  • We are going to take a shot at doing a bit of what this tweet suggests ️➡️

  • Try to channel some of the ideas from “What is an epidemic?” to revise widely-used CDC definitions and guidance.

  • Open up this document and read the instructions to get started.

“Public health would work better if we stopped mischaracterizing it as an academic field and instead defined it as a necessarily political practice that depends upon synthesizing tools from history, anthropology, epidemiology, geography, planetary sciences, biology, statistics etc.”

— Eric Reinhart (9/1/22)

Next Time

Explaining Epidemics

References

Rosenberg, Charles E. 2020. “What Is an Epidemic? AIDS in Historical Perspective.” Bulletin of the History of Medicine 94 (4): 563–77. https://doi.org/10.1353/bhm.2020.0082.