Rates help us compare between populations.  Rates can be expressed in different ways from per 100, per 1,000 or per 100,000.  One big component of public health is looking at disparity of services, health outcome disparity and people disproportionately impacted. In the end rates, help us make comparisons.

A great free course by Johns Hopkins on the basics of COVID-19 and concepts.  It is self paced and open to the public for free.  For all those who really want to understand what is an Epi curve, what is an infectious disease, what is a reproductive number to why incubation periods matter...

 COVID-19 disease took the public health system and shined a bright light on the terms, practices and history. Every day numbers and rates fill our news feeds, and we are bombarded with shifting messages and projections. This blog will explain some terminology and then answer these questions: what do these numbers mean, why are these strategies in place, and why are public health professionals, journalists and the world watching these numbers daily?

Public health professionals watch for outbreaks
Just like firefighters may watch for a blaze to spark in a forest to control its spread, public health professionals are always on alert to watch for disease outbreaks. In fact, outbreaks occur annually, monthly and even daily across communities all over the world. On a daily basis, health departments and professionals are monitoring diseases to look for outbreaks. For the public health, the key idea is to prevent an outbreak before it spreads and this requires vigilance and dedication.

The key terms for watching a disease grow are:

• Endemic: a health condition that appears at a steady rate in a geographic area or among a population.
• Outbreak: when the condition occurs above the typical endemic levels.
• Epidemic: when the outbreak spreads to larger areas.
• Pandemic: when the condition has spread globally.

With COVID-19 this disease moved quickly from an outbreak to an epidemic and now is a pandemic. This is not the world’s first pandemic, however. Public health agencies keep close records on past pandemics to determine what has worked in containing a pandemic. See the history of pandemics in the US here - the history of responses.

Who is in charge? Good Question. There are many people in charge...
In the United States, the public health system has different levels of key players, each with a specific role and limited power.

Two important points:

• The power to implement public health mandates lies with the local government and States. If you get the feeling that State and Federal governments have different approaches to this pandemic and mandates, this is why...they do.
• The second point is this division of power, is supported by the constitution and is open to interpretation. The 10th amendment allows policing power to be held by the States in certain circumstances.

Why public health people watch them closely
There are three big tenets to public health:

• Protecting the health of entire populations.
• Preventing problems from happening before people get sick or injured.
• Promoting healthcare equity, quality and accessibility.

At the core is the public service ethic, tempered by concerns for the individual. This focus on the public as a whole, places the needs of an individual aside. In public health pandemics, public health professionals will use different strategies to contain the disease from providing mandated screenings, enforcing isolation of the person with the disease, mandating quarantine and monitoring the spread of the disease. However, although public health professionals do have this power, it is often not used and only under extreme circumstances. It is important to note, in the US, we missed a key period to screen and isolate. We are now in the stage of implementing an evidence-based practice that slows the spread of a pandemic. See planning document here of evidence based strategies.

Why are there different numbers at different times of the day?
The data is collected at the local level, then reported to the State level and then in real time uploaded to the Center for Disease control. This is why you see a shift in numbers throughout the day. It depends on when you look at the data and where it was collected. The most up-to-date numbers are at the local health departments or State labs who are tracking cases in real time and then uploading the data in real time to CDC. These cases needed to be considered confirmed and verified prior to publishing the results. Depending on when and where you look, these numbers will shift throughout the day.

Pay attention to how the data is presented. It tells different stories.

• Linear Scale - this watches the number of cases each day and in a pandemic it shows a steepening line once the disease suddenly increases. This is called an Epi-Curve.
• Epi-Curve- this is a tool to monitor outbreaks (see CDC tutorial here)
• Log Scale -Why use this scale? Infectious diseases don’t spread in an even, linear fashion but a log scale shows exponential growth. It takes out the daily cases and has us focus on the growth and/or if it is declining. The scale is set to grow by a factor of 10. This allows us to see when cases take a jump exponentially. Often you will see trend lines in the graphs, which help show the rate of growth.
• Rate- an expression of the relative frequency with which an event occurs among a defined population per unit of time, calculated as the number of new cases or deaths during a specified period divided by either person-time or the average (midinterval) population. (see CDC Principles of Epi for definitions). Rates are used to compare populations to see who is impacted more than another population. In public health we use rates to look at health disparities. See example here of health disparity story on COVID 19.
• Testing data varies by area along with the lab response time. This is why it is important to pay attention to the log scale data which tunes out the small ups and downs and allows you to focus on the rate of growth. Go to this website for the growth rate in your county.
• For when we discuss rates next week- Week 3 see this excel spread sheet with rates. The source is Rachel Alexander, Salem Reporter Journalist who is downloading data from OHA

Below is a Google Slide presentation specific to California and Oregon. This will be updated each day. Watch the data come in and change in real time.

• The last slide provides favorite data links. 
  
• On the screen, you will need to move the cursor to see the full slide with notes.
  

Guess where I spent a few days  this summer?  Yep, you guessed right, at the Harvard T.H. Chan School of Public Health. I love this logo..."Powerful ideas for a healthier world"...see photo. I felt so empowered standing in front of the School of Public Health with this logo behind me.  I kept envisioning public health in Kern County and the powerful ideas we have discussed at our Hackathons and in our Bakersfield College Public Health Science classes in the Southern Central Valley.

Rewind back to June, 2018....I take a five hour plus flight from Los Angeles LAX to Boston Logan Airport, the home to Harvard School of Public Health.  The goal to learn from the experts of case study at Harvard School of Public Health. Like the business school, the Harvard School of Public Health has embraced the use of case studies in their teaching approach.  I attended the Teaching by Case Method: Principles and Practice for Public Health Educators. Three days with public health professionals discussing case studies, it can't get any better than that!  I was thrilled, excited and thoroughly exhausted by the end of each day. 

You might ask what is a case study approach in teaching? Case studies provide real world situations (usually three to eight pages, see a database here) where students are asked to explore, analyze and yes justify their answers. The professor is a facilitator only and guide on the side. Spoiler alert, there is no one right answer or multiple choice answer a,b,c or d all of the above! What better way to learn than be immersed in a real life example and be submerged in the tricky business of life? I say yes! That is what public health people thrive on, we like to be given situations that test the systems, make us question the why and come up with new ways to think. For this reason - the divergent thinking, I am a big fan of the concept of case studies. I have dabbled in them before and the few times I have used them, the results are positive...my students light up with ideas, solutions and sometimes approaches I never thought of. Most importantly, they become active learners. That is my ultimate goal....to turn on the switch to exploration. With case studies, this self exploration occurs, students demonstrate their expertise and experiences that are invaluable. It also mimics what is expected in the job workforce where the rubber meets the road. A shout out and thank StrongWork Force Grant for underwriting this learning experience and making this possible to bring these ideas back to Bakersfield College. Special thanks to Anthony Cordovo, Cindi Swoboda, and Yoli Aguilera.

Bakersfield College students, get ready for case studies from Harvard coming your way. I am excited to incorporate new strategies into the curriculum that tie directly to the workforce.

The second exciting part, besides being at Harvard of course...is meeting professors and professionals from public health programs across the United States.  Kern County, does not have a dedicated higher education public health program, but know that this is not the norm in other communities, which have Bachelors of Science in Public Health, as well as Master Public Health Programs.  This may change in the near future with California State University Bakersfield submitting for a new public health program.  Pictured above are people from all over the world from faculty of Health Sciences University of Pretoria, South Africa, University of North Carolina, Gillings School of Global Public Health, to Milken Institute School of Public Health George Washington University...the list continues.  I remember asking one program how many staff they had and it was around 50.  Humbling, to be with so many programs but also a reminder that beyond Bakersfield College lie public health and health science programs for our students to explore. 

Last but not least for my Bakersfield College Students....dream big and know that everything is in your reach.  Where you have a passion and commitment the world will open it's doors. Here are a couple of photos for you to begin planting that seed. My path never has been a straight arrow, look....you never know the places you will go!

Today, students in the Face to Face class broke up into groups and created one poster student guides.  I am posting them to here to show off all the great topics we cover in public health science but BOOM these are great study guides too. 
Rewrite these into your notes, and ace the Midterm Exam. Great job PBHS students. This my favorite way to do a review and get a jump on students making their own study guides. 

As part of my professional development, I am taking an online class on Technology Engagement.  The assignment asked that I write a blog and do a reflection.  So here it goes...I am sure this is going to go viral LOL...please feel free to share and re-post if you like.  No seriously thought...here are my thoughts

I participated in a Zoom chat and a google form activity.  Both went well, I am considering the Google Form idea for the midterm activity where they will all have to self select a chapter do a summary and then post on a google form as a class.

I found it beneficial.  I think the big take away is how online classes are hard to schedule time within the week.  I can see how my student's fall behind and also see if I don't create a routine for them with clear instructions, how they can get confused.  So I am creating a day when everything is always due.  No exceptions so they won't be caught off guard.

The two elements I selected are group and individual in learning. I admit not too challenging for me. The challenge is the time.  It is really hard to be fully engaged when managing so much. Again, it gives me empathy for my students.

I am currently applying a lot of the items currently in my class but I find the group work confusing and I see my students struggle with this also.

It all started with a text from a friend at Bakersfield College, simply a text, with the link to the job- Public Health Science Professor. With one simple click, I opened up the job description and boom my mind began to dream..... This would be the first public health program in Kern County in fact in the Southern Central Valley and think about all that it could do for Kern County? Just Imagine?  The public health professionals are change agents and right now,  public health degrees only exist out of the area. In fact, many people are completely unaware of public health careers and often recruitment occurs outside the area.

I left grant development and the world of K-12 education and changed jobs into Academia. I threw myself into starting a new program, curriculum development and creating a new Associate Science Transfer (AST) Degree, a Degree with a Guarantee in Public Health Science. And it happened...it has been exciting, the new AST rolled out in 2017 and Bakersfield College students are declaring their majors and we have some set already to graduate in Spring 2018. Check out the information on the degree, classes and exciting opportunities in public health.

Bakersfield College students are primed for the public health field in Kern County.  Who knows the Central Valley better?  You know your community and your passion and commitment will make a difference in Kern County. 

This blog website is dedicated to the Bakersfield College student...

This blog website will be dedicated to keeping students up to date on the degree and upcoming certificate.  It is a place to ask questions and explore the public health science pathway and the transfer opportunities to California State University and University California.