LECOM at Seton Hill Medical Student was Embedded with CDC Response Team

Max W. Jacobs

Max W. Jacobs, a fourth-year LECOM at Seton Hill medical student, always has been interested in the areas of infectious disease, public health, and disaster response. This penetrating interest led him to envision a career at the Centers for Disease Control and Prevention (CDC).

Understandably, Jacobs was thrilled to be accepted into the Epidemiology Elective Program (EEP), an eight-week rotation available to fourth-year medical students who are interested in public health. It mirrors the format of one of the CDC flagship offerings, the Epidemic Intelligence Service (EIS), a two-year field training program for epidemiologists, clinicians, and veterinarians. Students are matched with a specific division, but they may be deployed into the field in certain situations. Jacobs’ rotation within the Influenza Division, part of the National Center for Immunizations and Respiratory Diseases (NCIRD), positioned him within the core of one of the seven centers that comprise the CDC.

Known as Disease Detectives, the EIS places first responders into areas around the world that are experiencing the most pressing public health issues. The EIS is considered by many within the field as the most elite training that a public health professional can receive.

Jacobs’ EEP cohort included 25 students from locales across the United States; and 19 of them were assigned to various divisions at the Atlanta headquarters.

Jacobs’ orientation on January 13, 2020, would prove to be for him the start of an enlightening experience. As his team worked through the orientation, touring the Emergency Operations Center (EOC) and learning about the CDC response to public health crises, the team shared their eagerness to be deployed during the rotation.

Jacobs’ experience was to be further advanced. On the day before his orientation, the sequence for SARS-CoV-2 was published. The terms SARS-CoV-2 and COVID had not been coined at this point, but the group was well aware of the virus’ origins.

One week later, as Jacobs was designing projects with his team in the Influenza Division, COVID-19 became the watchword of nearly every conversation.

On January 20, 2020, the first case of COVID-19 in the United States was identified and one day later, the CDC activated the EOC response. By the end of the week, several of Jacobs’ EEP team were tasked to the EOC to assist in the response.

“How quickly can you be on a plane to Chicago?” The question from his EIS leadership would place Jacobs into a whirlwind of medical training.

Jacobs arrived at the hospital of “COVID-19 Patient #2” located in the Chicago suburbs. He worked with a team of CDC staff as well as with local and state health departments, including many current and former EIS officers. The epidemiologists rapidly developed a containment strategy by drawing upon their personal experiences with SARS, Ebola, Measles, and other disease outbreaks. “The group worked around-the-

clock, tracing known contacts, identifying persons-under-investigation (PUI), setting up testing, speaking with response teams from around the country, and uncovering the basic epidemiology of the disease,” the LECOM at Seton Hill scholar explained.

Jacobs’ team ultimately reported the first human-to-human transmission of SARS-CoV-2 in the United States, the report of which was published in The Lancet.

Upon returning from deployment, Jacobs completed COVID work while continuing influenza projects that had been placed on hold. “The 2019-20 influenza season followed several uncharacteristic trends and I was able to contribute to the only regularly scheduled outbreak response in the nation,” noted Jacobs. He initiated a systematic literature review, led medical training for surveillance officers, and used statistical software for several data projects. “The influenza surveillance system for which my team was responsible, FluServ-NET, was being adapted and leveraged to assist in COVID surveillance,” Jacobs expounded.

Jacobs feels incredibly fortunate to have worked with highly motivated students from around the nation who shared his interest.

The human loss and economic devastation wrought by the pandemic has been immeasurable, but the once-in-a-lifetime opportunity experienced by a profoundly inquisitive scholar, that of working at the CDC during the developing outbreak of a virus from across the globe, proved an experience of great educational value.

LECOM Scholar Joins the Global Battle of the Century

Until recently, viruses and anti-human microbes never had inflicted a significant and debilitating impact upon the American way of life. In only a few short months, the Coronavirus (COVID-19) transformed America and the world as globalization quickly facilitated the descent of the highly infectious disease upon the citizens of almost every nation.

As the United States called to mind the stoicism of the greatest generation, heralding the blitz spirit, and summoning the unbowed might of America, the whole of the medical community took its place on the front lines to battle the infectious disease of the century.

Early in the study of the virus, a Lake Erie College of Osteopathic Medicine (LECOM) scholar joined those battle lines to understand and to conquer the spread of the virus.

Max W. Jacobs was involved in the COVID-19 response and investigation as part of his recent rotation with the Centers for Disease Control and Prevention (CDC). His partnered research resulted in a salient piece entitled, First Known Person-to-Person Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the USA.

The investigation took place before the existence of published CDC guidance that classified exposure risk among contacts of patients with COVID-19. It was, therefore, a groundbreaking study as it meticulously detailed the exposure rates of the contagion.

Jacobs co-authored the work that was published in The Lancet, one of the oldest, most prestigious, and best known general medical journals in the world.

Jacobs' efforts suggest that challenges, once overcome, allow one to gain knowledge and find victory over them.

The LECOM spirit, bold in its origin, visionary in its growth, strong in its rise to prominence, and ever triumphant over momentary vicissitudes, is reflected in the successes of its progeny, scholars like Max Jacobs, who have set out to face and to conquer an invisible foe.

First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA

Isaac Ghinai*, Tristan D McPherson*, Jennifer C Hunter, Hannah L Kirking, Demian Christiansen, Kiran Joshi, Rachel Rubin, Shirley Morales-Estrada, Stephanie R Black, Massimo Pacilli, Marielle J Fricchione, Rashmi K Chugh, Kelly A Walblay, N Seema Ahmed, William C Stoecker, Nausheen F Hasan, Deborah P Burdsall, Heather E Reese, Megan Wallace, Chen Wang, Darcie Moeller, Jacqueline Korpics, Shannon A Novosad, Isaac Benowitz, Max W Jacobs, Vishal S Dasari, Megan T Patel, Judy Kauerauf, E Matt Charles, Ngozi O Ezike, Victoria Chu, Claire M Midgley, Melissa A Rolfes, Susan I Gerber, Xiaoyan Lu, Stephen Lindstrom, Jennifer R Verani, Jennifer E Layden, for the Illinois COVID-19 Investigation Team†

Summary Background Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first detected in China in December, 2019. In January, 2020, state, local, and federal public health agencies investigated the first case of COVID-19 in Illinois, USA.

Methods Patients with confirmed COVID-19 were defined as those with a positive SARS-CoV-2 test. Contacts were people with exposure to a patient with COVID-19 on or after the patient’s symptom onset date. Contacts underwent active symptom monitoring for 14 days following their last exposure. Contacts who developed fever, cough, or shortness of breath became persons under investigation and were tested for SARS-CoV-2. A convenience sample of 32 asymptomatic health-care personnel contacts were also tested.

Findings Patient 1—a woman in her 60s—returned from China in mid-January, 2020. 1 week later, she was hospitalised with pneumonia and tested positive for SARS-CoV-2. Her husband (Patient 2) did not travel but had frequent close contact with his wife. He was admitted 8 days later and tested positive for SARS-CoV-2. Overall, 372 contacts of both cases were identified; 347 underwent active symptom monitoring, including 152 community contacts and 195 health-care personnel. Of monitored contacts, 43 became persons under investigation, in addition to Patient 2. These 43 persons under investigation and all 32 asymptomatic health-care personnel tested negative for SARS-CoV-2.

Interpretation Person-to-person transmission of SARS-CoV-2 occurred between two people with prolonged, unprotected exposure while Patient 1 was symptomatic. Despite active symptom monitoring and testing of symptomatic and some asymptomatic contacts, no further transmission was detected.

Funding None.

Copyright © 2020 Elsevier Ltd. All rights reserved.

Introduction

In January, 2020, a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified as the causative agent for a cluster of pneumonia cases initially detected in Wuhan City, Hubei province, China.1 SARS-CoV-2, which causes the disease now named coronavirus disease 2019 (COVID-19), had spread throughout China and to 26 additional countries as of Feb 18, 2020. 2 Phylogenetic data implicate a zoonotic origin,3 and the rapid spread suggests ongoing personto-person transmission. Several studies offer additional insight into person-to-person transmission.4–9 However, substantial knowledge gaps remain regarding the transmissibility between humans, including the level of exposure to a confirmed case at which transmission is more likely to occur.

On Jan 23, 2020, Illinois, USA, reported the state’s first laboratory-confirmed case (index case) of COVID-19 in a traveller who returned from Wuhan in mid-January, 2020. Subsequently, the first evidence of secondary transmission in the USA was reported on Jan 30, when the husband of the index patient, who had not travelled outside the USA, tested positive for SARS-CoV-2. Public health authorities did an intensive epidemiological investigation of the two confirmed cases.

This Article describes the first person-to-person transmission of COVID-19 in the USA, including the clinical and laboratory features of both patients and the assessment and monitoring of several hundred individuals with potential exposure to SARS-CoV-2.

Methods Epidemiological investigation

The Illinois Department of Public Health, Chicago Department of Public Health, Cook County Department of Public Health, and DuPage County Health Department consulted with the US Centers for Disease Control and Prevention (CDC) for technical assistance and invited a CDC field team to assist with onsite investigations after laboratory confirmation of the first case of COVID-19.

Lancet 2020; 395: 1137–44

Published Online March 12, 2020 https://doi.org/10.1016/ S0140-6736(20)30607-3

See Comment page 1093 *These authors contributed equally †Memberrs of the Illinois COVID-19 Investigation Team are listed in the appendix (pp 1–2)

Epidemic Intelligence Service

(I Ghinai MBBS, T D McPherson MD, H E Reese PhD, M Wallace DrPH, V Chu MD), Division of

Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious

Diseases (J C Hunter DrPH, S A Novosad MD, I Benowitz MD), Division of Viral

Diseases, National Center for Immunization and Respiratory

Diseases (H L Kirking MD, M Wallace, V Chu, C M Midgley PhD, S I Gerber MD, X Lu MS, S Lindstrom PhD),

Division of Bacterial Diseases, National Center for Immunization and Respiratory

Diseases (H E Reese, J R Verani MD), Influenza

Division, National Center for Immunization and Respiratory

Diseases (M W Jacobs BA, M A Rolfes PhD), One Health

Office, National Center for Emerging and Zoonotic Infectious Diseases

(V S Dasari MPH), Centers for

Disease Control and Prevention, Atlanta, GA, USA; Illinois Department of Public Health,

Springfield, IL, USA (I Ghinai, D P Burdsdall PhD, M T Patel MPH, J Kauerauf MPH, E M Charles BA, N O Ezike MD);

Chicago Department of Public Health, Chicago, IL, USA

(T D McPherson, S R Black MD, M Pacilli MPH, M J Fricchione MD, K A Walblay MPH, J E Layden MD);

Cook County Department of Public Health, Oak Forest, IL,

USA (D Christiansen DrPH,