August 2020 - The Epidemiology Monitor by The Epidemiology Monitor

Latest Projections Are For Almost 310,000 Deaths In The US By December 1, 2020 Daily Deaths To Increase From 1K To 2K Per Day Universal Mask Use Could Prevent More Than 50% Of The Anticipated Deaths As evidence for the lack of control of the SARS CoV-2 pandemic in the US, the number of daily deaths is expected to continue climbing from approximately 1,000 per day now to reach approximately 2,000 per day by mid-November. Projections The latest projections from the Institute for Health Metrics and Evaluation (IMHE) at the University of Washington School of Medicine

indicate that an estimated 135,218 additional deaths are projected to occur between mid-August and the beginning of December 2020. This number would add to the approximately 174,100 COVID deaths that have already occurred in the US as of August 21, 2020. The total projected by December 1 now reaches 309,918, an increase of about 15,000 deaths just - Projections con't on page 2

Deadly Failure To Control Transmission Of SARS-CoV-2 In The US Triggers Proposals For New Strategies Or Better Use Of Existing Countermeasures The deadly failure of the US to achieve control of the current coronavirus pandemic has frustrated and angered many experts as well as everyday Americans. It has sent some infectious disease and policy experts back to the drawing boards to formulate alternative approaches or reinvigorate old ones that have the best chance of success at this relatively late phase in August 2020

the pandemic in the United States. Lessons Learned A comprehensive review of the experiences of many US states as well as that of several other countries by the Center for American Progress entitled - Control cont'd on page 3 â&#x20AC;˘

Volume Forty One â&#x20AC;˘

Number Eight

In This Issue -6Virus Threat Alert System -7Epidemiologists Embroiled in Pandemic Control Conflicts -9Excess Deaths Provide Valuable COVID Data -12Notes on People -13Near Term Epi Calendar -14Marketplace

-Projections cont'd from page 1 The Epidemiology Monitor ISSN (0744-0898) is published monthly by Roger Bernier, Ph.D., MPH at 33 Indigo Plantation Rd, Okatie, SC, 29909, USA.

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since the last projection was released on August 6, 2020.

where each state stands as of midAugust, visit: https://bit.ly/3hmkQGo

Warning

Mask Effectiveness

The IMHE warns that the projected number of deaths could be much higher if the states with daily death rates over 8 per million fail to reimpose mandates to control transmission. Half of all the 50 states are likely to have to reimpose mandates between now and December 1 not to exceed the already high projected number.

IMHE estimates from its statistical analysis that mask mandates with no penalties increase mask wearing by about 8 percentage points which increases to 15 percentage points when mandates are accompanied with penalties. No national goal or mask wearing target has been established to try to achieve the maximum reduction in deaths. The initiative has been left to states to carry out. IMHE indicates that mandated mask use with penalties and/or a concerted public information campaign will be needed to save the estimated 69,027 lives that could be saved over the next three months.

Mask Use More than half of the new anticipated deaths or 69,027 could be prevented according to the IMHE with universal use of masks which it defines as 95% of people wearing masks outside their homes. Currently, the IMHE estimates that mask use has held steady at approximately 55% since July but some states are at a higher level of mask use. A recent survey of states by the Association for the Advancement of Retired Persons (AARP) finds that as of August 4, 2020 34 states or two-thirds of state jurisdictions require people to wear face coverings in public. The District of Columbia and Puerto Rico also have such mask orders. Mask Use Variation According to AARP, State mandates vary in details (for example, exemptions for children range in cutoff age from 2 to 12), but broadly speaking, they require masks in indoor public spaces such as restaurants and stores, on public transit and ride-hailing services, and outdoors when unable to maintain 6 feet of distance from others. Exceptions are given for a variety of reasons and conditions. For a list of

Deadly Cycle The pattern of mask use appears to wax and wane as infections increase or decrease in a particular population. IMHE calls this “a deadly cycle”. According to IMHE Director Christopher Murray, the public’s behavior has a major impact on transmission risk and therefore an impact on the numbers of deaths. “Such efforts to act more cautiously and responsibly will be an important aspect of COVID-19 forecasting and the up-and-down patterns in individual states throughout the coming months and into next year,” according to Murray. ■

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-Control cont'd from page 1 “A New Strategy to Control the Coronavirus” has identified several lessons learned. Based on these analyses and the success achieved by New York and other Northeast states in maintaining low incidence levels, the Center has proposed the following strategy to prevent future waves of cases in the coming year. 1. Close indoor dining and bars. Experience has shown that these locations are foci of transmission and they should be kept closed or reclosed if reopened, particularly in hotspots. Support with good unemployment insurance should be provided for workers as well as financial support to cover the fixed costs of businesses forced to close. 2. Monitor other potentially high-risk venues Other potentially important sources of transmission such as gyms and places of worship could be closed or other measures used to lower risk such as requiring capacity limits, moving outdoors, or requiring masks. Nail and hair salons have not been linked to outbreaks but are inherently risky and should be monitored closely for breaches in compliance with face coverings. Public education about avoiding any indoor gatherings such as parties especially without masks is needed. 3. Mandate masks This recommendation calls on governors and mayors to implement state and local mask mandates. Financial assistance to businesses should require mask mandates before the aid is provided. 4. Adopt cluster-based contact tracing. The goal of cluster -based tracing is to

study the patterns in chains of transmission to identify sources that can produce a large number of cases. These types of sources are superspreading events and the focus should be on identifying and preventing them rather than tracing all chains of transmission. Bars are an example of such sources but contact tracing may identify others. According to the Center, the model for this approach is Japan which finds patterns in cluster-based contact tracing and uses the information to identify sources that could become major outbreaks.

“...the model for this approach is Japan..."

Think Differently About Test Sensitivity Another new strategic approach is being advocated by Michael Mina, professor of epidemiology at the Harvard School of Public Health. He was interviewed recently on the podcast This Week in Virology where he made the case for a different way of thinking about testing. Heretofore, the focus has been on having highly sensitive tests that are able to accurately determine if an individual is infected with SARS-CoV-2. This for the most part has meant relying on polymerase chain reaction or PCR tests to diagnose individuals. However, the PCR test is very sensitive and can even detect virus fragments that may not be capable of spreading and causing transmission to other persons. These tests are relatively expensive and are not easy and straightforward to carry out. Also there has been a long delay in reporting the test results which have made some contact tracing work ineffective because it is too late to halt transmission. - Control cont'd on page 4

“...he made the case for a different way of thinking about testing."

-Control cont'd from page 3 New Approach

“In other words: Mina wants to test nearly everyone, nearly every day.”

“New York has done what the rest of the country can and should now do."

A different approach argues Mina is to lower the bar for how sensitive tests need to be and to focus instead on other kinds of tests that are cheap, easy to carry out, and provide results in minutes rather than days. The type of test Mina is calling for utilizes a thin paper strip that only requires a saliva sample and can deliver results in 15 minutes or less. This type of test will be less sensitive but may be considered sensitive enough to detect infectious persons. In this way of thinking, false negatives are of no concern because they are unlikely to be contagious and the test is good enough to be considered sensitive in picking up persons who are likely to transmit. Thus, if made widely available at low cost, these “contagiousness tests” could become ubiquitous and could serve to quickly determine if someone should be admitted to school or work or into any other environment where the risk of transmission exists. Positive persons would be kept away from others. And the test could be repeated daily if necessary to keep close monitoring of each situation. Test, Test, Test Mina’s idea was also explained recently in a feature article in the Atlantic. It described Mina’s idea this way. “Test negative, and you many enter the public space. Test positive, and you are sent home. In other words: Mina wants to test nearly everyone, nearly every day.” Real Lockdown

Another idea has been put forward by Michael Osterholm at the Center for Infectious Disease Research and

Prevention (CIDRAP) and Neel Kashkari, president of the Federal Reserve in Minneapolis. In an op-ed piece in the New York Times, Osterholm and Kashkari call for a second more rigid lockdown throughout the US. They believe the earlier lockdown was not carried out well enough and that the only way to get the virus under control now is to get serious about keeping everyone at home for six weeks. The goal of the new lockdown would be to get reported cases to a level as low as 1 case per 100,000 because at that level public health control measures have a possibility of being effective. As rates stand now, the volume of cases is too large for effective testing and contact tracing, according to the authors. New York Example Failing such a rigorous intervention, Osterholm believes that another coronavirus “forest fire” will spread out of control in the US in future months. In one of the regular podcasts from CIDRAP, Osterholm said the US could look to the situation in New York State to envisage how the new lockdown could drive the seven day average numbers of cases and deaths lower. New York had approximately 9800 cases and 921 deaths as of April 10. By June the cases had fallen to 662 and deaths to 39. By August 10, cases were at 651 and 8 deaths and the averages have been flat since June. According to Osterholm, New York has done what the rest of the country can and should now do. Since we have to get through at least 68 months without a vaccine, according - Control cont'd on page 5

-Control cont'd from page 3

social distancing is a civic responsibility.

to Osterholm, the number of cases is going to get much worse. We should take our medicine now and get ready to manage the smaller caseload that will emerge after a rigorous lockdown, he said. It is a pay now or pay me later situation he believes. He is hopeful their proposed strategy can earn discussion and support.

2. Better Use of Data Obtaining and sharing more information about how the pandemic is unfolding in various populations and places and how it is being managed could allow public health officials to provide better forecasts of what is coming so that people could adjust their plans accordingly.

“It is a pay now or pay me later situation..."

NY Times Editorial Board In perhaps a less surprising new strategy, the New York Times Editorial Board has proposed making better use of the tools the US has to achieve a higher level of control that has eluded it. In its view, the US has never really had a true lockdown compared to other countries. It estimated that the US only closed down or “shuttered” half of the country rather than the 90% that was attained in other areas. Consequently the US never achieved the dampening effect that other countries were capable of producing. The Board proposed a new strategy consisting of the following key steps: 1. Clear and consistent messaging. Because of the confusion that has been sown, it is now important to coordinate messaging at every level, especially from the top---masks are essential, and

3. Smarter shutdowns. Alert levels could be created to warn people about what behaviors are permissible and which are not at different risk levels or at different levels of transmission in the community. Shutdowns would not need to be equally aggressive in all communities. Such color coded alert systems have been developed in Harris County Texas as an example. (See next article). 4. Testing, Tracing, Isolation, and Quarantine The US has failed at all of these. The Times calls for more effective and rapid diagnostics and the federal government should compel companies to make the needed tests available. Once testing is taking place at a high enough volume, then the other public health measures can be made effective to control the outbreak. ■

"... masks are essential, and social distancing is a civic responsibility."

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From Harris County Website readyharris.org Harris County COVID-19 Threat Level System The Harris County COVID-19 Threat Level system advises four levels of transmission:

visiting permissible businesses that follow public health guidance.

Level 1: Stay Home (Current Level)

Level 3: Stay Vigilant Level three signifies a moderate, but controlled level of COVID-19 in Harris County, meaning a demonstrated reduction in transmission and the local healthcare system is within capacity. Residents should remain vigilant, but resume contact with others and resume leaving home.

Level one signifies a severe and uncontrolled level of COVID-19 in Harris County, meaning outbreaks are present and worsening and that testing and contact tracing capacity is strained or exceeded. At this level, residents take action to minimize contacts with others wherever possible and avoid leaving home except for the most essential needs like going to the grocery store for food and medicine. Level 2: Minimize ALL Contacts Level two signifies a significant and uncontrolled level of COVID-19 in Harris County, meaning that there is ongoing transmission of the virus and that testing and contact tracing capacity is likely sufficient to meet demand. At this level, residents should minimize contact with others, avoiding any medium or large gatherings and only

Level 4: Resume Normal Activity Level four signifies a minimal and controlled level of COVID-19 in Harris County, meaning new chains of transmission are limited and quickly broken or a vaccine and/or treatment has been developed and widely deployed. At this level, residents may resume normal contact with others unless sick. â&#x2013;

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Epidemiologists and Public Health Officials Becoming Embroiled In Pandemic Control Conflicts As uncontrolled community transmission of COVID-19 persists in the United States, epidemiologists and public health officials are involved in difficult situations. Media accounts of firings, resignations, harassment, and threats are proliferating. While there may be more than one reason for these conflicts, failure to use evidence as the primary basis for decision making is emerging as a common theme in several situations. So is the highly polarized social and political environment in the US. Federal Level Preview The challenges that are playing out at the state and local level are a reflection of similar challenges that have already produced headlines about similar conflicts at the federal level involving all of the major health agencies including the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health. Sometimes valid political and often serious economic considerations are bumping up against scientific facts or expertise. List of Turnovers A list maintained by Kaiser Health News (KHN) and the Associated Press reportedly contains almost 50 state and local officials who have resigned, retired, or been fired since April. In an article in The Hill, NIH Director Francis Collins stated “To see this kind of really widespread resignations from critical roles at a time of great importance for our country ought to be a source for everyone to be

concerned…I am very troubled to see that kind of turnover…The idea that you have to either pick to support the economy or pick public health measures is so upside down. The public health measures are going to get our economy going again. And yet somehow in many of these situations, these are pitted against each other in a way that causes a great deal of anger and resentment and political furor to kick in.”

“…I am very troubled to see that kind of turnover…"

In a recent report, KHN quoted former CDC Director Tom Frieden “The overall tone toward public health in the U.S. is so hostile that it has kind of emboldened people to make these attacks.” Bad Feelings In the same report, KHN quoted former West Virginia public health commissioner Dr. Cathy Slemp, who was forced to resign by Republican Gov. Jim Justice in June. The past few months have been “frustrating and tiring and disheartening” for public health officials, said Slemp. “You care about community, and you’re committed to the work you do and societal role that you’re given. You feel a duty to serve, and yet it’s really hard in the current environment,” Slemp added.

"You feel a duty to serve, and yet it’s really hard in the current environment,”

Examples of these conflicts and challenges involving epidemiologists are described below. Indiana Episode The Indianapolis Star reports that - Embroiled cont'd on page 8

-Embroiled cont'd from page 7 Hawaii Episode

“This is a level of interference I had never seen before in a public health agency..."

Eileen White, the only epidemiologist working for the local city Fishers Health Department resigned earlier this month alleging too much interference by the city’s mayor, especially pushing hard to open classrooms too soon. In an account by the Indy Star, White says “This is a level of interference I had never seen before in a public health agency…I have never seen a health department set up as a business before… I have a feeling of failure that all of us in public health have right now…I had so much hope for what I could do. But we are continuing to see more pushback and politics in public health.” White previously worked for the Minnesota Health Department for three years. The mayor’s office and White’s supervisor pushed back hard in a written statement to the newspaper. Official Response

"What we could not have predicted, quite frankly, is how badly our community would behave.”

"My administration, in concert with the Fishers Health Department, has had a constant focus on what is in the best interest and safety of our residents," the statement read. "That said, we continue to believe in, and follow the direction of, our public health department leadership, (Chief Medical Director) Dr. Indy Lane and (Public Health Director) Monica Heltz. Any assertion of anything other than that is categorically false." Heltz said what White characterizes as interference she considers the full backing of the mayor. "I have felt nothing but support from the city," she said. "The suggestion that it has been anything but supportive is disappointing."

In Hawaii, the state epidemiologist Sarah Park has been sidelined for not having in place the required number of contact tracers needed to handle an upsurge of cases in the state. It apparently had a plan for controlling the virus that was not adequately implemented, according to the publication Civil Beat. Park reportedly had refused to accept outside help offered months before the upsurge because she believed the Department could bring on contact tracers quickly if needed. Only about 100 contact tracers are actively working when hundreds were called for three months previously. While continuing at the Department to focus on other aspects of the pandemic, Park will no longer oversee the contact tracing activities which have been transferred to a Department deputy director and the chief of the disease investigations branch. Park Testimony In her defense, Park gave testimony recently in front of a Senate Special Committee on COVID-19. According to the Civil Beat article, “Park downplayed the importance of contact tracing, saying that some states no longer even do it. Park ultimately blamed the public for the surge in cases. She cited beach and house parties and other gatherings that people should have known not to engage in as causes for the surge in cases that quickly overwhelmed the system. She was quoted saying “What we could not have predicted, quite frankly, is how badly our community would behave.” - Embroiled con't on page 11

Excess Deaths Provide Additional Estimate Of The Burden Of Disease Related To COVID-19 Absence Of Excess Deaths Might Also Be Used As An Indicator That Community Risk Level Has Returned To “Normal” The Centers for Disease Control and Prevention (CDC) is providing provisional counts of weekly deaths from all causes to supplement routinely reported counts of deaths due to COVID-19. When compared to the expected number of deaths from all causes over recent years, the number of excess deaths can provide another measurement of the overall impact of COVID-19. This is useful since COVID19 related mortality may be undercounted in the routine reporting. Incomplete Count And that is precisely what an investigation of these deaths is showing. As reported in an ongoing NY Times analysis of the CDC data, an estimated 211,500 more people have died than usual in the US from March 15 to Aug. 1 2020. This analysis adjusts current death records to account for typical reporting lags. The number of deaths from all causes is 56,000 more

than the official count of coronavirus deaths for that period. Even later as of mid-August, the official CDC death count from COVID-19 is 171,012, well below the 211,500 figure. In looking at the actual number of weekly deaths from all causes in the United States in 2017-2019 before the pandemic, the number of weekly deaths varies by season but the number and pattern is relatively consistent from year to year. For example, during the period April-June of 2019, the number of weekly deaths ranged narrowly from a low of approximately 52,000 to 57,000. In 2020 that weekly number has ranged more broadly from a low of approximately 59,000 to a high of approximately 79,000 in the spring. Stated differently, the percentage increase of deaths over the threshold (defined as the average expected number of weekly deaths in 2020) ranged from a low of approximately

“The number of deaths from all causes is 56,000 more than the official count..."

- Deaths con't on page 10

-Deaths cont'd from page 9 10% to approximately 40% higher than normal.

"Deaths are definitive and the count is considered relatively complete..."

The estimated number of deaths from all causes may contain deaths from COVID-19 that were not diagnosed because of lack of testing or misclassified for other reasons. Also, the deaths from all causes would include deaths brought about indirectly by the pandemic virus because of health care shortages, overwhelmed health care systems, or even suicides. The average number of deaths used for comparison in calculating the excess number of deaths does not take into consideration any changes that could have lowered the expected number of deaths because of behavior changes such as lowered risk from less automobile driving. Excess Deaths As Indicators

"...even with an effective vaccine, SARS-CoV-2 may become an endemic virus..."

Much discussion during the pandemic has centered on what indicators might be used to decide that it is safe to open schools or safe for persons to resume their normal lives by eating in restaurants or going to the gym. Some suggested indicators have been the reported number of cases, the percentage of persons testing positive for SARS-CoV-2, the testing and contact tracing capacity, or the number of hospitalizations for COVID. Each of these has its shortcomings that are difficult to quantify but which affect the reliability of the number as a valid indicator of personal or community risk. Deaths are definitive and the count is considered relatively complete and so it has perhaps greater reliability as an indicator of the risk of acquiring COVID. When the number of excess deaths falls below the threshold expected, this might be the time to

declare an all-clear for the community and resume normal activities. Threat Level Schemes Some health officials such as those in Harris County Texas have attempted to measure community risk levels by publishing a color coded scheme for each level of risk. These levels are #1 Severe Uncontrolled Community Transmission, #2 Significant Uncontrolled Community Transmission, #3 Moderate Controlled Transmission, and #4 Minimal Controlled Transmission. Among the criteria used to establish the different threat levels, there is no mention of excess deaths. The lowest level of risk achievable is described as â&#x20AC;&#x153;minimal controlled transmissionâ&#x20AC;?. Such a minimal risk level may still be unacceptably high for vulnerable individuals 65 or older or persons with pre-existing conditions since even in this scheme persons are advised to leave home only as necessary. These individuals could resume normal lives more safely and more confidently if SARS-CoV-2 circulation was low enough not to be causing any measurable increase in the expected number of deaths. This is potentially important because even with an effective vaccine, SARS-CoV-2 may become an endemic virus and a total halt of viral circulation may not be achievable. The other more frequently used measures of viral activity could also be factored in. â&#x2013;

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-Embroiled cont'd from page 7 South Carolina Episode In another situation in South Carolina, state epidemiologist Linda Bell has expressed regret in internal emails at not being more forceful and speaking out in press briefings with the governor who has been reluctant to require mandates for mask use and other measures. According to the account published in The State, Bell said in emails to agency public relations specialists that Gov. Henry McMaster’s staff has been “somewhat manipulative” in meetings prior to news conferences about the coronavirus. Bell also said her not speaking out more from “a policy perspective is one of the reasons that South Carolina is now among the states with the worst outlook.”

group of organizations in the state issued an open letter of support for Bell. In another development, South Carolina lawmakers have called for top health officials to speak out more frankly and forcefully about the pandemic. Most people should be disturbed by the emails, SC House Minority Leader Todd Rutherford told The State. He added, “We need to take steps to separate the governor from DHEC (state’s Department of Health and Environmental Control) and the governor from our chief epidemiologist so that we can get data that is unvarnished by someone’s political ideology.” ■

"... lawmakers have called for top health officials to speak out more frankly and forcefully about the pandemic."

After these emails became public, a

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Notes on People Do you have news about yourself, a colleague, or a student? Please help The Epidemiology Monitor keep the community informed by sending relevant news to us at this address for inclusion in our next issue. people@epimonitor.net

Ailing: Margot Gage Witvliet, Associate Professor of Social Epidemiology at Lamar University, with persistent COVID-19 symptoms. Dr Witvliet traveled to Europe in March and started having flu-like symptoms 10 days after returning to the US. She described her plight as being one of the COVID "long-haulers", that is, persons who have symptoms of the illness but never recover completely. At one point she felt like she was dying and has not felt well for over four months as described in a recent account published at The Conversation.

Regretful: Linda Bell, South Carolina state epidemiologist, about not speaking out more forcefully about the right measures to mitigate the spread of COVID-19, according to The Center Square. The report was based on internal email correspondence obtained by The State newspaper. In one email, Bell wrote “I will not ‘stand next to the governor’ anymore without speaking to what the science tells us is the right thing to do, particularly as his staff intend to portray that as my complicity with his position.” (See story in this issue)

Resigned: Eileen White, city of Fishers Health Department epidemiologist, because of perceived political interference by the mayor in the decision-making of the health department around coronavirus. “This is a level of interference I had never seen before in a public health agency,” White told the Indianapolis Star. (See story in this issue).

Sidelined: Sarah Park, Hawaii state epidemiologist, reportedly for not having implemented a state plan to hire a large number of contact tracers to be on hand in case of an upsurge in coronavirus cases. The management of these tracers has been handed over to other Health Department officials but Park will remain to conduct other activities. (See story in this issue)

Notes on People Honored: Zhong Nanshan, Chinese epidemiologist, with the Medal of the Republic. He was the only recipient of this highest award this year. “He bravely treated [patients] and bravely spoke out, raising human-to-human transmission [to the public], and emphasized strict prevention and control measures,” read the nomination for Zhong, according to state news agency Xinhua.

Newsmaker: Harvey Risch, Yale epidemiologist, for his views on the use of hydroxychloroquine in combination with the antibiotic azithromycin in the treatment of COVID-19. According to Yale News, more than 20 Yale colleagues expressed their concerns in a letter stating “As his colleagues, we defend the right of Dr Risch, a respected cancer epidemiologist, to voice his opinions…But he is not an expert in infectious disease epidemiology and he has not been swayed by the body of scientific evidence from rigorously conducted clinical trials, which refute the plausibility of his arguments.” Yale News reports Dr Risch did not respond to requests for comments.

Profiled: Marie-Roseline Belizaire, a World Health Organization epidemiologist assigned to the Central African Republic (CAR) to set up the organization’s COVID-19 response. She worked previously to slow the spread of Ebola in the Democratic Republic of Congo (DRC) and is seeking to apply lessons learned from DRC to the CAR. Among them was this one from working with the community. “I sat down and ate with them. If you eat with them, they will trust you.”

Near Term Epidemiology Event Calendar Every December The Epidemiology Monitor dedicates that issue to a calendar of events for the upcoming year. However that often means we don't have full information for events later in the year. Thus an online copy exists on our website that is updated regularly. To view the full year please go to: http://www.epimonitor.net/Events Alternately you can view individual months online:

SEPTEMBER OCTOBER

SCIENCE EDITOR Environmental Health Perspectives (EHP), a monthly journal of environmental health research and news published with support from the National Institute of Environmental Health Sciences (NIEHS), is recruiting a Science Editor to work in their offices on the NIEHS campus in Research Triangle Park, North Carolina. The Science Editor serves as a science advisor to the Editor-in-Chief (EIC), and works closely with a team of Science Editors, Deputy Editors, and Associate Editors, who are recognized experts in the core environmental health disciplines, including human physiology and disease, exposure science, epidemiology, toxicology, and environmental health. Science Editors collaborate with various editorial team members to develop, communicate, and uphold rigorous and fair peer review standards. They work with the entire EHP team on activities related to scientific content, peer review management, outreach and communications, publication policies and journal practices. EHP seeks a diverse pool of editors and especially welcomes individuals from groups historically underrepresented in editorial positions to apply. For detailed information about the job, qualifications and the application process – CLICK HERE

Assistant Professor - Appointment Stream The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh invites applications for a full-time faculty position at the level of Assistant Professor, appointment stream. The position is available immediately and requires a doctoral degree in epidemiology or a related discipline with post-doctoral training in epidemiology. Preference will be given to candidates who have expertise in neuroepidemiology of aging and Alzheimer’s Disease. We seek a team scientist who is interested in developing his/her own independent program of research and who has the potential of sustained research funding. The faculty member will join a multi-disciplinary academic department with an extensive collaborative research portfolio and a robust teaching program in the School’s fully accredited programs. The successful candidate will be expected to establish and maintain a strong record of collaborative research, extramural funding, and publications; participate in the teaching and mentoring of master’s and doctoral students within the Department of Epidemiology; and contribute to the mission of the Graduate School of Public Health through service. Review of applications will commence upon receipt of all application materials and will continue until the position is filled. Please apply by going to www.join.pitt.edu and applying for requisition #20002903. Please attach a cover letter, curriculum vitae, a statement of current and future research directions, and the names of three references to your online application. The University of Pittsburgh is an Affirmative Action/ Equal Opportunity Employer and values equality of opportunity, human dignity and diversity, EOE, including disability/vets.

Director, Division of Health Services Research and Implementation Science The Department of Research and Evaluation at Kaiser Permanente Southern California (KPSC) is recruiting candidates for the Director of the Division of Health Services Research and Implementation Science (Department chair equivalent). This position is an ideal opportunity for a visionary and dynamic leader to work with the Department and Leadership at KPSC to promote, conduct, and lead high-quality health services research that results in improvements to patient care. Health services research can include the comparative effectiveness of delivery systems; patient-centered care; health care for people with diverse racial/ethnic backgrounds; as well as health care access, utilization, and dissemination and implementation of findings and practices. Qualifications: Doctoral Degree (Ph.D., Dr. PH, MD, ScD) in health services research, epidemiology, health economics or related fields or equivalent training and mastery. Competent in advanced research methods, including statistical techniques and study design commonly used in health services research, implementation science, epidemiology, behavioral research, economics or related fields. At least 13 years of experience in health services research are required. Proven success in the academic environment with an established track record in extramural grant funding, scientific publications and mentoring junior investigators required. Must be able to consistently demonstrate the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to all. Experience partnering with operational leadership in a learning health system preferred. Duties: The Director has primary responsibility for the planning and directing health services research activities as well as dissemination and translation of results in support of the mission and vision of the Department and overall organization. Collaborates across groups, site, and enterprise to improve processes and patient-centered care within and outside the organization. Reports to the Senior Director of Research and serves on scientific and administrative leadership committees. May serve on faculty of the Kaiser Permanente Bernard J. Tyson School of Medicine. Prepares internal reports and peerreviewed publications, independently and collaboratively. Presents at national and international scientific meetings. Teaches and/or reviews papers for national and international journals. Evaluates and consults on research proposals. Supervises the activities of junior research scientists or post-doctoral research fellows. Serves as mentor and collaborator on grant proposals of junior research scientists and fellows. Designs, develops, and directs well defined research. Provides service to the scientific community through membership in peer-review groups and national boards. May consult with local, state and national governmental agencies. Maintains awareness of scientific developments within his/her area of expertise, both in terms of new methodology, new research activities and identification of competent, potential investigators and collaborators. Consistently supports compliance and the Principles of Responsibility (Kaiser Permanenteâ&#x20AC;&#x2122;s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation and licensure requirements (if applicable), and Kaiser Permanenteâ&#x20AC;&#x2122;s policies and procedures. In addition to defined technical requirements, accountable for consistently demonstrating service behavior and principles defined by the Kaiser Permanente Service Quality Credo, the Kaiser Permanente mission as well as the specific departmental/organizational initiatives. This position will include a core support package for the successful applicant that can be used to conduct pilot studies that leverage existing infrastructure to facilitate the development of an extramurally funded research program. This support includes staffing for administrative tasks, programming and analysis, and research support as well as modest funding for nonpersonnel-related costs. A description of the Department of Research & Evaluation is available on the web (http://kp.org/research). It is the home to 30+ doctorally-prepared investigators and over 350 support staff. The Division currently has 7 investigators and more than 35 support staff. The Department is located in Pasadena, a community of 140,000 residents and the home of the California Institute of Technology, the Rose Bowl, the Jet Propulsion Lab, and other historical and cultural sites. Information about the community can be found on-line at http://www.pasadenacal.com/visitors.htm. Pasadena is in the San Gabriel Valley 15 minutes north of downtown Los Angeles in sunny southern California. Kaiser Permanente Southern California is an Equal Opportunity/Affirmative Action Employer and offers competitive salary and comprehensive benefit packages. Interested candidates should submit their letter of interest, CV and references to Dr. Steven J. Jacobsen, Senior Director of Research (c/o mailto:Jennifer.X.Wong@kp.org). and apply online at kp.org/careers, reference #899509. Principals only.

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