The Things We Carry After a Pandemic

It has been a busy week for me.

I have been on the infectious diseases consult service while also following every update of the unfolding Hantavirus outbreak linked to the Hondius. In many ways, it has felt like reliving the early days of the COVID-19 pandemic, except this time, it is not a novel pathogen, but a well-described virus appearing in an entirely new epidemiologic context: transmission aboard a cruise ship.

As I sat down to write this entry, I found myself wondering what exactly I wanted the focus to be.

So much has already been written about the outbreak itself; the ongoing investigation, contact tracing efforts, debates about airborne spread, arguments over what constitutes “close contact,” and the inevitable re-litigation of every success and failure of the COVID-19 pandemic response. Once again, the WHO and CDC are being placed on trial in the court of public opinion by people who still hold those institutions singularly responsible for everything that went wrong during the hardest years of the pandemic.

The truth is that many of these debates will never be fully settled in our lifetimes.

When you survive a global pandemic, you are never quite the same afterward. Those of us who lived through COVID-19 will probably spend years continuing to metabolize what happened scientifically, psychologically, politically, and personally.

So rather than rehashing familiar arguments, I want to focus on something else entirely, how we respond emotionally to the next infectious threat, and how not to let the trauma of COVID distort our judgment and overwhelm common sense.

What much of the public does not fully appreciate is how frequently those of us working in infectious diseases and public health confront potential outbreak scenarios. Most simply never become visible outside hospital walls.

The needle-stick injury from a patient with hepatitis B in a chaotic emergency room.

The patient with measles who sat unmasked in a crowded hallway for hours before the diagnosis was recognized.

The patient with active pulmonary tuberculosis who was not placed on airborne precautions because nobody initially suspected MTB.

These situations happen all the time.

Most never escalate into anything that reaches even local news because well-established infection prevention systems rapidly activate. Identify the index case. Isolate. Trace contacts. Secure specimens. Notify the appropriate authorities. Provide prophylaxis or treatment when necessary. Repeat.

It is unglamorous work. Mostly invisible work. But it is the work that prevents outbreaks from becoming catastrophes.

One particular experience from several years ago crystallized this reality for me.

At the end of a long clinical day, I received a page from a colleague in the ICU requesting approval for a respiratory viral panel for a critically ill patient who had been admitted overnight and was now mechanically ventilated. At the time, these tests were expensive and restricted through Infectious Diseases approval.

I asked for more clinical context.

“Well,” my colleague replied, “this is a young man who arrived from the Democratic Republic of Congo two days ago. He was found unconscious in the field and intubated by EMS.”

Immediately, every alarm bell in my head went off. Not simply because the patient was critically ill, but because I was aware of an ongoing Ebola outbreak in the DRC at that exact time.

I told my colleague immediately: “Isolate the patient. I am coming to evaluate him now.”

I quickly reviewed the chart. Fever. Thrombocytopenia. Altered mental status. Very limited collateral history. No clarity about exactly where in the DRC he had traveled from, what exposures he might have had, or how long he had been symptomatic before arrival.

I rushed to the ICU, donned PPE, and entered the room.

After examining the patient, I had an internal conversation that I hope never to repeat:

“What if this is Ebola?”

“And if I even remotely suspect it, how can I justify not acting?”

I made the decision immediately.

I spoke with the ICU attending and recommended sealing off the room, limiting care teams, and implementing strict isolation protocols pending further evaluation.

Within an hour, hospital leadership had been activated. Infection prevention teams mobilized. The cascade began.

Which emergency room bay had he initially occupied?

Who had entered the room?

Where were his laboratory specimens?

Which lab personnel had handled them?

Should those samples now be considered potential biosafety level-4 material until proven otherwise?

The CDC was notified. Discussions began regarding possible transfer to a specialized biocontainment unit. Emergency diagnostic testing was arranged.

For six hours, my world narrowed to a single terrifying question.

And somewhere in the middle of all this, another realization quietly surfaced, I myself was now potentially exposed.

Even though I had worn airborne and contact PPE, pathogens like Ebola demand an entirely different level of precaution and psychological reckoning.

Those six hours remain among the most intense of my professional career.

Then the results came back.

Negative.

Not Ebola. Not another deadly hemorrhagic fever virus. The patient ultimately recovered fully.

This story never made the news because it did not need to. When I reflect on moments like that and on the countless near-misses that occur daily around the world, I actually find reassurance in what modern infectious disease systems are capable of. We understand disease transmission extraordinarily well. We know how to contain outbreaks. We know how to interrupt chains of spread. We know how to implement infection prevention measures rapidly under uncertainty.

COVID altered many things, including the amount of grace the public is willing to extend toward institutions responding to outbreaks in real time. Some criticism of the pandemic response was absolutely warranted. Public health agencies made mistakes. Messaging sometimes changed in confusing ways. Scientific uncertainty was not always communicated clearly.

But there is a difference between demanding accountability and abandoning trust altogether.

Does endlessly placing the WHO or CDC on trial over every evolving recommendation from 2020 actually improve our ability to respond to the next outbreak?

Does convincing the public that every changing recommendation is evidence of deception rather than scientific adaptation make anyone safer?

I do not think it does.

None of this means public health institutions are beyond criticism. Institutions are made up of human beings, and human systems are inevitably shaped by politics, bureaucracy, competing interests, and at times genuine mistakes. COVID exposed many of those fractures in painful and very public ways.

But I also think something important gets lost in these conversations.

The people who actually do this work; infectious diseases physicians, epidemiologists, infection prevention teams, laboratorians, field investigators, nurses, and public health responders remain deeply committed to the mission that brought many of us into these professions in the first place. We trained for this work because we believe outbreaks matter, containment matters, and because protecting the public matters.

When the outbreak aboard the Hondius was recognized, the response team deployed to the ship included infectious diseases physicians and epidemiologists. That detail may sound unremarkable to most people, but to me it says everything.

This is who we are.

When outbreaks happen, people like us go toward them.

Not because it is glamorous or politically convenient. But because it is the job we trained to do.

In infectious diseases, there is often an unspoken understanding that when everyone else is trying to determine how dangerous something may be, someone still has to be willing to walk into the room first.

As I have watched public anxiety, chaotic messaging, and reflexive blame re-emerge during the Hantavirus outbreak, I find myself leaning less into outrage and more into humility. Those of us in infectious diseases and public health respond to threats constantly. We make decisions quickly, often with incomplete information. Sometimes we make mistakes because we are human beings operating under pressure and uncertainty.

But the core principles of outbreak management have not fundamentally changed. Identify. Isolate. Trace. Contain. Communicate. And despite all the anger and distrust left behind by COVID, those systems still work far more often than most people realize.

Perhaps the lesson here is not that public health institutions are infallible. They are not. It is that a world without functioning public health systems, outbreak investigators, infection prevention teams, laboratorians, epidemiologists, and frontline clinicians would be immeasurably more dangerous. The people doing this work have always been there, before COVID, during COVID, and now again during the next outbreak.

Most of the time, you simply never hear about the disasters that never happened.

I am an infectious diseases physician and scientist writing at the intersection of medicine, global public health, society and justice. If this piece resonated with you consider sharing it and subscribing.