As someone who spent their undergraduate degree in the laboratory, worked as a biomedical scientist and later pursued a PhD, I thought my future would be spent in the laboratory. Maybe with an occasional scurry back to a computer to perform some rough analysis, a bit of complicated statistics and writing a paper thrown in, just to mix things up. However shortly into my post-graduate degree, I applied for a job as, and was successful in becoming an epidemiologist. Luckily, this was just after the third wave of COVID-19 (so they must have been desperate).
My epidemiological role is also an unusual one, with little to no lab work and a lot more data analysis. A lot of epidemiology in the UK focuses on monitoring disease occurrence, transmission and responding to sudden outbreak of food poisoning, parasites, or respiratory viruses (though I think we’re all a bit tired of the last one). My position is (as far as I’m aware) unique to Wales in that the NHS health boards (NHS Trusts in other parts of the UK) each have a designated epidemiologist who works directly with the Infection, Prevention and Control (IP&C) teams. In this role I have access to, and use multiple data sources – from digital databases to paper notes. I use these to not only find patterns and cases that have occurred within multiple sites of the Local Health Board, but also to identify how and where transmission of disease has occurred and what measures are required to prevent it.
There’s no such as thing as a typical day for the role. It can vary wildly if an outbreak of a multi-drug resistant organism (MDRO) is suspected or if cases of Clostridioides difficile suddenly rise (which is unfortunately a common occurrence in healthcare settings).
The start of the day usually involves some quick data analysis using R. I usually extract data from various databases and see if there has been a sudden spike in cases of any organisms across any of the hospital sites. Since there are many organisms to monitor, the primary focus in healthcare settings is major MDROs. However, identifying transmission of more susceptible organisms can allow interventions to be put in place that may prevent MDROs from transmitting around healthcare settings.
This is followed by a daily meeting with the IP&C teams, where we share any cases we’ve identified, and other situations that are going on within each hospital site. These can include wards with known outbreaks, which IP&C measures have been implemented, and where. Additionally, we look at whether there are any issues, or ongoing routine work that may decrease the effectiveness of these measures.
These two items are the standard part of the workday and are usually completed by 10AM, the rest can be made up of any of the following:
- Outbreak Meetings: This usually involves meeting with ward staff, IP&C, microbiologists, and other clinical staff such as speciality consultants. The nature of these meetings is usually to discuss the current state of the outbreak ward, what issues may be causing the outbreak and what is being done to prevent further cases. Sometimes patients will be discussed and investigations into time/location overlaps, shared equipment and other common factors between patients. These assist in understanding the outbreak and bringing it to a close.
- Project Work: A lot of epidemiology can be reactive work, responding after outbreaks have been identified and identifying how transmission occurred. As such, the role allows us to work on projects that improve the surveillance of diseases or focus on methods that could predict/prevent future outbreaks. Each healthcare epidemiologist tends to have their own projects, based on their specialities and what the Health Boards require. These projects can also be part of national healthcare, as being directly employed by Public Health Wales means that some projects focus on improving national surveillance.
- Surveillance: Understanding the spread of disease in the population is necessary to help prevent transmission. In this case looking at specific diseases, how they’re spread in the healthcare environment and their links in the community helps understand how cases are transmitted and helps prevent their spread throughout facilities where vulnerable people are present.
In any case a day often contains a mixture of these things, a few meetings, and a lot of data analysis to either prevent infections or find out the root cause of an outbreak. It often leads to interesting discoveries and the role can almost make you feel like a detective, looking for scraps of information from numerous computer systems, paper notes and patient charts to find the missing links.
It’s an interesting role and while I sometimes miss my pipettes and (strangely) the smell of freshly made agar (not the smell of autoclaves though!), it’s fascinating to see the prevalence of these diseases and how they spread, as well as the role each department has in identifying and preventing each outbreak.