Mock Outbreak Provides Public Health Lesson for Calif. Students

Feb. 08--When a group of about 30 brainy high school students boarded a bus Wednesday morning, they thought they were in store for a tour of the Kern County Public Health Services Department.

Instead, they were tossed into a whirlwind.

Radio chatter crackled as Kern County Public Health Director Matt Constantine boarded their bus.

"Emergency medical services is reporting that local hospitals are experiencing an overwhelming influx of emergency patients. Hospitals around Bakersfield are activating mass casualty protocols in response to the high number of patients coming into the rooms suffering from Hepatitis A," an emergency dispatcher said.

It would be up to the students, Constantine said, to determine the source of the outbreak.

Moments after stepping off the bus, students were stepping into Tyvek hazmat suits, getting organized into strike teams and rushing off to motels, daycare centers, apartment complexes and homeless shelters -- anywhere they could trace to the source of the outbreak.

It was, of course, all a staged event. There was no mass casualty event and no disease outbreak. The motels, daycare centers and hospitals were all staged within the Kern Public Health Department's building on Mount Vernon Avenue. The mock disease scavenger hunt was part of Youth Leadership Bakersfield, a Chamber of Commerce program that recruits high-achieving high school students and introduces them to all facets of county and city governance.

Some days in the program, students hear from guest lecturers about ethics in governing or tour city hall. On Wednesday, they took a hands-on approach and became disease hunters tasked with all the same duties as an epidemiologist tracking down a hepatitis outbreak.

Hepatitis A, students learned, is a highly contagious infection that attacks the liver and causes inflammation. It's most commonly transmitted when food or water is contaminated with fecal matter, but can also be spread sexually, by being in close contact with someone who has been infected with the virus, and even through surfaces.

It's gained attention recently after several high-profile outbreaks.

Almost 300 people got sick in 2016 in Hawaii, where public health officials traced the outbreak to scallops served in a sushi restaurant, Kern County Epidemiology Manager Kim Hernandez explained to the students. Outbreaks have also been traced to frozen berries sold at Costco, and most recently, among the homeless population in San Diego and Los Angeles counties, Hernandez said.

"Oh gosh, this thing is horrible," one curly-haired high school student said.

The disease's long 50-day incubation period and its ability to be transmitted from surfaces make it all the more important for public health strike teams to quickly identify where outbreaks start, Assistant Public Health Director Brynn Carrigan said.

Those duties start in the hospital, interviewing patients and investigating where they might have transmitted Hepatitis A.

"This is one of the tools in our box to ensure we're investigating quickly," Russell Hasting, a public health nurse, told students as they interviewed patients.

When students burst through the double doors of the mock hospital, they found six patients laid up on gurneys. Their faces were covered in vomit, their arms bruised and cut, and skin jaundice. All of them were public health employees-turned-actors for the day (and the vomit was oatmeal.)

Those employees made the experience as realistic as possible, roiling in pain in their gurneys and wailing in fake agony. In one case, a patient recognized a friend she knew from the homeless shelter in the hospital bed across from hers and began screaming, shouting and berating her.

"Hannah! Are you going to own up to this black eye?" Erika Garcia, a microbiologist who was playing a delusional patient, yelled at her colleague from across the room. "She got me so upset, I put my hand in my own poop."

Garcia later complained of doctors replacing her brain with bits of plastic, and was so certain of it that she scratched her arms raw "to let the stuff the doctors injected me with seep out," she said.

That kind of staged chaos, public health officials have said, is typical of what strike teams would find during a disease outbreak. Hastings told his students to pay attention to what matters most: the symptoms, and where the disease might have been transmitted.

"Keep your eye on all the details," he said.

Students then mapped their findings, identifying a cluster of cases that appeared to stem in the southwest, just a couple miles east of Cal State Bakersfield.

"This helps you paint a picture of where people are getting sick," Lisa Amarillas, a public health GIS specialist told students.

There was a fresh fruit stand, a rundown motel, a homeless shelter, an apartment complex and a daycare center.

Any of those places could have been the source of the outbreak.

Students traveled to the sites and began conducting interviews.

They found the fruit stand was unpermitted, and that its owner didn't have access to a bathroom, but would relieve himself during work hours without washing his hands. They also learned he would return home to his apartment complex in the evenings where he sold his neighbors a lot of fruit.

The homeless shelter had no running water, and a man living there -- played by Kern County Network for Children Executive Director Tom Corson -- complained that the bathroom stunk.

"Larry, it stinks," he shouted as students interviewed the shelter director.

The Starkey Apartment Complex, students found, was run by a slumlord who let sewage run over her property and drain into an unchlorinated pool.

Students thought they might have been done after concluding their investigations -- but what's a mock disease outbreak without pushy news reporters asking a bunch of questions?

They staged a mock press conference.

"Be as transparent as possible," Kern County Public Health spokeswoman Michelle Corson coached students before they took to the podium.

They explained their findings, stressed hand-washing and proper hygiene as a way to prevent disease and assured the public that there was nothing to worry about.

But local professional television and newspaper reporters lobbed questions, sometimes hardballs -- and students evaded.

Has a definitive source of the outbreak been confirmed, one reporter asked.

No, Yadira Galindo, an Independence High School student responded.

So how could she ensure public safety?

Crickets.

Just then, Mackenzie Starkey, a Kern County public information officer, stepped in to save the day. The source of the outbreak, she said, had been identified -- something that would probably never happen during a real disease outbreak press conference.

So, what was the source of the outbreak? Starkey Apartment Complex, Starkey said, declining to answer anymore questions and getting off the stage in a hurry.