Sturm und Drang
The Knox County County Health Department’s top epidemiologist works within the eye of the coronavirus pandemic storm.
Roberta Sturm doesn’t use swabs to collect samples from people for coronavirus tests. She doesn’t examine patients with respiratory problems or tend the ventilators that can make the difference between life and death for those stricken by COVID-19. She is not, in other words, on the front lines of the battle against the worldwide pandemic that has arrived in Knox County.
For epidemiologists at the Knox County Health Department, the coronavirus response is familiar work but much greater in scale.
Still, Sturm is in the thick of the fight. As the Knox County Health Department’s emergency preparedness epidemiologist, she commands the situation room.
In many ways, the novel coronavirus isn’t novel for Sturm; tracking the course of disease outbreaks is what she does. “We are very seasoned in outbreak investigations,” she said in a recent interview.
When outbreaks of any disease occur, the Health Department assigns one or two public health professionals to investigate cases and interview patients to produce data for Sturm to crunch. She said the Health Department conducts a dozen or fewer investigations in a typical year.
This year is anything but typical, however. The novel coronavirus forced the department to ramp up exponentially. The work is essentially the same, but there are approximately 30 people on the coronavirus response team.
“The scope and scale is different,” said Sturm, who has worked on more than 100 outbreaks at the local, state and national levels.
The Health Department’s Epidemiology Department tracks more than 80 diseases and conditions that healthcare providers must report to the state. Among the diseases are cholera, gonorrhea, mumps, malaria, lyme disease, hepatitis, smallpox and the plague.
Influenza, the disease most commonly mentioned in the same breath as COVID-19, is not reported, in part because so many people who contract the flu “tough it out” and do not seek professional medical treatment.
One illness that many think of as eradicated that still crops up from time to time is whooping cough. “It hasn’t gone away,” Sturm said. “We see a lot of cases every year.”
The data goes into the National Electronic Disease Surveillance System Base System, or NBS. The Centers for Disease Control and Prevention developed the NBS to help public health departments manage and report disease data.
The Health Department also collaborates with local hospitals through ESSENCE, a system that tracks the chief complaints from hospital patients to help identify outbreaks or monitor the overall health of the community.
Sturm sifts through data to identify a variety of public health threats. She looks for patterns amid statistics, interview responses and other data points. “When we see several cases that come in at one time, that’s a red flag,” she said.
Some of the most valuable information comes from the outbreak teams as they conduct “contact tracking,” which is basically connecting the dots of an outbreak back to its source. In each case, the teams interview individuals, filling out an extensive questionnaire that can be 13 pages long.
For an E. coli or salmonella outbreak, for example, the team questions the patient about the food they have eaten — down to the type of lettuce or cut of meat — and where and when they ate it. They talk to others who may have eaten the same food from the same supermarket or wedding reception or restaurant.
Sturm and her team also check with their colleagues in surrounding counties to see if they are seeing the similar cases. Diseases don’t respect lines on a map separating counties.
The goal, Sturm said, is to find “epi-links” — the web of connections that form the contours of the outbreak. They also counsel patients on what they should do next. “For every case, we talk to them about how to keep from spreading it to a loved one or someone else,” she said.
Sturm, known to her colleagues as “Bert,” grew up in West Virginia. She earned a bachelor’s degree in public health from the University of Tennessee and a master’s degree from East Tennessee State University. She’s been at the Health Department for 13 years and assumed her current position a little more than a year ago.
Sturm has taught epidemiology and biostatistics at King University and is an instructor at the University of Tennessee for the student outbreak rapid response training.
One key contribution to fighting disease outbreaks can’t be found in the data, according to Sturm’s boss.
“The hard part is articulating the number of people who didn’t get sick during any given outbreak due to Roberta’s rapid identification of and response to these events,” said Charity Menefee, director of communicable and environmental disease at the Health Department. “The good work that public health does is often hard to quantify. I can say, without a doubt, that she helps people daily and they never know it.”
Sturm isn’t all about outbreaks all the time. She and her colleagues also use data to help the community address chronic diseases and conditions such as diabetes and obesity, as well as the dangers from substance misuse and smoking.
Every five years, the Health Department publishes its Community Health Assessment, which gives a high-altitude overview of Knox Countians’ collective health status. “Over five years we can see where we’re moving the needle and where we might need to do some work,” Sturm said.
“We can inform our community about health issues and what our priorities should be,” she continued. “It informs our work.”
The Community Health Assessment takes longer than a year to assemble. The newest version was set to come out later this month, but the coronavirus response has pushed that back indefinitely.
Sturm also authored the Health Department’s report on naloxone, the drug carried by many first responders to reverse the symptoms of opioid overdose. She has presented the report to the U.S. Surgeon General, the Tennessee Bureau of Investigation and professional organizations.
The coronavirus might have temporarily halted the publication of the Community Health Assessment, but it cannot stop the outbreak of other diseases. For example, flu season theoretically ended on March 31, but diseases treat calendars with the same cavalier attitude they show county lines.
“Reportable diseases do not stop,” Sturm said. “It would not surprise me to have another outbreak.”
She isn’t concerned about the Health Department’s ability to handle more than one outbreak at a time, even if one of them is a global pandemic involving a previously unknown coronavirus. “We have the capacity here to divide and conquer,” Sturm said.
UPDATE: A reference to Roberta Sturm's service on the University of Tennessee Institutional Biosafety Committee has been removed. On its website, the Knox County Health Department mistakenly stated she was a committee member.