Epidemiology refers to the process of identifying the distribution of diseases, conditions, and health-related factors in the population. This method is essential for investigating and preventing public health issues, such as disease outbreaks. They occur when the number of disease cases spreads at a faster rate than expected within a specific time and geographical area (Stanhope & Lancaster, 2016). In this context, epidemiologists play a vital role in solving the outbreak as they collect and analyze the data related to the spread of illness affecting the community. The Centers for Disease Control and Prevention (CDC) developed a game that provides people with an opportunity to try on the role of the epidemiologist and establish the cause of the disease in given scenarios. In particular, the CDC’s simulation educates the audience about the steps of the outbreak investigation process involved in an epidemiologic field investigation (Rasmussen & Goodman, 2018). This paper aims to provide a review of the mission “Breathless in the Midwest” as part of the CDC’s game “Solve the Outbreak” and identify the epidemiological process used and results obtained.
In the given scenario, “Breathless in the Midwest,” an acute outbreak was reported with 15 sick patients hospitalized with similar symptoms and seven deaths within the past two days. The incidents occurred in Chicago and Milwaukee, and the people turning to emergency rooms complained of high fever, fatigue, chest pain, coughing, and difficulty breathing. The first case reported was Zeke, a musician from Chicago who recently led a music workshop for students at a local concert hall. Based on the data given, the cause and origin of the outbreak needed to be determined through the use of the epidemiological process and careful analysis. Namely, a field investigation was required to study and control the health problem threatening the population.
Given the severe nature of the health issue in Chicago and Milwaukee, it was essential to work quickly towards identifying the underlying causes of the outbreak. However, it was equally important to get the correct answer and avoid errors, which might have endangered more people and affected a larger area. The steps of the epidemiological process included preparing for fieldwork, reviewing case reports for prevalent symptoms, interviewing patients, performing descriptive epidemiology, developing and evaluating the hypothesis, and implementing control and prevention measures.
To begin with, it was necessary to talk to the first reported case, which would provide initial information regarding the activities to look out for in other patients. For instance, the interview with Zeke revealed that he led a music workshop shortly after his vacation in Mali, where he had made drums with a local craftsman. His friends returning from Mali on the same flight had not reported any symptoms, while Zeke recalled feeling sick immediately after the music workshop. Meanwhile, laboratory results showed that hospitalized patients were supposedly infected with anthrax. This infectious disease is caused by the spore-forming bacterium Bacillus anthracis, which can affect wild and domestic areas and is usually found in soil (Stanhope & Lancaster, 2016). The possible ways of getting infected with anthrax include coming in contact with or inhaling the spores from contaminated animal products, as well as consuming undercooked meat of infected animals. Furthermore, this biological agent is often associated with a high risk of bioterrorism involved, which implied the need to investigate this scenario as well. However, the bioterrorism threat was ruled out when authorities found no evidence of anthrax at governmental buildings.
Along with confirming the laboratory test results, it was essential to continue interviewing other sick people and their families to identify the list of activities that might have caused the disease. Additionally, the population at risk of getting sick was contacted to obtain data. As a result, the attack rate was calculated for various activities, indicating the number of people who did and did not participate in them. This fundamental concept of epidemiology can help identify the possible exposures contributing to the disease (Stanhope & Lancaster, 2016). It was essential to focus both on a high attack rate for people involved in an activity and a low attack rate for those not participating. Upon the analysis of the data, the attendance of a music event in Chicago was identified as a possible exposure causing the outbreak.
In addition, the CDC’s laboratory test results confirmed the presence of Bacillus anthracis in the blood samples of the hospitalized people. The patients were diagnosed with inhalation anthrax, and immediate treatment with antibiotics was required. It was established that the spores were released during the music workshop, and it was critical to ensure post-exposure prophylaxis for the participants who did not report symptoms. Further investigation revealed that the drum maker in Mali died soon after Zeke’s departure. Moreover, the goat hide he brought to the US from Africa for his workshop was contaminated with anthrax spores due to the lack of appropriate treatment with chemicals. As a result, people at the music event were exposed to spores and infected. The simulation by CDC highlighted the crucial steps of the epidemiological process, particularly descriptive epidemiology, developing, evaluating, refining the hypothesis, and implementing control and prevention mechanisms.
In the CDC’s simulation “Breathless in the Midwest,” the epidemiological process allowed for establishing the disease and implementing measures for public safety. The inhalation anthrax outbreak was attributed to the audience’s exposure to contaminated goat hide during a music workshop. This condition is regarded as a rare but the most dangerous form of anthrax. It does not spread from person to person and can take up to two months for the infected individual to get ill (Stanhope & Lancaster, 2016). These facts explain why Zeke’s friends taking the same flight from Mali did not get anthrax while people exposed to the spores from goat hide did. The initial symptoms include fever, cough, and fatigue which resemble a common cold, which prevented Zeke from attributing his illness to the drum-making process in Africa. Anthrax can be diagnosed through blood tests, which were conducted to confirm the hypothesis. It is worth noting that post-exposure prophylaxis was imperative for people who did not report any symptoms but had been exposed to the agent. Furthermore, immediate treatment with antibiotics was required for the hospitalized patients.
To conclude, the simulation “Breathless in the Midwest” by CDC used an efficient epidemiological process to investigate an acute outbreak in Chicago and Milwaukee. The crucial steps of the epidemiologic field investigation included establishing a plan, conducting patient interviews, performing descriptive epidemiology, developing and evaluating the hypothesis, and executing control and prevention measures. A critical data analysis was required to study the problem at hand and establish the right course of action to ensure public safety.
Rasmussen, S. A., & Goodman, R. A. (Eds.). (2018). The CDC field epidemiology manual. Oxford University Press.
Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in the community (9th ed.). Mosby Elsevier.