Presented by Alaska Native Tribal Health Consortium

Before COVID-19 arrived in the U.S., you might not have thought much about the role of epidemiology in your life. But behind the scenes, Alaska’s collaborative community of epidemiologists is constantly at work, studying the diseases and trends that impact everyone’s health.

“Epidemiology is an everyday science,” said Carla Britton, lead epidemiologist at the ANTHC Alaska Native Epidemiology Center. “Public health is really something that everybody participates in every day. There’s just a bigger context now for it than there ever has been.”

Tracking diseases through data

When the Indian Health Service introduced Tribal Epidemiology Centers in 1996, Alaska was one of the first service areas to open one. Now under the management of the Alaska Native Tribal Health Consortium, the Alaska Native Epidemiology Center (or “the EpiCenter,” as it’s called for short) is one of 12 such centers nationwide. The centers’ core functions, outlined in the reauthorization of the Indian Health Care Improvement Act, include collecting data and making targeted recommendations about public health issues that affect Indigenous people in each service area. In Alaska, that means working with partners including the State of Alaska and the Centers for Disease Control and Prevention’s Arctic Investigations Program to address infectious illnesses like COVID-19 as well as non-infectious diseases such as cancer and substance abuse.

“When people have connected with epidemiology, it’s always kind of been around infectious disease,” Britton said. “But epidemiology is really about our everyday health, even when we’re not having a pandemic.”

One of the EpiCenter’s focus areas is “surveillance” -- a term that’s used quite a bit in epidemiology. Surveillance, in this case, doesn’t mean disease investigators are using listening devices or camped out with binoculars. In epidemiological terms, “surveillance” simply means the systematic gathering of data about health outcomes and risk factors to inform future prevention and control efforts. Information is gathered in many ways, including by telephone surveys and increasingly through the growing body of anonymized health data like trauma registries and discharge datasets that Britton describes as “the pulse of the health of the state.”

The ANTHC EpiCenter works to collect and share this data and translate it for different audiences (including in reports that are available to the general public). That information is used as the foundation for grant applications, program planning, funding decisions and public health initiatives. The EpiCenter also assists the State of Alaska Section of Epidemiology with the contact tracing and case investigation that are an essential part of disease control.

“(Data) informs action,” said Dr. Ellen Provost, director for the Alaska Native Epidemiology Center. “It helps to inform decision makers so that they can make decisions about what actions to take. It helps to garner resources to address issues of concern.”

And right now, it’s informing Alaska’s response to the global pandemic.

Tracking COVID-19 in Alaska

Before the pandemic hit, ANTHC Director of Organizational Development Kalani Parnell mostly engaged with the EpiCenter in the course of facilitating meetings and supporting strategic planning. With the advent of COVID-19, Parnell was put in charge of ANTHC’s Incident Command System’s Coronavirus Situation Unit, which works on data infrastructure, reporting, data surveillance, predictive modeling, and media monitoring related to the virus -- and epidemiology is now part of his everyday life.

Parnell’s unit collaborates with state and local government, the University of Alaska, experts from multiple scientific and technical fields, and epidemiologists from across the country, including Provost and two others from the EpiCenter who have been embedded in the unit.

“We have been trying to answer several big questions,” Parnell said.

Among them: What is the pandemic presenting to ANTHC today, and what resources does the organization have to address it? And what will the answer to that question be in two weeks?

“Every community within the state has experienced the coronavirus differently,” Parnell said.

Part of his team’s mission is to understand how communities are being impacted by the virus, as well as what they’re doing to confront it. And with a brand-new virus, that can be especially tricky.

“We have generally abided by the quote attributed to George Box that says, ‘All models are wrong, but some are useful,’ meaning that all models fall short of the complexities of reality but can still be of use,” Parnell said.

In other words, just as it’s important to learn everything that can be learned about the virus, it’s also important to understand what is unknown and how confident researchers can be in the data they do have.

“Keep in mind that in this pandemic, understanding is constantly changing, which impacts how we define things, which impacts our models that then need to be adjusted and communicated,” Parnell said.

That’s where the EpiCenter comes in.

Every day, the Situation Unit meets to evaluate the latest information and adjust course as necessary. The epidemiologists are there to explain epidemiological research practices and help their colleagues know what data should be available -- and filter good information out of the “noise,” according to Parnell.

It’s fascinating work, he added, and it plays a key role in helping the team make good recommendations to its partners in Alaska’s Tribal health system.

“I tend to react emotionally to data because I don’t understand it within a larger context, so I make assumptive leaps that aren’t necessarily value-adding,” he said. “The epidemiologists I’m working with are calming, collected, and understand the big context and complexity of it all.”

That means they can help the team keep perspective and formulate responses based on analysis, not emotion -- a contribution that Parnell said provides a valuable grounding effect.

“I am just smart enough to know that I work with a group of real brilliance,” Parnell said.

‘It is still among us’

One thing epidemiologists have observed: Alaska’s uniqueness, sometimes a challenge in the health care world, has probably been a protective factor in keeping the virus at bay.

“I think we’ve benefited greatly by being Alaska, by being a little bit more isolated from other populations, and then benefitting from learning from others -- from other cities, from other countries,” Provost said. “We’re not densely populated. We have fewer people per square mile than many other places. That’s maybe a unique factor that has maybe contributed to things not going as badly as it has gone elsewhere.”

The actions taken by local communities to slow the spread and “flatten the curve” have also helped mitigate what could be “a really terrible situation,” Provost added.

“It’s really going to be up to people now as we start relaxing restrictions, and communities to continue to make decisions for their own protection, because it is still among us,” she said.

While the virus continues to spread, there is good news: Advances in data gathering and availability, along with scientific development, mean that the response to new diseases like COVID-19 can move much more quickly than it would have in the past. Britton points out that while the disease was unheard of a few months ago, researchers have already identified the responsible organism and sequenced its genome.

“That’s kind of unprecedented,” she said. “We weren’t able to do that with the 1918 flu epidemic. H1N1, and now coronavirus, has just been a really different picture in how we respond and how epidemiologists work.”


This story was sponsored by Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization designed to meet the unique health needs of more than 175,000 Alaska Native and American Indian people living in Alaska.

This story was produced by the creative services department of the Anchorage Daily News in collaboration with Alaska Native Tribal Health Consortium. The ADN newsroom was not involved in its production.