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Staging the Plague

Students training in a variety of health professions worked in interdisciplinary teams to come up with comprehensive solutions to protect public health through a simulated outbreak scenario, held in Fagin Hall and dubbed PennDemic.

A child with a swollen armpit and high fever dies in Washington, D.C. The cause is found to be Yersinia pestis, the bacteria that causes plague. Two days later, a 35-year-old man goes to a Philadelphia-area hospital with similar symptoms and is later confirmed to also have the plague. If you’re a public-health professional, what questions do you have? What do you need to know in order to protect your community?

This fictional scenario, presented to 81 Penn students this past Saturday, constituted the launch of an infectious disease outbreak simulation exercise. Throughout the day, as event coordinators provided participants new information about the “outbreak,” students worked in interdisciplinary teams to address the emerging health crisis. Engaging in dynamic discussions, they worked to plot out what information they had, what new information they needed to gather, and eventually what actions needed to be completed to contain the spread of disease.

“The point of this is to teach students how to work in interdisciplinary teams,” says Shelley Rankin, professor of microbiology in Penn’s School of Veterinary Medicine and one of the lead organizers of PennDemic. “Getting the ‘right answer’ is not why we’re doing this. We’re letting them get to know how disciplines outside their own view things, how to capably work together, and also how to manage some of the chaos that can ensue during public-health emergencies.”

Participants in the event, held in the School of Nursing’s Fagin Hall, were primarily graduate students from Penn Vet, Penn Nursing, the Perelman School of Medicine (including the Master of Public Health Program), the Graduate School of Education, the School of Social Policy & Practice, and the University of the Sciences’ pharmacy program. A few nursing undergraduates also participated. Hailing from many different academic backgrounds, the students brought their own personal and academic experiences to bear during the simulation.

Chloe Glynn, for example, a teacher at Philadelphia’s Science Leadership Academy at Beeber and a student in Penn GSE’s Urban Teacher Leadership Program, has a personal interest in viral-disease transmission. She also decided to participate in order to soak up ideas she might apply to her own classroom.

“As a science teacher, I’m really interested in hands-on, immersive activities,” she says. “It would be great to be able to replicate something like this with my students.”

Other students showed up on the rainy Saturday to bolster training in their chosen fields. Elle Saine, a fourth-year M.D.-Ph.D. student in epidemiology, had previous experience in disaster response, but the focus on collaboration across multiple disciplines made the simulation unique.

“I like the fact that we’re all coming from different backgrounds in terms of what we’re thinking when it comes to a mass outbreak and panic,” she says. “It’s been interesting to learn what the others’ concerns are and what their knowledge base is.”

The idea for the table-top simulation event was borne of a Perry World House symposium held last year on the topic of pandemic risk, which engaged faculty experts from Penn and beyond. Bonnie Jenkins, a visiting fellow with Perry World House, collaborated with Penn Vet’s Shelley Rankin, Stephen Cole, and Jennifer Punt; Penn Nursing’s Deborah Becker; and Penn Medicine’s Hillary Nelson to organize the simulation. In addition, students in an interprofessional course in One Health Study Design, taught last spring by Rankin, Cole, and Punt, applied for a University Research Foundation Impact Seminar grant to support the event.

The day began with a welcome and introductions from Jenkins, followed by a presentation from Becker, offering the students a primer in elements that make teams effective.

“Teamwork doesn’t happen by itself; you have to work at it,” Becker said. She urged students to get to know one another, be assertive yet flexible, practice conflict resolution, and consider issues from others’ perspectives.

The rest of the day, students put those principles to work. After being briefed on the basic facts of the case, students met quickly with others in their same discipline before devoting the bulk of the eight-hour event to working in groups with students from other professional tracks.

For Daniel Gonzalez, who is training at Penn to be a nurse practitioner and works as a nurse at the Robert Wood Johnson University Hospital, the simulation was not his first experience in emergency response. Since age 16, he’s worked in health care, first in EMS, then as an EMT, then a nurse. He’s deployed in a number of disasters, including Ground Zero and the aftermath of Hurricane Maria in Puerto Rico, where he’s from. What was different about this experience, however, was the emphasis on working in a diverse team.

“This has been great,” he says. “It’s nice seeing what people are thinking outside your discipline. There is so much that has been talked about that I wouldn’t have thought about myself.”

Before the working lunch, a talk from Damon Centola of the Annenberg School for Communication introduced students to how social factors might influence responses to the outbreak. His research has examined how social networks can influence the spread of behaviors and ideas, with implications for how either disease or healthy habits, like gym-going or routine vaccination, might also be “contagious” through such networks. “When social links are spread around the world,” he says, “it allows disease to spread widely and can make it difficult to contain.”

Periodically throughout the event, students received updates on the outbreak, with new information about the case leaking out, implicating cats, rats, even ISIS as possible culprits in introducing the disease in Philadelphia.

“We put a few red herrings in there to keep things interesting,” says Rankin.

In addition to the faculty organizers and other facilitators from Penn, an array of outside experts were on hand in a “bullpen” through the day to provide guidance. Representatives included staff from the U.S. Centers for Disease Control and Prevention, Pennsylvania Department of Health, Federal Bureau of Investigation, Philadelphia Fire Department, and the Philadelphia Department of Public Health Vector Control.

After each new piece of information was presented—say, a SEPTA bus driver fell ill with symptoms suggestive of plague—students were asked to go back to their teams and work together to provide three recommendations on how to proceed. For example, how should they advise the city government on managing the transportation difficulties that arose after SEPTA drivers failed to come to work for fear of contracting the infection.

To keep an air of urgency and chaos going through the day, the organizers played air raid sirens as they introduced breaking news on the outbreak, with fabricated “reports” from outlets such as CNN and CBS3 sharing how the general public and media was responding to the ongoing outbreak.

The day wrapped up with a debriefing session where the students shared the action steps they had developed together, and then received feedback from the experts about what steps they consider best practices in an outbreak scenario.

The event organizers are already mulling how to revamp the event for future groups; they hope to make it an annual event. In their view, the need for trained health professionals who are comfortable with working in teams with diverse viewpoints will only grow.

“For me, I think about the threats these students are going to face in the future: climate change, disease, biosecurity,” says Jenkins. “They all require interdisciplinary expertise.”

This article was written by Katherine Unger Baillie, science news office in University Communications, with photography by Eric Sucar. It first appeared in Penn Today.