Global Health Spotlight: Sarah Richter

SANAYA RAU, SAMANTHA PARKER & SUHA SAGHEER

Sarah Richter is an MPH Epidemiology student in the Dalla Lana School of Public Health at the University of Toronto. Her Kinesiology background influenced her decision to further explore chronic disease pathology, treatment & prevention with a public health approach. Highlights of her past work include interdisciplinary initiatives among allied health students, facilitating improved physical & mental health in individuals with spinal cord injury and athletic therapy roles with amateur & elite athletes. Sarah recently joined forces with other MPH students in the Infectious Disease Working Group, which educates & supports UofT students and beyond through knowledge and community engagement. 

1. What does the UofT Infectious Disease Working Group do, and what is the role of the group specifically now during this pandemic. What role do you play in the working group?

 The UofT Infectious Disease Working Group serves multiple roles. In terms of the current pandemic, the group was created soon after the declaration of COVID-19 as a Public Health Emergency of Concern. A student-led working group previously existed to address Ebola. Recognizing that there are long-term effects from every pandemic and that other infectious diseases continue to affect different global regions, the group’s chairs recognized the need for our work to continue on, which is why it was given the broad title of “Infectious Disease” instead of “COVID-19” exclusively. The group serves many roles, which keep evolving. Collectively, all group members serve to resolve myths, create awareness, address disparities in health equity, and advocate on behalf of disproportionately affected groups. Three sub-committees exist (Events, Knowledge Translation, Community Engagement), which consist of Year 1 and Year 2 students in the departments of Epidemiology, Indigenous Health, Occupational & Environmental Health, and Social & Behavioural Health Sciences. I am one of the Epidemiology students in the working group, currently writing op-eds as part of the Knowledge Translation sub-committee. So far, our goal with the op-eds has been to create relatable narratives for other UofT students and anyone else we can reach, while incorporating some peer-reviewed literature and providing resources to readers. 

 2. You mentioned that you are part of the Knowledge Translation Sub-Committee for the working group. Misinformation, fear mongering and xenophobia were prevalent especially in the early days of the pandemic. Can you comment on how effective the knowledge translation strategy has been for COVID-19 both in Canada and around the world, and what we can do better in the coming months?  

I can only speak to the knowledge translation that I’ve been exposed to. Most knowledge translation has been disseminated via social media, in order to reach a lay audience. Despite some provincial, national and global groups producing impressive synthesized work, some of it has yet to reach a broader audience. The World Health Organization (WHO) has consistently produced infographics through their social media outlets; these infographics typically include common questions and their evidence-based answers in a succinct format with a graphic. One challenge the WHO faces with their knowledge translation is that they have to address everyone. Therefore, some of the knowledge translation produced may not seem relevant to us in Canada, but still has a great impact. An example of longer translations I would like to highlight includes work performed by Public Health Ontario (PHO). Quite frequently, they have produced synopses of emerging articles: https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novel-coronavirus/articles.

No matter the effort of clinicians, researchers, and students, it remains that some groups will still ignore existing knowledge translation. In order to improve on strategies, I believe students play an important role. We are young and live in large diverse communities; our large networks allow us to get the right information to people in need. As much as I will promote the sharing of available information, I encourage the lay audience to critically analyze the information they receive to ensure highly valid and accurate work continues to spread.

3. According to your research, what will the next 4-6 months look like? What are the epidemiological risks of letting up social distancing regulations too early? Can we expect to stay home and social distance long-term? 

I wish I could say that I’m confident in my following answer, but the fact is there are a lot of variables to consider! Not only will we see differences between countries, but within countries too. In Canada, we’ve witnessed BC’s earlier plateau of COVID-19 rates. 

A lot of the research I have given my attention to is the work of my professors and public health authorities from both of my homes (BC and Ontario). The BC Centre for Disease Control has created projections based on models of other places: Hubei, Northern Italy and South Korea. The number of people in critical care in BC seems to follow a trajectory between that of Hubei and South Korea, but with a longer plateau. As for 4-6 months from now, the case counts should be low if this trajectory continues, but I believe there will be plenty of residual cases, especially in rural communities. As we’ve seen with Tuberculosis in Canada, once an infectious disease enters a marginalized or rural community, it’s difficult to remove it. As for Ontario, PHO’s latest modelling displays that cases and deaths were still on the rise, but approaching their peak. It seems Ontario’s peak will be reached in May, and we’ll begin to see a decrease.

As data-driven as these projections are, we’ve seen how unexpected actions and large volumes of air travel can disprove mathematical models. A meat-packing plant in Alberta, correctional facilities, and nursing homes have all been home to surges of cases. If social distancing regulations are let up too early, we could see a second wave of the virus and a situation similar to that of the Spanish flu; its second wave was deadlier than the first. As for long-term expectations, I believe that we will continue to stay home and distance. It is less likely it will be to the degree we are at now, but we need to recognize that some form of physical distancing might be the new normal. Currently, it’s easy to be selfish in our thoughts, as even I have been. We need to remind ourselves of more vulnerable individuals we are protecting, by maintaining physical distance standards.

To provide some perspective, I’ve included a clip from Global News, which shared a public notice from my hometown (Kelowna, BC) during the 1918 flu pandemic.Screen Shot 2020-05-04 at 1.28.22 PM

4. Most of our readers are students who are trying to figure out how to transform their interests into a career. Your focus areas are kinesiology and epidemiology. How do you marry the two fields in the pursuit of your professional goals?

My professional goals have changed a lot over the last few years, and still aren’t completely set. It’s been a challenge in and of itself becoming comfortable with this fluidity. Regardless of professional goals, kinesiology and epidemiology pair very well together. At their core, kinesiology is the study of human movement and epidemiology is the distribution of disease or health-related characteristics in a population, but they’re so much more than this. In my undergraduate studies, kinesiology exposed me to health promotion, biomedical ethics, chronic disease pathology, exercise as rehabilitation, neuropsychology, and injury assessment & prevention. As an interdisciplinary field, it drove my peers and I to consider futures outside of the rehabilitation sciences, which people traditionally pursue graduate studies for. What really piqued my interest was improving accessibility for people with disabilities and chronic disease prevention. Both of these are areas which require rigorous knowledge translation in order for communities to adopt open mindsets and healthier lifestyles. Before you can develop any preventive measures, you need to understand the pre-existing burden on populations- this is where epidemiology comes in! In my graduate epidemiologic courses at Dalla Lana, I’ve continued to learn about topics like exercise promotion, concussion, and respiratory conditions, which I previously explored. Although infectious disease remains the cornerstone of public health, the disproportionate effect of COVID-19 on individuals with comorbidities is a great example of the need to address chronic disease. Additionally, epidemiology’s close ties with healthy policy creates a great opportunity for me to advocate on behalf of my friends in healthcare roles who are crucial to addressing all disease and injury.

5. What does global health mean to you, both as an academic and a human being, particularly during this global pandemic that we are in?

As an academic, I interpret global health as a difference in systems. We witness it within Canada, too! Some societies and governments are established in a way that favours certain demographics. This difference in treatment produces consequential health disparities. Communicable and non-communicable diseases burden different parts of the globe, disproportionately. The underlying reason for this burden is not necessarily based on citizens’ genetic characteristics, but the society or geography in which they live.

As a human being, my interpretation of global health is teamwork. Some countries are better fit to address certain health crises. Global health is a sharing of resources, much like addressing strengths and weaknesses in a team setting, in order to produce the best collective results. Countries can learn from each other and how they battle disease, whether it be with advanced research, more allied healthcare practitioners, or policy change.