Jim Setzer


One of my first jobs in public health was to manage 25 emergency treatment centers during a cholera epidemic in Kinshasa, Zaire (now Democratic Republic of the Congo).

Cholera is a highly contagious disease passed by fecal-oral transmission through contaminated water. It is a messy, dirty killer. There was no effective vaccine at the time and we knew that for every case we saw there were up to nine infected — but asymptomatic — people continuing to circulate in the community and infecting others unknowingly.

I spent long days in a Zairian army truck delivering necessary drugs and supplies, and collecting data and specimens so we could track the disease and plan our next moves. I was 24 years old and it was a long summer and almost 400 people died in our centers.

I believe that if not for the efforts of our team, it could have been much, much worse. I learned a lot about epidemiology — the study of the spread and control of diseases — and went on to a career in public health, which included responding to epidemics of measles, meningitis, Ebola and avian influenza.

As I sit now, social distancing at my place upriver outside of Pendleton, a number of things I learned come to mind that have relevance to us all as we stare down the threat posed by the COVID-19 pandemic.

Simple actions and interventions when followed by everybody can make a big difference, and break the chain of transmission. For cholera, that included disinfecting everything, washing hands and purifying drinking water. Through clear and consistent messaging, people got the message, did what they were asked and it worked. With COVID-19, we are asking people to wash hands and practice social distancing.

Be like Wayne Gretzky — don’t skate to where the puck is — skate to where it is going to be. The actions we ask people to take should be based on what the data suggest the situation will be in a week or two. If we are reacting only to the situation as it is today, we have lost. Dr. Anthony Fauci, a true public health giant, said we should be overreacting to the current situation in order to prevent it from getting worse.

We are all in this together and need to act like it. Even if you consider your personal risk of serious illness to be low, you must act as if you are at high risk of being a “spreader” who can transmit the disease to someone who may become seriously ill. To do otherwise is just plain selfish.

Monday morning quarterbacking does us no good. Let the leaders lead. Now that the internet has made everyone an expert, it’s easy to second-guess the difficult decisions made by medical and political leaders. They have a difficult job of sorting through data to decide the best course of action. Their analysis goes well beyond a Google search. I sincerely believe that if we cannot agree our leaders actually have our best interests at heart and are trying their best to help us get through this, we are lost.

So, where do we go from here? I think we need to agree that the threat is real and could be very serious for many members of our community, especially the elderly and those with complicating conditions. Frankly, we need to decide if we are even a community that cares about each other and is willing to make sacrifices that protect not just ourselves but our neighbors. We need to agree to act together and hold ourselves accountable for our individual as well as collective behaviors.

Look to the tragic events unfolding in Italy to see what happens if we don’t.


Jim Setzer has a master’s degree in public health and tropical medicine from Tulane University, with 35 years of worldwide experience in epidemiology, health planning and health information systems. Now semi-retired, he and his wife Kathy live outside of Pendleton wedged between the Blue Mountains and the Umatilla River.

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