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Linda Niccolai is a professor of the Department of Epidemiology of Microbial Diseases at the Yale School of Public Health. She also holds two other positions: director of the Connecticut Emerging Infections Program at the Yale School of Public Health and director of the HPV Vaccine Working Group, also at Yale. (Photo by Maria Caulfield/The Source | Buy This Photo)
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The COVID-19 outbreak will likely get worse before it gets better.
This is the general scenario Dr. Linda Niccolai paints for the public.
An infectious disease epidemiologist, Linda talks in plain language with an ability to explain complex topics by breaking down scientific concepts to layman’s terms. She communicates with logic and clarity and avoids sugarcoating hard facts, but also sees hope wherever it presents itself.
“I think by now everybody’s heard the message to ‘wash your hands’ and ‘don’t touch your face,’ and we’ve all stopped shaking hands. That message is clear. I think the most important message that I really want to get across to people is to stay calm. We will get through this. It is going to get worse before it gets better. But we will get through this,” she says.
Perhaps her no-nonsense style carries over from her hard work and advanced education. She is a professor of the Department of Epidemiology of Microbial Diseases at the Yale School of Public Health. She also holds two other positions: director of the Connecticut Emerging Infections Program at the Yale School of Public Health and director of the HPV Vaccine Working Group, also at Yale.
She has a B.S. in mathematics and sociology from Georgetown University, a master’s degree in epidemiology from the Harvard School of Public Health, and a doctorate in epidemiology from Tulane University.
Linda’s projection is consistent with the information given by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).
On March 11, the COVID-19 outbreak was officially characterized by the WHO as a pandemic, which it says “is not a word to use lightly or carelessly.”
Following this declaration, the CDC explains the outbreak in its website, on a situation summary page updated March 12: “Pandemics begin with an investigation phase, followed by recognition, initiation, and acceleration phases. The peak of illnesses occurs at the end of the acceleration phase, which is followed by a deceleration phase, during which there is a decrease in illnesses. Different countries can be in different phases of the pandemic at any point in time and different parts of the same country can also be in different phases of a pandemic.”
The CDC continues, “More cases of COVID-19 are likely to be identified in the United States in the coming days, including more instances of community spread.” It adds that it “expects that widespread transmission of COVID-19 in the United States will occur. In the coming months, most of the U.S. population will be exposed to this virus.”
As of March 13, the CDC reported 1,629 total cases in the U.S., with total deaths at 41. The figures come from 47 jurisdictions, including the District of Columbia. For the latest information about COVID-19, visit www.cdc.gov.
Reason to Hope
But Linda also offers a few glimmers of hope.
She points out that although COVID-19 is spreading rapidly, “80 percent of people who get the virus have mild illness.”
Also noteworthy is her observation that children seem to manifest relative resilience against the virus.
“The story with children is very interesting. Typically, like influenza for example, we see the highest risk of disease in children, older people, and people with comorbid conditions [or] other diseases. This COVID-19 doesn’t seem to be affecting children as much as we might have expected,” she says.
The CDC supports Linda on her observation and says on its website, “Based on available evidence, children do not appear to be at higher risk for COVID-19 than adults. While some children and infants have been sick with COVID-19, adults make up most of the known cases to date.”
Linda explains that severe symptoms tend to manifest more in vulnerable sectors of society, namely, adults in their 60s and older, people with underlying health conditions, and those with compromised immunity.
“This is where social distancing becomes really important,” she says. “If a person has a fever and a cough, we would really like that person to stay home. It might be COVID-19. It might be the cold or it might be the flu, but either way, whatever it is, somebody who’s sick should really stay home so they don’t infect other people.”
She confirms that the State of Connecticut has been reporting a rising number of verified cases of COVID-19. The cases will continue to increase for the state and much of the country as test kits become more available and reporting becomes more accurate.
As of March 16, the state had reported 26 confirmed cases in Connecticut.
Linda also talks about “flattening the curve” a term that has entered the public’s lexicon as a result of the outbreak.
“In infectious diseases, we like to talk about getting ahead of the curve. [When] you prevent the curve, there is no curve; there’s just a flat line. We are beyond that point,” she says. “This idea of flattening the curve, instead of having it be a huge peak of cases, we’d like to minimize the number of cases.”
She adds, “I think the biggest piece of advice that I can really give people during this time would be to listen to the public health officials, whether it’s CDC at the national level, or our state health department at the local level...If the Health Department says stay home for 14 days, then please stay home for 14 days.”
She notes that the preventive measures urged by the CDC and health officials are worth repeating because they help slow down the spread of the disease and flatten the curve: Wash your hands or use hand sanitizer; avoid touching your eyes, nose, and mouth; stay at home if you feel sick; avoid large gatherings; practice social distancing; and postpone cruises or nonessential air travel.
“If you think about an infectious disease, it goes from person to person to person. And what we like to talk about in infectious diseases is breaking that chain of transmission. So, if you can keep a [sick] person home, you break that chain of transmission and all of the future waves of infections...And those waves might reach older people or sick people,” she explains.
The spread of COVID-19 has been so rapid, most health experts have remarked on its speed, including Linda.
“It’s evolving so fast,” she says. “I’ve been doing disease epidemiology for 20 years and I never experienced anything like this.”
Although COVID-19 is a new disease, the family of coronaviruses is not. Human coronaviruses were first identified in the mid-1960s. Named for the crown-like spikes on their surface, coronaviruses have seven types.
Four of these—229E, NL63, OC43, and HKU1—are common human coronaviruses that infect people around the world.
The other three can have more serious symptoms: the MERS-CoV, which causes the Middle East Respiratory Syndrome; the SARS-CoV, which causes severe acute respiratory syndrome; and the SARS-CoV-2, which causes the novel COVID-19, so named for coronavirus disease 2019, the year it was discovered in Wuhan, China.
Linda reveals that her interest in infectious diseases was sparked in the early 1990s by the emergence of human immunodeficiency virus (HIV), which causes AIDS. Her first job out of college was as a research assistant at the George Washington University Medical Center on a study of people living with HIV.
Other involvements take up her time when she is not at work.
She talks with affection about her two sons, Patrick, a junior at the University of Vermont, and Steven, a senior at Daniel Hand High School (DHHS). They have been residents of Madison for 18 years.
“I think one of the things I was really drawn to about Madison is the natural beauty of this town,” she says. Her interest in the town’s natural resources led her to serve in the Madison Land Conservation Trust. Today she serves as the secretary of the board of directors.
She also enjoys giving back to the community by advocating for public health and other issues.
At a recent event marking the 100th anniversary of women’s suffrage in the U.S., Linda was among a list of women who spoke at a panel organized by a DHHS student.
In addition, she has spoken about vaccinations before the state legislature in Hartford and about career opportunities in epidemiology and public health at the Guilford High School and DHHS.
She says “In the past week or two, people have come to me to express their gratitude for our work, especially for this [outbreak]. There is no question, people are grateful for what we do.”
Her message of concern and advocacy for public health resonates, especially during a crisis like COVID-19.
“It’s helpful if people can stay calm and don’t panic. Be prudent. Practice social distancing if you can. It works. And help each other because this is going to be a major disruption… This is going to be mentally very difficult for people. I think we really need to come together, support each other, and help each other the best we can.”
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