The Root of the Crisis
From opioids to COVID-19, Zoe Kaplan urges us to look at who pays the price
Zoe Kaplan ’18 was interning at the National Center for Emerging and Zoonotic Infectious Diseases at the Centers for Disease Control and Prevention in Atlanta last December, fielding policy questions about Ebola and Zika, when something new began to bubble up.
“A lot of times viruses like this are often flare-ups,” she said, “more like Triple E (Eastern Equine Encephalitis) or another sort of virus that makes an appearance and then quickly dissipates.”
Of course, this wasn’t a flare-up, nor did it dissipate. As what emerged as COVID-19 continued to spread, Kaplan, an intern from the nearby Rollins School of Public Health at Emory University, saw her CDC colleagues begin to be deployed as part of the response. Speaking personally, and not in a capacity as a spokesperson for the CDC, she said, “At that point, the focus was containment, containment, containment.”
Her internship continues at CDC, where she has been fielding inquiries from elected officials and other agencies about the policies surrounding the pandemic. Back at Emory, as she is finishing her master’s degree in science health services research, Kaplan is also volunteering at an Atlanta mental health call center, where most questions center on COVID-19 and its non-viral symptoms: unemployment, anxiety. “The main question we get is, ‘When is this going to be over? When can I go back to day-to-day life?’”
No one knows the answer to that, but Kaplan tries to be reassuring, drawing on her background in both epidemiology, which she studied at Colby, and counseling, which she first offered to opioid addicts in Maine when she was a student. And whether it’s a novel virus or heroin, the last epidemic to crisscross the country, “public health experts are the individuals who are trained in this. We need to listen to them.”
COVID-19 response is just the sort of crisis for which Kaplan has been training, but it’s the latest in a series of increasingly focused forays into public health. At Colby, she was certified as an emergency medical technician. Reading the newspaper over lunch in Dana, she saw a call for volunteers to work with people convicted of minor opioid-related crimes. She signed up and was inspired to recruit other Colby students. While at Colby studying biology, she interned at the University of Texas Medical Branch at Galveston through a National Institute of Drug Abuse grant, focusing on drug addiction. After graduation, she worked at the Irish Cancer Society in Dublin, then moved to Atlanta, where she joined the Georgia Prevention Project, which aims to reduce the use of drugs by teens.
At Emory, her thesis—one of two in her graduating class recently nominated for the Charles C. Shepard Award, recognizing the most outstanding thesis by a master’s student at RSPH—explores the economics of access to healthcare for people in the criminal justice system and the impact of Medicaid expansion on the availability of drug treatment. She wants to know if the drug diversion movement, which aims to push inmates out of prisons and jails and into community-based treatment, offers an adequate supply of community-based treatment programs that will accept them. Kaplan’s conclusion? It’s complicated.
Medicaid expansion did increase a facility’s likelihood of accepting Medicaid insurance. But that was diminished with the inclusion of a criminal justice program. “Despite the well-intentioned efforts of this policy, so far, Medicaid expansion has failed to significantly increase treatment accessibility for criminal justice clients,” Kaplan wrote in a follow-up email. More concentrated national efforts are needed, her study concluded.
She can trace that work with some of the nation’s leading public health experts at Emory back to a microbiology study she did at Colby with Professor of Biology Frank Fekete, examining the increase in community-acquired MRSA, the so-called superbug, among intravenous drug users—and a resulting uptick in emergency room admittances.
The CDC has grants on the table—delayed by COVID-19—that would fund similar research. In her immediate future is a job starting this summer working for a data analytics firm in Washington, D.C., that currently is consulting with the CDC on COVID-19 evaluation data, including morbidity (the rate of disease in a population), mortality, and health disparities.
She said the underlying problem she saw in her earlier research is the same with COVID-19.“As you look at the communities themselves that are being hit the hardest, it is individuals with lower access to care, higher health disparities,” she said.
The solution:
“It’s seeing that there is this huge divide within our communities in the haves and have nots,” Kaplan said. “I think it’s learning to bridge those gaps and addressing the problem at its systemic root rather than waiting until a crisis occurs, when our resources have run dry and we’re running around trying to address the problem when it flared up, instead of looking at it from a different perspective. Looking at it from an economic standpoint and saying, okay, this could have been addressed much earlier. It would not have had as much of a cost financially and societally if it had been better addressed when it was a very minimal problem.”
