Blog Entry by Jacob Brock and Brendan Hanson:
Dr. Christopher Reh is the operational leader for the CDC’s nested group, ATSDR. Toxicologists, nurses, industrial hygienists and risk assessment professionals are part of the ATSDR team. Dr. Reh’s team is currently reviewing PFAS (per- and polyfluoroalkyl substances) exposure, commonly found in drinking water, and ethylene oxide, used in medical sterilization. Some of the main programs that people are more aware of include toxicological profiles on chemicals and worksite health consultation for chemical exposure. The Choose Safe Places for Early Care and Education (CSPECE) program assists communities in identifying areas that are free from chemicals so children are not exposed to legacy chemicals at the site.

Dr. Yulia Carroll is Associate Director for Science, DEHSP, CDC. Before joining the DEHSP, she was a fellow in the EIS, nested within the CDC. The part of her team at EIS performed community outreach which was able to assist with “popcorn lung” (bronchiolitis obliterans) evaluation in businesses incorporating new flavorings for coffee. She was gracious enough to display information regarding internships and fellowships within, not only her program, but the entire CDC as well. DEHSP has focus areas to apply innovative data to detect health hazards, build the environmental public health database, and develop public health best practices. As an asthmatic, I was delighted to see the CDC studying asthma as it related to community health. 

Dr. Carroll recently completed a 6 month deployment working on a coronavirus task force. Dr. Carroll started working with an asthma program to assess how people were affected by COVID-19. People were working endlessly to update tracking maps related to coronavirus. She assisted in collecting data which was forwarded to the state and local health departments. Measures were in place to ensure that there was no missing data. The pandemic required a lot of resources to be diverted from other projects, halting normal work. To address the increasing concerns of the public, the CDC has had to investigate whether COVID-19 could spread through water. Furthermore, ATSDR investigated whether certain health conditions may be risk factors for COVID-19. COVID-19 impacted the participation of screening services. For example, the CDC asthma screening program has had a large decrease in participation due to COVID-19. 

Dr. Daniel Mandel is Associate Director for Policy, Division of Laboratory Sciences, CDC. The flagship program for the Division of Laboratory Services is the National Biomonitoring Program. The National Biomonitoring Program assists in creating datasets for the National Health and Nutrition Examination Survey (NHANES). NHANES is a national dataset that displays the concentrations of chemicals of interest in the blood, urine, and other biological matrices of humans across the country. The pandemic has greatly affected the ability of the CDC to collect biomonitoring samples. According to Dr. Mandel, the pandemic required the Division of Laboratory Services to operate at 20% capacity.  After the pandemic, the Division of Laboratory Services will be determining how to accomplish the work that has been halted due to the pandemic.

• Massive decline in screening services related to asthma
• CDC was required to answer questions related to whether COVID-19 spreads through water
• Anyone with expertise had to be deployed for COVID-19
• Other medical conditions were considered for risk factors related to COVID-19
• Normal work has been halted
• Other issues such as wildfires has been splitting the attention from COVID-19

Dr. Mandel presenting on the Division of Laboratory Sciences at the CDC

Blog Entry by Vishal Nathu and Joury Gould:
The speakers shared their past, current, and future work at their time with the CDC. Due to the current pandemic condition, CY2020 efforts were focused on the COVID-19 response. Based on current needs in CY2021, the previous year's work will be continued and further evaluated to aid not only the United States, but also the entire world. 

• A key individual, Dr. Christopher M. Reh, Associate Director, ATSDR, mentioned the plans to continue to help communities with known environmental health hazards. This was based on the recognition of hazards which impacted the mental health of a given community. The Agency also planned to expand its community outreach on perfluorooctanoic acid's impacts, which is primarily discussed in the scientific community due to adverse health outcomes. 
• Another key individual during the virtual visit, Yulia Carroll, MD, PhD, Associate Director for Science, DEHSP, CDC, described her work with the DEHSP. One of the numerous discussions about moving forward in collecting data and improving community health through applied environmental public health science and practice in five priority areas was most interesting as there were students in the environmental health discipline within the ERC. These areas were asthma, lead, well water contamination, the public impact of weather-related disasters, and environmental public health preparedness. 
• Overall, this virtual trip was highly insightful and value-added to our ERC and the ERC members and its unique disciplines. We cannot thank the speakers enough for their time!  

Blog Entry by Logan Tipton and Swade Barned:

The virtual experience provided several insights into opportunities to get involved and potentially start a career at the CDC. One of the most highlighted opportunities presented was fellowships. One fellowship specifically that the CDC presents is the Laboratory Leadership Service (LLS) Fellowship. The LLS aims to connect laboratory science and public health and allows participants to grow and strengthen important skills. Those, who are selected for the opportunity, commit to a two-year program and are fully trained for responsibilities at the CDC in Atlanta, Georgia. Additionally, anyone who is selected for the opportunity may have to relocate, which also provides a broad opportunity for networking in different parts of the country. The members and staff of the CDC also provided networking opportunities for attendees of the virtual experience. Each presenter generously provided a contact email. They invited participants to reach out to them with any questions and inquiries about future opportunities at the CDC. 

There are also internships presented by the CDC. The opportunities are designed for multiple education levels, including high school through doctoral students. These opportunities vary based on time of year and the relevance of certain global and local events. Internships vary from year to year at the CDC, so the opportunity for a variety of experiences is present. These internships are usually short-term when compared to fellowships but do provide educational opportunities for some students over the summer. 

The students would like to thank the CDC and its faculty for presenting on these opportunities and for providing a virtual presentation regarding the CDC and its components. The students would also like to thank the University of Cincinnati ERC for making this opportunity possible virtually, even during the continually changing guidelines that the current global pandemic necessitates.

Blog Entry by Thomas Gerding:
As Associate Director of the ATSDR, Dr. Christopher Reh, explained that the ATSDR is a sister agency of the CDC even though they are technically nested within the CDC. The ATSDR has a large environmental justice footprint and is embedded into everything they do. The ATSDR is the lead agency in investigating health effects associated with exposures to PFAS and PFOA. The most common source of exposure to these types of chemicals is through drinking water. Additionally, they have been researching ethylene oxide and are looking at a multisite cancer study related to ethylene oxide.

Another bread and butter program of the ATSDR is their toxicological profiles for specific chemicals as they develop what is referred to as minimum risk levels (MRLs). For this reason, their research is concerned with the most sensitive subjects such as the elderly and children, so these levels are not really comparable to OSHA limits which are specifically for occupational exposures. One of the primary areas the ATSDR is expanding into is the area of mental health aspects of environmental exposures or wastes. Dr. Reh said there can be a significant mental health impact on affected individuals, resulting in higher rates of anxiety and depression or even PTSD when individuals in the community are aware that there are certain environmental hazards that exist in the community. 

Finally, the ATSDR has an incident management structure set up. It is the lead agency responding to chemical hazards related to natural disasters, chemical explosions, or chemical releases. During the COVID-19 pandemic, they have had about half of their staff at any time detailed to the COVID-19 taskforce response and have helped with Ebola and polio in the past. For these reasons, people in the ATSDR have nearly daily contact with state and regional health officials to provide expertise and assistance in matters related to public health and safety. 

 

Blog Entry by Nathan Frank:
The ATSDR is involved in emergency response. Teams are available 24 hours a day, 7 days of the week. Response teams from the ATSDR consist of toxicologists, physicians, industrial hygienists, and various other specialists. When conducting an emergency response, it is in response to a release of a toxic substance or chemical in a community close to a disaster site. These disasters include hurricanes and tornadoes. Natural disasters, such as these, often create releases of toxic substances into the disaster zone. Manmade disasters such as pipeline ruptures and massive explosions also often involve an emergency response from the ATSDR. This is because these release hazardous substances and chemicals into nearby communities. 

The ASTDR also provides resources for first responders and various agencies that respond to these disasters. Response teams are regionally deployed throughout the nation with 10 regional bases, including Hawaii and Alaska. These regional offices work closely with state and local agencies for best emergency preparedness. Two notable emergencies, to which the ATSDR responded, were the COVID-19 pandemic and toxic water release in Florida. During the COVID-19 pandemic, the applicable regional response team assisted in setting up a mass vaccination site in Houston, Texas, as part of “Operation Warp Speed”. For toxic substance release, response teams will monitor exposures to make sure that MRLs (minimum risk levels) and other applicable exposure limits are not exceeded. They also determine which areas are dangerous and which are safe around a disaster site. The ATSDR community aspect comes into play because the response teams provide information and protective measures for the disaster stricken communities.      

 

Blog Entry by Ada Jesuthasan:
Dr. Yulia Carroll started her career in the EIS under CDC. EIS officers are responsible for emergent public health or work-related diseases. Currently, Dr. Carroll is a part of the DEHSP. Their mission statement is to prevent exposure to environmental health hazards to improve the health of the people in the community by applying public health science and practice. DEHSP focus areas include innovative data to detect environmental public health hazards, build environmental public health evidence base, and develop and implement environmental public health practices. 

 

Dr. Carroll presenting on priority topics of the DEHSP

Dr. Carroll discussed a project under the Water, Food and Environmental Health Services Branch, where they focus on safe water in hospitals, schools etc., and food safety regarding outbreaks in restaurants, environmental health practice and vessel sanitation such as infectious disease outbreak on cruise ships. The Asthma and Community Health Branch (ACHB) project focuses on asthma, air quality, CO poisoning, climate health and mold. The final project discussed was in the Tracking, Radiation, Chemical and Environmental Epidemiology Branch where they conduct radiation studies, chemical emergency and weapons elimination, environmental public health tracking, health studies and field investigations.  

Blog Entry by John Singletary:
Dr. Reh began his career at NIOSH. He then worked some years in the private sector at Gillette, Proctor and Gamble, and Coca-Cola.

In 2017 he started work back in the government sector, working for ATSDR as the Associate Director and Operational Leader. Most of his work has been with the superfund hazardous waste industry. His work looked into the human health effects of PFAS (per- and polyfluoroalkyl substances) chemicals (w/ USDA & DOD) and ethylene oxide (w/ FDA). 

They also work closely with health departments upon request to come and test for harmful chemicals. They develop MRLs (minimum risk levels) that are not enforceable, but these levels are considered safe for the most sensitive parts of the population. These often focus on children as many schools and daycare centers are close to factories that emit these harmful chemicals. 

They also evaluate the mental health impact environmental health hazards may have on the communities, not just to help but to educate mental health practitioners on how these environmental health conditions can affect mental health.

In addition, the ATSDR is the lead agency for chemical spills, and for the past year, they have been involved with “COVID-19 Operation Warp Speed”.

End of part 2. Thank you to the CDC representatives for sharing your experiences with regional ERC students and faculty!