How Does N.H.'s State Epidemiologist Handle
Unexpected Outbreaks?

The COVID-19 vaccine was first made available in December 2020 and increasingly became accessible to the public through the winter and spring of 2021. Chan and his team reviewed the available data to help New Hampshire residents and healthcare providers understand the new vaccine recommendations—who should get the vaccine and when—and to determine how the vaccine would affect statewide policies around social distancing, indoor gatherings, and masking. “Our response was to get vaccines out into the community while they were still in short supply,” Chan says. “We transitioned out of containment and mitigation mode to how to better live with the virus and rely on vaccine immunity for protection.”

Facing a pandemic was an unexpected addition to his résumé, but evaluating health and disease data and developing evidence-based guidelines had been part of his work since he accepted the position at the New Hampshire Department of Health and Human Services in 2014. Throughout his more than 12 years working in public health, Chan has been on the front lines of emerging infectious diseases, even ones rarely seen in the United States. For example, during the largest Ebola outbreak on record, from 2014–2016, more than 28,000 cases were reported in several West African countries. But the deadly disease spread to other countries, too, including Italy, Spain, the United Kingdom, and the U.S.

“Providers here have almost no experience dealing with highly infectious diseases like Ebola,” Chan says, underscoring the utility of a state’s public health office. “So, we monitor and look to prevent importation of disease. There’s always some new threat emerging that requires learning and communicating with the public, healthcare providers, and other partners about what the new disease is and how it’s being managed.”

A Lifelong Learner

To this day, Chan has continued to look for opportunities to gain more experience and combine his interests in infectious disease and public health—something he also did while at Geisel and Dartmouth Health’s Dartmouth Hitchcock Medical Center (DHMC). One of his three residencies was the Leadership Preventive Medicine Residency (LPMR), which is unique to DHMC and only available in conjunction with another clinical residency or fellowship. As an infectious disease fellow, Chan was able to add the LPMR training to his studies, and in the process, earned a Master of Public Health from The Dartmouth Institute for Health Policy & Clinical Practice. At The Dartmouth Institute, researchers, educators, and clinicians from multiple disciplines work together to improve population health and health equity, among other objectives.

“The melding of [the infectious disease fellowship, the LPMR, and the Master of Public Health program] led me to the position I’m in today,” Chan says. “It was three different areas of training combined into one program.”

As part of the LPMR, Chan led a quality improvement project related to his specialty of infectious disease. He focused on the challenge of safely administering and monitoring the antibiotic vancomycin, given intravenously to treat serious bacterial infections such as bloodstream infections caused by MRSA (methicillin-resistant Staphylococcus aureus). Because vancomycin can sometimes cause kidney damage and other side effects, clinicians must check a patient’s bloodwork regularly to ensure the antibiotic remains within therapeutic range.

“We did a deep dive into healthcare delivery and worked with multiple departments [at Dartmouth Health] to enact change within the healthcare system,” Chan says. “It was an incredible experience.”

Today, on the other side of academics, Chan works with DHMC residents in the infectious disease fellowship and LPMR programs, bringing his expertise to new classes of clinical and public health leaders.

“Public health tends to be confusing and complicated,” Chan says. “I enjoy imparting my experience and knowledge so these medical residents can better understand how to engage with the public health system and find information and resources that are important to them and their patients.”

“Who Knows What Next Week Will Bring?”

One reason Chan loves his job as state epidemiologist is that there’s always something new happening. His current concern: the reemergence of vaccine-preventable diseases, particularly measles, which was eradicated from the United States in 2000 but has reemerged in the past couple of years, causing large outbreaks.

“Our challenge is to get better data around vaccination rates, which will help us prevent and respond to outbreaks,” Chan says, noting that importation of diseases from other countries could affect unvaccinated or under-vaccinated populations in the U.S. “There’s not one specific person or group that can respond to these challenges. It involves many people across disciplines at the local, state, and federal levels to address these challenges.”