It’s funny what passes for high praise in public health.

Victoria Beeler, a Public Health Nurse II in our Disease Investigation program, remembers a patient she worked with who appreciated her thoughtfulness during a rough time.

“They were like, wow, you’re really worried about my diarrhea—that makes me feel so cared for!’” she laughed. “And yeah, public health actually cares about your diarrhea! That’s what we do.”

To be clear, it’s not all we do. It’s National Public Health Week, and if you follow along on our social media, you’ll hear about some of the other great things we’re working on.

But today, we’re looking at a team that does what public health does best: Working quietly in the background to prevent your family from getting sick—and jumping into action if you do.

‘I love detective work.’

Jeni Nybo was born and raised in Pierce County and worked for years as a pediatric nurse before she joined the Health Department. Now she leads our Disease Investigation program. She’s so well suited for it, it’s hard to imagine her doing anything else.

“It’s fun to be a detective,” Nybo said. “A lot of what we do is put the puzzle together. I love detective work.”

Detective work is a great way to describe it. When things like measles, salmonella, or whooping cough threaten your health, Nybo’s team is on the case. They quickly get to work figuring out where the outbreak started and how far it may have spread. Once they know all that, they can start to contain it.

Investigations can vary dramatically. Public Health Nurse II Elle Cooper is our primary liaison with long-term care facilities. If, for instance, a multidrug-resistant organism (MDRO) like C. auris shows up at a nursing home, she leads the charge.

“We need to get to the bottom of it quickly,” Cooper said. “We ask things like ‘Where are they living? Where have they been? Where have they been admitted? Where did they probably pick it up?’”

In many cases, the most vulnerable patients are also the most complicated to investigate because they’ve been transferred between several facilities.

That’s one of the reasons Cooper spends her time working closely with staff at her facilities.

“We’re always working to build relationships,” she said. “We’re making sure they know who we are and what we do and what they need to report and when they need to report it.”

“We try to have an easy-going, collaborative approach to it.”

‘We’re very available to people.’

Many investigations might seem mundane if it weren’t for the fact lives are potentially at stake.

Beeler provides surge support for our tuberculosis (TB) program. In a typical year, Pierce County might get 20 or 30 cases of active TB.

When she gets a case, she works to find out more about the patient, where they’ve been, and who they’ve been in contact with. She’ll make sure the patient knows next steps, and she’ll make sure the care team does, too, as she offers support through what can be a long treatment. And she’ll help people the patient may have exposed get tested.

Often, by the time our nurses get involved, the patient has been through a lot in a stressful time. They’re grateful to have someone focused on them and their unique needs.

“What’s so wonderful about public health is by the time we’re talking to them, the news has had a chance to sink in and now they feel comfortable asking questions,” she said. “‘Can you spell it so I can Google it? Does my loved one need to gown up? Does my family need to screen?’

“They’re very appreciative of us being able to take the time to answer. We’re very available to people. We give them our number and say if you have questions later or need resources that are patient-friendly, call us.

“They’re very thankful to get those questions answered.”

‘We knew there was a piece of the puzzle that was missing.’

Sometimes, though, the investigations can get quite complex.

Our investigators assisted Washington State Department of Health 2 years ago with a listeria outbreak that led to 3 deaths and 6 hospitalizations. It took several months to find the source of the outbreak, but everyone involved persisted.

Cutting-edge technology pointed to a single, regional source. The problem was finding it.

“They do what’s called whole-genome sequencing at the state lab,” Nybo said. “You can tell if there seems to be a connection, if it appears to all be from the same source.

“All the people had an unusual disease—listeria doesn’t come up very often—and we hadn’t found the connection yet through our investigation. But, when we looked at the genetics, we could see the cases were connected.

“We knew there was a piece of the puzzle that was missing—we just had to keep digging to find it.”

And find it they did. Months after the first case came in, the breakthrough happened. A patient who hadn’t been in condition to talk, was finally able. After a long illness, food was front of mind. The patient was more than happy to discuss everything they’d eaten before they got sick—including a milkshake that ultimately proved to be the source of the outbreak.

“It’s a lot about developing relationships and working together,” Nybo said. “We know a lot. We don’t know everything, but we’ve got good networks to find the answers if we don’t have them.”

A pound of prevention.

Of course, the best infectious disease is the one you don’t get. The team spends as much time as it can muster on prevention.

Cooper, for instance, works with long-term care and post-acute care facilities on infection control. She visits in person and talks to staff about everything from handwashing to personal protection equipment to disinfecting surfaces. She makes sure their policies and procedures are in good shape and that staff are getting great education and training.

“I work where people are most vulnerable,” she said. “It’s about working where things could happen and preventing them before they do. Then, we’re keeping things contained if there’s an outbreak.”

The team also helps prevent spread, which can mean offering preventative treatments or vaccines to a patient’s contacts.

Nybo sees prevention as increasingly important.

“That is the direction we need to be going more and more,” she said. “It’s very important that we’re mitigating outbreaks. We need to be able to have a common language with facilities when we’re working with them. There’s lots of turnover in healthcare, so it’s important to spend time in facilities to have historical knowledge and make sure they know we have the resources to help them.”

A week to celebrate public health.

The theme of this year’s National Public Health Week is “It starts here: Your health is our mission.”

And it’s true! Our mission is to protect and improve the health of all people and places in Pierce County. That means everything from making sure the food you eat and water you drink are safe, to promoting vaccinations, to connecting new moms with support, to helping people overcome substance misuse.

Check our social media this week to learn more about this year’s topics:

• Tuesday: Climate action starts here: Championing resilience for health.
• Wednesday: Health equity starts here: Optimizing health for all.
• Thursday: Advocacy starts here: Amplifying voices for public health.
• Friday: The future of public health starts here: Strengthening the public health workforce.

And remember, even if you’re not thinking about us, we’re thinking about how we can help you.

“We’re always here and protecting the community even when we’re not talking directly to you,” Beeler said. “We’re always keeping our eyes out for what could be coming. Even if you don’t hear from us, we’re still working to protect you and protect the community.”

Follow our social media accounts and sign up for the Your Reliable Source blog for regular updates on important public health topics.