Glad you asked.
If you have been a long-time reader of this blog, you might think that what keeps me up at night is the anti-vaccine movement that is so pervasive in this country. They don’t keep me up at night. You might even think that it’s a doctoral student in epidemiology who is one year removed from their PhD and is blatantly anti-vaccine. They and the harm they may inflict on public health also don’t keep me up at night. Heck, you might think that it’s the Orioles melting down in a spectacular fashion this season, or whether or not Mexico make it to the World Cup in soccer.
None of that keeps me up at night.
What keeps me up at night is this and scenes like it the world over:
That right there, ladies and gentlemen, is the Al-Haram mosque during the annual pilgrimage of the Hajj. It keeps me up at night because of the number of people gathering at one place at one time. This kind of situation is ripe with opportunities for bad things to happen. From an outbreak of an infectious disease to a terrorist attack, public gatherings this big and this important keep me up at night because — for whatever reason — I’ve been “programmed” to think of worst-case scenarios when it comes to public health.
I won’t tell you what I’m thinking when I see these big gatherings because I don’t want to give anyone any ideas, but I bet you can come up with some messed-up scenarios in your mind that could really make a mess of things the world over.
And it’s not just the Hajj that gives me bad dreams. We have plenty of similarly-sized events here in the United States, like the Super Bowl or the Presidential Inauguration.
Also, cities are not getting any smaller. More and more people the world over are moving into cities, straining whatever resources are available. That’s kind of why we have the Ebola situation in West Africa right now. A lot of people in urban centers are encroaching on natural habitats of the likeliest of hosts for the virus: bats. And then a lot of the infected people are having a lot of contact with a lot of other people.
So crowded places with people traveling to and from them from different parts of the world keep me up at night wondering what will happen next, what will be the next pandemic, and what can I and other epidemiologists dream up to detect it early and counter it. In fact, in a few weeks, I’ll be heading to Minnesota for a conference on how to use new technologies to keep track of influenza, a killer in its own right. Technology is growing by leaps and bounds, and we still have a hard time using it to counter some very serious threats. It’s time to change that.
That’s what keeps me up at night. Again, thanks for asking.