Abraar Karan, MD, MPH, DTM&H, an aspiring infectious diseases specialist and medical resident in the Hiatt Residency in Global Health Equity program, serves as a medical fellow in the office of Massachusetts Department of Public Health (DPH) Commissioner Monica Bharel, MD, MPH, on the state’s response to COVID-19.
In this role, Karan collaborates with DPH leadership, including the commissioner, state medical director and state epidemiologist, to assist the state with its epidemic response strategy for the COVID-19 pandemic.
Karan recently spoke with Brigham Bulletin about his experiences.
How did you get interested in epidemics?
AK: I spent the last 12 years working in the global health sector, with most of my past experiences in Sub-Saharan Africa, Latin America and South Asia focused on ground-level work related to infectious diseases. The Ebola epidemic in West Africa in 2014 was what really sparked my interest in emerging infectious disease outbreaks, though. To me, it became clear how pandemic-prone diseases were, in a way, the ultimate test of the strength of a society’s fabric; they put a strain on every pillar of what holds us together. They require such an immensely complex interdisciplinary response — an understanding of medicine, politics, epidemiology, anthropology, ethics, law and more.
How were you selected to join Commissioner Bharel’s team?
AK: While I was earning my master’s degree at the Harvard T.H. Chan School of Public Health in 2016 and 2017, I worked at the DPH’s Office of Health Equity for my year-long practicum on combating homelessness in Massachusetts. The commissioner is very passionate about caring for homeless populations and was the leader in our state on this prior to her current role. Over the past few years, we have kept in touch, and I am lucky to call her a mentor.
Ultimately, it ended up being a matter of timing and being prepared. When Ebola struck again in the Democratic Republic of the Congo in 2018, during my second year of residency at the Brigham, I tried to understand how that response was managed. I went on to serve as the editor of the American Medical Association’s Journal of Ethics January 2020 theme issue on epidemic response, focusing on the Ebola outbreak. Through this, I had a chance to learn from many experts in epidemics. I had also just finished my Diploma in Tropical Medicine in London, which I pursued through the support of the Global Health Equity Residency, and much of my time there was also focused on epidemics. I remember in January when I had returned to Boston, I met with my program directors, Dr. Joel Katz and Dr. Joe Rhatigan, as well as Dr. Marshall Wolf, to let them know I had decided to commit to infectious disease training and epidemic response. Weeks after this, COVID-19 struck the U.S. in full force. I started at the DPH the last week of February when Massachusetts was just about to be hit hard.
What’s a typical day at the Department of Public Health like?
AK: Every day is different than the last as DPH communicates with its many stakeholders in the state, including legislators, local boards of health, the media, hospitals, schools, the transportation sector, emergency medical services and many others. DPH has an enormous purview and is responsible for so many aspects of public health, so the team needs to be on its toes at all times, really at any hour of the day.
During the pandemic response, our team at DPH would have calls and meetings every morning, most evenings and every weekend. I would join many of these team calls regarding new developments that needed attention. Earlier in the epidemic, I would get to the department around 8 a.m. and leave around 7 p.m., but I would usually be awake reading updates on new scientific and clinical literature until much later into the night. I am totally a night owl; even when I’m on clinical service, I rarely sleep before midnight, so it has worked out well.
What did you work on over the past few months?
AK: I’ve had the chance to work with the DPH team on our state Crisis Standards of Care Committee; with the ventilator procurement group; with the state reopening advisory board, which the commissioner is part of; the remdesivir allocation team and more. I’ve also been keeping up with the scientific literature and sending short daily summaries to the team. The work has been dynamic, and nonstop, but I always wake up energized, so I know it’s right for me.
How have your experiences at the Brigham prepared you for this role?
AK: Seeing patients, you are on the front lines of care delivery. I was working in our Emergency Department COVID-19 pod in April during the peak of the Massachusetts epidemic, as well as on the wards at the Faulkner intermittently. I was able to bring my clinical, ground-level experience and perspective back to the DPH. One key thing I noticed was how hard it was for patients with COVID-19 to safely isolate at home. I wrote about this important topic in an op-ed in the Washington Post and brought this up during my state work. I remember keeping one patient overnight in the ED so we could send her to Boston Hope in the morning. It felt great to be able to do that for her.
What do you hope to do next?
AK: This summer, I am continuing COVID-19 work at the DPH and starting to expand my research and studies into infectious disease modeling through some remote coursework with faculty at the Harvard Chan School and the University of Washington. I am applying for an infectious disease fellowship and hope to gain more field epidemiology training afterward, possibly through the CDC’s Epidemic Intelligence Service. I’m very excited about it!