A key concept in infectious diseases epidemiology is generation time — the interval between one person becoming infected and transmitting the pathogen to another. Speed is essential to a pathogen’s trajectory, and it is equally essential to extinguishing an outbreak.
But speed is critical to the field of infectious diseases for an additional reason. Clinicians must move fast to extinguish disease in patients, to implement the latest findings from clinical trials and to keep pace with an ever-changing field. It is that need for speed and relevance that I hope to more than meet as the first editor-in-chief of IDSA Reporter, IDSA’s new online news magazine.
Consider the Ebola outbreak in the Democratic Republic of the Congo. It is being driven by the rarer Bundibugyo species, for which there is no approved vaccine. Part of the response is examining whether a vaccine developed against Zaire ebolavirus might offer cross-protection. If we consulted a textbook, it would not be of much help in understanding this outbreak and the countermeasure rationale; IDSA Reporter hopes to fill that gap.
Infectious diseases move faster than most, if not all, medical specialties. In a single week, infectious diseases clinicians might be expected to contend with a Cyclospora outbreak generating local infections, measles re-establishing endemicity, Ebola screening protocols and a Legionnaire’s cluster. The next week there may be no new threats. No other specialty has this attribute, and it is one of the reasons the field is endlessly fascinating and intellectually challenging.
I envision IDSA Reporter content guided by infectious diseases clinicians for infectious diseases clinicians. The goal is not simply to tell readers what happened, but to explain what it means.
During the hantavirus outbreak on the MV Hondius, for example, the lay press breathlessly reported a Level 3 CDC activation without emphasizing what mattered: Level 3 is CDC’s lowest activation level. Similarly, when infections caused by a particular pathogen are increasing, the numbers alone are rarely the whole story. The questions of why they are rising and what clinicians should make of the increase must accompany them.
The IDSA journals will continue to do their work of publishing the best peer-reviewed research in clinical and translational infectious diseases. The IDSA Reporter fills a different need, putting today’s infectious diseases news in context.
As editor-in-chief, I bring both bedside experience treating patients and policy expertise developed through work with a leading infectious diseases think tank and serving on IDSA committees. I also bring a habit familiar to every clinician: looking for what is structurally new or for the zebra when everything looks like horses.
I came up in infectious diseases inside IDSA, attending meetings and serving on committees and working groups. In 2014, when Ebola reached Dallas, I spent weeks as an IDSA spokesperson explaining the difference between a deadly virus and a highly contagious one. Since then, I've worked with the Society on the case for the ID workforce: the physicians who staff every outbreak response, much of it uncompensated.
IDSA is now putting its name behind this publication and its members' trust behind my editorial judgment. I don't treat that as a title. It's a standard I must meet for clinicians reading between consults who will act on what I publish.
Here is what my regular column will do: tell you what's new, what's noise and what may change your practice. Judge this column by whether what I flag as significant in January turns out, by June, to have mattered. Send me what you're seeing at your institution: the resistant organism that doesn't fit the local antibiogram, the reportable diseases call that got no response or the drug shortage nobody's tracking. That is often where the real story lies.
In this field, being late is a form of being wrong.