What I Don't Know Yet

My Published Work

Most of the links below are to stories I’ve written since I began freelancing in 2008. If you scroll all the way down, you’ll find a few from my time at the Toledo Blade.

Racing with Hepatitis A:

Can Louisville Keep the Virus from Spreading by Derby?

By Jenni Laidman

Published Louisville Magazine

May 2018

Week 1, Sept. 3-9, 2017:
One case of hepatitis A

Rui Zhao hunkers behind his twin computer monitors. Most visitors to the epidemiologist’s uncomfortably cramped office talk to his brow and the short black hair on the top of his head. They may glimpse his eyes when he looks up from his screens. On the wall to his left are small stuffed toys of irregular shapes, each a cuddly version of some nasty germ. From this third-floor office at the Louisville Metro Department of Public Health and Wellness, Zhao watches other germs work their way across Louisville. In the 90-degree days of early September, it’s a bit too soon to think about influenza, which will sweep through nursing homes in cold weather, taking lives as it does most every year. More of interest now: the chronic liver diseases hepatitis B and C. In fact, cases of hepatitis B are dancing upward in the metro area. Hepatitis C is already considered an epidemic, although the number of new cases is tiny.

Of hepatitis A, there’s a single case. And there’s no case the following week. It’s meaningless noise in the ebb and flow of the 25 or so infectious diseases surveilled by the state. Each year, one or two people in the city — and, rarely, as many as five — will contract the hepatitis A virus. They travel to a country where it’s common, endemic. They bring it home from mission trips or as a souvenir from an exotic vacation. More frequently, travelers never know they have it. About 30 percent of adults with hepatitis A produce no symptoms.

But for the unlucky, it can be brutal, bringing low-grade fever, headache, weakness and exhaustion, diarrhea, sudden nausea and vomiting, and abdominal pain, especially under the ribs on the right side, where the liver sits. Stools turn pale and urine dark. There may be intense itching. The white of the eye and skin often yellow, another sign that the virus is in the liver. And that’s the end of it, usually. Unlike hepatitis B and C, hepatitis A doesn’t settle in for a lifetime, grinding away at the liver. Uncomfortable? Absolutely. Miserable? Often. Life-threatening? Only in people older than 50 and those with other health problems. And it’s self-resolving, with no cure but time. It’s also highly contagious, most likely to spread while its host feels tip-top, before discomfort sets in. Any virus shed during infection lingers on surfaces for months. It is frequently transmitted by food, and while it succumbs to soap and water, or near-boiling temperatures, gel sanitizers can’t touch it.

Hepatitis B and C, on the other hand, infect via body fluids like blood, semen or vaginal secretions — the same pathways taken by the virus that causes AIDS. Since February 2017, a combined hepatitis A-B vaccine has been offered to visitors at the syringe-exchange sites operated by Metro Health and Wellness. There is no vaccine against the relatively new virus hepatitis C, which was discovered in 1989 and originally called non-A, non-B hepatitis. The syringe-exchange clinic is one sure way for the health department to reach a group of people normally driven into the shadows, a population vulnerable to a variety of diseases.

The importance of such contact is about to increase. The question is, will it be enough? By April, few will think so.

 

Weeks 2-5, Sept. 10-Oct. 7:
Three new cases of hepatitis A. Total: 4

The Courier Journal is full of the troubles facing the University of Louisville basketball program as October rolls in with 70- and 80-degree days and enough sunshine to convince anyone that summer will stretch on forever. Zhao notes that hepatitis A cases are now double the number seen in a normal year. But whether those four cases are significant isn’t clear. There’s also an unusual surge in false-positive hep A tests. He always sees a few. Every year, three or four people will test positive, yet their illness makes no sense. Usually, these cases of mistaken viral identity involve women 60 and older who have symptoms that would fit any number of diseases, including hepatitis A. It’s essentially a bad joke played by an aging immune system. Immune defenses lose precision with each passing year; our bodies are more prone to interpret any number of ailments as an attack on the liver and ramp up antibody production to fight a phantom infection.

But the bump in false positives this year doesn’t add up. “We’re seeing false positives at a rate that we haven’t seen before,” Zhao says. “What’s going on? Were the tests messed up? That’s a possibility. Or are doctors testing more?” It creates a signal-to-noise problem. Is Louisville heading into an epidemic or just dealing with flukes?

Or, what if what looks like a rise in false positives isn’t false at all?

 

Weeks 6-9, Oct. 8-Nov. 4:
10 new cases. Total: 14

Although the number of hepatitis A cases is just over a dozen, people in public health are concerned. Dr. Sarah Moyer, the director and chief health strategist of Metro Health and Wellness, thinks, “Oh, no. We’re going to have an outbreak like California.” (The health department uses “outbreak” and “epidemic” interchangeably.) San Diego has battled a hep A epidemic since fall 2016. Moyer hopes Louisville will instead go the way of Utah, which in October seems to have halted its own hep A outbreak at 40 cases. (In truth, Utah will eventually follow San Diego’s lead, slammed by climbing case numbers.) Outbreaks also emerge in Arizona and Colorado in October. And Michigan fights an outbreak that began a few months before San Diego’s.

In October, Moyer has led the department and its 220 employees for two months. Although new to the director position, for the two years previous she was the department’s medical director while also practicing family medicine. Working in public health was a long-time goal. In 2004, when she graduated from Colorado College with a degree in physics, she realized that every person doing work that interested her had an M.P.H. (Master of Public Health) after their name. Moyer earned her own master’s in public health at Dartmouth in 2006, then completed her medical degree at Temple University in 2010.

San Diego nags at Zhao, too. He has been following the Southern California epidemic, tracking what his fellow epidemiologists have to say, following news reports of that city’s outreach efforts and its headline-grabbing sidewalk-bleaching campaign. At first, it was just professional curiosity, the kind he considers essential for a man in his position. “I get alerts from all over the world for various cases, because you never know who might show up in your backyard, right?” he says. “I kept it on my radar. I’m saying, ‘Well, they’re seeing it in the homeless and in the drug-use population.’”

He wonders how he would investigate disease in people without addresses. How would his team make inroads in drug-using populations that fear any kind of scrutiny? With the San Diego and Utah epidemics looming, Metro Health and Wellness officials sense the risk to Louisville’s homeless population. Restaurant inspectors take fliers to shelters throughout the county, explaining that people can protect themselves from the virus with handwashing, safe food-handling practices and vaccination.

San Diego’s epidemic began in November 2016 with the diagnosis of two hep A cases. A month later, there were four. In January 2017, there was a single case: a misleading calm. Seven more cases in February triggered official recognition of an outbreak, primarily in the homeless and drug-using population. By May, the city of 1.4 million had 86 cases in a single month. In August, there were 95. Before the epidemic slowed, 20 of the 587 known hepatitis A patients had died.

But there’s a continent between Louisville and San Diego, and so far, nothing suggests a link between the Derby City and the coastal metropolis. So where are Louisville’s cases coming from?

 

Weeks 10 and 11, Nov. 5-18:
Seven new cases. Total: 21

In the argot of infection specialists, a vector is an agent that transmits germs: mosquitoes for West Nile virus, ticks for Lyme disease, lice for typhus. For hepatitis A, it’s dirty hands. Traditionally, hepatitis A outbreaks begin with food handlers. An infected restaurant employee who doesn’t yet feel sick fails to wash his hands well. When contaminated feces contacts mucous membrane — usually in the mouth, but the eye, the nose or the urogenital tract work just as well — infection follows. Vigorous handwashing with soap and water — long enough to sing “Happy Birthday” twice — is a critical preventive factor. Resolving such epidemics comes down to changing habits and discovering where patients ate.

That’s what Dr. David T. Allen faced in 1988. Louisvillians from every walk of life and every part of town were coming down with vicious cases of hepatitis A. As medical director for the Board of Health, it was Allen’s responsibility to triangulate the source from patient interviews. But patients weren’t naming a single restaurant. The 216 people diagnosed in February and March of that year named 379 different restaurants. Allen eventually concluded that a shipment of contaminated iceberg lettuce caused the outbreak, and every restaurant that served lettuce from that semi-trailer load helped spread the virus. To contain the outbreak, the health department printed half a million brochures to educate the public about handwashing. “We papered every bathroom. Every commercial restaurant had these brochures in their bathrooms. We had a major ‘Wash Your Hands’ campaign,” Allen says. Not long after the outbreak, the health department instituted a mandatory food-preparation class to educate restaurant workers on safe food handling. A vaccine didn’t exist in 1988. Handwashing alone stopped the spread.

Could a restaurant be behind the current hepatitis A rise? The scanty data Zhao analyzes doesn’t suggest it. Zhao contacts his counterparts in the Kentucky Cabinet of Health and Family Services, and together they hash out what they know. It’s not much. Zhao’s interviews with patients are dead ends. Those he can reach appear to have little in common. No single restaurant or food source emerges as a probable epicenter of infection. Several times, he can’t arrange a patient interview. Infected people leave the hospital against medical advice before Zhao and his team can reach them. Some he does find are simply uncommunicative. “We’re just not sure how these cases are tied together,” Zhao says. “People don’t want to tell us.”

What he needs is a way to look at the virus itself. And the U.S. Centers for Disease Control and Prevention has one — a genetic test to read the RNA encoding the virus, the gold standard for determining hepatitis A. To run the test, Zhao needs patient blood. He contacts two of the people he has already interviewed. Both agree to a blood draw.

Zhao is close to cracking the case.

 

Week 12, Nov. 19-25:
Three new cases. Total: 24

In mid-November, Dr. Lori Caloia, a physician at Norton Healthcare and a former flight surgeon in the U.S. Air Force, takes director Moyer’s previous job as medical director of Metro Health and Wellness. Moyer warns her what’s on the horizon. “We might be leading into a hepatitis A outbreak here, so just be on the lookout,” she tells Caloia on her first day on the job. “You’ll probably have to spend some time doing that.” The next day, the day before Thanksgiving, Kentucky declares a hepatitis A outbreak.

The genetic tests on the two blood samples from Louisville reveal that the city’s cases are the same strain of hepatitis A in San Diego and Utah. The genetic linkage leads state epidemiologist Jonathan Ballard to declare the outbreak, even though the number of cases statewide — 31 so far — isn’t much higher than the 20 cases Kentucky averages from year to year. The state backdates the epidemic to Aug. 1 to account for the disease incubation period, which can range from seven to 49 days. The tests also solve the signal-to-noise problem. One of the two blood samples was from a suspected false positive case — a person with no recognizable ties to any risk factor. It turns out some of those false positives weren’t false at all — they were evidence of a new epidemic.

With the announcement, the Louisville health department swings into crisis mode, reconfiguring itself into “the Incident Command System.” Job duties shift overnight as employees gear up to deal with the outbreak. Some 25 people meet daily — including a few from the state on speakerphone — to launch the department’s constantly updated Outbreak Support Plan. Ken Luther, manager of public health preparedness for the health department for the last two years, moves into the foreground to coordinate the response and guide the daily briefing. It will be Luther’s first health emergency at the department, but hardly his first emergency. The former Army colonel learned emergency management during two tours in Iraq, two in Afghanistan and several operations across eastern Africa in his 23 years of service. “I’ve been running things like this in bigger situations for a long, long time,” he says. Based on that experience, he knows the Outbreak Support Plan will change daily. “No plan survives first contact with the enemy,” Luther says. “Plans are useless, but planning is essential.” It feels like one of those truths he’s been explaining to people for a long time.

 

Weeks 13-16, Nov. 26-Dec. 23:
19 new cases. Total: 43

It’s an evening in early December, and Paul and Nancy Kern pack for their first mission. It takes both to hoist a giant cooler into Paul’s Jeep. It’s essential equipment, safeguarding several doses of hepatitis A vaccine at the mandated temperature range of 36 to 46 degrees. By happenstance, the Kerns will become the health department’s street outreach team. They’re looking for people who don’t go to shelters. During the day, Paul is the public health planner for the health department and the planning section chief for epidemic response. Nancy is a nurse practitioner and an associate professor at Spalding University. Inspired by their son Chuck’s work with a homeless-outreach organization in Indianapolis, they recently began volunteering at the Hip Hop Cares meal site under the Interstate 65 overpass at Broadway and First Street. With the epidemic on their doorstep, a transition into hepatitis outreach is natural, even inevitable. The first night, they tag along with an experienced group from Fern Creek United Methodist. They surmise that if they want homeless people to accept them, they need to be part of trusted groups. The Fern Creek church is just one among many organizations in Louisville’s extensive homeless outreach network that the health department will partner with as it wrestles hep A.

The Kerns set up operation in the back of Paul’s Jeep, working that first night in the dark. In the coming weeks, they’ll add lights and a marine battery to power them. Although December came in like a lamb, as the new year approaches temperatures fall below 10 degrees. In this bitter weather, the Kerns keep the Jeep heater running so people can slide inside before they peel off layers to bare an arm. Eventually, the couple receives smaller coolers with which to transport the vaccine and Nancy adds hot cocoa to their offerings. “It’s: ‘Would you like some hot cocoa? And by the way, I can give you a hep A injection. You know, there’s an outbreak,’” she says. It works.

The severe weather is bad news on another front. Ballard, the state epidemiologist, says it may accelerate the disease spread. Utah saw its hep A numbers surge as temperatures fell. “Winter came and people congregated. People are indoors more and in close contact with each other. That may lead to a spike in hepatitis A,” Ballard says.

Louisville’s hepatitis A cases are at 43 and growing, which makes the Kerns operation a tiny canoe bobbing on a flood-swollen Ohio River. But theirs isn’t the only boat. As the weeks pass, the health department establishes regular vaccination initiatives in several locations targeting the homeless and drug users. People who work mosquito control in the warm seasons help deliver vaccines. Nurses add shift upon shift. Health educators, public facility inspectors and top management all pick up duties to push out more vaccine. Volunteers from the Medical Reserve Corps, Norton Healthcare and the U of L Global Health Initiative step up. But it’s a mad scramble at the start. Paul Kern says daily briefings are a cascade of questions. “What’s available to us? How do we get vaccines? What can we get? How soon can we get it? What do we need to be able to administer everything? How do we prioritize where we go with it?”

Although the first vaccines arrived quickly, “the whole process was a quagmire,” Kern says. Obtaining and handling the CDC-supplied vaccines requires special protocols. Only state-registered people can handle them. The health department can’t hand them off to a third party to use, even if it’s to nurses giving shots to at-risk groups. Every dose demands paperwork. Vaccine losses must be recorded and explained, and there better not be too many. Slip up anywhere along the line, and the CDC can close the vaccine spigot. It’s a potent threat. One morning briefing features a PowerPoint slide detailing the five-step procedure required to handle the patient encounter forms required with each inoculation.

Those at the greatest risk for hepatitis A are priority targets for the CDC vaccine. And there’s no question who that is: drug users and the homeless, just as in San Diego and Salt Lake City. From the start, at least half of all hep A cases in Louisville are among people who use illegal drugs — and not just injection drug users. Further, most of the time the drug users are also homeless or in unstable housing, which means they live in shelters, are couch surfing or have other temporary arrangements. Although unstable housing is always a part of the problem, by December, only 6 percent of the people with hepatitis A have housing as their only risk factor. Ninety-four percent are drug users, half of whom are also homeless or likely to become so soon.

If the virus is going to jump from the at-risk groups to the general population, it will be under the power of drugs. “Drugs, unfortunately, are one of the great unifiers of all classes of society,” Zhao says. “People get together — homeless, non-homeless — and get high, whether that’s shooting, snorting, smoking or crushing pills.” And all of those practices can transmit hepatitis A.

That makes the department’s five syringe-exchange sites essential in hep A prevention. A few months ago, the syringe-exchange program began offering hepatitis B vaccinations. That vaccine also inoculated against hepatitis A — a fringe benefit that’s now the featured act. To encourage syringe-exchange visitors to accept vaccination, the health department adopts a strategy of gentle assertiveness. A greeter meets every person who comes through syringe clinic doors and tells them about the epidemic and the vaccine. Employees from all parts of the health department take turns in this friendly persuasion, traveling, eventually, to outreach sites all over the city.

By focusing on the people at greatest risk, health officials aim to prevent disease in those least able to withstand it, and at the same time keep the epidemic from breaking into the rest of the community. The worry is that it won’t be enough.

 

Weeks 17-20, Dec. 24-Jan. 20, 2018:
18 new cases. Total: 61

Early on, state health officials arranged conference calls with health officials in San Diego and Utah. Zhao says the goal was brain picking: “How did they go about reaching these populations?” Officials of both Western cities pointed to one critical nexus: the constantly churning, highly vulnerable jail population.

Every day, about 90 people check in at the Louisville Metro Department of Corrections. In 2017, there were enough jail bookings to raise the population of Jeffersontown (26,500) by 6,000. On any given day, 2,200 occupy corrections beds. “We knew, due to our target population, that hepatitis A was going to make it into the jail sooner or later,” Nick Hart says. Normally, Hart’s duties as an environmental health manager keep him focused on hazardous material response, childhood lead poisoning and mosquito-borne diseases. Now, he coordinates vaccine outreach to the jail. “It doesn’t matter how well your jail is run,” Hart says. “It doesn’t matter how clean your jail is. When you put a bunch of people in close proximity to one another, you’re creating a situation for transmission of disease.” Hart estimates that 22 hepatitis A cases so far may have a jail connection. “The city is the jail and the jail is the city,” Hart says.

In early December, Zhao created a map showing where drug and alcohol arrests took place in Louisville last year. Then he added dots to represent hepatitis A patient addresses. The overlap is suggestive: The most hepatitis A cases come from the neighborhoods where drug and alcohol arrests are highest.

The first step in a jail-hep A response was easy — vaccinating corrections staff. That began Dec. 4. Vaccinating inmates has been a more complicated problem. Because every person booked into the jail must meet with an intake nurse, intake seemed like the perfect moment to offer a shot. But not everyone is at their best just then. They may be drunk. They may be high. They may be just uncooperative, angry about getting in trouble. Further, booking is a 24-hour operation. There aren’t enough overtime hours, let alone health department nurses, to staff it round-the-clock. The compromise was to send nurses during the busiest booking time, Hart says, roughly between 4 p.m. and 9 p.m. The effort was both a success and a flop. Although the nurses vaccinated a significant share of the new inmates, that still left 19 hours of booking and scores of inmates uncovered. After a week, it was clear: The payback didn’t justify the cost. It was time to find a new plan.

Weeks passed before jail vaccination resumed, this time by “deputizing” the intake nurses to the health department and getting them certified to handle the CDC vaccine. Immunization started again in early January.

 

Week 21, Jan. 21-27:
Eight new cases. Total: 69

The Department of Public Health and Wellness on Gray Street, between Chestnut Street and Broadway, does its best to model global climate change on a local scale, with some rooms so warm people crank open windows and others cold enough to safely preserve perishables. The building was born in 1968. So was Will Smith, but he’s aging a lot better.

In the overheated second-floor conference room, Ken Luther leads the hepatitis A briefing group through the day’s update. A week ago, the team changed from daily to twice-weekly meetings, even as the department’s response to the 21-week-old epidemic grows new tentacles daily. The department has administered more than 1,700 vaccines. (From the start of the outbreak, health department workers were encouraged to get vaccinated, covered by insurance.)

For a moment, the conversation turns to April. In 90 days, three-quarters of a million people will crowd the riverfront for Thunder Over Louisville. On the heels of Thunder, several hundred thousand from all over the world will fill Churchill Downs for the Kentucky Derby. More crowds will gather for dozens of Derby Festival events. At some point, those in the group agree, protecting this surge of visitors needs to be in the planning mix.

 

Weeks 22-24, Jan. 28-Feb. 17:
24 new cases. Total: 93

Kern increases his efforts to find more vaccination sites in the Portland neighborhood. Although hepatitis A cases dot the map from east Louisville to west, Portland is clearly a hot spot. Kern’s list of priority vaccination sites is four times longer than it was just weeks ago. One of his jobs is making the community connections that lead to more ways to reach those at risk. Making connections was something he did when he worked in disaster preparedness with the Red Cross until 2016. “You just talk to people and you get other names. You develop this network,” he said.

That’s much harder to do for drug users, both securely housed and otherwise, who now dominate the hepatitis A rolls. Among people with hepatitis A who admit to drug use, 18 percent say they never use injection drugs, 44 percent say they only use injection drugs and 39 percent use both (percentages rounded). And most resist any overture from a stranger offering vaccination. Kern and his wife travel with an outreach group to an abandoned building where residents may have been exposed to hepatitis A. But no one accepts a shot until the couple makes a second visit accompanied by someone familiar to building residents.

Epidemiologist Zhao says drug use also complicates data gathering — an essential component in tracking and fighting the disease. “Some individuals do not care. They’ll tell me everything,” Zhao says. “Some flat out lie to me and it’s like, I have your tox (toxicology) screen. I know you do drugs, but you’re still going to tell me you don’t do drugs?” Others grow angry, taking inquiries like accusations as Zhao runs through the list of questions he asks every hepatitis A patient. “And sometimes they falsely blame other individuals,” Zhao says. He worries that naming homelessness and drug addiction as risk factors further burdens an already ostracized population. “People want to say (addiction) is a choice,” Zhao says, “but it’s not a choice. Did they have choice when doctors prescribed them opiates? Did they have choice when all these opiates were put on the market, and we were told they were clinical, safe and non-addictive?

“The things that happened in the ’90s are having repercussions now and will have repercussions for years.”

It’s an issue that troubles Moyer. “Why is it hard to reach (drug users)?” she says. “Because we jail people with substance-abuse disease. We don’t jail people with diabetes. Eighty-five percent of people in corrections have substance-abuse disorder.” If society treated substance abuse like any other chronic disease, Moyer says, the hepatitis A outbreak would be that much easier to fight. “We have to change the language around substance-abuse disorder.”

 

Weeks 25 and 26, Feb. 18-March 3:
34 new cases. Total: 127

During the hepatitis-A briefing on Feb. 23, Zhao reports a new potential source of hepatitis A infections: sex workers. He realized it during a patient interview. He conducts each interview using a questionnaire adapted by the state for this outbreak. Over the months, he has tacked on additional questions as he learns the particulars of the Louisville outbreak. Now he has a new one about sex work.

He added it when a young woman told him women in her neighborhood “were hopping into cars, trading sex for drugs or houses or food.” Until that moment, no one was thinking about sex work as a possible mode of hep A transmission. “We know that (trading sex) happens among the homeless and housing-insecure individuals. We know that it happens with drugs and other disease,” Zhao says. “But it wasn’t really identified here for hepatitis A.” And no one is conducting hep A outreach to sex workers.

Paul Kern expands his search. He needs vaccination sites that might be welcoming to sex workers. He needs connections with people these women and men would trust. “Given the sensitivity of all this, it’s one of those things you don’t just barge into,” he says. “That would probably stifle a lot of opportunities.”

 

Week 27, March 4-10:
Nine new cases. Total: 136

March brings unwelcome news. A produce worker at a Kroger on Dixie Highway (of the two Krogers on Dixie, this one is closest to Interstate 264) is diagnosed with hepatitis A. An employee at Denny’s on Dutchmans Lane comes down with the virus. There is no proven transmission from either site, but it adds a complication to Zhao’s attempt to track the virus. Now, when he asks new hepatitis A patients whether anyone they know uses drugs, or whether they have other risk factors, many blame their hepatitis on Kroger or Denny’s, frequently mentioning the wrong Kroger location or a different Denny’s. It’s another barrier to pinpointing the real source of infection, another way the virus slips away.

The city also sees its first hepatitis A death. Due to privacy concerns, the health department releases little information about the individual, except to indicate he or she had severe pre-existing health problems. Louisville has been lucky when it comes to hepatitis A mortality. The San Diego outbreak led to 20 deaths, and the Michigan outbreak has racked up 25 deaths among its 894 hepatitis A patients since the epidemic started in August 2016. Kentucky head epidemiologist Ballard says the high mortality rate in San Diego may reflect an older and sicker homeless population. “It hit a vulnerable population, people with chronic liver disease. A lot already had hepatitis C,” he says. “It’s interesting that most people contracting it in Kentucky are younger and healthier.”

The average age of Louisville hepatitis A patients is consistently about 37. No patient has been younger than 18, and the oldest patient by March is 69. (By mid-April, this will rise to 75.) The age range tells two stories, Ballard says. The simplest story is that drug users and homeless people are generally younger adults. But it also suggests something about the history of the disease in the last 50 or so years.

Before 2000, hepatitis A outbreaks were common. In 1971, just after development of a blood test for hepatitis A, there were 59,606 confirmed cases in the United States. Even as recently as the 1980s and ’90s, U.S. physicians reported an average of 26,000 cases annually. But the introduction of a hep A vaccine in the mid-’90s changed everything. By 1999, infection rates plummeted as many states mandated childhood hepatitis A vaccination — something Kentucky introduced this year for school-age children. By 2010, hepatitis A was so rare, only 1,670 cases were reported nationwide. It’s a good news-bad news thing: Now far fewer people contend with a disease that can take them out of circulation for two weeks or longer. At the same time, far fewer people are protected against it when it rears up. More bad news, if you were alive when hepatitis A was endemic in the United States: You probably don’t know if you were ever exposed. Children infected with hepatitis A rarely have symptoms.

 

Weeks 28 and 29, March 11-24:
36 new cases. Total: 172

Connie Mendel, sanitation unit supervisor during the outbreak, works with one eye trained to the calendar. It’s March 13. Thunder Over Louisville is April 21 — 40 days away. The Kentucky Derby is May 5, 53 days away. But the dates she’s tracking are two weeks earlier, April 8 and April 20. People vaccinated before April 8 would have adequate protection against hepatitis A in time for Thunder and would be, therefore, less likely to be a hepatitis A carrier. Anyone vaccinated by April 20 will be protected in time for the Kentucky Derby. Studies show that people produce protective levels of hepatitis A antibodies within two weeks of the initial shot. Although the vaccine is actually a two-dose regimen, that first shot is more than 90 percent protective. It’s enough.

In a normal year, Mendel’s unit, which handles restaurant inspections, is also responsible for examining every food vendor at every festival, even going up and down the route of the Pegasus Parade. “We, unfortunately, quarantine a lot of food that day,” Mendel says. But this year’s epidemic has heightened those normal concerns. She’s talking to Kentucky Derby Festival event coordinators about handwashing stations and portable toilets (called “Thunder Pots” for Thunder, of course). Will it be a problem, she wonders, when handwashing stations at Thunder run out of water and there’s no way to resupply them through the crowds? And what about vaccinating the food and beverage workers? Many of the Thunder vendors are from out of town, but as many as 25 are from Louisville. How to best reach them? And what about the 4,000 mostly local people hired to work the crowds at Derby each year?

It hasn’t been easy getting the attention of restaurants. When the epidemic started, Mendel says, the health department notified restaurants through listservs, encouraging vaccination for all food-service employees and repeating the handwashing gospel. But the initial announcement was only so much background chatter. No restaurants followed up. On March 13, Mendel is about to send another notice, this one announcing reduced-cost vaccines for restaurant employees through the U of L Global Health Initiative. Perhaps recent cases at Kroger and Denny’s will incite other food operations to take preventive measures, even if just to protect reputations.

Food inspectors already visit any restaurant hepatitis A patients say they frequent. The inspectors let the businesses know about the outbreak, check if anyone on staff has been sick and look for other hepatitis A risk factors. For a few venues, the risk factors are onsite drug use, Mendel says. “They’ve seen it in their parking lot. They’ve seen it in their restaurant. One said they had someone OD in their drive-thru lane,” she says. A Portland fast-food outlet removes all its electric outlets from the dining area to keep people from hanging out, charging phones and — they suspect — using drugs in the restaurant.

As the March 13 health department briefing wraps up, a half-dozen people remain at the table to talk Derby. Right now, it’s mostly questions: How will they reach hotel employees? What about sex workers? How about all those barbecue and sandwich businesses that pop up in the neighborhoods around the Downs on Derby Day? “Do we have people go literally house-to-house?” Caloia asks. Will there be enough vaccines, not just the CDC-supplied inoculations for the at-risk groups, but vaccines for everyone else who could spread hepatitis?

The following week, Zhao shows the team the latest epidemiological map. The neighborhoods off Taylor Boulevard near Churchill Downs now appear to be one of the city’s major hepatitis A clusters. The Kentucky Derby is 43 days away.

 

Week 30, March 25-31:
27 new cases. Total 199

The number of hepatitis cases has risen steadily in March. In January, there were 28 new cases. In February, 48. By the end of March, there will be 72. Forty-nine cases come in during the final two weeks of March, overwhelming the people charged with investigating every case. It takes 45 minutes to an hour to interview each new patient. Several of the people who conduct these interviews have other outbreak-related duties, and all have non-outbreak duties. Keeping up is near impossible.

As the month closes, Jefferson County Public Schools has a hep A scare. An employee for a food-preparation company shows evidence of hepatitis A. But follow-up genetic sequencing — the gold standard for diagnosis — reveals the individual is a false positive. The Portland Kroger isn’t so lucky: An employee tests positive for hepatitis A. So does a worker at the new restaurant Sarino on Goss Avenue. Frightened residents flood the health department with calls. Zhao’s office is among several inundated by the phone queries. “The calls are really disruptive,” he says. Many callers are upset. Some don’t understand why they can’t get the free vaccine, which is earmarked for people without insurance and anyone in a high-risk group. The department turns to Metro United Way 211, providing it with information about which calls to forward to which office and scripts to cover general outbreak information.

Everyone is busy. By the end of the month, the department will have administered more than 8,400 vaccines since the epidemic began. Vaccination events fill the calendar as nurses and others head to drug-treatment centers, shelters and halfway houses. They go to Family Health Center Portland, the Franciscan Kitchen on South Preston Street, the Lord’s Kitchen on Standard Avenue, the Cathedral of the Assumption on South Fifth Street, Hotel Louisville on West Broadway, the House of Grace, Wayside Christian Mission, Portland Presbyterian, the Healing Place, Gratitude House, Community Transitional Services and others. The Kerns continue their outreach with an organization called My Dog Eats First. About 150 people line up early in front of the former Boys and Girls Club on Portland Avenue to collect dog food and other needed supplies. Many live in the neighborhood; some live on the streets. Several bring their dogs to the old school gym, patiently waiting in a line that snakes out the door. Just before visitors wander back into the mild evening air, they pass the table where the Kerns are working. None of the student nurses who usually assist Nancy could make it tonight, so by herself, she vaccinates 25 people. No one complains as they wait.

During the March 27 briefing, Mendel says the Louisville Downtown Partnership has agreed to champion vaccinations to workers at all downtown hotels. But there’s still no plan to vaccinate the 4,000 temporary Derby workers, nor a plan for the food purveyors coming to Thunder. There’s talk of offering vaccinations to Derby workers at orientation and training sessions, but is it even worth the effort? How many temp workers will fit the high-risk definition required to receive the CDC-issued vaccine? The Substance Abuse and Mental Health Service Administration reports drug abuse and addiction rates of 20 percent in the accommodations and food-service industries — the highest of any industry, according to data from 2008 to 2012. (Across all industries, the average is 10 percent.) For a moment, the health department briefing group decides to drop the notion of vaccinating the temp employees. They’ll make due with informational fliers, posters and repeated admonitions to wash your hands.

Kathy Harrison Turner, the communications director, leans forward. “So if we have so many food-service workers in our high-risk population, tell me again why we wouldn’t want to do vaccinations at orientation?”

Director Moyer chimes in. The CDC-supplied vaccine will be gone soon anyway, she says. The health department will have to buy its own supply at $33 per dose. If the health department buys the vaccine, it can distribute it to anybody. “I think it’s worth it,” Moyer says. Suddenly, vaccinations are a go. Now all they need to to do is arrange a mass vaccination event for 4,000 people.

 

Weeks 31-32, April 1-14:
41 new cases. Total: 240

Mendel, the sanitation supervisor, feels like the subject of a weird physics experiment demonstrating the vagaries of time and space. Although the people from Levy Restaurants — the national firm that operates food and beverage service at Churchill Downs — were amenable to vaccinating their employees the first time she spoke to them in March, they had to talk to corporate. Then time slowed to a crawl. “For us, this is an immediate, urgent event,” Mendel says. “I think I’m getting a slow response from some of these people — I hope I’m not badgering them — but it’s because we’re moving so fast.”

In truth, it’s remarkable how rapidly things finally come together. On April 12, the Kentucky Nurses Association and medical students are in a room behind PBR Louisville at Fourth Street Live, vaccinating a steady stream of employees from the surrounding restaurants and bars. The Cordish Companies, which owns the entertainment district, is paying for its employee inoculations. On Saturday, April 14, Ken Luther, a nurse and an administrator head to Waterfront Park during a food truck and craft beer festival and vaccinate food-truck operators. From there, they to go Fourth Street Live, where the Louisville Taco Festival is in full swing, and vaccinate several more food-truck operators.

The following week, the nurse association and medical students set up shop at Whiskey Row, where employers are helping pay for employee vaccinations. Plans are underway to stage another event for NuLu employees. The Louisville Downtown Partnership continues to cheerlead vaccination of hotel employees. In addition, Anthem and Aetna chip in $35,000 toward vaccination. That donation allows the health department to lower the price of vaccines to $25 for food-service workers. Kroger also donates vaccines not used by their employees. By mid-April, the health department has spent nearly $600,000 on vaccines, although the state picked up a significant portion of the total.

On April 17, state health officials issue a recommendation that everybody in Jefferson County should receive a hepatitis A vaccination. The public learns that another restaurant employee, this one at an Applebee’s on Dixie Highway, tested positive for hep A. On April 18 and 19, just before the pre-Derby vaccination window slams shut, a mass vaccination event takes place during mandatory training for the 4,000 temporary employees at Churchill Downs. “I think the biggest thing about Derby is people are coming here and some let their guard down, doing things they might not normally do,” Caloia, the medical director, says. “We don’t want to be infamous for spreading hepatitis A.”

——   ——–    ——-

Trouble In Mind

Can magnetic energy change the face of autism?

Louisville Magazine | August 2013 | Jenni Laidman

They stand like microsoldiers in tight ranks, shoulder-to-shoulder across the top of your brain, each sentry humming its own tune, these millions of tiny processors running your life.

Little in Dr. Manuel Casanova’s office stands in such orderly fashion. Behind him, a bookcase overflows, extra volumes shoehorned in at every odd angle. There are books to the right of him, books to the left of him. Every flat surface supports towers of books. He peers between the stacks that tile his desk, looking past the photographs of his four daughters and past his brains. They are plastic brains, more talismans than teaching tools, too crude to illustrate the microscopic processors that take up so much real estate in Casanova’s thoughts, those minicolumns of neurons snapping away in the folds and ridges of his cerebral cortex.

His office is in a part of the University of Louisville Health Sciences Center campus that makes a fetish of concrete. There is an expanse of hot pavement forming a courtyard fringed by three examples of 1960s brutalist architecture. If you’re standing on Preston, facing west, Casanova’s office is dead ahead, in the tallest building. To your left is Kornhauser Library. And in the building to your right, researcher Estate “Tato” Sokhadze moves amid the warren of small rooms that make up his laboratory.

Maureen “Moe” Womack walks into the lab on a Friday afternoon in May trailing three children. Her hair is blond and wind-styled, and she clutches a stuffed Mickey Mouse dressed in lurid emerald green. It belongs to Augusta, the smallest of the three children flowing around her, a pixie of a girl with sky-blue eyes, luminous skin and a cap of thick brown hair. Sokhadze stands to greet them, his voice rising an octave and growing louder, taking on the musical tone adults use with children. “So how are you?” he says to Augusta, who is wearing two ribbons on her shirt. “Is this a prize you got at school?” Augusta affirms this in the tiniest voice. “Congratulations!” he says. “So it was after school? It was a competition?” She nods. “Very good!” he says. “It looks very nice!”

She is here to take part in an experiment, one of more than 120 youngsters to visit Dr. Tato – that’s what everyone calls him – for treatment that is showing promise to an intractable problem. In this treatment, Sokhadze and Casanova are a team. Casanova has the theory; Sokhadze waves the magic wand. Together, they hope to change the lives, at least to some degree, of children with autism. Augusta, diagnosed with autism at age four, is one of those children.

Continued . . . 

Printers Row: The Chicago Tribune

Savage

Anthropology

and

Napoleon

Chagnon

March 01, 2013|By Jenni Laidman

In 1998, just before Napoleon Chagnon retired from the University of California at Santa Barbara, he signed a contract to write a book about his life as an anthropologist among the Yanomamö people, who live in the forests of Venezuela and Brazil. It promised rip-snorting adventure — threats at spear point, psychedelic snuff, wars over women — from a serious and celebrated academic who had lived among people who had little or no previous contact with the modern world when he began his work in the 1960s.

Now, 15 years post retirement, Chagnon’s book, “Noble Savages: My Life Among Two Dangerous Tribes — the Yanomamö and the Anthropologists,” is finally available. That it took Chagnon nearly a decade and a half to write it should surprise no one given the events of the intervening years. What may be more surprising is that it doesn’t drip bitterness on every page. It very nearly did.

“I’d write two or three days, produce a chapter for my book, and tear it up and throw it in the garbage can,” Chagnon said in a telephone interview from his new home in Columbia, Mo. He joined the anthropology faculty at the University of Missouri in December after a long hiatus from academia. “Everything I said sounded very depressing and very angry,” he said. “Everything I wrote became tarred with the putrid smell of (author Patrick) Tierney, (and) the American Anthropological Association ….”

Of the many tales Chagnon tells about life with the Yanomamö, about death threats from angry head men and tragic epidemics and killing raids, probably few are more bracing than what happened to him in his home country, among his own tribe, the American Anthropological Association. Chagnon’s shove from grace is about as spectacular as it gets, featuring long smoldering academic disagreements that burst into a wildfire of accusations — accusations that continue to reverberate. Late last month, Marshall Sahlins, professor emeritus of anthropology at the University of Chicago, resigned from the National Academy of Sciences, citing Chagnon’s election to the academy as one reason.

Chagnon’s ideas had long been controversial among some of his colleagues. His depiction of the Yanomamö as “The Fierce People” — the subtitle of his best-selling textbook, “Yanomamö” — drew critics who said he exaggerated Yanomamö violence. The reasons for the violence were also in dispute. Chagnon said extensive taped interviews in many Yanomamö villages prove that many of these battles were over women. But opponents said the fights were due to the lack of animal protein in the people’s diet. Chagnon created more enemies when he came to champion sociobiology — an idea that, when introduced in 1975, met angry denunciation through its claims that all behavior, even human behavior, is shaped by natural selection.

An article Chagnon published in Science magazine in 1988 led to further ruptures among the cultural anthropologists. Chagnon’s data showed that Yanomamö men who participated in killings had more wives and more offspring than those who had not killed — in fact, three times more children. His opponents said he manipulated his data to exaggerate violence and that his research led to violence against the Yanomamö, charges he vigorously rejected.

Continued . . .

What is Bill Lamb Up To?

Louisville Magazine | October 2012 | Jenni Laidman

The future of newspapers, he thinks, is television.

Bill Lamb leans back on the couch in his stifling office. His suit jacket is off, revealing a white-on-white striped shirt and gold knot cufflinks. Six-foot-three, with blue-gray eyes, he’s better looking in person than on his twice-weekly television appearances as the editorial voice of Louisville’s Fox affiliate, WDRB. Onscreen, his ears seem a bit too noticeable, his hair and persona a tad too uptight.

His is a business where looks matter, where everyone, including the 58-year-old Lamb, meets with appearance consultants periodically. As president and general manager of WDRB and vice president of broadcasting for station owner Block Communications Inc., he represents a type of media notorious for its superficiality – notorious, at least, among print journalists, who often feel smugly superior to their more popular television competition, with its 45-second stories, its in-depth investigations of the obvious, and all that perfect hair. Four times in the course of two long conversations, Lamb mentions that WDRB reporters may be good looking, but they’re also “tough as nails,” betraying a degree of defensiveness at any casual dismissal of local television as the dumb blonde of journalism. But it’s no more than an annoyance, a conversational gnat swipe. The way he sees it, he’s a few steps ahead of the journalistic pack, and his well-groomed people are manning battle stations. Then it’s bye-bye Courier-Journal.

The future of newspapers in Louisville is, according to Lamb, WDRB.

You need not be a media junkie to catch the weird vibes on the airwaves this year.

Continued . . .

Chicago Tribune: Printers Row

Cracking the Code

of Linear B

in ‘The Riddle of the Labyrinth’

June 10, 2013|By Jenni Laidman

At the opening of the 20th century, an archaeologist unearthed a Bronze Age palace larger than Buckingham on an island of Crete in the ancient city of Knossos. In that collapsed edifice, which extended some six acres, he found hundreds of clay tablets where small inscrutable symbols dance along horizontal rules.

Some of the incised drawings surely stood for the things they depicted: horses and pigs and goblets and spears. Others were more puzzling — marks that looked like pitchforks or telephone poles or buttons. Arthur Evans, the British archaeologist who uncovered the site, which was abandoned sometime between 1400 B.C. and 1100 B.C., recognized the inscriptions as a writing system never seen before, for a language that was anyone’s guess. And for the next several decades, guessing is what many people did, including Evans.

In 1952, a 29-year-old British man named Michael Ventris drew worldwide acclaim when he worked out a way to read that writing, designated as Linear B. But behind his accomplishment — and it was an accomplishment — was the painstaking but unacknowledged detective work of a woman named Alice Kober, whose remarkably thorough and thoroughly logical approach to the squiggles and horses and lines provided the keys that Ventris employed to solve the riddle.

The New York Times senior writer Margalit Fox tells an intricate and riveting story of how the writing system was deciphered in her book, “The Riddle of the Labyrinth: The Quest to Crack an Ancient Code.” What emerges is a puzzle-solvers delight and a detective story full of longing and frustration, discovery and maddening egotism. At the story’s center is Kober, a professor at Brooklyn College, laboring under the requirements of teaching a full course load to undergraduates while she works out the secrets of the strange writing system in her spare time.

Continued . . .

Scientific American Online

Speedy Genes:

The Race

for Genetic

Advantage

May 4, 2012| By Jenni Laidman

When the Kentucky Derby winner crosses the finish line in front of 160,000 roaring spectators on May 5, there’s a good chance it will have two copies of a gene that makes a horse a sprinter.

The so-called speed gene, which several laboratories say determines whether a horse prefers a short sprint, a marathon or something in between, is just one of the genetic markers identified in the search for the roots of elite performance in thoroughbreds. Now the race is on among five or six commercial laboratories to convince thoroughbred breeders and buyers that testing for this gene and other markers is the road to the Triple Crown. In the meantime, the geneticists behind these companies scramble to lay claim to the best markers for athletic traits. Major thoroughbred farms are signing up horses for testing, even though some say they’re not sure what the results mean.

“We don’t know what to make of it,” says Elliott Walden, president, CEO and racing manager of Winstar Farms in Versailles, Ky. Winstar, the 685-hectare birthplace of 2010 Kentucky Derby winner Super Saver, is dabbling in genetic testing. “We don’t know how to evaluate the information. We’re still figuring it out.”

He’s not the only one puzzling over these tests, which start at around $500 per horse.

Continued . . .

Why Do They Hate Us?

 Kentucky hates Louisville: True or False

“Some folks, not naming names, seem to think that if you don’t live within 40 or 50 miles of Louisville or Lexington you’re just out of touch and likely married to your sister. Additionally, we’re uneducated, overreligious, shack-dwelling inbreds and have only poor underachieving schools that only teach about Jesus. We’re out of touch, out of date and out at Klan rallies.”

Louisville Magazine | July 2012 | Jenni Laidman

We walk to the garage, where two pale faces, one skeletal and one round, glow from the gloom of a cave-like service bay. The ground around us is carpeted with little toothed metal disks, bolts, nuts, doohickeys, glittering blackly. The gaunt face lifts its chin, directing me to the man walking our way, and I am ushered inside the building with the hand-painted sign proclaiming “Bible & Tire.”

We were just east of Morehead, Ky., when my husband and I had spotted Bible & Tire. Bibles are a seasonal business, owner Garrett Dehart now tells me, and this isn’t the season, so stock is low, although given the weather – it’s a preview of hell, with temperatures pushing 100 degrees – a little wise promotion might goose a sinner or two toward scripture.

Dehart says he took up his calling not long after his marriage ended. That was 20 years ago. “I had lost everything,” he says. “I was home – you probably won’t believe this . . .” He stops to look through me with Frank Sinatra-blue eyes.

“I’ll believe it,” I promise.

He continues. “One day I heard a voice on the couch: ‘Come down and lease this garage.”‘ He says he drove right over. But the owner had not heard the same instruction, requiring the Lord to send Dehart again. This time, heavenly communications were clearer. Eventually Dehart bought the place. Now Bible & Tire is just what the sign says: It sells tires; it sells bibles. And Dehart occasionally gives bibles away.

It is his mission. Yet I, too, have a mission. A misbegotten mission. Maybe a stupid mission. But it was born of one of the first conversations I had in Louisville, with our mover. The rest of the state, the mover said, hates Louisville. He wouldn’t live anywhere else – although he was born a few counties over – and people in the rest of the state wouldn’t come here. This hardly seemed credible to me, charmed as I was by my new hometown. Then I ran across an online discussion in which people from all over Kentucky talked trash about Louisville.

“There is a deep-seeded (sic) dislike of Louisville in most of the rural areas of Kentucky,” one wrote.

“I’ve heard from quite a few people outside of Louisville that believe that native Louisvillians tend to seem a little ignorant, narrow-minded and arrogant . . . putting Louisville too high up on a pedestal while at the same time being condescending to other areas.”

“Some folks, not naming names, seem to think that if you don’t live within 40 or 50 miles of Louisville or Lexington you’re just out of touch and likely married to your sister. Additionally, we’re uneducated, overreligious, shack-dwelling inbreds and have only poor underachieving schools that only teach about Jesus. We’re out of touch, out of date and out at Klan rallies.”

Wow, I thought. Is the divide that bad? Are we truly such arrogant jerks? Thus, my mission was born, launching me on a 2,500-mile journey, looking for answers from Pikeville in the east to the farthest western outpost of Madrid Bend.

So I ask Ol’ Blue Eyes this question: Why does the rest of the state hate us?

He can’t say. In fact, he’s never been to Louisville. “I’ve been to the edge,” he says. “There are good people and bad all over.”

This is discouraging. . . .Continued

Clean Coal? You’re Kidding, right?

Photograph by John Nation

Mike McInnis wears a blue cable-knit sweater zipped to his chin. It’s cold outside The Summit office building on Brownsboro Road, and snow has been falling all day. McInnis looks like he’s trying to warm up after skiing to work.

He will warm up. Get him talking about American energy policy, and he sounds frustrated, incredulous, sarcastic, heated. But we don’t get to that large subject until more than an hour into our conversation. With an air of mild frustration, he explains the intricacies of his business, the U.S. Environmental Protection Agency rulings, fluctuations in natural gas prices, the unsteady state of the credit markets. All those complexities, intimately bound up in a project he and his partners at The Erora Group have shepherded for 10 years, fail to raise his ire. But the big picture? It gets him steamed.

At the center of the debate is the question: How are we going to get to the middle of this century? How are we going to turn on our lights, make our coffee, watch Real Housewives on big, energy-sucking flatscreen TVs, kill Nazi zombies on our computers, run our air conditioners, freeze our food and thaw it later in the microwave, and, eventually, charge our cars? Where will the energy come from?

For McInnis, and many others, the answer is coal. Forget the green future you’ve been waiting for, where windmills turn sedately against a clear blue sky. Oh, windmills have a role to play, as has solar and geothermal and even nuclear and hydroelectric and algae and weeds. And all those things will probably constitute the full mix of our energy needs sometime in the future. But for the next half-century, many believe, wind turbines, solar panels and other “renewables” won’t even make a dent.

Only coal can carry us to a green future.

Coal, the least green of all fuels, famous for despoiling landscapes, blackening lungs, increasing death rates wherever it’s burned, putting mercury in our fish, acid in our rain and nitrogen oxides in our skies. Coal, a leading culprit in global climate change, spewing more carbon dioxide into the atmosphere than any other fuel, where its accumulation triggers ocean acidification, rising sea levels, chaotic weather systems, melting ice caps and a warming planet. Coal: That’s the stuff of our salvation.

Really?

Yeah, really.

READ THE REST OF THE STORY

*–*–*–*

Not everything I write gets a byline. Stories I’ve written for Howard Hughes Medical Institute, for instance, generally aren’t bylined. But a story HHMI published
in the HHMI Bulletin did get a byline. It’s a different kind of piece. I worked with researcher Evan Eichler of the University of Washington to create his first-person story. So I interpret, and then I try to write in his voice. It helps to be the voice of someone who’s very articulate. And his work is utterly cool. I also enjoyed the fact that it was a challenge to explain. His lab is reading the parts of our genome researchers couldn’t get to before. What he’s finding … well, read the story.

Crucibles of Dynamism

We’re accustomed to thinking of evolution moving forward one base pair at a time: A single nucleotide is replaced in the ribbon of our DNA and a gene is gradually transformed from one function to another, or a disease emerges as the gene’s function is perturbed by these small stepwise changes. But there is another, parallel story unfolding within our genes, which, until recently, no one was able to easily read.

To all appearances, it’s a more dramatic tale, with big events and rapid cataclysmic change.

READ THE REST OF THE STORY

*–*–*–*

When all the fighting was over, it seemed most people forgot that the University of Louisville was building a laboratory for some of the world’s most dangerous germs in the middle of suburbia. I took a look at the NIH BioSafety Level 3 laboratory just before it opened, explaining what was going on in the nondescript building on the university’s satellite campus.

Biology’s Bad Boys

Her eyes are hazel. They open doors.

The iris scanning camera doesn’t actually see their color; rather, it compares the unique angles within to a database. Only then can Colleen Jonsson activate the electronic access that lets her inside.

There are five doors, each with special security requirement, between the entrance to the University of Louisville’s Regional Biocontainment Laboratory and the room where she leaves street clothes behind in favor of surgical scrubs. She tops the scrubs with a white Tyvek coverall and dons an air-purifying respirator, a hood, double gloves, and special shoes and socks. If the experiment under way is particularly risk, even underwear stays behind. After years of working in such laboratories, Jonsson, director of the Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases — of which the laboratory is the major part — rarely wears jewelry. Why put on something you’re only going to take off again in a little while?

This is biology’s inner sanctum, soon to be home to Louisville’s most dangerous inhabitants, lined up in tiny tubes inside locked freezers. There will be bubonic plague, and hantavirus — the respiratory infection that swept through the Four Corners region of the United States in 1993, killing 13. There will be commoners, such as influenza, and exotics, such as SARS (severe acute respiratory syndrome), which killed nearly 10 percent of its victims in 2003. The number of frozen criminals could increase as new infectious disease emerge, or as their danger as instruments of terror rises.

READ THE REST OF THE STORY

*–*–*–*

I suppose it’s inevitable: Move to Louisville, take an interest in horse racing. These are my first stories on the sport. One makes fun of my ignorance about the Kentucky Derby and is preoccupied with horse sex. The other looks at the perilous economics of thoroughbred racing in the Bluegrass and the policy debate in the state capital of Frankfort.

Take Me Out to the Derby

By Jenni Laidman | May 2010

Safe Sex

Here is what I knew about Thoroughbred racing when I moved to Louisville a little more than two years ago:

It involved horses.

But I’m a Louisvillian now, and I need to get serious. I need to elevate my game if I’m to understand my adopted home, to be one of the people whose eyes fill with tears when the University of Louisville Marching Band strikes up “My Old Kentucky Home,” to develop a taste for bourbon and to acquire a big hat. I want to be one with the Kentucky Derby.

But how?

I cannot put enough emphasis on my ignorance. I did not clearly understand what the word “handicap” meant if it did not pertain to the Americans with Disabilities Act. I was not sure what color “bay” might be, or “chestnut.” Don’t even ask me to find the cannon bone. Or the fetlock. I was clueless, uncertain even of where to begin. So I began at the beginning, so to speak, arriving at Darley America in Lexington before dawn one Wednesday to visit the breeding shed.

Did you know that horses roar? They do.

READ THE REST OF THE STORY

*–*–*–*

Playing for High Stakes

By Jenni Laidman | January 2010

It was the second time Craig Bandoroff felt pummeled by Frankfort. The first was more than 30 years earlier. He was a top jockey in New Jersey when a colt named Old Frankfort tried to jump the inside rail, flipping Bandoroff into the air like an unwilling acrobat,t hen falling atop the young jockey. Bandoroff would never use his right arm again.

Today, Bandoroff is the 54-year-old owner of Denali Stud near Paris, Ky., and he’s worried that his latest blow from Frankfort could be mortal. As he watched on June 22, members of the Senate Appropriations and Revenue Committee voted 10 to 5 against slot machines for Kentucky racetracks. In a few short minutes, everything he had hoped for withered and died. He was devastated. To his mind, this had been the legislature’s best chance to rescue what he saw as a deeply threatened industry. The Senate left the future of Kentucky horse racing in grave peril, he believed.

He walked to his car alone.

“I don’t think anybody saw me,” he says, “But I was in tears.”

His voice grows sandy with the retelling.

“To think that’s how government works.”

READ THE REST OF THE STORY

*–*–*–*

2010 Person of the Year:

The Dealmaker

Louisville Magazine | December 2010 | Jenni Laidman

It was the eve of the big day: July 23, 2008.

Jim Host was more exhilarated than tired as he turned onto his street in Lexington after another long day in Louisville. Since January of that year, when he learned the financing deal for Louisville’s proposed downtown arena was in deep trouble, he had jawed his way through a hundred conversations, sent scores of e-mail, from his ever-present Blackberry, used every ounce of salesmanship and trademark shoot-from-the-lip candor at his command–and somehow managed to find safe passage in a financial market so chaotic that any move seemed perilous.

That very afternoon he had signed 456 documents lined up along table after table, each scrawl bringing him closer to closure and the more than $360 million in financing needed to build a state-of-the-art, 22,000-seat college basketball facility.

On the upcoming morning of July 23, Host and Dan Ulmer, chairman of the Louisville Bars and former PNC Bank chairman, would meet with the executive committee of Greater Louisville Inc. to trumpet the done deal. Later, Gov. Steve Beshear would stand beside Mayor Jerry Abramson during a press conference announcing the success. And that evening, 200 people would gather at the Jefferson Club for a gala celebrating this critical milestone.

It was going to be a great day.

Nearly 7 p.m. on the dot. Host pulled into his driveway and punched the button on his garage door opener. His cell phone rang.

It was Goldman Sachs, the Louisville Arena Authority’s bond underwriters.

“We’ve got some news,” Greg Cary, an executive at Goldman Sachs, told Host. “Are you sitting down?”

Continued . . .

I often write about plastic surgery for HerScene magazine. This year, I followed a woman through her breast implant surgery.

Diary of a Breast Augmentation

By Jenni Laidman | June 11, 2010

7:20 a.m. Friday, April 2 Imaage Medical Spa

Shay Perna hadn’t slept much last night. Instead, her mind raced. For weeks she’d wondered what if, just moments after the anesthetic took hold, she change her mind but was too doped up to say anything?

But now, walking into the surgery center on New LaGrange Road, groggy and nervous, the 29-year-old Brandenburg, Ky., woman has no doubts. Her heart races, but she is ready. She has thought about this since she was about 20. A petite 5-foot-2 and 103 pounds, Shay has a doll’s proportions — just not a Barbie doll’s. Her flat stomach and trim waist and hips aren’t accompanied by Barbie’s voluptuousness.

That’s about to change.

READ DIARY OF A BREAST AUGMENTATION

*–*–*–*

For the second year, HerScene magazine wanted to present a compendium of services of interest to women in Louisville’s sprawling, competitive hospital market. I confess that I sometimes refer to this as the wall-color guide to hospitals, since it’s heavy on aesthetics. The challenge is to blend the superficial assessments with substantive summaries of medical service. This comprehensive review ran in June of 2010.

A Women’s Guide to Louisville Hospitals

By Jenni Laidman  | June 11, 2010

Women are the primary decision makers when it comes to health care, and Louisville hospitals are surely keeping us in mind as they give our local health-care market a makeover.

Today, health care is pretty. The dowdy hospital with that odd perfume of humanity and antiseptic cleaners is no more. Even the lobby floor are works of art, to say nothing of the actual art on the walls. And, in Louisville at least, health care is increasingly convenient.

Odds are, skilled medical care is closer to you than ever — especially if you’re in a fast-growing ZIP code where income is higher. But the upgrades are more than window dressing. While conveniences abound, there are also important developments in research and patient care that will affect you and your family for years to come.

*–*–*–*

A Battle of Nerves

Louisville Magazine | August 2009 | Jenni Laidman

When neurosurgeon-to-be Christopher Shields was a young man, he and his sister Alexis decided to emulate the world’s reigning stars of pairs figure skating. The Shieldses were already respected competitors in Canada, consistently ranked among the nation’s best, but stalled in the number two spot. That’s when they fell under the spell of the Russian couple who dominated the sport during the early-’60s, Lyudmila Belousova and Oleg Protopopov. “Oleg would hold Lyudmila up and he’d spin and she’d twist in the air,” Shields said in a recent interview. The move was revolutionary and the pair from the tiny gold-mining town of Schumacher, Ontario, began practicing it.

When the Shieldses performed in the 1963 Canadian national skating competition, Shields lifted his sister above his head in imitation of Protopopov, and, exactly as planned, his sister twisted gracefully above his head.

But there was a problem. The move wasn’t permitted. Canadian skating competitions didn’t allow this lift. The rules stipulated that a lift was to be a continuous motion–the girl goes up and the girl comes down in one sweet parabolic glide–with no stop in the middle for partner-twirling. Instead of impressing the judges with their innovation, the Shieldses lost points for their unauthorized acrobatics. They finished second again. A few years later, the Canadian figure skating organization changed its rules to allow the lifts created by the Protopopovs, but by then the Shieldses had left skating behind.

Another case of running afoul of the powers that be may have begun for Dr. Christopher Shields on Jan. 23, 2009, when he walked into the office of Dr. Edward Halperin, dean of the University of Louisville School of Medicine, with a proposal he was confident would wow the dean–the creation of a prestigious neurosurgery institute that Shields envisioned as competing with the biggest players in the field. “This was such a big offer to the university,” Shields said. “This was really a gift.”

Continued . . . 

Our relationship to animals, as well as animal behavior, have been long-time interests of mine. Louisville Magazine hired me to write about the future of elephants in zoos, in particular, the Louisville Zoo’s baby elephant, Scotty. In 2010, about a year after this story ran, Scotty died of a bacterial infection.

What’s Best for Scotty?

By Jenni Laidman | May 2009

In late March, several hundred people crowded around the elephant exhibit at the Louisville Zoo to watch Scotty the African elephant celebrate his second birthday. The youngster marched around the yard while the zoo loudspeaker blared an endless loop of “Baby Elephant Walk.” On command he sat upright and raised a chubby leg; he stood on small table in time-honored circus fashion and posed; he lay down and got back up again. Then he followed two adult elephants to his birthday “cake” of straw and vegetables and occasionally dashed beneath his mom’s trunk to grab a morsel and run away. Meanwhile, the two bigger elephants tore the cake to bits and grabbed most of the good stuff.

Little boosts a zoo’s gate receipts like a new baby, especially among the “charismatic megafauna,” the big animals people love to see. Elephants are as mega as they come, and Scotty is nothing if not charismatic. But these days, the birth of an elephant is about more than annual attendance figures, or even the desire by zoos like Louisville’s to increase the number of homegrown animals so visitors can appreciate their wild counterparts. Instead, elephants are emerging as the newest symbol in the ethical battle over animal captivity. As in other fights over keeping wide-roaming species such as polar bears captive, or caging our closest relatives, the great apes, the argument is emotional and difficult. It asks whether any zoo, even the very best with the most dedicated staff, is capable of raising and providing a proper environment for Scotty and elephants like him. It points to mistakes in the past and problems in the present.

It can make a guy like Dave Campbell, the Louisville Zoo’s elephant-area supervisor, seem like he’s operating int he eye of a hurricane.

READ “WHAT’S BEST FOR SCOTTY?”

*–*–*–*

Louisville Magazine decided to publish its first sex issue, and the editor asked me to write about sex toy parties, which are apparently wildly popular in Louisville. What a fun story.

(Sex) Toy Stories

By Jenni Laidman | October 2009

Nicole Cissell draws the curtains in the small but elegant living room. Moments later, through the sheers, I see two police officers approach the front door. I knew this was a little naughty, but really, the police?

It’s a Friday night in late summer, and Cissell had just emptied a gun case onto a table in the living room of a Smoketown home. What in the world will the police think when the door opens? I’m not the only one wondering this, and laughter grows raucous among the women in the room.

Beneath a dazzling chandelier are a dozen festively colored vibrators and dildos that Cissell toted here in her gun case. It’s not illegal. (We’re not in Alabama, for pity sake; it is illegal there.) It’s just a bunch of women attending a version of a Tupperware party that the inventors of multi-level marketing schemes probably didn’t envision.

READ THE REST OF THE (SEX) TOY STORY

*–*–*–*

Louisville was one of two cities involved in the U.S. Supreme Court case that overturned race-based school assignment. I had been in town about a year when I drew the assignment to write about it from Louisville Magazine for their Law issue. The case began and ended before I thought about moving to Louisville.

Order From The Court

By Jenni Laidman | March 2009

Frank Mellen climbed into the taxicab in Washington, D.C., and realized he was hearing a familiar voice coming from the radio,

His own.

There was never any question about the importance of what he did that morning. But it took on an air of surreal theater as he settled into the backseat of the cab crawling through the Washington traffic and listened to himself answer questions from justices of the United States Supreme Court.

Kentucky had its share of headline-grabbing lawsuits in the last year, but none drew more attention, or had greater impact, then the one Frank Mellen and Wyatt, Tarrant & Combs colleague Byron Leet pursued for the defense in Washington on Dec. 4, 2006 — the debate over which school Louisvillian Crystal M. Meredith’s son could attend. The question: Could her son, Joshua McDonald, who is white — or any child of any race — be put in a particular school, or kept out of one, because of the color of his skin? Would courts now forbid a practice developed to assure equal education to all children?

That cold and clear-blue morning, Mellen and Leet had their final showdown with another Louisville lawyer, Teddy Gordon — who this time was assisted by counsel from the Bush administration’s solicitor general. Gordon had been picking away at the Jefferson County Public School’s race-conscious student-assignment plan for nearly 10 years.

READ THE REST OF “ORDER FROM THE COURT”

*–*–*–*

Immune No More

I was lucky with this one. I was already working on this story on whooping when a neighboring county reported an outbreak of the disease.

It started with a single case of whooping cough in a student at Freedom Elementary School in Shepherdsville, reported by a doctor to the Bullitt County Health Department in mid-October.

For some it might seem like a call from the past, a sepia-toned dispatch about an antique disease that once felled newsboys in knee britches and girls in sausage curls and pinafores. But to the Bullitt County Health Department and county public schools, a case of pertussis — whooping cough — was anything but quaint.

READ THE REST OF IMMUNE NO MORE

*–*–*–*

Before I turned to freelancing,  most of my work was as the science writer for the Toledo Blade, writing about a wide variety of issues. What follows are some of the projects I wrote while at the Blade.

The Twilight of the Frogs

The Toledo Blade

EL VALLE DE ANTON, Panama – Kent Bekker of the Toledo Zoo starts his day swinging a makeshift net across damp grass. It’s about 8:30 in the morning, and already, the air is near liquid with humidity.

One doesn’t so much move through the day as swim through it. Nothing dries out. Skin glistens with sweat even when the evening’s mountain breezes make light jackets necessary. Car interiors smell of mildew. An abandoned damp towel sprouts a carpet of mold. A climate that allows a gardener’s dream of lush flowers is the perfect breeding ground for fungi.

It is also the ideal home for a fungus few here have heard of. It’s called chytrid (KIT-rid), or formally Batrachochytrium dendrobatidis, and it’s completing a deadly sweep through Central America. It threatens to kill nearly all of Panama’s frogs, as it has in Costa Rica and Mexico before this, and as it is doing on every continent on the planet. It’s why the Toledo Zoo sent Mr. Bekker to Panama. He’s part of a team attempting an unprecedented feat: the rescue of dozens of frog species from extinction.

Mr. Bekker snaps his net through the air as though it were a flag, hoping to dry it out just a bit. It’s a cloth bag, and it sticks to itself. He looks in the plastic cup humming with the insects he’s collected so far. There are not enough to feed all the frogs.

Finding enough frog food, it turns out, is just another crisis, faced like any other critical chore in an unusual project where a mistake could contribute to the extinction of a species.

READ THE REST OF THE STORY

*–*–*–*

When a small group of patients agreed to help researchers determine the safety of a cancer drug, they quickly forgot this was their goal, and instead hoped the monoclonal antibody would cure them of  late-stage cancers.  Following these incredible women on their journey gave me a chance to delve into the often misunderstood arena of cancer and its treatment.

Working on a Cure: Cancer on Trial

The Toledo Blade

Pat Krzeminski marches into her doctor’s office at the Medical College of Ohio.

Secretaries and nurses eddy around her, snickering as they get a good look at the back of her head. She summons her physician.

Pat’s hair is punk short. Her eyes are wide, with carefully arched eyebrows, and dark liner.

Dr. James Fanning, angular, bearded, and just a little confused by the unexpected visit, answers the call.

“I did something, and you need to know what I did,” Pat tells him. Then she pivots…. READ THE REST OF THE STORY

*–*–*–*

While none of us were really even paying attention, our relationship to human reproduction changed entirely. A series I wrote in 2004 attempted to survey the vast changes in baby making and scientific progress.

The Embryonic Revolution:Harnessing the Power of Creation

The Toledo Blade

Alana Saarinen is an adorable, curious, shy, clever, devilish, affectionate girl. In short, a normal 3-year-old.

She may also be entirely new to biology. She may carry DNA from three people.

The cheerful girl in pigtails was born of her parents’ fifth attempt at in vitro fertilization – the meeting of sperm and egg in a laboratory dish, the “birthplace” of more than 1 million children worldwide in the last 26 years.

But Alana is more than a much-treasured personal victory over infertility – long and painfully fought – for Paul and Sharon Saarinen of West Bloomfield, Mich.

She represents a revolution born of the human embryo.

The revolution’s advance is often silent, crystallized within the private decisions of desperate couples and inventive fertility doctors. At the same time, it is a scientific revolution of unusual public prominence, the subject of presidential electioneering, Congressional debates, dire predictions, and … READ THE REST OF THE STORY.

*–*–*–*

While habitat loss continues to be the No. 1 threat to species the world over, for primates, the bush meat trade — the sales and consumption of wild animals — is proving a bigger threat. I traveled to Africa in 2000 to tell the story of people trying to save infant gorillas rescued from the trade.

Orphans of the Slaughter

The Toledo Blade

MPASSA, Gabon – The toddler wakes with a start and a scream.

His is a panicked, curdling cry, and Linda Percy has no choice but to hold the infant and wait for the moment to pass. The youngster tries to bury himself in her chest. His arms grasping, his legs pushing, he drives his head into her with desperate force. He’s unconscious in terror.

Every night. Night after night. Every few hours. It’s always the same: the same panicked cry, the same rooting for comfort, the same 18-month-old that will not be consoled.

Could it be memory, Linda wonders as she scoops up a bottle she hopes he’ll accept. This can’t be hunger. More often than not he refuses the milk she prepared for him.

She can’t prove it, but she’s convinced the small gorilla holds a nightmare.

Tormenting him is the memory of the slaughter of his family, the days of starvation that followed, the rope that wore infected ruts into his hips.

Ivindo remembers, Linda believes. She holds the sick youngster tighter and waits for exhaustion to quiet him.

In the tradition of the adventure stories that first revealed Africa to westerners, the continent is gripped by a new tale of man against beast. But this is one never imagined by the big game hunters and swashbuckling explorers who saw themselves conquering an untamable wilderness In this battle, gorillas, chimpanzees, monkeys, and scores of other species are the ones fighting for survival as traditional hunting practices are perverted into a growing commerce known as the bushmeat trade…..READ THE REST OF THE STORY.

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