Dr. Pauline Thomas

Pauline Thomas

CHAMBERLAND: This is Dr. Mary Chamberland, and I'm here with Dr. Pauline, Polly Thomas at the Centers for Disease Control and Prevention [CDC] in Atlanta, Georgia. Today is Monday, July 31, 2017. I'm interviewing Dr. Thomas as part of the oral history project, The Early Years of AIDS: CDC's Response to an Historic Epidemic. Polly, welcome to the project.

THOMAS: Thank you.

CHAMBERLAND: Do I have your permission to interview you and to record this interview?

THOMAS: Absolutely.

CHAMBERLAND: Polly, you were an Epidemic Intelligence Service Officer, or EIS Officer, assigned to the New York City Department of Health from 1981 to 1983. This was very shortly after the publication in June 1981 of the first Morbidity and Mortality Weekly Report [MMWR] on Pneumocystis carinii pneumonia among homosexual men. You were involved in some of the key investigations of early cases and subsequently played a national leadership role in pediatric AIDS 00:01:00[acquired immunodeficiency syndrome] and HIV [human immunodeficiency virus] infection. After completion of EIS in 1983, you stayed on as an employee of the New York City Department of Health for some 20 years, working on HIV/AIDS and assuming increasing leadership positions in the Health Department.

Before we delve into the details of all of this, though, let's talk a little bit about your background. Could you tell us where you grew up and about your early family life?

THOMAS: Sure. I was born actually at Camp Atterbury, a military hospital in Indiana, because my dad was stationed there. Then I grew up in Forty Fort, where my mother had also grown up. Forty Fort, Pennsylvania. And it's still a little town about 6,000 population near Wilkes-Barre, which is a better-known city. Three years after I was born, my sister was born with Down syndrome, and that 00:02:00has had a huge effect on my life. She's a great sister. She's now in her 60s and just a wonderful person. My mother did a good job raising her before there was a lot of Special Ed [Education], and that was a big-picture thing in my life.

I went to a private high school because the local public schools were merging, and my parents didn't know how that was going to work out. The name of the high school was Wyoming Seminary. They did a great job of education back then. Then I went to Yale [University] undergraduate [school], majored in biology and then Yale Medical School. During the time when I was applying to medical school, I also applied to forestry school. When I was 11, I was an entomologist. That only lasted a little while, but I still love walking in the woods and identifying plants and so on.

CHAMBERLAND: So, forestry or medical school?

THOMAS: Right. Well, they're both biological.

CHAMBERLAND: How is it that medical school won out? What really kind of convinced you that that was going to be your future?

THOMAS: Part of it was thinking about what job I might have. Epidemiology is closer to ecology and the types of things you might do with a forestry school education than some clinical medicine. But I also think it was due to my sister. There is a study showing that people with disabled siblings are likely to go into caring professions. I don't know if that's still true, but--

CHAMBERLAND: And what led you to pediatrics?

THOMAS: I really didn't like the first two years of medical school. I felt that they had--in college I had learned to think and write, and in medical school, they just wanted you to memorize stuff. So happy to get onto the clinical aspect of medical education, and pediatrics was the best. I think people gravitate to 00:04:00specific specialties based on personality. People who go into pediatrics tend to not mind babies crying and have a sort of ability to handle nonverbal aspects.

CHAMBERLAND: So, after medical school you did an internship and residency in peds [pediatrics]?

THOMAS: Right. In medical school, though, I took a couple of classes in the School of Public Health at Yale. One of them was a medical detective's course taught by [Dr. Alfred S.] Al Evans. Al Evans wrote a great book called Viruses in Humans, In his class he used CDC cases where you had to use elementary biostatistics and logic to solve. One of them was ice cubes on the cruise ship. There were some classic CDC cases, and that introduced me to CDC and I started 00:05:00thinking about it.

CHAMBERLAND: So, did you end up applying for EIS right after completing your residency?

THOMAS: No, during my residency, and I almost left. I was accepted into EIS when I was a second-year pediatric resident, and then I decided that was nuts--I really should finish the clinical training. CDC was able to defer my admission. I entered CDC--I finished PGY [post-graduate year] 3 in July. I was chief resident for six months, and then I went to CDC the following summer.

CHAMBERLAND: And you ended up being posted, if you will, to the New York City Department of Health for your EIS assignment.

THOMAS: Yes.

CHAMBERLAND: How did that come about?

THOMAS: I had just gotten married. Right after finishing residency, I got married to a New York City architect who came down to Atlanta with me and interviewed. He really wanted to stay in New York, which is the mecca for 00:06:00architecture in his opinion. So, I was able to be posted in New York. New York [City] at the time had very limited resources. They had had a big budget fiasco in the end of the '70s. There was one great epidemiologist, [Dr. Stephen] Steve Friedman, who became my supervisor, and a cadre of excellent nurse epidemiologists led by Eleanor Bell.

CHAMBERLAND: So, as I noted a few minutes ago, your arrival at the New York City Department of Health would have been about the end of July, the beginning of August of 1981, so really weeks after the publication of that first MMWR talking about the cases of Kaposi sarcoma and opportunistic infections in gay men. And in Atlanta, things were really starting to coalesce--the formation of a task 00:07:00force and the like. During the [EIS] course, did you have any contact with [Dr. James W.] Jim Curran or others in the task force? Did you have a sense that you were going to be tapped into working on this new disease?

THOMAS: I actually approached them. One of my worries--I had been so excited to work for CDC, and then I was a little concerned about how I would stay connected. In those days, you know, we didn't have Internet, email, texting, or Adobe Connect. There was none of the technology that can keep people connected. I was concerned that I would be too distant in the New York City Health Department. So, while I was at CDC, the New York Times published the little article--I think it was on page one, about [Dr.] Linda Laubenstein, [Dr. Alvin] Friedman-Kien and Kaposi sarcoma. And I saw that, and I don't know how I figured out that Jim Curran was the person to talk to, but I went, and I asked him if I could work with him when I got to New York.

CHAMBERLAND: Interesting. And sure enough, there was a lot going on in New York.

THOMAS: And that led to decades of work in this area, yes.

CHAMBERLAND: So, that MMWR report as I recall really triggered a lot of interest on the part of CDC to go out to New York, to LA [Los Angeles], to San Francisco and really start to do some intensive investigations around these early cases - interviewing patients, reviewing medical records - just to try and get an understanding of what this was about.

THOMAS: What the heck was going on.

CHAMBERLAND: So, were you part of those early efforts?

THOMAS: [Dr.] Mary Guinan came to New York to do interviews.

CHAMBERLAND: So, Mary was from headquarters here in Atlanta?

THOMAS: Right, and I know you've interviewed Mary as well. I was able to join her, and they had developed a sort of a "fishing" interview.

CHAMBERLAND: Kind of an exploratory interview?

THOMAS: Exploratory, thank you, interview. We went and started interviewing the patients in the hospitals mainly. I did my first couple with Mary. Because she had worked in STDs [sexually transmitted diseases], she was comfortable with some of the questions, which were pretty graphic sexual practice questions. Then I proceeded to do them on my own. They actually had to call me off, I think, because I think it was [Dr. Harold Jaffe] Harold who said, "You know, we have to stop interviewing people, because we're going to want to do a case-control study and we want them to be not biased by having been interviewed previously."

CHAMBERLAND: I see, okay, so that was--

THOMAS: That was all in August.

CHAMBERLAND: Okay, so that was all really within the first month after you arrived. You alluded to it, but in pediatrics you obviously weren't probably asking a lot of questions about intimate sexual activities, and what was that 00:10:00like? Mary must have been a good teacher, but still and all, what was that like?

THOMAS: Yes, so you know, you just distance yourself a little bit, right? I think as a physician you learn to have distance between what you're actually asking and hearing from your patient and intellectualizing it. So, that was okay. Although I have to say I did interview one gentleman--I think this was--I don't know if this was the case-control study or one of the exploratory interviews--a gentleman in a shop in Greenwich Village. He said to me, "Is this the first time you're asking these questions?" He turned out to be someone who was producing poppers [amyl nitrate] in his bathtub in his home. He was manufacturing. And then a couple years later, remember we reviewed death certificates?

CHAMBERLAND: Mm-hmm.

THOMAS: This is, again, before there was a great computerized system. His death certificate passed my desk, and I felt sad about that.

CHAMBERLAND: Those were difficult days, because it was inevitably almost a death sentence for the vast majority of these patients. You mentioned the case-control study Harold Jaffe. Soon after they had done these initial exploratory investigations, you're right, people wanted to try and look in sort of a more rigorous epidemiologic fashion to try and figure out what risk factors were. They tried the case-control approach, where you interview cases--people that have the disease--and controls. In this case, the study was restricted to gay men, so controls who would -- the best one could tell at the time - did not have the disease.

THOMAS: They didn't have AIDS.

CHAMBERLAND: They didn't have AIDS.

THOMAS: Right. And I think one of the strengths of the case-control study was that controls were selected in three, maybe more, ways. I think one was from the 00:12:00physicians. The physicians were able to find--

CHAMBERLAND: So, you approached physicians in New York City?

THOMAS: Physicians who had diagnosed the case or who had been the primary care provider of the case were able to offer up additional patients as controls and then I can't remember--I guess it was a friend, and there was--

CHAMBERLAND: A friend control, and I think there were clinic controls, as well.

THOMAS: Okay, there were lots of controls. I think we did begin to suspect that some of the controls had something, but they didn't have this terrible life-threatening opportunistic illness.

CHAMBERLAND: Let's talk a little bit about sort of the mechanics of how this operated, because this was a fair number of people to interview--a lengthy interview. So, who or how was this organized? Did you have to--I mean, obviously, Atlanta had written a protocol, but in New York City, you and others 00:13:00had to operationalize it. So, I'm interested in how that came about. Where did you interview these people?

THOMAS: So, Jim Curran was the team leader, and he was great. He was like just very organized. He set up headquarters in a hotel.

CHAMBERLAND: Jim, now as you said --

THOMAS: Jim Curran.

CHAMBERLAND: Jim Curran, OK-- came up to Atlanta--

THOMAS: Came up to New York City, and he was there for a few weeks headquartered in a hotel in the Upper East Side, which I was going to remember the name for you. I don't remember the name, but they had a couple of rooms rented. And so a lot of people got interviewed in those tiny little New York City hotel rooms. They had some refrigerators, so part of the case-control study involved taking blood samples, right? I think we had to draw blood samples, and so the blood samples could be refrigerated and then later packaged and mailed. I have 00:14:00recently learned that one of the ways this worked was that the manager of the hotel - or whoever managed the front--was that you that told me that? -- in the lobby was very sympathetic to this effort and helped guide the young men who were coming in to the correct rooms. But I also interviewed people at cafes and sometimes in their apartments. I had one man who photographed food and that was amazing. So, he was a food photographer and I was able to go to his studio and interview him and see how that worked.

CHAMBERLAND: And these were lengthy interviews, were they not?

THOMAS: I think so. That's a long time ago, Mary.

CHAMBERLAND: Yes. Yes. You mentioned the collection of specimens, too. Did that make you nervous at the time?

THOMAS: It did not.

CHAMBERLAND: It did not? Collecting blood and all --because we were doing--

THOMAS: Not back then.

CHAMBERLAND: No gloves--

THOMAS: Later I-- I don't know, can I skip around?

CHAMBERLAND: Sure.

THOMAS: Later, I guess it was the next year--and you must have been in New York by then--we did Project 4. Project 4 was bringing the controls back in to get additional blood specimens to check their CD4 [cluster of differentiation 4] levels, and I did a very brief exam. I looked for oral thrush and lymphadenopathy. And we did a lot of those in the STD clinic in Chelsea [Chelsea Health Center]. I think it's now called the Leona Baumgartner Clinic on 28th Street. At that time, I was then pregnant with my second child, and a few people said to me, "You're going to get CMV [cytomegalovirus]. This is not good." CMV can damage a fetus. I said, "I'm washing my hands, you know, it's okay." There was another doctor pregnant at the same time, a CDC doctor, [Dr.] Ruth 00:16:00Berkelman, who came to New York and, I think it was at that same time, to investigate a hepatitis A outbreak in a hospital and she was also pregnant at the same time and they really kept chastising the two of us for doing this. Anyway, But no, we weren't worried about it.

CHAMBERLAND: You weren't--it was not--

THOMAS: I mean, we weren't sticking ourselves with needles. We were careful.

CHAMBERLAND: But we weren't taking basic precautions that now--

THOMAS: No gloves, yes. I think other precautions, you know, just being careful and washing your hands.

CHAMBERLAND: The men that you interviewed, I'm just curious how cooperative they were?

THOMAS: Oh, fully cooperative. Of course, these were people who had agreed to be--

CHAMBERLAND: True. But you're a U.S. Government employee. You're plunging ahead with a long questionnaire.

THOMAS: Yeah, so you know, Mary, we were very young.

CHAMBERLAND: This is true.

THOMAS: I don't think I looked too bureaucratic, you know. I just remember we 00:17:00did a lot of--I remember not being able to take off. The city has a lot of holidays in the fall. For example, Columbus Day and Veterans Day, and I remember not having those holidays that fall.

CHAMBERLAND: Because there was a real intense push.

THOMAS: Because we had to get it done, yes. But the men were just very helpful and congenial. They wanted to get to the bottom of it, too. I think they were frightened.

CHAMBERLAND: I also want to go back in time. You mentioned the word "poppers." So, there was a lot of speculation at the time about what possible causes could be responsible for this new disease. One of them was this interest in the so-called "poppers" [amyl nitrate inhalants] that at the time gay men were commonly using to heighten their sexual experience. I believe Atlanta headquarters sent you on a popper-related mission in New York City?

THOMAS: Yes. So, I did that with [Dr.] Lilla Lyon. Lilla Lyon was another 00:18:00physician--not a federal employee--working at the [New York] City Health Department. And she was a little older than me and a little more familiar with the New York scene and so she and I went together to Greenwich Village to many little shops and the Meatpacking District, which was a-- I don't know--

CHAMBERLAND: At that time, I don't think it was very up and coming as it is now.

THOMAS: [It was] an area where you could go pick up guys--a guy could go pick up guys. And we bought lots of little bottles, all different--and I think I went back to my friend in Greenwich Village in the shop and got one of his or two and I had them all lined up on my desk and all different colors - but little - colors and sizes and took a picture of it. I had a picture of it for a long time. I don't know where that went, but at one point one of the caps was loose and I got a whiff, and I thought "Oh, now I'm going to be sick."

CHAMBERLAND: And then you had to pack them up and send them to Atlanta for analysis?

THOMAS: Pack them up and send them to Atlanta. I have no idea-- they gave them to guinea pigs or something. I don't know what they did with them.

CHAMBERLAND: But nothing really came of the popper hypothesis?

THOMAS: No, because that wasn't the cause for this disaster.

CHAMBERLAND: You were very involved in these special studies, the case-control study. At the same time you were on the front lines of what we would call early case surveillance and reporting, and I wanted to talk a little bit about that. When you first arrived at the Health Department--again, this was 1981. Can you tell us how case reporting was happening? I think it was sort of a rather informal affair at the time?

THOMAS: Yes, and I don't remember when CDC gave us a case report form, but it was not at all a computer form. It was just lines--

CHAMBERLAND: Had you come up with a case form on your own in New York City?

THOMAS: I don't remember. I think CDC probably gave us one, and then we started having the hospitals call in. But you were the one that systemized this, right? So, at first it was just, people would call us and we would write down the information on the form. And for a while we were putting names on those forms. And then one of our STD Public Health Advisors - and Public Health Advisors are the heroes in this story, by the way -- [James M.] Jim Monroe, he said to us, "You cannot send names to Atlanta." I think he'd learned that from STD surveillance. You didn't send names for STD surveillance, so why were we doing it now. So we stopped. We just sent the information and a number and kept the link to the name at the Health Department.

CHAMBERLAND: I know I arrived a year after you did, in the summer of 1982 as an 00:21:00EIS Officer, and I do recall arriving and your giving me the lesson on--

THOMAS: The confidentiality lesson.

CHAMBERLAND: Confidentiality and on case reporting. I recall we had something called the "telephone case report form." It was typewritten--there were some handwritten additions in your handwriting, because you're right, there was no systematic surveillance in place, really anywhere. It was in January of 1983 that CDC awarded the first cooperative agreement to embark on a more systematic hospital-based approach to surveillance in New York City, which ultimately was a pilot for national surveillance. So, it was really informal. I remember being struck that even less than a year into the sort of recognition of this new 00:22:00syndrome, people were getting tired. The docs, doctors were getting tired of reporting, because it's time-consuming.

THOMAS: Right. Yes, and I'm not sure they knew what the point was. You know, I'm not sure they realized--and then that's when-- Dr. [David J.] Sencer arrived before you, right? So, Mayor [Edward I.] Koch was the mayor of New York when AIDS hit, and he hired Dave Sencer, who had been head of CDC for 11 years sometime earlier. Dr. Sencer took over, and he was wonderful. He knew how to look at an epidemic and how to think about it. He pulled physicians in from all the hospitals--the major virologists and infectious disease docs and cancer docs 00:23:00who were struggling with this. He pulled them in and-- did these meetings start before you came? We started giving them a statistical report every month.

CHAMBERLAND: I think you're talking about what became known as the monthly New York City Department of Health AIDS--we weren't using the term AIDS, but the "monthly meeting."

THOMAS: We called it "Unexplained Immunodeficiency." First, we called it Kaposi sarcoma and Pneumocystis carinii pneumonia, and then we called it Unexplained Immunodeficiency. There was another crude name on the street - GRID, Gay-Related Immune Deficiency - and the government never adopted that.

CHAMBERLAND: That's right.

THOMAS: The government, the City Health Department - we never adopted that name. But by the time you came, we were probably calling it Unexplained Immunodeficiency.

CHAMBERLAND: So, Dr. Sencer sort of came up with this idea of, as you said, pulling together all of the New York City physicians and researchers, because 00:24:00first of all, there are a lot of them in New York City, and academics being what it is, there probably was not a lot of communication.

THOMAS: And that's a key public health issue, right, to make a team--involve the community. So, this was the community. These doctors who were seeing their patients perishing.

CHAMBERLAND: So, how did these meetings work? Can you tell us a little bit about how--

THOMAS: So, the first few, and maybe you were already there, were in the boardroom. There was a boardroom on the third floor. The Health Department was at 125 Worth Street, which is a WPA [Works Progress Administration] Building--very charming.

CHAMBERLAND: WPA is?

THOMAS: From the '30s, right?

CHAMBERLAND: Public Work Pro--

THOMAS: I don't know. Anyway, the boardroom was a big square room with windows looking out on Worth Street and the park. I forget the name of the park, Paine Park?

CHAMBERLAND: Good!

THOMAS: The only thing on the walls that I recall were pictures of all the prior health commissioners. So, headshots of 40 prior New York City health commissioners. We all sat in there, and you or I would present statistics, which we had prepared with a typewriter and hand-drawn graphs on graph paper.

CHAMBERLAND: So, these were the surveillance summaries for New York City cases?

THOMAS: Beautiful works of art, right. And I remember the first meeting or so, I included how many cases were coming from which hospital. One of the doctors said, "You can't do that. You can't reveal what's happening at any particular hospital." So ever since then, that's also included in my confidentiality talk. When I teach students or residents, I say, "The hospital's identity is confidential, the patient's identity is more than confidential, the doctor's 00:26:00identity--you can discuss statistics, but these are protected information, bits of protected information." Then Dr. Sencer would lead a conversation. The doctors all had issues.

CHAMBERLAND: Because they were also invited to participate, I think, and present--

THOMAS: Cases and situations--

CHAMBERLAND: --interesting cases or research questions. What do you think the impact of this meeting was on the greater New York City health and research community? Did they welcome this?

THOMAS: Yes, I think they really did, and I think this made the Health Department welcomed into the community. And to this day the New York City Health Department seems to be a very welcomed institution in New York. I just think it made it part of the whole scene.

CHAMBERLAND: And I think we forget people were hungry for information, and so it 00:27:00really worked like a two-way information exchange. We provided them with updated monthly statistics about cases in New York City, and I think also some national data. And as you said, it was all hand-tabulated. There were no computers.

THOMAS: Yes. We were writing--we were filling out a big spreadsheet. So we used to have these big white sheets with lines and columns. Not graph paper, but they were called spreadsheets, and we would fill in a line for every case. Once we got past 300, we had trouble.

CHAMBERLAND: Getting the numbers to agree.

THOMAS: Yes., and at that point, then Dr. Sencer commanded that the cases be punched into IBM [International Business Machines Corporation] cards. The ladies on the 6th floor had to type all the case reports into an IBM card somehow.

CHAMBERLAND: So very early IT [information technology] days. This series of meetings I think went on for several years, too.

THOMAS: Yes, it continued after you left, and it became very political. It became huge and moved to the auditorium. The Health Department building has an auditorium that seats a couple hundred, and activists would come and yell from the back and it continued after Dr. Sencer left.

CHAMBERLAND: I wanted to touch a little bit on connection with AIDS case surveillance. Again, it's early days, it's '82, '83, '84, and everyone was very keen to be alert to potentially unusual modes of transmission. They were heady days in New York City. We were interviewing and investigating the first cases of 00:29:00transfusion AIDS or heterosexual contact cases. So, these cases that upon initial report, that didn't fit into the traditional risk factors, became known as the "no identified risk cases." Were you involved in some of these investigations?

THOMAS: Absolutely. I actually thought that was one of the most important things that I worked on at the New York City Health Department. Early on, I don't know if it was the fall of '81 or the spring of '82, but I remember drawing a grid or seeing a grid in a lecture how is this transmitted: and you know, sexual, through urine, through saliva, mother-to-child, needle-related. And several viruses were put on the grid, and this unknown, Unexplained Immunodeficiency, 00:30:00most resembled hepatitis B. Cytomegalovirus seemed to be more easy to transmit, more like--I don't know how that's transmitted. I don't know if you can get it from sneezes and coughs. But HIV seemed most similar to hepatitis B and that really struck me. And you know, I was young, trying to be an epidemiologist and trying to use data, and I was really convinced that this was not something that was going to be spread in households. And we would have conversations about that-- we just weren't seeing--people that lived with people with HIV just weren't getting it. When there was a case with no risk-- and the first few, you know, there was a young man I interviewed at Mount Sinai [Hospital], and he had Kaposi sarcoma. He told me he did sex with men for money in Times Square. 00:31:00Subsequently, another investigator, who I will not name, went to the man's home and interviewed him in the living room with his father in the next room. He declined to mention this sex for-- I remember having an argument with this investigator, saying, "I'm sorry, but he didn't want to talk about that with his father in the next room. Why would he have told me that if it wasn't true?"

The other group that was very interesting to me was the Haitian group. The first few Haitian men that we interviewed had been--there were resorts in Haiti where gay men would go--and apparently beautiful hotels. Some of the young Haitian men would get money for doing sex with these New York City or American gay guys that were going down there for vacation. There was a point at which the Haitians stopped reporting that, and I just thought, "Okay, you know, they just decided 00:32:00they don't want to talk about that anymore." I think that also convinced me, showed me how people really don't want to talk about some of this stuff. Whenever we had a case without identified risks, we really tried hard to identify what was going on. There's a New York Times article that I actually read yesterday while I was preparing for this interview. Apparently, I went up to the Bronx to interview a sanitation worker who had Pneumocystis pneumonia, and he was very ill. I don't know if we ever found a risk in him, but he could have stuck himself with a needle doing his job. I don't know what became of him, but the New York Times reporter was writing about this "no identified risk" situation.

CHAMBERLAND: Yes, because those were some of the hot-button issues, as you say-- 00:33:00sanitation workers being exposed on the job to needles that were being discarded by hospitals or by the--

THOMAS: And that's a real concern. That would be a real concern, right?

CHAMBERLAND: Exactly. These "no identified risk" investigations were really approached, again, with kind of a lengthy interview format and--

THOMAS: Right, and at one point we obtained Institutional Review Board approval. Were you there when that happened? Someone said, "You know, this is not part of mainstream surveillance." Health departments are entitled to do surveillance for mandated conditions. But someone--I don't know if it was Dr. Sencer, perhaps, decided you know what, this is not exactly research, but we need special approval. So we developed a protocol and got approval.

CHAMBERLAND: There was also a cadre of highly experienced Public Health Advisor 00:34:00interviewers. Do you remember--

THOMAS: Anastasia Lakatsis, right? We have the picture of you and her and Mayor Koch and Dr. Sencer when Dr. Sencer came to New York a few years ago to do some oral history himself, and Anastasia joined us. She was a master detective. People would talk to her. She just had a lovely way. Rebecca Reiss was another person who was a wonderful detective. Rebecca herself died of AIDS. She had been working for STD and also had spent time I think in Zimbabwe--I don't know if it was Zimbabwe or Rwanda. Somewhere she had been splashed in the eye, drawing blood from a woman in a brothel in New York. She thought maybe that was where she got it, but it could have been also in Africa. Anyway, they were just heroes.

CHAMBERLAND: My recall is that because they were such experienced interviewers and many of them came from a history of working in sexually transmitted disease programs, they had a lot of interviewing background. I do recall that there was a bit of rebellion against this 20-25 page standard questionnaire that they felt--

THOMAS: They needed to have more of a free-flowing discussion.

CHAMBERLAND: And I think they were right.

THOMAS: Yes. So, I think at some point you took over that project, and that must have been after you took it over. I had my second child in 1984, so you were still an EIS officer, right?

CHAMBERLAND: I was. I would have left at the end of June in 1984.

THOMAS: And then I came back part-time, so I think during that period you took over that project.

CHAMBERLAND: And just sort of largely coordinating the interview investigation 00:36:00aspects and tabulation of data, because again, this was a national effort. There was great interest in trying to run down these cases and determine if there were any new risks that were coming along the way. I think it also highlights, going back to another point that you made, about issues about confidentiality and the real importance of keeping people's identities and their names really safeguarded.

THOMAS: Right. You know, that continues in the HIV program. And I just want to mentor some other Public Health Advisors. Rita O'Donnell ran the Pediatric HIV Surveillance Program, and then later in the '90s, [Rosalyn] Roz Williams and Flor Vasquez Betancourt- I think they both work now in Vital Statistics in New York City - but they ran surveillance. They made sure that people did not even 00:37:00talk among themselves in the office using actual names. We had famous people reported, and the New York Times might say, "So-and-so has AIDS." We would not discuss that in the office. It was just--you had to keep a wall, you know, inside your brain.

CHAMBERLAND: And you mentioned Jim Monroe, the Public Health Advisor in New York City, and Dr. Sencer also really took a leadership role on this and was I think very instrumental in putting forward the idea of using the Soundex system [the alphanumeric code where case report forms would not have any names on them and names would be translated into this alphanumeric code]. The Health Departments obviously maintained the linkages because--

THOMAS: Right, so we could do matches with death certificates and matches with 00:38:00the cancer registry. The Soundex was needed, though, because CDC began to have the problem of duplicates.

CHAMBERLAND: Exactly.

THOMAS: So, New Jersey and New York or California and New York might report the same person, and CDC had no way of knowing. So, I think that's one reason they developed the Soundex, so they could have at least a statistical likelihood that this was the same person.

CHAMBERLAND: Yes, Soundex coupled with date of birth is apparently a pretty unique identifier. Because the health departments were still retaining names, separated, if you will, from the case report form, it did allow health departments to talk with one another and sort out if there were cases that were duplicates or not. That was deemed very much permissible and part of routine public health, but certainly not on a national level. It became clear--

THOMAS: It would be unwieldy. Once there were thousands of cases, you just have 00:39:00to give up.

CHAMBERLAND: There was no real need at the national level to have named case reporting. One of the evolving, if you will, risk groups that became apparent, certainly I think it was in 1982, was when cases of unusual immunodeficiency started to pop up among children and infants. Can you recall how you first heard about these "AIDS-like" illnesses in children and some of the early investigative efforts around this?

THOMAS: Right. [Dr. James M.] Jim Oleske, who is a pediatrician at New Jersey Medical School at Rutgers in Newark, started--I guess he called CDC. He was very worried because he knew about AIDS, and he was seeing these children. He was an immunologist and had never seen so many children with immunodeficiency. At the 00:40:00same time in New York City, the most outspoken physician was [Dr.] Arye Rubenstein at Einstein [Albert Einstein Hospital], who was also seeing numbers of children. And they both communicated -- I guess they must have communicated first with CDC and then CDC began to investigate. And Jim Curran had a good nose for all of this, and he knew immediately that this was real, that this was transmitted to the babies. So, I think it was [Dr. Thomas J.] Tom Spira is a virologist?

CHAMBERLAND: Immunologist.

THOMAS: Immunologist who came up to New York City--

CHAMBERLAND: From CDC, yes.

THOMAS: Right. And he and I reviewed many case reports and came up with a case definition. And then [Dr.] Martha Rogers was assigned at the CDC level to be in charge of this. She was another--I'm a pediatrician and Martha was a pediatrician. So, we began to do surveillance for pediatric AIDS, as well.

CHAMBERLAND: So, this was actually really a natural fit for you and your background to really be leading on the pediatric efforts. So, adult surveillance was pretty much a well-oiled machine by that time. So, did you have to really replicate that for pediatrics?

THOMAS: Pretty much. We contacted all of the pediatric infectious disease and immunology folks and started to collect cases - and I guess we had a similar typed case report form -- and started to do reports of how many cases and how old. We wrote up one paper on this--I don't remember what year--'84 maybe, and then Martha did a national report a year or two later. This was all, you know, 00:42:00this started before we had a test for the virus. Once we had a test for the virus, it became easier.

CHAMBERLAND: Yes, as I recall it was a difficult exercise to come up with a case definition, because there are a lot of immunologic deficiency syndromes in infants and little children. People intuitively felt this was different, but how to characterize it--

THOMAS: But they were all very rare. They were all very rare. And so, if you accidentally out of 20 included one kid that had one of the genetic [conditions]--although I don't actually, Mary, remember the case definition, so it may be that--

CHAMBERLAND: It was complicated.

THOMAS: It may be that we did rule out most of the--

CHAMBERLAND: And there were epidemiologic linkages.

THOMAS: Absolutely. Many of the mothers were ill, and so it became--

CHAMBERLAND: Ill with AIDS or histories of IV drug use and the like?

THOMAS: Right.

CHAMBERLAND: Did you have monthly meetings with the pediatric community?

THOMAS: We started monthly meetings. We duplicated Dr. Sencer's meetings with other infectious disease and immunology docs. I don't know how long those went on. At one point, I had minutes from those meetings, and I gave them to Jim Oleske. He was going to write up something about it. And the pediatricians really appreciated that. And then at some point we decided--and Martha was instrumental in this--we needed to look at what was the transmission rate. What were the factors? Because all the HIV-infected women were not--all of the babies born to them were not infected. So, in 1986, Martha funded us to begin looking at the transmission factors.

CHAMBERLAND: Interesting. Was that in New York City?

THOMAS: New York City, yes. Because we had the most pediatric AIDS, I think at the time.

CHAMBERLAND: True.

THOMAS: Newark had a lot, but we had more. Newark is much smaller than New York City.

CHAMBERLAND: And what were some of the things that fell out of that study in terms of risk factors?

THOMAS: So that study--the first thing that fell out of that study was that it was not easy. Martha and I thought, "Okay, we're going to collect data for two years, and we'll have all the answers." That study went on for a decade. It was just very complicated. Enrolling the moms, getting the correct data, and following the baby long enough to know if the baby was truly infected. I don't know when viral load became available, but at first there were just antibody results. You had to wait until the baby was 18 months old and had lost all of his maternal antibodies.

CHAMBERLAND: That's right, because it's passively transferred from mom to infant.

THOMAS: Right, exactly. To know for sure whether the baby was truly infected or not. So, it was complicated. And then eventually it was clear that maternal CD4 00:45:00count and maternal viral load, once we had that, were strongly associated with transmission to the baby, and then they started the AZT [azidothymidine] trial. When was that--'92?

CHAMBERLAND: That sounds about right, yes.

THOMAS: They started giving the moms AZT, and they could lower the viral load enough, the babies were spared.

CHAMBERLAND: That was probably one of the most surprising moments, I think, in AIDS-related research, was the AZT trial in pregnant women and the risk of transmission.

THOMAS: Right. That and stopping it through transfusions were two triumphs of public health, and then the gay men basically stopped the huge epidemic. They stopped that themselves by '85. The gay community had put a stopper--

CHAMBERLAND: Can you talk a little bit about the gay community in the early to 00:46:00mid-80s and what sort of activities they engaged in to try and put into place some education and prevention?

THOMAS: Right. Now this is where I told you when we were talking a couple of days ago, we were very young. I wasn't fully aware of all the politics swirling around me. I also had two little kids. I had one baby in '82 while I was still an EIS Officer the second one in '84, and I'm not particularly sophisticated politically, anyway. So, I know Dr. Sencer set up an Office of Gay and Lesbian Health, and the first director was [Dr.] Roger Enlow. They were working on educating the gay community about this and condoms and limiting sex partners. Some of the gay men would go to a bathhouse on the weekend -- this is in the 00:47:00late 70s, early 80s -- and have 15 partners in a night. And that's a great way to spread all kinds of infections. And so, by '85, that type of lifestyle had pretty much been tamped down. And Roger Enlow and Dr. Sencer and we would talk about how to educate--how do you educate? And I remember Dr. Sencer saying to someone in the hall, you know, "You really have to do it one-on-one is best." I don't know. Health education and behavior change is a science unto itself, and I think this epidemic contributed to that.

CHAMBERLAND: So, these were the days when Larry Kramer, who was a very prominent activist, founded the group ACT UP [The AIDS Coalition To Unleash Power].

THOMAS: Yes. Oh, was he the founder? Okay. So, I was on a TV show with Larry Kramer. You know we used to be on the TV often. You also. So, this was with Sue 00:48:00Simmons and the guy that she was on with. It was a talk show.

CHAMBERLAND: These are New York City anchors?

THOMAS: 4 p.m. New York City local TV show, and there I was with Larry Kramer. I just remember Sue Simmons having difficulty with the name "autoimmune." It was a difficult word. Kramer did most of the talking. He was a storyteller. But he had [written] his play, The Normal Heart, and I guess that--I didn't know this at the time. I knew about the play, but apparently that did influence the community and put pressure on Mayor Koch to put more money into AIDS. I guess at that point also the Feds started to put more money into AIDS.

CHAMBERLAND: On Dr. Sencer's part, this was a bit novel, establishing this Office for Gay and Lesbian Health Affairs with Roger Enlow, who was an openly gay physician in New York City.

THOMAS: And they became great friends and I remember the last time I saw Dr. Sencer - Roger Enlow eventually moved to Idaho, I think-- I think to get away from it all - Dr. Sencer and I talking about him.

CHAMBERLAND: Yes, he was a good colleague. Well, in terms of pediatric AIDS - we're going to go back a little bit to pediatric AIDS - the identification of AIDS in young children really raised a lot of concerns and questions about the potential presence of HIV-infected children in classrooms and this all came to a head in New York City in the fall of 1985. We'll talk about this in some detail 00:50:00here. But before we get into that, can you maybe reflect a little bit on what were the concerns that parents, that teachers and school officials had about the possibility of having an HIV-infected child in their classroom or in their daycare center?

THOMAS: Right. Well, I don't think people had really thought about that much until the viral test was available. And that's when we began to be able to say, "This is how many HIV-infected kids there are," or "This is how many have inherited this antibody from their moms, and we have to see how many become infected." But at the same time, we were doing all those "no identified risk" investigations, and we started doing that with children as well. So, the 00:51:00children were almost all born to HIV-infected mothers. There weren't children living in the same home who were infected unless they were born to the HIV-infected mother. And so, I think it was earlier in 1985 - and again, I've just been reading about this, so I wasn't aware of this at the time - the laboratory--science teachers in New York apparently asked the Health Department for a judgment about whether HIV-infected kids could be in laboratories. I'm not sure what that was all about. Somebody else will have to explain that.

But then we began thinking, okay, now it was '85, even if the earliest kids were born in '81, and we later did a study. [Dr.] Mary [Ann] Chiasson, who was one of the epidemiologists in New York City, suggested that we look at year of birth of 00:52:00all the kids reported to us. And Roz Williams and I - Roz Williams was one of the Public Health Advisors - she and I looked at the data, and there were no cases born before 1977, and I think it was September 1977. It appeared that the virus had entered women in New York in the middle of 1977 or I guess early '77, and then the baby was born in September. But now we knew there was kids old enough to go to school, because it was '80, '85, and a kid born in '81 would be 4 and could go to nursery school or kindergarten. Martha Rogers convened a meeting in Atlanta, and I don't know if it was June or July, and we talked about, well, what do we do? We talked about the fact that the kids were not going to pose a threat to each other, and somebody would say, "What if they bite 00:53:00each other?" And there wasn't really much data about whether you could get AIDS from a bite, but the people talking about school said, "Well, you know, little kids--grade school kids aren't biting each other, and the little kids in nursery school are not breaking the skin if they do bite each other." So, CDC began to draft guidelines.

CHAMBERLAND: Guidelines about this. Because this is still fairly early days--it's the mid-80s, and there's a lot of fear about transmission of HIV.

THOMAS: There was a lot of fear. I don't know what year this was, but people were being evicted from their apartments and fired from jobs and--

CHAMBERLAND: This is also the time in terms of schools and HIV-infected children that Ryan White, who became a nationally known--

THOMAS: And he was excluded from school.

CHAMBERLAND: --a nationally known case of this. He was a boy with hemophilia.

THOMAS: Yes, and he was from Indiana, right? Absolutely lovely young man and excluded from school.

CHAMBERLAND: But excluded from school. So, all of this is swirling about, and it's sometimes hard to imagine--to put yourself back in time, but it was very real.

THOMAS: Is it? Is it because this is, you know, before that people were afraid of cancer or strep [Streptococcus]. You know, people use to put quarantine signs on the homes of people with--didn't they--strep? I think we're always afraid of--

CHAMBERLANND: Communicable disease.

THOMAS: --infection, especially infection that can kill. Ebola? We just did this with that nurse who was quarantined in New Jersey.

CHAMBERLAND: You're right. You're right. Communicable diseases really do--especially ones that have a high mortality rate--

THOMAS: I think we're all scared. Yes.

CHAMBERLAND: Really engender a lot of fear and thinking about all sorts of remote possible ways in which transmission could occur.

THOMAS: Right and so the New York City public just knew about the gays, and I guess by '85 they knew about drug users, too--that drug users could get this. And they were sort of shocked, I think, to find out that children had it, and then didn't know how to handle that information.

CHAMBERLAND: So, you know you've got kids in school--HIV infected children of school age could be in school, so CDC in Atlanta is working on national guidelines, but in New York City you are also working on developing guidelines, weren't you?

THOMAS: Right. Right. So, that summer Dr. Sencer was in constant communication, I think, with Mayor Koch, trying to figure out what to do about this. And they decided to put together a little committee to review all the kids who were old enough to go to school. And the committee included me, [Dr.] Jane Pitt, who was an infectious disease specialist from Columbia [University Medical Center], a 00:56:00woman from the Board of Ed [Education], whose name I do not remember, and a member of the public, a woman who was on community organizations. And Rita O'Donnell, the Public Health Advisor, pulled all the cases of children that had been reported with AIDS--now don't forget, we didn't have HIV reporting yet, so just kids with AIDS who were, I guess, 5 and up. And we spoke together. We called their physicians and spoke to them, and only one was healthy enough. Three of them were too sick, but one was fine, and she was going to school. I don't remember what grade she was going to, first or second grade. And so, the day we made this decision, Sencer was sitting in Koch's office--

CHAMBERLAND: So, what was the guide-- before we-- so you developed a guidance--

THOMAS: Oh, so we had already decided--

CHAMBERLAND: So, what was your recommendation?

THOMAS: I guess Sencer had already decided and Koch had agreed that we were not going to keep kids out of school. That that would make no sense.

CHAMBERLAND: But would they have to be screened in any way or evaluated?

THOMAS: I think the idea was if they were healthy enough to go to school, they weren't going to be a risk to anyone. So that was the only criterion, was that the pediatrician said, "Yes, this child is healthy enough to go to school."

CHAMBERLAND: I see. You were using case surveillance to identify who the children were, and then you would talk to physicians--

THOMAS: Yes, we called their doctors.

CHAMBERLAND: --and make a determination as to whether you thought they were healthy enough?

THOMAS: Well, no, not whether we thought. The pediatrician would tell us. We weren't evaluating--we weren't examining the children. It was the pediatrician who said, "This child is fine, has not been in the hospital recently, and can certainly go to school." Only one was able to go to school.

CHAMBERLAND: One was able to go.

THOMAS: One was going to go to school. The other three were too sick. They were in the hospital or on intravenous therapy, or couldn't get out of bed, or whatever.

CHAMBERLAND: While this is going on, are you--I'm just--I'm trying to break this 00:58:00down into a little bit by bit, because I think it's a fascinating story. So, at the same time Atlanta is working on a national guidance for schoolchildren--

THOMAS: Yes, and I think we were like, "Please come out with this--please come out with this."

CHAMBERLAND: But were you engaged in that national effort as well?

THOMAS: Yes, I guess so.

CHAMBERLAND: Were you and Martha Rogers communicating back and forth about--

THOMAS: You know, Mary, I don't remember. I assume so, because I had been to her meeting where the ground was laid for what would go into the guidelines, but I would have to look at the document to see whether I remember working on it. But in New York City--

CHAMBERLAND: So, Atlanta must have been aware that New York City was not going to exclude children.

THOMAS: Absolutely. And that had been the decision at Martha's meeting, as well.

CHAMBERLAND: So, nationally that was going to be the decision, as well?

THOMAS: Yes. It just wasn't written down and signed, sealed, and delivered. And I guess the Board of Ed agreed that summer because the woman from the Board of 00:59:00Ed was on our committee, so they must have been in agreement with this policy. But I have to tell you, again, the politics were a little above my head, but a young man named [R.] Kyle Alagood has just written an analysis of the AIDS in school trial and I recommend it. It's good reading and really explains some of the issues of that summer. So, we didn't publicize anything.

CHAMBERLAND: Although the Health Department - to get to the trial -- what really pushed this issue of infected children being allowed to attend school into the courts was in the fall of '85, when the Health Department had--

THOMAS: It was still August.

CHAMBERLAND: --come up with its approach as to how it was going to handle it. There was a public announcement, I believe.

THOMAS: Yes. So, what happened was this little committee of four women met, reviewed these cases--very small number of cases--and Dr. Sencer called us. He was in Mayor Koch's office -- and he asked us, "Okay, what do you decide?" We said, "One of them is going to school." So, he and Mayor Koch then made the announcement.

CHAMBERLAND: That there was going to be a child--completely unidentified--

THOMAS: Oh, yes.

CHAMBERLAND: --not identified where the child would be going to school.

THOMAS: Yes, and we didn't even know. We didn't know what school. The committee didn't know what school the kid was going to.

CHAMBERLAND: Oh, interesting.

THOMAS: And so, the people in District 27 Queens took it to court.

CHAMBERLAND: In preparing for this interview, I did read a bit of Kyle Alagood's very well-documented report about this court case and it was just astounding to read his description of some of the events. The parents in Queens were so 01:01:00troubled by the notion that a child somewhere in New York City with AIDS was going to go to school that ten to twenty thousand pupils in Queens were kept out of school by their parents to protest the Health Department's decision. One protesting child was dressed as an AIDS patient and wheeled into the school in a plywood coffin.

THOMAS: I know. It's frightening.

CHAMBERLAND: So, the district, the school districts in Queens had requested this temporary restraining order to bar this unknown child from attending school, which was denied, but this case ultimately went to trial, and you were an expert witness for the Department of Health.

THOMAS: Yes.

CHAMBERLAND: So, tell us a little bit about this experience. It's not certainly one that EIS prepares you for-- so how did you prepare for being put on the 01:02:00stand in this very volatile environment?

THOMAS: Oh, my gosh. I guess this is standard legal activity, but [Frederick A. O. Schwarz, Jr.] Fritz Schwarz, who was the brilliant lead lawyer for the City, and -- I forget the other guy's name, but it's in Kyle's report--Ellen [AN1]somebody - they pulled me in, and also the woman from the Board of Ed who had been on our committee. They drilled us, and they gave us examples of questions we might get and helped us to be prepared to be put on the stand. But I wasn't prepared for the circus. At one point, I came out of the elevator in the courthouse, and there was a camera right outside--took my picture standing 01:03:00in the elevator. Another time Channel 11 interviewed me, and I just didn't want to say anything. They hadn't asked if they could interview me. They just stopped me in the hallway and asked me questions, and I was dumbfounded. I didn't say anything. And they put that on the television. It was awful.

CHAMBERLAND: Did you attend the trial? It went on for several weeks. Did you attend?

THOMAS: Yes, I was there the whole time.

CHAMBERLAND: The entire time? You went every day?

THOMAS: Yes, yes.

CHAMBERLAND: And then how--

THOMAS: It was amazing to me. Doctors that would--I think [they were] paid--I mean, I wasn't paid anything. You know, I was a witness for the City, but the doctors paid to be on the plaintiff's side, I was just amazed that people would be willing to do that. Anyway.

CHAMBERLAND: There was apparently a real effort on the part of the City and the 01:04:00representatives from--

THOMAS: To bring out data.

CHAMBERLAND: --to bring out data.

THOMAS: Yes. Kyle Alagood attributes that partly to the judge. I was unaware of the judge's sophistication at the time. I just felt that Fritz Schwarz was such a smart man and so well educated and was helping everybody to understand AIDS. So, it was treated as an educational effort, and the papers covered it. It was in the paper every single day.

CHAMBERLAND: But it must have been very difficult, because I'm sure you were pressed to answer questions along the lines of, "How do you know it can't be transmitted by a bite or body fluids?"

THOMAS: Right. So being on the witness stand was not fun, and I wouldn't want to do it again. At one point, [Robert G.] Sullivan, the lawyer for the Queens people, from like 20 feet--he holds up a piece of paper: "Dr. Thomas, are you 01:05:00familiar with this memo?" And he's way over there, I couldn't believe--with this memo. I didn't know what memo that was. And I don't remember what it was, but it was just like really, you're asking me if I'm familiar with a memo, and you're way over there? And it was obviously staging, right? It was like stagecraft to get the witness to react.

I had done a study of children in homes. So, we had gone around and drawn blood from children in homes. We were trying to figure out if there was casual transmission or if was just maternal-child transmission--and we were asking all kinds of questions including "Do you share toothbrushes?" At one point, the judge turned to me, "Did you really ask people if they shared toothbrushes?" I said, "Yes, we did ask that." I had two little kids at the time, born in '82 and '84, so they were 1 and 3. They said, "If your child is bitten in nursery 01:06:00school, do you want to know if the other child has AIDS?" and I said, "No, I don't want to know." There was nothing to do about it. There was no AZT yet.

CHAMBERLAND: Were people surprised that you said that?

THOMAS: Apparently. One of my kids found an article last year. I think there's a bunch of flurry about this. I don't know why just now, maybe because Mr. Alagood was working on his paper. But there's a story that the mothers in the courtroom gasped. I don't know if that's true, but that they-- then I think they began to think they were overreacting, because here was this mother sitting on the--I just couldn't imagine. I knew there were other kids in the--right? We knew that there had to be other children that weren't sick that had HIV that were in school. There was no way we were going to identify all of them unless we were going to test every school kid every year.

CHAMBERLAND: Was this a question that the lawyers had prepared you for?

THOMAS: No, that question? No.

CHAMBERLAND: Really?

THOMAS: But I had in my head--I think I had prepared myself and I had in my head--and we had talked about this--is that a world you want to live in? But I also had the firm understanding from looking at data. And looking at data is so important, and that's one of the things I think CDC teaches you. Right? That you really have to look at the data.

CHAMBERLAND: Well, you mentioned--

THOMAS: That there wasn't a risk.

CHAMBERLAND: --there were these studies that were being done in households where there were persons with AIDS or HIV residing. So, there was obviously in a household a lot of day-to-day contact.

THOMAS: And there were several of those studies going on around the country and around the world.

CHAMBERLAND: That didn't show any evidence of transmission apart from sexual transmission among sexual partners. That AIDS was not being transmitted casually through sharing of dishes or even toothbrushes--whatever. That certainly I think 01:08:00provided some level of reassurance.

THOMAS: Very reassuring. Very reassuring.

CHAMBERLAND: So how did the case turn out?

THOMAS: Well, the City won, but that wasn't known for a few months.

CHAMBERLAND: The judge took his time, I guess, writing the decision?

THOMAS: Yes.

CHAMBERLAND: And did it take time for things to sort of settle down?

THOMAS: Well, I think once the trial was over--

CHAMBERLAND: And CDC's national guidelines were out there?

THOMAS: Yeah, they came out--did they come out before the trial or--

CHAMBERLAND: I think right before the trial.

THOMAS: That was very reassuring, as well.

CHAMBERLAND: Was that the only trial you were involved in?

THOMAS: We went on to other things. I had just been named Director of Immunizations, and my next challenge was measles in New York.

CHAMBERLAND: Well, actually, that's a nice segue into talking a little bit about the Health Department, because you and I both worked there as EIS Officers. New 01:09:00York City was certainly one of the first recognized epicenters for this new outbreak and certainly played a significant role under Dr. Sencer's leadership in investigating early cases and establishing model programs for surveillance and development of policy. Can you tell us a little bit about the Health Department? You mentioned where it was located: Worth Street, which is down by the Brooklyn Bridge in New York City. When you first arrived, how many people were working -- I was going to say on AIDS -- I should probably say communicable diseases--

THOMAS: Right, nobody was working on AIDS. So, in [the Bureau of] Communicable Disease, so there was Dr. Friedman and I don't know maybe six or eight public health nurses and Lilla Lyon who was the woman who went with me to buy poppers--she was in the next desk, [Dr. Andrew] Andy Goodman, who is now a 01:10:00Deputy Commissioner, I think, or Assistant Commissioner in chronic disease at the Health Department. We were all so young, you know. I replaced another EIS Officer, [Dr.] Steven Phillips, who had gone to work for Exxon Mobile with a former Deputy Commissioner--

CHAMBERLAND: John Miles?

THOMAS: [Dr.] John Marr.

CHAMBERLAND: John [S.] Marr, that's right.

THOMAS: --who wrote a couple of great books about New York, The Black Death and so on.

CHAMBERLAND: So, a small, really small cadre.

THOMAS: It was very tiny. The Commissioner was really not particularly involved.

CHAMBERLAND: This is pre- Dr. Sencer?

THOMAS: Oh, absolutely. Dr. Sencer came in January and turned the place around. We were in the Commissioner's suite, because the Commissioner at the time was on the sixth floor. We were in the Commissioner's suite on the third floor, and when Dr. Sencer came, we were kicked out.

CHAMBERLAND: You also mentioned a real cadre of really strong public health 01:11:00nurses. What did they do?

THOMAS: Yes, they investigated everything--hospital outbreaks and community outbreaks, and they would involve me when they could. They gave a lot of counseling on the phone and kept all the records.

CHAMBERLAND: So, since you were at the Health Department for so many years, you witnessed a pretty dramatic expansion.

THOMAS: Absolutely, yes. In '87, I think that's when PCs [personal computers] came into being. So before '87, the IBM cards were recording all the AIDS cases and then I think it was '87--maybe '86 we started to have PCs and I remember Dr. Sencer had a Compaq [Computer Corporation]--C-O-M-P-A-Q. And that was the first PC I had ever seen and then we had Wangs [word processors], which were just basically computerized typewriters. There was a secretary who worked with Dr. 01:12:00Friedman named Sally Koch -- no relation to Ed Koch. I think she could type 80 words a minute. Honestly, when those Wangs came in, she retired, because I don't think she was going to be able to keep up.

Also Dr. Sencer brought in, not only you, but he brought in two other CDC EIS [Officers]--he brought in [Dr.] Rand Stoneburner, who investigated tuberculosis and unexplained pneumonia and ran the HIV research program for many years, and [Dr.] George Rutherford, who ran immunizations and then moved on and now works at [The University of California, San Francisco] UCSF and the California Health Department. I think George does a lot of global health work right now. The place just kept growing.

Part of that was AIDS money, I think, from CDC. I think after about '85, I know 01:13:00that politically there were complaints that [President Ronald W.] Reagan didn't supply enough funds for AIDS at first, but after '85, I just remember we were always sending in applications to CDC for AIDS projects, and many of them were funded. We were able to increase the number of Public Health Advisors and increase the number of researchers and young MPH [Master of Public Health]-level researchers, as well as doctoral and MD researchers. And by the way, one thing about Reagan is he did appoint [Dr.] C. Everett Koop as Surgeon General. Do you remember that?

CHAMBERLAND: Yes, I do.

THOMAS: The public health community was appalled. This was a pediatric surgeon who was antiabortion, very religious, but he was a wonderful Surgeon General, except for the fact he made you guys start wearing uniforms. I escaped that. But 01:14:00he imposed uniforms on the CDC folks. He sent a report on AIDS to every household in America. He had a pediatric AIDS conference in Philadelphia that was phenomenal, and [he did] other things, not [only] AIDS. He had a study of abortion and whether women were damaged by abortion and determined that they were not. And he had a lot of courage, C. Everett Koop. Again, to look at data. Don't try to make it up. Let's see what the data shows.

CHAMBERLAND: I want to ask you a little bit more about David Sencer who passed away some six years ago and actually the idea for this oral history project came from Dr. Sencer, who felt strongly that CDC needed to tell its story about the early days of AIDS and regrettably, we're not able to capture his own stories in 01:15:00this project. Can you reflect a little bit about Dr. Sencer,

THOMAS: Yes, I would love to.

CHAMBERLAND: --his role that he played and any good stories?

THOMAS: When I was an EIS Officer and you were there and Rand Stoneburner, first of all, he was a walk-around manager. That's what [Dr.] Lyle Petersen-- Lyle Petersen?

CHAMBERLAND: Conrad?

THOMAS: Conrad, [Dr. J.] Lyle Conrad who was the head of Field Services for CDC, he was one of my mentors. He told me "Watch out, Dr. Sencer --because he'd worked for Sencer also when Sencer ran CDC --Dr. Sencer - walk-around manager." And there was a myth - maybe true - that he knew every secretary who was reading the newspaper, staring out of the window, not doing their work - but he would 01:16:00come up and see us at 5:00 p.m., end of the day. I guess he was done with his meetings. "What's happening with that unexplained pneumonia? Have you looked at heterosexual cases?" And of course, we had never looked at whatever it was. It was like, oh, my God. So, by the next morning, we had to have looked at it. Do you remember that?

CHAMBERLAND: I do.

THOMAS: We had to have--and he had such a nose--and I just thought, this man has public health sense. He has a sixth sense for this, which Jim Curran did, too, in a slightly different way, but we were very lucky to have the two of them. Sencer, he was just great for us, right? And he pulled you and me into a bunch of things. So, one thing you and I did together, Mary, was I'm going to say the more famous one second - that boat. That cruise ship--

CHAMBERLAND: This is a non-AIDS outbreak, right.

THOMAS: Cruise ship outbreak.

CHAMBERLAND: A cruise ship outbreak of gastrointestinal illness.

THOMAS: Probably norovirus--but I was pregnant, so I must have been pregnant with Elsie, my second child. You and I had to go on the cruise ship, and I remember thinking, "I'm pregnant and I can't drink anything." That was hysterical. I had a box of reports from that for many years until I left the Health Department. I left the Health Department in 2004, but I had a box from our interviews on the Sea Princess.

CHAMBERLAND: Ah, the cruise ship outbreak, right.

THOMAS: Okay. The other thing he pulled us into was 3-2-1 Contact. Remember that? Someone approached him and said they wanted to -- or maybe he approached them, I don't know -- but he got you and me to do an episode of 3-2-1 Contact with the young actors.

CHAMBERLAND: Right, this was a Public Broadcasting System [program].

THOMAS: This was a science program for kids.

CHAMBERLAND: A science program similar to Sesame Street, but it's pitched to an older audience.

THOMAS: We did a hepatitis A outbreak.

CHAMBERLAND: In a pizzeria in New York City. And you're right, Dr. Sencer--I 01:18:00think they initially wanted to film in Atlanta. And they contacted Dr. Sencer, and he said, "You don't need to go to Atlanta. We've got EIS Officers right here."

THOMAS: We have these two gorgeous women that can do it here.

CHAMBERLAND: We filmed very ad hoc, [with] all of the child actors who were really teenagers--

THOMAS: Were like 30 years old.

CHAMBERLAND: --and older, and had scripts. They would just turn to one of us and say, "Okay, so now you're in the pizzeria. Explain to the kids why you want to interview cases and controls. Roll 'em!" We were--it was a little off the cuff, our remarks. You're right, he did get us into some unusual--

THOMAS: That was fun, yes. But he just did a very good job for New York City. I remember being so honored-- once he took me with him to present AIDS statistics to Mayor Koch. This must have been very early. I think we had a computer printout, so maybe it was '84-'85. But he took me with him, I guess, in case 01:19:00Koch asked a question that he needed help with. I'm not sure I would have been able to help. So, being able to be in the presence of Koch was another honor.

CHAMBERLAND: I had a similar experience where he took me to Gracie Mansion [the Mayor's official residence]. It was in the evening. It had nothing to do with AIDS. It was one of the Tylenol scares where people were contaminating bottles of Tylenol. It was late. It was after 5 o'clock, and he was roaming the halls and found me, and he said, "Get in the car, we're going to Gracie Mansion." He did really mentor his officers. He took a real personal interest in our careers and exposing us to so much that was out there in the great city of New York.

THOMAS: Speaking of his car, he had a great driver. I forget his name.

CHAMBERLAND: Otto.

THOMAS: Otto, right. Okay. And he always played classical music on the radio.

CHAMBERLAND: In the city cars that we were driven around in. Well, you were at 01:20:00the New York City Department of Health for some 20 years and did a lot of AIDS, but some non-AIDS things. But when you look back, you were part of something that changed history in the course of public health. How has that affected you personally and professionally, when you think about it?

THOMAS: Number one, I was so privileged to be with so many wonderful, smart, talented researchers, virologists, pediatricians, immunologists, infectious disease people from around the world. AIDS is still an international disaster, and they developed sort of an extension of Dr. Sencer's monthly meetings. People need to talk, and people need to share information. The International AIDS Organization was developed and began to have annual meetings. Right? Now I think 01:21:00they are every other year. I was able to go to Amsterdam and Berlin and Florence and present papers to an international audience and meet people from other countries, and that was just an incredible influence on my career. But more than that, just being part of CDC and seeing how you could use data and try to be rational and then learn how to communicate with the public, and that came in very helpful to me later.

There are always big outbreaks happening. In '99 we had West Nile virus in New York, and I was not in charge of that. You know, [Dr. Marcelle] Marci Layton is the epidemiologist who ran that with [Dr.] Annie Fine, who is another epidemiologist. They both still work there in [the Bureau of Communicable Disease] Communicable, but they showed me the cases, and I was involved in the 01:22:00public response. And then 9/11--and 9/11 was huge and traumatic. More traumatic personally. AIDS was -- you know, I lost friends and colleagues to AIDS. I lost a babysitter to AIDS, so my kids have personal knowledge of this. You know when you're a professional woman, you have people come and take care of your kids. So, I had a wonderful Haitian babysitter who is still a friend of our family, and then she got another job and recommended her friend, who proceeded to become ill. It was before there was treatment, and so she died. So, I had that. But 9/11 was huge. But all the time you have this baseline of okay, we have to 01:23:00collect data and we have to look at the data, and we have to make sure the other doctors in the community are aware of what's happening. And then the anthrax outbreak was another--so things are happening in New York City all the time.

CHAMBERLAND: But all reflect back on some very basic fundamentals--

THOMAS: Basic fundamental skills, right.

CHAMBERLAND: --that we cut our teeth on in the New York City Health Department.

THOMAS: Right.

CHAMBERLAND: Under Dr. Sencer's watchful leadership.

THOMAS: And one of the big ones I really think for AIDS was--and I'm not an expert in public health communication--public health education, but I do think a lot of work done with AIDS built on skills and theories of how do you communicate and I think now the public health communicators are at another--I think they're having another crisis, right? Because it used to be there were 01:24:00three TV stations, and you could run a public service ad, or you could get some interviews, and everyone would see them. And now there just aren't three--there are hundreds.

CHAMBERLAND: It's a lot more challenging.

THOMAS: And then there's Twitter and Facebook.

CHAMBERLAND: So more challenging, but it always comes back to the--

THOMAS: I think it's a huge challenge, but the principles are the same.

CHAMBERLAND: Well, I think that's a good note to go out on here. Any closing thoughts that you might have that we haven't covered that you'd like to mention?

THOMAS: I'm just very honored that you're including me in this effort. Thank you.

CHAMBERLAND: Well, we're so pleased that you came to Atlanta to join us. Thanks so much, Polly.

THOMAS: Thank you, Mary.