Steven Rekant

Q: Today is Friday July 29, 2022. This is Mary Hilpertshauser for the COVID-19 Oral History and Memory Archive Project. I am in Atlanta, Georgia and I will be talking to Steve Rekant, who is also in Atlanta. We have had one pre-interview and we are recording through Zoom. Steve, do I have your permission to record this?

REKANT: Yes, you do.

Q: Thank you so much for being here with me today and being part of this project. For the record, can I ask you to say your full name and then tell me what your current position is?

REKANT: My name is Steven Isaac Rekant, and I am a public health veterinary medical officer with USDA [United States Department of Agriculture] APHIS [Animal and Plant Health Inspection Service] Veterinary Services, One Health Coordination.

Q: Thank you. Before we dive into the details here about CDC [Centers for Disease Control], and COVID-19, and EIS [Epidemic Intelligence Service], could you tell me a little bit about your family background and the community where you grew up?

REKANT: I am the oldest of three children. I was born in Red Bank, New Jersey, I grew up in Central New Jersey. We lived there—actually my parents still live there. We went to school through the public school system there and it wasn’t until it became time to start looking at colleges that we started to disperse, and I guess disperse we have. Yes, I always a math and science kid growing up. We had a lot of outdoor space, played in the woods a lot, went on little like, I wouldn’t call them hikes, but exploring on the trails and playing with the neighborhood kids. We were on a cul-de-sac, so it was a relatively safe place to spend a lot of time outside.

Q: What got you interested in the sciences other than, it looks like, playing in the woods?

REKANT: I’m not sure if there’s another sparking interest there. I’ve really always been fascinated with kind of the how of things and even to this day I often go for a walk at the end of the workday, which is a bit of sanity maintenance from the work from home environment to just get out, and have a signal. I often am whistling back at birds, I am stopping to look at bees pollinating the plants, and I am still just kind of fascinated by the little details, and how a lot of these things fit together, or don’t kind of obviously fit together, and I then I like to explore a little more deeply.

Q: A natural curiosity of nature. Were you interested in biology when you were in high school or once again was it just your natural curiosity in nature?

REKANT: Yes, I think to a certain extent it was the path that was laid out for us in some ways. In my high school if you were slightly advanced in—I take that back. I think even in elementary and middle school I was just more deeply tackling science questions and kind of more interested in those kinds of things, science and math. Then when it came time for high school the path that was laid out for some of the kids who were either a little further advanced in math, or kind of thinking about things, was biology class. We all had to take biology, physics, and chemistry at some point, but early in high school the advanced class for the freshman was biology. I think that, again, really helped spark some more questions, really show me where they were—help explain some of the things I did know, and I think the good metaphor is like an expanding balloon. It’s full of more air so there’s more stuff you know, but the surface area, the stuff you don’t know, keeps expanding, so it really helped kind of expand that search of – okay, I found this thing, where do I look next, I’ve got more places to look now.

Q: Then you went off to college. How did you pick that college?

REKANT: I went to the University of Virginia, and I was—there were two of us from my high school my year I went, and we were, I believe, the second and third people ever from my high school to go UVA [University of Virginia]. A lot of folks, being in New Jersey, there are a lot of really good schools in the Mid-Atlantic, in the Northeast, that I think people tend to go to, and for whatever reason they tended not to look south all that far, not to look all that far west. I grew up fifteen minutes from Rutgers University, which is a great school, and we would send probably ten percent of the graduating class there.

But I did extensive touring. We traveled up, we traveled west a little bit, we traveled south for a couple of schools, and I really just—it’s funny in retrospect to think about the things that resonated with me at UVA, but the tour was great, and there’s also kind of funny stereotype of the tour guides being pretentious, once you’re a student there, and that was kind of entertaining. UVA has rooms on the Lawn, so the Lawn is—gosh, I’m out of practice, I should know. It’s a UN World Heritage site, but it’s effectively the Quad. There are some of the academic buildings there and lining it are the Arcades? The Colonnades? I think the Colonnades. These are a series of residential facilities, I guess. Really, it’s this one room dorm rooms that are reserved for fourth-year students. Frankly the idea being able to wake up, take a step out, and already be on the Lawn, it really seemed exciting. I took to UVA just kind of generally, just felt pretty good there. I did an overnight for accepted students and I remember this very clearly, I was staying with some first years, we played volleyball on the courts between the dorms, and we played video games for a little bit, we watched The Usual Suspects, I had never seen that before. I just kind of felt comfortable. I felt like yes, this is a thing, I could do this for four years, this would be neat. It worked out great. I loved my time in Charlottesville.

It was a bit further away than I think I might have been—I thought I was ready for, but once I settled in, actually partially driven by some weather. I was supposed to come home after the first month or so and Hurricane [Isabel], I forget what it was, in 2003, which one it was. It was so severe power was out all over town and the train back to DC [Washington DC] and back to home was actually not running. I had to reckon with this idea that I wasn’t here for a month vacation at a time like summer camp, I’m here, and I’m staying here, and that was a really turning point for me. Then I think once I accepted that, once I knew that I was there, once I kind of internalized that, really took to UVA, and had a great experience there.

Q: Then you graduated with this BS [Bachelor of Science] in Biology –and then what did you do?

REKANT: Yes, I knew about halfway through undergrad that I wanted to go to veterinary school. Being a math and science kid, I think the tendency is—I think the tendency that follows well is to look at human medicine. It’s more than this, I don’t mean to be too cheeky about it, but I hung out with some of the pre-med kids, and they frankly weren’t all that much fun. I got to do a little bit of work with the animal sciences, took some animal morphology courses, and it really just resonated with me. At that point, again, through third and into fourth year of undergrad I was going to be Dr. Steve, pillar of the community, treat everyone’s cats and dogs, sponsor a Little League team, that sort of thing, and was looking forward to that. I went home. I had planned to take at least a year off between undergrad and vet school. Not a year off, a year to work, to gain experience. I had some research experience from my time in undergrad, but I really didn’t have any clinical experience. I’d come home over the summers and apply to vet clinics to be a technician for the summer, and they understandably wanted someone more than just the summer, they wanted someone to be there for a bit. For one summer I split my time between a—sorry, for one summer I split my time between a pet store, a lab associated with a vet clinic, then I was volunteering for a vet clinic just in my hometown. I was driving for the other two ones, and this was a bit closer where I had contact with a veterinarian and he said, yes, if you want to come shadow me a couple days a week, and kind of see what this is like, sounds great. I can’t pay you but come see what this is.

I ended up doing that for two days a week, two days the other onenm[pet store], and three for the lab. That summer I found myself quite full getting a good variety of experience. I was an undergrad so when it was time to [graduate and] come home and looking for experience I actually called back that veterinarian that I had been shadowing and asked kind of wink-wink, do you know anyone who is hiring someone for a technician spot. He said, I know you’ve got no real experience, but if you want to work here, we’d be happy to have you. I worked for the vet clinic for that year. It’s interesting because at that point I think a lot of folks who are my path had had clinical experience, had had some of that experience handling cats and dogs, and giving injections, and all these kind of clinical things. We had a dog growing up, but otherwise I didn’t really have that experience. My father is allergic to cats, so I hadn’t really had any cat experience growing up. I’ve gotten quite a bunch since and I have a cat now, so I’ve come around there.

Q: What about scaly and feathered?

REKANT: Not real experience there. I think one of the things that was interesting, it’s funny to think about this being a formative story because it’s such a small thing, but it stuck with me, I think I was game kind of for whatever came in sometimes. Like I said, I had research experience and at least once, if not more than once, on my day off from the clinic someone was coming in with a pet mouse. And as my friends and parents like to joke, I am a certified mouse wrangler, I have taken that training, so I was able to come in and help with that kind of thing. Like I said, I remember one day in particular someone had found I think it was a small garter snake in his trash can, covered in packing tape, and he’s like, I don’t know what to do with this, but you guys are great with my pets, I figured I’d see what you can do. We looked up for some of the potential problems here because even the vet I was working for wasn’t too familiar with reptile issues, but we looked up how to safely remove this, and I spent probably an hour or so with a q-tip and a vat of mineral oil and was steadily slowly disentangling the snake from the bit of tape. Again, it was something I had no experience with, but we had a pretty good sense of what to do, and how to provide good care for this animal. Fortunately, I had the flexibility, I didn’t have to—I was given the leave to focus on this, to actually spend the time to do this part right. It was interesting, had a breadth of experience there.

For better or worse, and ultimately for probably better, one of the veterinarians, not the practice owner, but one of the veterinarians, was a bit less comfortable with my kind of steep learning curve and learning some of the things on the fly, especially when it came to, as we touched on, restraining cats, which can be pretty complicated. Especially if we’re talking about getting ready for surgery and that kind of thing. Combine that with the fact that the office manager had gotten pregnant and was having issues with morning sickness and I’m not shy around computers, I spent a chunk of my time, most of the time for the first six months of that year as a technician, but a little bit more and more helping with management things. For the last half of the year, I actually spent a whole lot more time being upfront. I was taking phone calls, checking people in when they arrived, which was also interesting because I think typically when you walk into a vet clinic you expect a young female person, and to see an early-twenties, over six-foot tall, male person, checking you in puts people, I think, generally at ease. It’s more of a surprise maybe, but I had some really good conversations with folks about their pets and was able to hopefully do a good job in that part of it. I also worked a lot with the practice management and kind of some of the protocols for running the place, some of the financial work. One of the last things I did when I was there was I helped the veterinarian search for and buy a therapeutic laser, and were looking at different real estate spots for him to expand to, and negotiating—not negotiating, I didn’t do any of that, but picking the right credit card processing deal to kind of understand how the clinic worked.

Remember at this point I’m following his path, I’m going to be Dr. Steve, and treat cats and dogs, and snakes, and mice, and whatever else comes in. I talked to him about it, he was really good about giving career advice and kind of helped me on my path. I realized that for one, I was more fulfilled by the practice management work than the day-to-day medicine, and for two, I kind of craved a bit more variety. Each individual day was good. Some were not, of course, but in general the days were good. I’d get to the end of the week or a month and say, hey, you did a lot of upset stomachs, and skin problems, and new puppy vaccines, and this kind of thing, and it’s like, yes, that’s what this is. That seemed ninety-ish-percent of this is that and that ten percent is the variety. I remember thinking to myself, I don’t know if that’s enough. I like to kind of bounce around, I like to have just a wider variety of things to think about, to focus on. I still applied to vet school and fortunately had some really good conversations along the way that really helped shaped what I was up to next.

Q: You were trying to expand your balloon and your balloon wasn’t expanding with you.

REKANT: Yes, I think that’s a good way to put it. At Virginia-Maryland [College of Veterinary Medicine], where I eventually went to vet school, the way they do the interview is they have a hot interview and a cold interview. At the hot interview they know everything about you, they’ve got your whole application, and they ask you specific questions about your experiences just to kind of understand what’s not on the page. In the cold interview they know your name, and I think they know where you’re from, and that’s it. You just have a conversation, you help guide it, and then they help kind of see where it goes. I ended up applying twice, so the first time I applied the windows are, I think, supposed to be fifteen minutes, fifteen for the hot, fifteen for the cold. Coming in on like half an hour I actually had to stop my cold interview because one of the two interviewers was this old Army veterinarian, and we started talking about some of the interests I had picked up through college as things I wouldn’t—I wasn’t sure that they’d necessarily be related, but were still interesting to me, in particular food security, but also infectious disease was also a thing that I found interesting, and I really took to in some of those animal disease and animal physiology courses. We kept talking kind of thinking about other ways this can go because I think a lot of folks, and frankly a lot of my classmates, a lot of people that I ever talked to, think vet medicine is a [strictly] clinical field. It’s really important to have that understanding, but there’s a ton of work that can be done outside of the clinic, and I just hadn’t been exposed to it at that point.

I remember very distinctly, and this is where the EIS part of the story really does start a full ten years before I would actually join EIS. Again, this Army veterinarian, Dr. Michael Reardon, he, after having the conversation, introduced me to Dr. Bettye Walters who was at FDA [Food and Drug Administration] at the time. I believe Dr. Walters has since retired, I’m not sure. He’s [Dr. Reardon] like, hey, this is someone who is interested in doing kind of the broader work, is thinking about being a veterinarian in potentially government work to look at some of these issues. Dr. Walters, I think you’d be able to have some good advice for him. We talked, we talked about a bunch of things, talked about her job at FDA. She asked me, hey, have you ever heard of CDC’s EIS program? At that point I had not. This was the spring or summer of 2008. I had not, I looked quite a bit into it. There’s good stuff on the website and I was able to really get a sense of it and it just sounded exciting. It sounded like something I thought I wanted to do. I’m trying to think how short I can make this part of the story. I ended up getting into that school [Virginia-Maryland College of Veterinary Medicine] but declining. I was an out of state student and when you get in off the waiting list in kind of mid to late July, what they do is they call you up and say, hey, congratulations, you’ve been accepted to vet school, please let us know by tomorrow morning if you’re going to accept.

I understand [the urgency] because if I say no, then the person they call tomorrow has that same conversation but one day closer to school, so I get that from their perspective. I actually was getting ready to leave for a friend’s wedding, I was going to drive from New Jersey to Virginia and Virginia to Tennessee. I forget exactly what days it was, but I think they called me on Monday, I declined on Tuesday after making a bunch of calls, and Tuesday evening I drove down to Virginia. At that point it had been about four, five months since the interview, a couple of months since I talked with Dr. Walters and learned those things—(sorry, my Adobe is uncooperative apparently)—since then I had looked at some other options. I was looking at getting a degree in agricultural economics as a potential option and was offered a spot in school shortly after that, that was an even tighter timeline. But my younger brother went to Michigan State University, so we took a family road trip to get him back to school at the end of the summer, and they just so happened to have an Ag Econ [Agricultural Economics] program there. I had a good chat to a couple of professors and when he was moving stuff into his—I think he was in the frat house at that point. When he was moving stuff into his room, I was taking interviews. I was going around the Ag Econ school and talking to folks about the program, and how it might—again, I was really thinking about food security as a major interest and that’s where I think things could go, that would be a potentially good degree for that. After talking to some folks both there and back at the vet school I really came to think, and I think this is still true, although I have to say I’m a bit biased, that the Ag Econ degree was going to be a bit more focused and narrow than what I was hoping to get from it. One of the things, especially after talking to some of the veterinarians who had a perspective that was a bit broader than the clinical only perspective, was that the veterinarian degree really is pretty flexible. It’s the kind of thing where I didn’t have to be Dr. Steve and work on cats and dogs, and snakes, and whatever else came in the door, that I could do policy, I could do infectious disease, there’s international work to be done, there’s food security work to be done, and not just the food safety or the production—production animal work.

At that point I decided that vet school was the plan. I was still okay with my decision to decline, because as an out of state student the math of going to vet school, it was a little bit tough to square. With a better plan and not much time to execute that plan, this being early August I think at this point, I applied again. I picked a couple of schools— I think I cast a wider net the second time. I also knew more about EIS at this point, so I looked for schools that had an MPH [Master of Public Health] option because I knew that was going to be important for my EIS application. I wouldn’t know that would be many, many years down the road, but important to know at that point. I looked at the states that I was interested in possibly going to and what it would take to establish residency. It turns out that going back to Virginia with some of the connections I had, and the timing was going to work out pretty well, so I moved back to Virginia, I got a job in a research lab through some old connections I had. I might have the dates a little bit wrong, but it has been since summer of 2008, hopefully I’ll be forgiven for getting the day wrong, day or two wrong, but I believe I was told I got the job on August 20, which was great because I needed to be working in Virginia for a full year before school started to become a resident to become an in-state student. That was August 20, classes started on August 25 the next year.

I was golden, five days, plenty of time. As I’m kind of reveling in getting a job, I’m all set, they’re like all it’s going to take is a week-long background check before we can officially hire you. I’m like, no, that’s the 27th, that’s a couple days late. I reached out to folks around town. I remember this pretty clearly— I was applying to be a waiter at a brick oven pizza restaurant. Fortunately, I got a call back from a job I was more excited about. When I was a fourth-year undergrad I had actually done some volunteer work with an equine vet. I set it up, so my classes were such that I had, I believe I had no Friday classes. I forget which day it was—I think it was Fridays. This was an entirely ambulatory practice, so I’d meet him outside of town on Friday mornings, I’d spend all day riding around with him, and just getting equine experience. Like I said, I’m from the suburbs of Central New Jersey, I rode horses at summer camp once or twice, but I didn’t have the breadth of experience, so it was really good to get that from him. When I called him up, I’m like, hey, Dr. [Jeff] Shane, I’d love to work for you for a little bit. Here’s my situation, I’m really trying to establish residency so if there’s something—I’ll organize your office for a week or something, whatever it is, just let me help out because I need to establish residency. Fortunately [he said] yes, come on board, we’ve got stuff for you, we’ll keep you on. I worked for him for a week and switched to the research lab. Which was great, he actually came to give a talk while I was in vet school, so I got to reconnect with him and thank him in person a couple weeks later for the weeklong job that saved me tens of thousands of dollars becoming an in-state student.

Q: Your path it’s like fate, and destiny, and happy coincidences that just seem to all happen almost at the last minute.

REKANT: It’s funny you say that because one of the things I do really like to do is to talk to vet students and early career veterinarians to kind of pay back what was given to me, the sense of it’s a pretty broad field. One of the things I remember very distinctly was—I feel like I’ve used that phrasing a bit, but I’ve got some of these really clear memories. Between second and third year of veterinary school I was at a summer program up at Cornell University and someone who is now a friend of my mine, Dr. Jason Baldwin, was running this training program. He was the first person who told me, and again this was halfway through vet school, he’s the first person who told me, Steve, if you don’t want to practice clinically you don’t have to practice clinically. You don’t have to do a year in a small clinic just to kind of show people that you’re a real veterinarian or any of that, do what you want to do, you have this flexibility. That’s a thing I really like telling folks as early as I can.

One of the things, and I like that you invoke the metaphor of the path, because one of the things I tell all the students, anyone I talk to, is that they can’t follow my path. That’s not a reflection on them. Many of the kids I actually was speaking with—I picked up a new mentee on Wednesday, this is a student that I’ll be working for the second, third, and fourth years of her time in veterinary school, and the training she has, the experience she has, the kind of focus that she has at that point, is so far ahead of where I was at that point. This is not a reflection on their not having the ability to, not being able to follow my path, it is just hey, some of these things kind of come up, and you have to be able to be walking along your path and look out to the side, and be like oh, that’s interesting, maybe I’ll go that way. It’s one thing to just do that on your own, and hopefully for all these students that I talk to, it’s really helpful to be like Steve told me about something that was kind of over there, I don’t want to go over there, that route’s closed off, but there’s something nearby, I’m going to go take a look. Or this looks kind of familiar, so I feel empowered to walk down that way and at least give it a try, be game, and see what comes of it. I think yes, some of the things do feel a bit like kismet, that’s the word I’m searching for, but there’s also a certain amount of understanding what you’re trying to do, kind of boiling it down to that motivation, and being game, going for hey, this is a way I can solve this problem, I can answer this question, so let’s give it a try.

Fortunately, I’m making all these decisions from a place of relative comfort. I have the support to be able to give that a try, go over that way and see what it looks like. They haven’t all worked out, but I probably—there’s a bit of recall bias here, I remember the ones that worked out, or the one that taught me something, of course, as well. It is, I think, really helpful and frankly one of the reasons I was excited to jump at this opportunity, is to get more of a path out there. There are people at CDC who helped shape my path doing the same thing. Again, the more stories that are out there, the more folks realize that a non-clinical career is an option, is potentially fulfilling, I think is really hopefully helpful.

Q: I think so too. It’s nice to hear a story where it’s not just go to school, get a job, and then you’re out there. Sometimes you don’t really know what you want even when you are in college or even before college. It’s important to know that you don’t have to always decide everything when you’re eighteen.

REKANT: Yes, like I said, I was really excited about EIS, but I also remember telling people during interviews, they’re like, wait, you’re not going to work in a clinic, what are you doing to do, and I told them, and I felt confident in this answer then, and it fortunately worked out, like I don’t know, but I have a sense of the kinds of things I want to do, and I want to go to vet school, and get those experiences, and give it a try. I’m going to get that experience— I’m going to see—fortunately for me I knew the rotation schedule was pretty flexible. I didn’t know which would specifically be my options a couple years down the road, but I was going to work at an import center and see if that was work, I wanted to do. I was going to have an office job, I had never had an office job before. Just to see what it was like to be a veterinarian who sits at a desk and works the computer like I do all day every day at this point.

Q: Right, because we talked about something called a public corporate track. I’m not quite sure what that means when you’re talking veterinarian, vet, public/corporate vet—

REKANT: Virginia-Maryland, I’ll actually use the full name even though the alumni are salty about it, it was the Virginia-Maryland Regional College of Veterinary Medicine and I think there’s a sweatshirt on the couch behind me that’s got the R for regional. But a couple of years ago they became the Virginia-Maryland College of Veterinary Medicine, and they dropped the regional, and now all of our alumni gear has that weird typo. Virginia-Maryland tracks. For all vet students you have to declare a track, which is kind of like declaring a major in undergrad. You can track small animal, you can track large animal or production, you can track equine, you can track mixed animal which is just like it sounds, a bit of everything, and you can track public/corporate. That is becoming kind of a catch-all. It’s everything from shelter medicine to welfare policy, to zoo medicine, to what I ended up doing, being an epidemiologist and working in public health. The corporate side I think that people certainly know about the vets at a clinic like Banfield, but they also employ epidemiologists and people that knew that kind of work, they’re industry veterinarians who work in the research lab, who work at the bench top. It can be a bit of a catch-all but one of the nice things is gives you the latitude to go within that and get those experiences. Fortunately, with some of the other campuses that are part of the Virginia-Maryland part is there is the proximity to DC and there’s other experiences to get, other connections, to some of the frankly people that we might not otherwise have access to. I remember at some point in vet school we had Dr. John Clifford come talk to our class.

He at that time, I believe, was the Deputy Administrator of Veterinary Services and he was the chief veterinary officer for the country. He was a representative to the World Organisation for Animal Health. He was giving us a lesson about—it was a retrospective on the Cow that Stole Christmas, which is a case of bovine spongiform encephalopathy, Mad Cow, that was detected in, I think, the week leading up to Christmas in 2003. Giving us the history and talking about what they would do, kind of what the response was. For a learning experience it was good timing because not a month later there was another BSE detection and we got to see Dr. Clifford really playing out the kinds of things that he had been talking about. Blacksburg [Virginia] is a couple hours’ drive from USDA headquarters [in Washington, DC], so our proximity got us some access to folks that might not have otherwise come down for those kinds of talks. Frankly our professors had connections to those folks as well, so it was really good to get that kind of great experience, that perspective of, again, what these jobs can be like, what this work can be like.

Q: Another fortunate perk.

REKANT: Yes.

Q: That’s what the public/corporate track is and that’s what you went for? That was your track?

REKANT: Yes.

Q: How did you incorporate—well, that would be easy. How did you incorporate public health into that? Are you doing your vet and masters at the same time?

REKANT: Yes, that’s actually a great thing I should bring up is that the MPH program was launching when we were arriving. It had not officially launched before we started school but when I got into—when I was—I actually got [accepted] off the waiting list the second year as well, just a little bit earlier this time, I was on the phone with Dr. François Elvinger while he was in Luxembourg because he was, I think, taking the summer off because professors are able to do that kind of thing sometimes. But I called him and I said, Dr. Elvinger, I’d love to attend Virginia-Maryland, I’m going to be in-state, this is going to work out, but I need to know that this MPH program is going to be a thing, that I’m going to be able to finish with an MPH, because as we talked about earlier, I need that MPH for EIS, it’s got to happen. I had actually been accepted to the University of Illinois, which had an established MPH program, though I would have been out of state, I think. Who knows what would have happened if I didn’t get into Virginia. I think I was prepared to go out of state because I was going to get the MPH because I knew that was there.

One of the interesting kind of somewhat formative things for me that was unexpected was we got some input on what this program would look like. It launched while we were in vet school, so our first year there wasn’t all that much going on, but during our second year we started to—I think we took a class or two on top of that curriculum, but we also talked about what the path would be like for the students, what it was going to be. Because initially there was some discussion about just taking enough classes during the four years, having no extra time. Then at some point there was a proposal to do two years of vet school, take a year off to do MPH things, and then rejoin the vet school stream with the class behind us for the other two years. We were able to push back against that. Again, being in the room with a handful of professors, and the eleven of us in my class. I think twelve. There was someone in the class ahead of us who was also coming along. Effectively negotiating what our program was going to look like was really interesting and I found myself in a—excuse me. I found myself in what would eventually become a familiar position of leading by default or kind of looking at a place where, well, something’s got to get done, and I don’t know if I see other folks doing this, so I’ll just start talking, I’ll just kind of work on this. Over time that confidence builds on itself, and you learn oh, I—I don’t want to get too philosophical or self-aggrandizing here, but oh, my opinions are valid. My thoughts are worth talking about, and sometimes that’s because that’s what other people are thinking, sometimes it’s because people aren’t thinking, and it sparks thoughts in them. It was worth whatever potential embarrassment of saying the wrong thing, of just feeling anxious about talking, to start things going to kind of help facilitate that discussion, and frankly make sure that my thoughts, but also the thoughts of my colleagues, were coming out.

Q: That was a fairly collaborative environment. You were allowed to voice your opinion, others were voicing their opinions, and together you filled in the gaps that needed to be filled.

REKANT: Yes, certainly. It was really pretty empowering to give to the students the ability to have that chance to shape things or even just to provide the feedback. I think there’s probably a bit less of that now, but when the program was starting, especially for those of us who were already in the vet school stream, it was really nice and it was a good bit of care, frankly, for them to say – hey, we’re going to meet you where you are, and we’re going to talk about how to do this thing alongside you. The path we ended up taking is a couple of extra classes along the way, some summer courses, and then a semester after the curriculum ended to focus on MPH classes to finish everything up. We also got to use our—with the public/corporate track our fourth year of seventeen three-week blocks, that’s how fourth year goes, for us at the time at least, we had a lot of flexibility. I spent about half of the year outside of Blacksburg because a lot of the rotations I was looking to do—we did basic ones that everyone has to do— of surgery, and anesthesiology, and large animal medicine, and community practice, and a few others I’m blanking on at the moment, and those have to be done at the vet school. But to get the public/corporate experience, you’re frankly not going to get it in Blacksburg.

I was able to get some local agricultural, local animal health experience at an outpost of the state Ag [Agricultural] department, but otherwise I was in Richmond, Virginia at the state health department, I was up in Middletown, New York, Newburg, New York, for that import center where very expensive horses come through. I was in Fort Collins, Colorado working in a cubicle for a couple of weeks. I was down in Atlanta, Georgia doing the CDC epidemiology elective for six weeks. Six weeks for that one, which ended up being another kind of fun EIS connection because I was looking at housing at Atlanta, they have a housing board that helps set things up, and the person who I ended up staying with, Dr. Danielle [M.] Tack and her husband Dr. Paul Hollier, these are both veterinarians, they both were in the military, and at least Dr. Tack, if not [also] Dr. Hollier, were EIS alums. They happened to have a room at a good rate, and they were helping that student kind of find a place to live for two months in Atlanta. I saw Danielle at a conference a month ago, and we’re still in touch, and she’s connected me again somewhat incidentally to some of her EIS classmates, and some other folks, and the network—again, this is as a fourth-year vet student who’s telling everyone who will listen he’s going to do EIS, people are excited about that. I remember talking to Dr. Jennie [Jennifer H.] McQuiston about EIS kind of in general. We were there because we were doing a fourth year—we were getting ready to do a fourth-year rotation project on the San Carlos Apache Nation in Globe, Arizona. Which, as I came to learn later, current at the time EIS officer Dr. Laura Adams, also a veterinarian, was running this project, and this was to do some spay/neuter work on the reservation because of Colorado Tick Fever—nope. RMSF Rodeo, Rocky Mountain Spotted Fever. Colorado Tick Fever was an EIS experience.

And we’re talking to Dr. McQuiston about some of the plans and we’re like— Oh hey, by the way, I have some questions about EIS, and she just cut me off and said, apply. Well, I want to kind of—she’s like, you should apply. So, it’s the—you should apply. Message received. She was right. I think she knew enough about me at that point and frankly why I was there. This was at CDC’s vet student day. For a variety of reasons, I think the answer was obvious and in front of her. Frankly she could have spent some time talking about the details, really going into it, but the thing I needed to hear from her was the story that stuck with me, which was apply.

Q: What year was that?

REKANT: That would have been I think January or so of 2012.

Q: This was before you graduated.

REKANT: Yes, the project in Arizona was actually one of my rotations where we—again, this is one of these chances to be game and solve the problem, we were at a spay and neuter clinic at the Boys and Girls Club on the reservation out there. Which one of my favorite pictures from that is I’m wearing gloves, and I’ve got my surgical equipment, and I’ve got a mask on, but I’ve got an old baseball cap with a little work light attached to it. That’s my surgical light and you can see that it’s not a typical veterinarian surgery suite around me, but we were there to do some work. It was a really good experience. I got a ton of surgery experience in the way that we really didn’t get at that school, but I really enjoyed. Later that year, during my fourth year, again we had those seventeen blocks, and I used it to get a variety of experience, to do my MPH project on rabies post-exposure prophylaxis with Dr. Julia Murphy, the state public health vet in Virginia, and also to see what her job was like in the wide variety of things that came in the door for her.

But one of our seventeen blocks is vacation, three weeks of vacation. I had just been basically saving it trying to make sure I had space in case a travel plan went wrong, or something like that, so if I had to take it in October then I could take that trip I was supposed to take in October in April toward the end of the year. Fortunately, none of those hiccups happened and I had my vacation block as my last block. Right in the middle of that block was the EIS conference that year. It’s a six-ish hour drive from Blacksburg to Atlanta and EIS conference is free to attend. I just had to figure out where to stay and I wanted to go. I actually reached back out to Danielle, Dr. Tack, who introduced me to Dr. Amy Peterson, another veterinarian, another EIS alum, who was renting a house for a week, and it had an extra room, so I ended up staying with Dr. Peterson for that week, and attending conference, and attending Dr. Adams’ talk about the project I had done out in Arizona. Just kind of seeing that I—similar to my experience at UVA where maybe I was a little bit less sold on it at the time, but I was there, and I kind of felt like yes, this feels good, and comfortable, and I like these people. I went to the EIS conference, I knew at that point I wasn’t going to apply right then, I still had intended to, but was going to finish up the MPH and apply following that. It was just a good time. I enjoyed going to the talks, I went to skit night which was kind of fascinating to see. But again, after going to a week of really professional and impressive talks to see, oh, these are real people too, was a great reminder for me. I still have a very grainy video of them doing the Thriller dance and I think they did the Harlem Shake, which again, it was the spring of 2013, so some things have come and gone since then. Yes, it was really neat to get to go see that and it only kind of strengthened my resolve that that was going to be on my path.

Q: Excellent. Then you graduate with your MPH and where are you now? Where are you going now?

REKANT: I mentioned when I met Dr. Jason Baldwin up at Cornell, part of that program, part of that week-long summer experience was going to Plum Island. The Plum Island Animal Disease Center, which is a USDA and DHS [Department of Homeland Security] run research lab off of Long Island in New York. I had gone up there and got experience, and by that point my friends knew me as the foreign animal disease guy. When stuff came up, they’re like oh, Steve, you should take a look at this. There was an ORISE scholarship, Oak Ridge Institute for Science and Education, or Science Education, I forget, an ORISE opportunity at Plum Island. This is one of the great thing about ORISE is that you get that access, you get that exposure that you wouldn’t have gotten, not as a fresh out of vet school, even with an MPH person interested in that kind of thing, I was not going to get a federal job at Plum Island. Those are tougher to come by. But I can get an ORISE fellowship and I can get up to Plum and do some interesting work right away, right out of school, not have to get some more experience before.

I was hired to this position with USDA ARS, the Agricultural Research Service, in the Foreign Animal Disease Research Unit. My project was effectively to determine whether or not an infrared camera was an effective tool at diagnosing Foot and Mouth Disease. One of the things that was a pretty big limiting factor in the UK [United Kingdom] when they had an outbreak of Foot and Mouth Disease in 2001 is that veterinarians would go on to an infected farm and they’d have to sit on the bench for five days after that. You couldn’t go to the next farm, you couldn’t investigate the next farm because—this is complicated and somewhat debatable, perhaps, but you were a risk of spreading disease to that farm if you went to the next one. But it took a veterinarian to diagnose it, you had to do a clinical exam on the cattle, on the sheep, whatever it was, to determine if they had Foot and Mouth Disease on the premises, so you had to do that. The idea of the infrared camera was what if you could sit at the fence line, you could sit outside, or you could even use someone who was specially trained in this, or frankly wasn’t as focused as a veterinarian might be as far as the training experience, and you could get at least get a sense, you could get a screen of just shooting an infrared camera looking for—frankly look for hot feet and hot cows, and say, hey, we didn’t do a physical exam, but we suspect diseases here, so we’re going to do all the quarantine, we’re going to do our intervention here, and really help stem the potential spread a bit more quickly.

I was hired for that project, I did a bunch more when I was at Plum. The infrared camera is affected by surface textures and it’s doing surface temperatures so one of the things that happens in the room with the cattle is they get washed down every day, which is great, and helpful, and very important for a variety of reasons, but if you’re going in with an infrared camera and you’re taking a picture of wet cattle, they’re going to look artificially cold, so your project is not really that helpful. I would take the boat to work because Plum Island is an island. Take the boat to work—I guess I would take Dramamine and then take the boat to work every day for two and a half years. I’d get to the animal rooms early, take my infrared pictures, and then help the technicians with some of the prep because we had to do the cleaning before we did the other experiments where we did nasal and oral swabs for Foot and Mouth Disease, where we did physical exams, and that kind of thing. My mornings were often go and take some pictures, put the camera in the pack, and then help out with the experiment for that day. Then in the afternoon come back to the lab and process the samples, run the assays. I ran, I guess it’s technically not countless because I have my logs and can tell you how many I did, but effectively countless ELISA [enzyme-linked immunoassay] test samples to understand some of the cytokine profiles, and I was doing that for basically two and a half years. The ORISE program is a one-year program, or one year at a time rather, but at the end of one year you and your supervisor have the option to mutually renew.

There are a couple other projects, I went up to the University of Vermont to use the infrared camera in the field, which was really interesting to work on the dairy for, gosh, I was there for three weeks I think, and then back for another week later. The whole time being very worried that I was going to spread Foot and Mouth Disease to domestic cattle. I guess I should note, Foot and Mouth Disease, which is what we study there, has not been detected in this country since 1929. It is genetically similar, it’s related to Hand, Foot, and Mouth Disease that children often get, but it’s a different virus specifically for livestock, and some other assorted species, but mostly for livestock. It’s not zoonotic, so would not really affect us directly, but it’s a really important One Health pathogen because of what it does to food security. It’s not great for the cattle. It doesn’t often kill the cattle, it sometimes is fatal to young animals.

Q: Virus or bacteria?

REKANT: Virus. Yes, it causes production losses. It makes production animals less productive. They produce less milk, they produce less meat, they gain less weight, and that has the knock-on effects of making the animal products more expensive because there’s less of it, so there’s some scarcity, but then the people that are producing them are producing less, so their economic remuneration is lower, and it really causes some knock-on effects that can have some serious problems. Even though humans won’t get sick from this virus, infections can still cause serious health problems to humans indirectly. It’s a disease of economic importance. When I was going to the farm up in Vermont, we made sure that I had a cool down period outside the lab for a couple of days to meet guidance, and again, we’re just very careful to not frankly torpedo my career in veterinary medicine if I was the person that brought Foot and Mouth Disease back to the US. There’s a special dispensation to have the virus on Plum Island and that is the only place in the country, I believe, where it exists.

Q: That’s only used in the lab there on Plum Island.

REKANT: Yes.

Q: So—go ahead.

REKANT: No, I was going to say EIS was the next step in my plan. I had actually gotten my materials together and had applied, I’m trying to get my timing right, I had applied to the class of 2016, so I was up at Plum from fall of 2013, as I was actually finishing my MPH from afar, and I actually went back to Virginia to do one last test and presentation in December, and I was there [at Plum] again for two and a half years. I was applying to the [EIS] class of 2016. I actually did not get in, I did not get an interview, which was disappointing. I had talked to some folks in the program, people had been mentors of mine along the way like Dr. Tracy Dutcher, who is at USDA, who is an alum, and I did a rotation with her in [vet] school, Dr. Stacey Bosch, who I think is just now leaving the program, but was a veterinarian with the EIS program for a while. I had done my epi-elective with her in DFWED, Division of Foodborne, Waterborne, and Environmental Diseases. That was my first actual CDC experience looking into salmonella and pet turtles and learning how many people will hug and kiss their turtle goodnight and then maybe get sick with salmonella. I talked to Dr. Dutcher, Dr. Bosch, again some folks that had been helpful along the way, and just thinking about what I might do if EIS was not going to happen, at least not at this point. I took the somewhat typical approach of applying to everything on USA Jobs trying to figure out what the next step might be. Fortunately, I found a job with the Select Agent program, which is a program that is co-run by USDA and CDC to inspect high containment labs frankly like Plum Island, like other places, and in this case my high containment lab experience had served me quite well because it was experience that a lot of folks didn’t have.

Plum, we talk about being worried about taking the virus back with you, there are some interesting ways in which that manifests. For one is you shower out of work every day, every time you leave an animal room you shower, so some of those days when I was going in early to take my infrared pictures and helping with the experiments, and actually would for one set of experiments came back in the afternoon to take pictures again, I was taking five showers a day at work.

Q: Dry skin.

REKANT: Yes, it’s funny the conversations you have with some folks when you get up there, they give you recommendations on the best lotion. We have health technicians who do a ton more going in and out of the rooms, you see some guys show up with I guess really any hair is the important thing, and pretty quickly there’s a lot of buzz cuts that happen, a lot of just making that part easier because you’re showering, again, a lot more than I was even, every day it’s part of your job, anything to make it easier, make it quicker, was the way to go. But some of those other funny ways are I remember being out at a bookstore in Connecticut where I lived and at some point, turned around, an outdoor mostly bookstore, and they had a goat on the premises. Well, I had left work two days prior, because this was a Saturday or a Sunday, and I had been in the lab, and goats are susceptible, and my quarantine period was five days. I very quickly I was like, I have to go. I was there with someone, we had to leave very quickly once I realized that. Or the time I ran into a petting zoo at the mall, and I just turned around and did my shopping elsewhere that day.

Q: Wow. I can’t imagine being with someone and them saying – We’ve got to go, there’s a goat here.

REKANT: I actually took a vacation with friends of mine, we went to Chicago for a week, and we did a bunch of interesting stuff that was a lot of fun, but we couldn’t go to the zoo because I wasn’t allowed to be there. Another kind of funny quirk, to help, if nothing else, maintain my sanity the whole way through I played in band, I played the horn. I learned through—actually when I was here in college, no, when I was here in vet school rather, I brought my horn with me, I played with the community band for the month and a half just because it was fun to get out and play. I had played with community bands in Charlottesville when I moved back there, I was playing with one in Blacksburg when I was in vet school, and when I moved to Connecticut, I played with the Old Lyme Town Band up there. At some point it just kind of came up that I worked at Plum Island, and the conspiracy theories are fun about that place, and quite well known. When I mentioned that everyone around me just like moved their chairs a little bit further away.

But this was actually it was in service of getting the band there. I, in kind of an effort of—I think part of it because I thought it was entertaining to have that reaction but to help demystify it, to do some public health outreach and communication, I worked with our folks, the public communication people at Plum Island often had people come visit the island. It was the Garden Club and whoever else, and this was a great chance for me. I was like, if the band is interested, we should bring them out there, and really kind of help demystify this place. It was great, to get my timing right it was probably in 2015, so I think it was seven years ago last week that the band came out to visit Plum, and I have my picture reminder of that the other day.

Q: Oh, did it come up on your phone?

REKANT: Yes. Just exciting to get folks out there. But again, to help take this really secretive work, it’s not secretive by nature, it just has that reputation, and help show folks. I talked about Foot and Mouth Disease and people didn’t know what it was. Understanding why it was important to do that work out there I think was important for me to help understand that. I don’t know if I knew it at the time that’s what I was doing but it was nice to kind of connect that work to the broader public, for me another part of my life in playing with bands, but also just another set of the public to understand kind of what we do, to help tell more folks that veterinarians are not just in the clinic sometimes.

Q: Then you demystify the whole Plum Island thing, and they can go and tell their friends that oh no, it’s not aliens.

REKANT: Right. You joke about that, that’s a—the Montauk Monster is a fun conspiracy theory.

Q: Wait, what’s Montauk Monster?

REKANT: Montauk is a mostly resort community on the end of Long Island. Plum Island is actually closer to the north fork of Long Island than anything else, although the boat ride I took from Connecticut was a bit longer, there was just more to do in Connecticut than that part of New York, so that’s where I lived. The Montauk Monster is, I believe it was a raccoon. It was some unfortunate animal that drowned and washed up on the shores of Montauk but because it had been in the water for so long really just started to look kind of weird and a bit different, and because it was close to Plum was very quickly tagged as some escaped biological project. Just again, fed into that Plum Island created Lyme Disease and used it as a bio-terror weapon, which is a good bit of nonsense, there are a bunch of reasons to know that’s not the case. It did lead to a very awkward lunch actually when I caught up with a friend from college who had since gotten a job at a Lyme Disease non-profit and herself believed that conspiracy theory when I was working at Plum. It made that lunch a little bit awkward to talk through that.

Q: Yes, I just looked it up on Wikipedia.

REKANT: Yes, not an alien but maybe closer than folks might expect.

Q: It’s a gruesome picture.

REKANT: I got the Select Agent job and was inspecting labs for a couple of years. USDA, specifically Veterinarian Services, every so often will sponsor an EIS officer. In the spring of 2017 there was an educational webinar, there was an advertisement for this, and again I had been thinking about it, had been thinking about getting my application back together, but really wasn’t sure. I had kind of frankly by not getting an interview, not getting in, I was a little bit unmoored from my plan in trying to figure out what to do. When this opportunity came along, I took a quick moment to think, well, it’s a training program, EIS is—I’m already a federal employee, I’ve got some training since I applied last time, is it really something that’s going to benefit me, and I very quickly dismissed that as nonsense because yes, of course it will. I applied to the sponsored position and was fortunately enough to be accepted. Through the long process of applying to EIS, again, I applied in—I applied to USDA in the spring of 2017 with the intention of starting EIS in the summer of 2018 because that’s how the timeline goes. Fortunately, I was picked as the USDA sponsored candidate.

It’s funny I was telling someone just yesterday— it wasn’t entirely clear to me if I was guaranteed a spot in EIS because of that [USDA sponsorship]. I still went through the CDC application portal, and I did interviews, and that kind of thing. I was pretty confident that I was in because of the sponsored nature, so I perhaps was a little more relaxed during my interview than I might have otherwise been, which I think worked out great. Again, fortunately was accepted. Finished up my Select Agent work and again the timeline is pretty—it’s a long tale on that application, but still was able to do inspections with Select Agent, and was glad to then start the next thing, to get I don’t know if back on track is quite the right word, we’ve talked a bit about how the path is not really set out, but to get back to the way point I was really hoping would be part of my path.

Q: This is something that you’ve been, I don’t want to say dreaming of, but really wanting to do since early 2000s, mid 2000s, and now you’re there.

REKANT: Yes, since talking to Dr. Walters in 2008 and learning that EIS existed. Then talking to people during that school because I was at CDC for the epi-elective, Dr. Bosch herself is an alum, and there were other folks in DFWED [Division of Foodborne, Waterborne, and Environmental Diseases] who were alumni, and they connected me to other EIS alumni, and it’s a great network, and it did very little to slow the momentum of me wanting to go that way. Come winter—or I guess fall of 2017, I believe when Jenn Wright called me and let me know. Dr. Jenn Wright who was also frankly in DFWED when I was there as a student for five years prior. It was really exciting still to get that call in the fall of 2017 and start to plan for what was going to be next.

Q: They usually call in October and then you don’t go to EIS until April?

REKANT: Yes, the EIS conference is when everyone matches. For mine it was in April, it’s pushing into—I think this past year was in May, the next year is going to be in the kind of end of April beginning of May timeframe. This is a thing I didn’t realize when I was a vet student attending an EIS conference, I was just going to talks. A lot of people are just going to talks. But the incoming officers are spending their entire week in this weird week-long speed date experience of talking to prospective sites and just trying to figure out the best match. I got some really good advice during that process, kind of leading up to it, specifically I remember hearing it from Dr. Casey [E.] Barton Behravesh, who was also in DFWED at the time when I was a student, so we kept in touch, but she is now and I believe at the time then even, was director of the One Health office, and in a nice bit of symmetry is someone that I work with on an at least weekly basis now at my current job. Casey told me it’s in order, if you can, it’s people, then projects, and then place. When you’re trying to match with an EIS spot, the most important thing is that you get along with supervisors, that you’re going to mesh well. EIS, the program does a nice thing of connecting you with an EIS big sib [sibling], a current officer to help just kind of answer questions. I remember mine in particular saying he’s got family near where his assignment was and he really felt the work was interesting, but sometimes he didn’t have quite the same— style, same work style, as his supervisors, and it made the experience not great at times. Which again, he checked the place box, he checked the projects box, and I don’t know if he knew this coming into it, but the people part really can be overriding.

With that in mind, I went to go match. I knew coming into EIS—I should back up a little bit. With the USDA program, with the sponsored position, you remain a USDA the whole time. I was a USDA employee effectively on loan, on detail, with CDC for two years, which comes with a continuous service agreement. I was going back to USDA when I was done [with EIS], I’m in the middle of that [obligation] now. But one of the really nice things, because I know other entities will sponsor positions sometimes for foreign health ministries, and the military will sponsor officers sometimes, and I think sometimes the—I think the plan can be a little bit more laid out for them. When I was talking with the program folks at USDA I asked should I go somewhere in particular, we’re going to do a lot of foodborne work at USDA, should I go to DFWED? And what they said was go where you want to go. We want you to get the EIS experience and we don’t want any restrictions on it. Which was great. I was glad to have that flexibility. I still used that coming back to VS [veterinary science] perspective to help inform my choices but for me EIS was always going to be—not always, after a bit, at least to kind of crystalize in the years coming up to it, but it was going to be a field experience.

I think I would have been happy at headquarters, there’s interesting work to do, but stemming a lot from my experience with Dr. Murphy at the Virginia Department of Health and seeing just the variety of stuff that came in, working on issues with local shelters and unowned cats, looking at rabies in livestock, look at disease disaster response teams, and studying for that training over the course of a week, when I think back to working in that clinic it wasn’t ten-percent variety and ninety-percent kind of routine things, it was seventy-five, eighty-percent variety, and the rest of it was routine things, so that kind of pace, that variety really appealed to me, so I was going to be out in the state. The way EIS conference is set up, the state and local departments that are matching up are in their own room and then the different—I think it’s organized by center, the headquarters positions are in other rooms. I walked around a little bit, I went to some of the center-based rooms, but I spent most of my EIS week as an incoming officer in the state room, and just talking to folks. It’s such an interesting experience where you have your spiel, you have your questions, and you sit down with supervisors in Oregon, and you have a five to fifteen minute conversation about those things, and you get up, and you walk ten feet to the table for Minnesota, and you have the same conversation, sometimes within earshot of the previous table, and you get up and you talk to Washington, and you get up and you talk to Arizona, and you do that kind of day after day. It’s not the same thing, but if you like a position, you go back the next day and you just—again because I had that lens, that framework of the people part, really focusing on that, I just wanted to talk to folks. I wanted to get a sense of what it might be like to work with them. I remember very distinctly the two supervisors who were there for Oregon, we talked about playing cards, we talked about one of the supervisors is from effectively the same part of Jersey that I am, but she and her husband had been in Oregon for a while, and we talked about the food that we missed from home. Talked about work of course as well, but it was really nice to get a more human picture of these folks.

I got that sense from other people as well, other states, but Oregon sticks out because that’s where I ended up going. One of the things, and to this day I point it out to incoming officers, and really it was one of those things that’s important, it’s not necessary, and it wasn’t on its own going to be enough, but in the Oregon position description I believe the phrase they have is “excellent soup club”.

Q: What does that mean?

REKANT: On Tuesdays through the winter the Oregon Health Department, the Oregon Health Authority, specifically through Acute and Communicable Disease Prevention, where I was stationed, runs a soup club. Which is there are three soups each day and everyone signs up over the course of the season, and you bring in a crockpot full of soup on your day, and that’s your ticket. If you’ve signed up, then you get to show up next Tuesday and just eat soup that someone else brought. There’s a vegetarian option, there’s a meat option, there’s a more flexible like chef’s choice option there, so everyone has got something potentially. Over the course it’s really a nice way to talk to folks, it’s a kind of fun thing for people to participate in.

Q: Do you swap the soups? Do you get to take them home?

REKANT: I think you’re supposed to take yours home at the end. There’s not usually that much in the way of leftovers. But it was also, it’s funny to think about this, because when you’re at EIS conference as well, you’re getting along with your colleagues, you’re meeting your classmates often for the first time. You met some folks during interviews and all that, but that was nine months ago. My colleague and a good friend of mine, Michelle Holshue, who was the officer who matched to Washington, gave me great advice as far as this question as kind of a proxy for the social environment at the department was to ask about where people eat lunch.

Were people at their desk, are they going out to lunch together, are they meeting in a cafeteria, and again, soup club—did I eat lunch at my desk most days at Oregon? Yes, probably. But every Tuesday in the winter was I having soup? Every Tuesday in the summer it became salad club because soup is not a great summer food. Was I having soup in the winter and salad in the summer every Tuesday? You bet. Spending that whole time getting to know my colleagues, the folks in Oregon who really became good close friends. I know we’ll touch on a bit with the pandemic response, but having friends, being able to walk into a room and see my friends, who happen to be smart talented people as well, and doing good work, and dedicated to it, really made stuff a good bit, frankly, easier.

Q: Sounds like a wise decision to do people, project, and place.

REKANT: It worked out great and it’s the advice I give anyone and everyone who’s willing to listen.

Q: [laughs] That’s great. Did you move from Virginia to Oregon?

REKANT: I feel compelled as someone who didn’t know coming up there, but now does know, it’s not Oregon, it’s Oregon.

Q: Thank you, Oregon.

REKANT: Yeah, Oregon is actually full of shibboleths.

Q: What?

REKANT: Shibboleth.

Q: You’re going to have to spell that later.

REKANT: I don’t know that I can. I can try. It’s actually a biblical story. It’s a word—it’s pronouncing a word to kind of show the people that you belong. In this case, I forget what the story actually was, but because of the dialect of one of the groups at war, they couldn’t pronounce—they didn’t pronounce shibboleth in the same way, so you could actually tell who was trying to maybe be a spy and get through, or that kind of thing. In Oregon, if you say Oregon, if you mispronounce the name of the river, which is the Willamette River, there is Couch Street, which is spelled like couch. These are all these little shibboleths. Some of these things that are—I think shibboleth is by definition a spoken thing, but I learned really quickly there were a lot of markers for Oregonians that you’re not a local. If, for example, you use an umbrella when it’s raining because true locals, they have the rain gear that they need, and you know what, sometimes it’s just kind of a light rain and you don’t need anything. I say that kind of jokingly, but I really came to adopt that over time. I still have an umbrella in my car just in case. I mentioned going for a walk at the end of the day and we don’t really get a light drizzle in Atlanta, so it’s not borne out the same way, but if we had one of those, I would sometimes just keep walking, don’t need a coat, don’t need an umbrella, it should be all right.

Q: Until you reach that place where they have incredible air conditioning and you’re wet and damp.

REKANT: Yes, definitely coming in from that was important. From Connecticut I moved to Virginia for the Select Agent job because that was my first experience with remote work. That job is based out of your home except when you are traveling. I traveled forty, fifty percent of the time, and when I wasn’t traveling I was at home writing reports from where I had just been, preparing for the next experience.

Q: That’s a lot of traveling.

REKANT: It’s a lot of traveling. It was really good experience as a veterinarian looking to become a federal employee. That was my first federal job, it was a kind of neat flexible way to do it. There are other more common ways that folks get their federal stamp, as it were, that are probably a bit less fun, and frankly I don’t think I would have taken to quite as well. It was a good way to do that and to see different parts of the country. I actually was in Atlanta a lot. The CDC was inspected a couple of times and we had trainings here a good bit. But I was living in Virginia partially because it was closer to my friends, I went to undergrad at UVA and vet school at Virginia Tech, and a lot of people moved to DC, and partially just because it was, I don’t know, a place I wanted to be.

I was living there, and I got into EIS. I came down to Atlanta for a summer course—[coughs] excuse me. I came down to Atlanta for a summer course, me, and my cat, and then I drove out to Oregon. I had never been to Oregon before this experience. I had visited family in California before, I had been to Seattle for a bit of training when I was in vet school, but I missed a state in between. Again, I think—not again, I don’t think I’ve said this at this point, but I viewed EIS as two years of adventure. I could do kind of whatever it was. I was not necessarily up for traveling so much in my kind of general constitution but one of the reasons I worked the public/corporate track in vet school, not just because the work suited me, is I kind of wanted EIS training, I wanted to spend three weeks in upstate New York, or middle New York, and then travel somewhere else, I wanted to kind of desensitize myself to being asked to get up and go quickly and adapt to a new place.

Q: That is EIS.

REKANT: Exactly, and I knew that, I knew I wasn’t, frankly, good at that. I had trouble going down to Virginia initially when I went to school for undergrad, I had trouble going from undergrad to vet school, just kind of adapting to the new place. I knew that about myself, and it was a weakness I wanted to address. So, I tell—traveling and that I think really helped open up when I was looking at states to apply to for EIS to try and match with, I think everything was west of the Mississippi, at least high up on my list. I’m someone who kind of, I think my running joke for a bit, was I had never received mail outside of the Eastern Time Zone before this experience. I went up and down the coast for school, and for work, and that kind of thing, but I was an east coaster, and still am an east coaster through and through, but I’d never been to Oregon. I left Atlanta the day after summer course ended, I picked up my sister in Nashville, Tennessee, she flew down to meet me along the way, and the three of us, me, Julie, and Zeke the cat, spent the next week driving across the country. It really was an incredible experience— it was a ton of fun. My sister is seven years younger than I am and we were close growing up, but at this point she had gone off and become a bit of an adult, and we got to connect in a different way. She was, I think at that point—I’m trying to think if she was in grad school at that point. I think she was in grad school at that point in a combined physical therapy/PhD program. We, in addition to having a lot of shared experiences growing up, we got to kind of talk shop about science a little bit. It really was a great experience.

Got out to Oregon and my first day was August 13. That was the Monday after—again, I had the week in the car, and settled into my temporary quarters. I was in temporary quarters for the first couple of weeks out there.

Q: Are those assigned to you?

REKANT: No. This part will make any other EIS officers maybe a little bit jealous. The sponsored position with USDA is a GS13 position, whereas most EIS officers come in as a Title 42 GS12. I believe starting with my class, people came in as a GS12 step three because CDC—[coughs] excuse me. Because CDC was no longer paying for relocation. USDA not only gave me a GS13, but also paid for my relocation. I found an Air BnB for, I was there for I think two weeks, and was scouting out apartment in the meantime, and found one that I ended up being quite happy with that was actually a walk from PSOB, from the Portland State Office Building where I worked, which was really nice. The location was nice, the apartment was fine.

It was not assigned, that was a place that I found when I got out there and was able to get some advice from people at the office, and from the small handful of friends in Oregon I had coming into it, into Portland, about where to look, and that kind of thing.

Q: It’s expensive?

REKANT: Yes, coming from DC I kind of expected that I wouldn’t get so much sticker shock, but it was—it was also a bit more urban, I guess, for lack of a better—it was more downtown than I’ve ever been. I lived in Virginia outside DC, but I was in the suburbs of Northern Virginia, I wasn’t like in the city. When I was in Connecticut, I was in rural shoreline Connecticut. Undergrad, vet school are kind of more out there parts, so that was the—going to Portland living a block away from where the Trailblazers play, that was a bit more built up, and therefore more expensive than I think I was maybe expecting, ready for. Like I said, I was being well-compensated for work, and it worked out fine.

Q: And you could walk to work.

REKANT: And you could walk to work. Yes, that was, again, one of those lessons I think I got from my time in Virginia where I was working from home and I would kind of get to the end of a day like, oh, I haven’t talked to a person or gone outside today, and I don’t feel good, so I started to learn a couple things there. Having that—I mean, walking to work was just great in general but also it was a nice signal to me physically like work is starting and then work is ending.

Q: Bookended.

REKANT: Yes.

Q: Assigned to Oregon Health Authority, is that correct?

REKANT: Yes.

Q: What does that entail? What does that mean? What is your day like? Going to the—you walk to work.

REKANT: Walk into work.

Q: Coffee?

REKANT: No, actually that’s a whole other thing. Put me on the outs with Oregon folks because I do enjoy coffee, but it was not part of my day to day. Fortunately, sometimes the walk into work was enough to get things going. It depended. There were some days that were kind of more regular in that they looked like the day before and the day after. But I got to participate in a variety of things. One of the great lessons I learned, and I think one of the things that made Oregon a great spot, a lot of EIS positions are like this, is that they’re supposed to be able to function with or without you. Your presence there doesn’t keep the lights on, doesn’t keep kind of the regular machine running. You get to be there to help as special projects come up, but you’re there to train, it really is a training program. I was glad to have the flexibility and the latitude to focus on that. Projects would come up and I joined our Cluster Buster’s team where we looked at foodborne disease illnesses, disease clusters, and kind of investigated those. I was on call for taking phone calls during the day, which led to just some great stories and fun interactions with the public. Not all of them fun, of course, but really interesting, and in a way that was kind of new to me, or at least not since I worked in a clinic, that feedback loop, that the work I’m doing and understanding how it impacts people was so much tighter, was so much closer working at the state health department than it was at a researcher at Plum Island, than it was an inspector going to research labs, where sure, I understood the feedback loop of the lab, and writing up the report, and that kind of thing, that was close. But the actual impact of protecting the public, knowing that biosecurity was good to prevent release, or helping the research forward, those are really long feedback loops, and it’s sometimes tough to stay motivated when you’re not getting that reinforcement. One of the nice things about being at the state is you did get that. You got really into it a good bit. My first day within literally half hour of walking in the door I was part of an outbreak investigation. This is where being game becomes an important part of it, this was about measles, and I learned very little about measles in veterinary school. It’s a human pathogen. There are diseases like it in animals, but you don’t really learn so much about it.

This was a great lesson for me because not only was it about something I didn’t know so much about physiologically, but I could still learn to apply some of the epi principles I learned. It was a great lesson in the importance of relationships, which became a theme through all my time at EIS, and frankly as part of a lot of my job now. In this particular case, people knew how to investigate measles outbreaks. They knew someone had this—in this case someone had been at a wedding, so they knew how to do contact tracing from the wedding, from the nail salon, from the rehearsal dinner. But this person took ride-sharing services around town as well, and when I get an Uber, or more importantly when I get out of an Uber, I see a receipt that says, oh, your driver was Chris. When the health department calls me up as someone with measles and says, who have you been in contact with in the past four days, like Chris from Uber. The relationship we had to, in this case build, this was totally new for them, was to go to these companies and say, we need you to give us information so we can do public health. This was a bit new to them in some ways. People hung up on us.

Because when we call up a company that is in the public eye for having a lot of data, and tells its users we protect your information, and the health department says, we need to know who drove Steve on this ride, and we need to know how to contact them. [coughs] Excuse me. If you don’t understand the public health importance of this, your knee-jerk reaction is no, we protect our users’ data, thank you, goodbye. It was really interesting to get that experience to learn that the companies we were working with had physical offices in the Portland area, so we could go in person and talk to someone, and really for that particular relationship it was important to show we were serious about this and here’s how we can help answer questions for someone who is ready to hear our questions. Part of that was really helpful too, both for me, because I got to show the folks in Oregon that I’m willing to dive in, I was just game for this, but also when it came time to do COVID-19 contact tracing, and we called up the people at [ridesharing companies], they had worked on this, they had figured out how to do this data sharing, and we could do that contact tracing a lot more easily than two years prior when it was a totally new experience to them. That really came back. It was interesting.

Q: Something new that public health has never had to—yes. But also coming up will also be important when we get to COVID, yes. Other things that you were assigned to besides measles, there was shigellosis, am I saying that right?

REKANT: You are, yes.

Q: Outbreak at a wedding.

REKANT: Yes, my first day of work was the measles outbreak. My second day of work we got notified of this Shigella outbreak associated with a wedding. Actually, those two outbreaks followed me through my EIS career. I presented them both at [EIS] conference. I keep presenting them actually when it’s time to talk about my time in Oregon.

Q: Is it because they’re classic outbreaks or?

REKANT: They aren’t actually, which is I think part of why. With measles—measles, that part is a classic outbreak to investigate, but the ride-sharing part was new. That was what made it more interesting. That’s what caused someone at CSTE [Council of State and Territorial Epidemiologists] Conference a year and a half later to call it “nightmare fuel” because we hadn’t really thought about this, this contact tracing, these exposures with a disease like measles maybe a bit less so because it spreads so easily, but something like SARS-CoV-2, with COVID-19, you know who your contacts are. I know generally who I spent time around. But I don’t know my Uber driver, I don’t know my Lyft driver, and trying to follow it up, if you called me up and asked me to do contact tracing, I could tell you here’s my fiancé, here’s her phone number, I was talking to the neighbor, here’s their phone number, I was at work talking to these folks, here’s how to contact them.

But I couldn’t tell you how to contact the folks that were giving me a ride somewhere because we talk about fifteen minutes within six feet, that’s usually thinking about in buildings, and we think about measles exposure kind of the same way, but if you’re in the car with someone that’s definitely close enough to transmit. That was what made that one a bit new. With the Shigella outbreak it was classic in that it was a foodborne outbreak, it was a wedding, we had frankly really good data, good cooperation from the local—the health department did great work working with the bridal party, but Shigella is kind of a weird one. It’s not typically foodborne. Oregon actually experienced an outbreak of shigellosis of people experiencing homelessness. Shigella is a waterborne bacterium so often after big rains we would see disease spikes and without access to clean water, it became a real risk. But for foodborne outbreak, that was really something uncommon. It was the second largest foodborne outbreak of this kind of Shigella ever reported in the US.

Q: Where was it found?

REKANT: I’m laughing because of one of my favorite slides that says –It was probably the asparagus. But we did a little bit of environmental sampling, we tested food, and we couldn’t—we never found it in a person that was working the event, or we never found it in the food, or the water, or that kind of thing at the event. This was a really important lesson for me too because we didn’t have lab evidence—we had lab evidence of the connection of the outbreak, but not the source. We didn’t have environmental evidence of the source but we had epi evidence. I did extensive food questionnaires, food exposure questionnaires, and we had pretty good data on that. We were able to say hey, we don’t have this part, we don’t have this part, but with this information we can say pretty confidentially what the cause was, what the culprit was here. Which was a good bit of training for me because in school you’re like you need the three parts, and in practice it’s like it’s great to have the three parts, but one of the great lessons I learned in Oregon, and again at the pace of a state department in particular, or even a local, is work’s got to get done. It’s great to have all of our data, and you can analyze all day long, but it’s important to make decisions, to kind of come to conclusions that are hopefully supported by the data, but really have to be put into practice.

This came back in a big way with COVID-19 because we did a lot of decision making, I wouldn’t say in an information vacuum, but without the answers, had to kind of come up with guidance without really knowing the answer sometimes.

Q: You mentioned COVID, which is the elephant in the room here. How did you start hearing about COVID?

REKANT: When I was getting ready for EIS and just kind of in general, I was paying more attention to ProMED, which is a daily email from the International Society for Infectious Diseases, I believe. It’s a daily digest of, it can be zoonotic focused, it can be plant focused, it can be human focused, it can be regional. I was getting the broad digest because it was really helpful for me to prepare for preventative medicine board exams. I was just in the habit of reading ProMED, just scanning, looking through. At the very end of December 2019 and in early January there started to be some of these messages, these new stories that were captured there about unexplained flu-like illness in China, and that’s kind of where it started. That’s why I first became aware of any of this. Within a couple of weeks of that Oregon started to spin up our response.

Q: Did that include cruise ships? Did you have cruise ships coming in?

REKANT: Yes. There are ports in Oregon that are big cruise ship destinations. Frankly are pretty important parts of local economy in some of those cities. There were cruise ships, later on there were fishing vessels that go out are out there, this kind of self-contained little city for two, three weeks at a time, which is something I had very little experience with. No experience with. But we started to hear about it, we started to hear about the repatriation efforts to get some of the American folks out of China. One of my first memories from the response, so we spun up the response with I think there are mid-teens to twenty people on that first set of paperwork, the incident action plan.

Q: These are all people from the Department of Health or are you working with other organizations?

REKANT: This is all from the—yes, this is all the State Health Department at this point. We organized our incident management team for information management at this point. There weren’t cases—we had not detected cases in Oregon. But there was a lot of chatter about it, and there was a lot of work going on, again, with repatriation, and like screening at the airports was a big part as well, so a lot of my work early on I remember going to, it ended up being a disused men’s shelter, because we were looking for a place to potentially house people coming in from China. People coming in on the airplanes to have to—both they had to quarantine for some time, and we had to house the people who were responding to take case of them. Scouting out a potential location to house the folks. We ended up not receiving those people who were repatriated, so it ended up not being an issue, but having that experience, going out and kind of being ready for that, was one of the first kind of oh this is going to be potentially real, a potentially big thing that’s going to impact our work in a broader way. There was a bit of that.

There was a lot of our work early on was getting lists from CDC of people who had been on planes and who had transited China or some of the other areas where early cases were detected. We weren’t doing the calling necessarily, a lot of this was—Oregon is a home rule state, so the local department is in charge, and the state helps coordinate. But the list came to us, and we had to come up with ways to tell Washington County, Multnomah County, Wallowa County—Wallowa is a bad example because the state—they don’t have a local health department and the state runs that one. Harney County, Clatsop, all of these places we had to tell them— Hey, you had some residents, so we would like you to follow up with these people and ask them to quarantine, check for clinical signs, add them to your list.

Q: Quarantine was how we handled it first on, so there was no testing at this point in time. It was just let’s isolate these people and see what happens.

REKANT: I think for a little bit there Oregon was able to run—through our state public health lab, working with CDC, I think we were able to run one plate of tests per day, which was I believe eighty samples, probably fewer than that because they were probably controls, but it was one set of test results. Which was interesting because we got into a cadence early on that was not the most helpful. It was fine when there were no positives, but because they had one to run, because it took time to get the samples in because they wanted to make sure that they most efficiently, that they were—Oregon is a pretty rural state in some places, and to get a sample in from Southeastern Oregon up to Portland in the opposite corner takes some time. We want to provide good service to all Oregonians, so it makes sense to wait a little bit for that sample to come in to then run the assay a little later in the day, make sure we’ve gotten theirs. That meant if we were getting positives when a positive—when a single case was really the big news, that news came in between five and six PM. Which is not really the ideal time to start doing a lot more work, to say hey, we’ve got our first case, what do we want to do, after everyone has been there all day long doing communications, doing the airplane lists, and whatever else. We got into a better cadence eventually but at that point testing was really limited to at the public health lab.

Another kind of really important lesson I learned there, with the restricted, with the kind of limited resource that we had to be careful. We couldn’t just say you get a test, you get a test, like sure you want a test, cool, do it. We got into this kind of weird or unfortunate, I don’t know what the right word is necessarily for this place where the people who were most likely to spread COVID-19, when there were cases—I think we knew this at the time, at least a little bit, these were not people in the hospitals because you know who’s not going out in the community? Someone who is hospitalized. But we need some criteria to use as a screen to say hey, this is serious enough to use our limited test resource to test you. We set up a system early on that was basically limited testing to hospitalized people. One of the important lessons I got from that too was it wasn’t just – are we testing the wrong people? Because they’re not going to spread it, they’re in the hospital. It’s important to understand too so the hospitals know what protections that can use for their workers definitely. But the question we were looking to answer there was kind of a different. It wasn’t how do we stop the spread, it was is this here, if it’s here, how much is here.

What we did there is we focused our approach on testing those highest risk people. People with clinical signs that made sense, that had potentially no exposure, eventually that was an important part of it, but because the question we were trying to answer was is the virus here, are people getting sick, if so how many? We had to kind of adjust our approach in a way that from the outside might not make sense because our goal was to stop the spread, and the people we’re testing are not spreading it. But our approach really was to answer, at that point, a different question. Testing was limited, that was really important. It also helped hone I think some of our messaging in that testing is not the only way to show people that we are responding, not the only way to show people that we care. I think testing became a very visible way for people to see that they were being cared for, that that was something they were being acknowledged, and it’s really important. But it’s also important to spin up other response mechanisms that are not just testing.

Q: Where were you getting your info on how to respond? Was CDC helping you with guidance? Where were you getting your information about COVID? Because it’s so fast coming in and of course since it’s a virus, it will be changing.

REKANT: I don’t remember when these started, but there were some regular calls from CDC, so the CDC was giving at some point a daily brief, a daily kind of digest to the state health departments about here’s what’s going on, here are our procedures too, this is how we’re supposed to handle, how we’re supposed to respond to these. A good bit of that was—what’s everyone else doing, or what are we being told to do, how do we do this in a coordinated way across the country? Then it shifted a little bit over time where it became more of a—again with Oregon being a home rule state, our local health departments are really in touch with their constituencies, and we would hear stories from folks about hey, we’re doing this thing, this is the guidance, but what we’re seeing in our county really doesn’t square with this, either the clinical signs are different, or when we do our investigations we’re just not getting traction this way, but we think there are other ways to do this to help answer these questions. Then it became kind of a hybrid from the guidance from CDC, of the stories from our healthcare community and local health departments, and the good old shadow network, which is what I like to refer to the group chats as. We stood one up recently as well for the Monkeypox response. Among EIS current officers and some recent alumni, we just have a group chat to kind of help share stories, to understand what questions are coming up, to understand what resources are out there as well. That was really important to know who to look to and how to make connections, where we talked a bit about quarantining people who had traveled. Well, some people come to Oregon and they keep going. Sorry.

Q: I’m sorry. These are the, when you say the shadow network, you’re talking about your EIS class and people you know through EIS? Is that the shadow network?

REKANT: Yes. My EIS class was the most active one, and we use this for social reasons as well, but when it came time for response like this, like the broader measles responses prior to that, the vaping-associated lung outbreak, we use these group chats to keep up with folks. When additional classes got integrated into, consumed by, the COVID response, then the group chat membership got a bit more broad.

Q: Wow. That’s kind of what EIS is there for. You use each other as a network.

REKANT: I would be remiss to not mention it was EIS and also LLS [Leadership Lab Services]. In my class and in the other classes because there are often a lot of diagnostic questions and the lab part it’s really important to nail that as well, so we often found ourselves asking questions back and forth of each other with that expertise.

Q: What’s LLS stand for?

REKANT: Laboratory Leadership Service? I think.

Q: Yes, I think that is right. We talked earlier and you were—the coordination of efforts through the Department of Health, but then you became this guidance answer guy, can you describe that role?

REKANT: Oregon has what we call investigative guidelines. For every disease on our reportable list, and some more catch-all ones, we have a document that is two, to twelve, to in the case of COVID-19, I think we’re pushing fifty now, pages long, and it’s basically a primer on how to be insert disease epi. How to response to measles, how to response to Legionnaires Disease, how to respond to salmonella, how to respond to COVID-19.

Q: Protocol.

REKANT: Exactly. It’s great because one of the things that I came to learn is the problem of decision fatigue. Making decisions can be tough and having to make decisions over and over, and frankly having to make the same decision multiple times, is draining. Having worked together often before response, but in this case during response, to come up with the answer to questions that were going to come up, and especially for us at the state to help our local folks to know that maybe the local health department just gets one of these questions, but each local department is getting that one question, so giving them the answers, giving them the help to help answer those questions when it comes up, was really important. My role pretty quickly became to wrangle that guidance, to take in the responses from CDC, to take in the guidance from CSTE about case definitions, and again, to take the feedback from the folks in Oregon about how our local situation did and didn’t square with the national picture. Part of my role became to keep the guidance up to date. You can go back and check those guidelines, have a history on them. I remember very distinctly when before we had cases in Oregon, I and a colleague, Amanda Faulkner, we were charged with going into a room—taking a step away from the airplane quarantine calls, from monitoring the Johns Hopkins dashboard with global cases—just a quick tangent on that. I gave a talk to an MPH program the day before our first case was detected in Oregon. I remember showing a screenshot of that dashboard with a big like there are no cases in Oregon. I guess I jinxed it.

Q: When was that talk?

REKANT: That was whenever—I forget the number day, but it was the Wednesday in late February. Thursday, we announced our first case, and Friday I picked up the night call phone, which was a very hectic—it ended up just being for me the week was only into Sunday because I got so many calls that they just had to have somebody pick up the phone after a bit. I was on the phone more or less constantly Friday night, all day Saturday, and all-day Sunday until someone helped. I say that they were helping along the way.

Q: What were you doing on phone calls?

REKANT: Mostly answering provider questions or local health department questions. This is a 24/7 line.

Q: Anybody can call?

REKANT: Anybody can call. We certainly encourage folks to call their local department who is supposed to have a mechanism to handle calls 24/7 as well, and they get to help filter things up to us. A lot of the questions were either from—frankly often from Portland Metro area healthcare providers who maybe knew to contact us or knew how to contact us more directly, but also from local departments with questions about how to handle whatever it was. I’d take a call and while I was taking that one call, I’d miss two more. I’d call one of those back and I’d miss two more. It just kept going.

Q: February you get your first case in Portland and then from there how many more came after that? Did it evolve quickly? Are you getting imported cases from people coming back on their cruise ships? Where are the cases coming? It’s a long question, sorry.

REKANT: Our cases were mostly local early on. I remember I think the fourth case nationally, I think it was the second California case, maybe it was the second California case, was described as community acquired and that really sent up alarm bells because we’re like so it’s in the community, so who gave it to this first person, where did this come from. That really sparked a lot more focus on—we were still doing, of course, the work with people traveling on planes, and coming from other states, and that kind of thing, but as far as we knew the hotspots were elsewhere. Then we started to have cases come in. I can’t recall actually— I think our second case was a close contact of our first case. I remember our third case distinctly, that was a couple of days later, and this is someone who had attended a high school event over the weekend, I believe, and collapsed at the event, was taken to a hospital, and a day or two later was diagnosed with COVID-19. We were still in that cadence of getting the lab results kind of late in the day, so we had to scramble a bit. I remember talking to a couple people that night, I think this was the first time I ever had a meeting invitation for midnight before, but this was at a school event, and the principal and folks in that school district needed the kind of care and support, we needed to talk through these questions. Because we didn’t know. This is the time where people are still buying all of the hand sanitizer, and clean wipes, and that kind of thing, and there’s no toilet paper on the shelves and all that. They’re like, can we open the gym tomorrow.

Fortunately, it was— I think it was ahead of a weekend, I don’t know if I have my timing right, I might not. But this was an auxiliary part of the school, and it was, can we open it, how do we clean it, how do we protect the people there cleaning it. This is what I kind of alluded to earlier about making decisions when there aren’t answers is someone has got to do this tomorrow, we’ve got to talk and think rationally about what to do. We had that meeting. We talked about it, we worked with them on communications because that was an essential part of any part of the response. I also remember the next day or two talking with the local, I think it was the fire chief, because our guidance at the time was to strictly quarantine contacts of cases. Well, this person collapsed at a public event, two EMTs attended this event—attended him and took him to the hospital. This was a smaller county and if we quarantined two EMTs for two weeks, that was a third of the workforce. There were a lot of people who were going to need support from those EMTs, and we had to think about how do we provide services. COVID-19 is not the only thing out there. At that there was more than I’m sure we realized, but still not that much, and what’s the balance of public health here? Should we take these two people out of the rotation for two weeks and compromise the care in that community for that whole time? Or do we find ways to maybe not follow the guidance explicitly and say here, you can do some work, you can do it safely, here’s how to mitigate the risk, here’s how to—it’s not, I don’t think, the classical use of the term harm reduction, but in looking at the options, in this case when the options were bad or worse, you go with bad, and stuff’s got to get done. People still need to, in this case, receive care. We talked a lot with—I met with, over the phone, many more fire chiefs and things like that then I ever expected because we had to talk through this. They were helped with the EMTs, and especially in these rural areas, how do we provide the best care given the situation. That was a really big part of it.

Then cases started to pop up more and more. I remember very distinctly there had been the outbreak at the nursing home in Seattle, which understandably got a lot of attention. There was a lot of illness, there were sadly a lot of deaths from that. The first retirement home cases in Oregon I remember very clearly. I was literally talking with a colleague in Oregon about this yesterday, about my experience there. It was a full-on approach. We had seen what had happened elsewhere. Like I said, testing is not the only way to show that you care, but I think it was a very clear signal people were associating with at the time as testing became a little bit more available, you saw—it’s perhaps not appropriate to say abuse of that testing capacity, but you saw people in prominent places doing a lot of testing, kind of trying to use that as care for themselves in ways that it might not be available folks more broadly. Then people see that signal and wonder why other folks are getting special treatment.

Q: And they’re not, yes.

REKANT: And they’re not. I remember going to the— I think it’s out in the news, I think it’s okay to say the name, the Oregon Veterans Home in Lebanon, another shibboleth by the way, not Lebanon, Lebanon. Working with the folks there, talking with them about how they provide care for the folks there. This is the veteran’s home. These are people the community is committed to care for and with good reason. But is it good care to keep everyone in their rooms for however long this outbreak is going to go? At that point, because of how scary the disease was, maybe it is. We talked about they brought in enrichment at all times, they had pets come in, they had demonstrations, they had talks, they had musicians. How do we keep these people living rich lives without compromising the health of them or the folks who are potentially going to come into the space? Then also we did a lot of testing. We mobilized one of Oregon’s disaster response teams to go and help us with this particular effort. Which was interesting.

Q: In February the CDC was pretty much—when local health departments were the place to get your testing results. Then the tests that came out of CDC were not accurate for a while there.

REKANT: Yes, the issues with the different targets that I think—admittedly I’m not as familiar with and this was a place where I did turn to that shadow network, and talked to my LLS colleagues, and asked hey, what does this mean, how do I actually put this information into practice. Yes, testing was really—was slow to roll out for a bit because of some of those issues.

Q: Testing was important because that was pretty much the only way to figure where an outbreak was happening or, as you were saying, how to show care.

REKANT: Yes, it was an important place—I mean, in practice definitely. You had to know where disease was because at that point, we were still operating on kind of stratified risk profiles, of looking at a place and saying, hey, Hubei Province and Wuhan, cities in China, highest risk. If you’re transiting there, we’ve got to worry about you. Over time you started to see there was a cluster of cases in Chicago, so is Chicago a risk, is Illinois as a state a risk?

You start to stratify some of these places where there had been cases. We think about now, we look at the map of the country, and we see areas of high, medium, and low transmission. Well, the, I can’t think of the word, the conceit there is that the disease is everywhere. Even in low transmission there are sick people. There are people that are getting infected, there are people getting ill, there are people that are dying with COVID-19, it’s just the transmission rate is low. But for a while there the risk was just based on did we find disease here. The way to find disease somewhere is to certainly to test. That is the way to kind of answer that. Again, when we had restricted testing to hospitalized folks, the question wasn’t necessarily how to prevent disease, because testing wasn’t going to do that for us. We had other responses, other tools to do that. The question we wanted to answer was is there disease and where is it. That was what we thought was the best use of limited testing resources at the time.

Q: By this time now, you’re probably into March, March is pretty much everybody, the whole world locks down.

REKANT: Yes, I referenced those daily CDC briefings and I remember, again, distinctly—I’ll find a different phrase than I remember distinctly, but I keep saying it—walking into the AOC, the Agency Operations Center, where we all were working. Pretty quickly in Oregon we moved from our desks down to the AOC where we’d all be working. For us the epi is the ten, the twelve, thirteen, fourteen of us that were all working together all day every day, sat around this horseshoe table, and that’s just where we were. I was going to say where we lived and that’s maybe more true than it should have been, but we were there, that’s where we were. I remember walking into the building, I was listening to the call on my phone, walking in and hearing Dr. Nancy Messonnier on the speakers and say—effectively sounding the alarm saying hey, this is serious, and things have changed. It wasn’t necessarily that things had changed, it was just things had gotten to a point where we could no longer say that things weren’t as serious as they were. That tonal shift kind of chilled a couple of us and it took a couple of moments to think like, we knew what our response was, and we had a sense of how much disease there was here, but we need to project forward a little bit more and think about frankly how bad this could get, the kind of range of outcomes here, the bottom here, the lower end of outcomes has gotten lower, and we need to account for that.

Q: This is really— just a matter of weeks we’re talking here. It was so fast but felt like forever when you’re in it.

REKANT: It felt like forever when you’re in it. One of the things that’s still mind blowing to me, as part of my current job I look at kind of a broader view over time of what cases were, and just remembering how hectic it was, how much each individual case felt like its own little, crisis is maybe too strong, but every case had a lot of work associated with it. Even when there weren’t necessarily cases, there was a ton of work associated with keeping care around the state. I remember a lot of meetings about hey, who’s got this retirement home, for example, there are cases there, how do we keep caring for people? Or we’ve got someone, and this is a thing I learned about this system, someone who works part-time at four or five, or maybe two or three, different homes. Well—Can they go to work now? How do we help keep that afloat? And if they can’t go, well someone’s got to work there, do we have the resources, can we bring people in, or are we going to ask people that are already stretched to stretch further because we can’t have this other person come into work. Then a lot of discussions about that, even when there wasn’t necessarily a lot of disease, there was still a lot of, frankly, work, and understandable worry around each case, and each potential case. But to look back at the epi-curve now, and see what the numbers were, and how busy things were, I almost have to laugh a little bit because there was so much work.

And compared to some of the surges there were so few cases. Part of it was we had a small team and things staffed up, it’s very well documented and well discussed how under supported public health generally has been, and we fortunately were able to bring a lot of new people into public health but are still, I’m sure, well, well below where we need to be to be able to respond to this. Because I guess part of the reason it felt like weeks, or the weeks felt like they took quite a long time, is there were just a couple of us. There were a lot of us working really longer, harder than we probably ever had. I reflect on some of the days in vet school where we’re at school all day long, go to lab in the evening, studying, reading, and that was tiring, and I might have spent more time at vet school on some of those long days, but never concentrated like this. The intensity of those days was just so much more that it weighed on you. It was just tough.

Q: Was the intensity because there was an unknown?

REKANT: Yes, I think the—I referenced the decision fatigue and having to think rationally kind of in the absence of information to point to takes some work. I think – I didn’t touch on but I can certainly circle back to this now, we had our investigative guidelines, but depending on the week we had three, to four, to six, to seven hours of calls with our local health departments where we would often give updates from the state about new policies for schools, and new updates for what’s happening in the correctional settings, and whatever else was happening at different parts around the state, but a lot of those calls turned into, and some of those calls were dedicated to, here’s what the guidance says, what are your questions. I remember this really clearly, so Paul [R] Cieslak was my primary supervisor in Oregon, and he was and is still looked to from people around the state as someone who can just help make decisions, who can think rationally. We’d be in this room with twelve, fifteen people, we’d go to a different room for this call depending on who was updating, and a question would come, and we’d realize immediately there was not an answer, there isn’t a known answer to this. Pretty quickly people would look to Paul. Like Paul, What do you got? He’s comfortable in this space so he would start to talk.

We would go back after and kind of talk about some of the decisions because again, I had to fold some of these interpretations into the investigative guidelines, both the questions that came up, and then help refine our answer. Then over time that moment became me and Paul looking at each other, and looking okay, who’s going to move first, who’s going to move towards the microphone to answer first, and in just an incredible—one of the things when I was going to EIS, I was very clear about wanting good supervision, good mentorship, partially because I don’t believe I had had that before. I had had that kind of here and there, but especially a professional capacity, I really hadn’t had it. I had people help me through with school, I had people I could turn to. I forget if it was Paul, it might have also been Scott Lindquist, Dr. Lindquist in Washington, who at match week asked me, what does that look like to you. I didn’t have an answer. I got my answers in Oregon. I got to see what it looked like. In this really empowering move for me, Paul would start deferring to me. He would see the wheels turning, he would see me start to lean towards the microphone, and he’d lean back. He’d let me answer. Over time those calls kind of became—I don’t think this is too self-aggrandizing, people would describe it this way as well, they kind of became Q&A with Steve. I would get questions then and it was my job to know the guidance. For one to say like, this guidance exists, here’s your answer. But to also recognize when hey, this guidance doesn’t exist, here’s your answer. It was my job to think rationally. It was incredible training. I felt professional growth on an almost daily basis because of my ability to think through some of these issues, but also my confidence to trust my public health sense. I felt that sense kind of growing. One of the great things about my time at EIS was learning to trust it, was learning to know just like when I started talking during those MPH negotiations with faculty at vet school, to know that the thoughts that are coming out of my brain are ones that are valid, are ones that I should share with people, that can be helpful.

Q: Plus, he allowed you to do that.

REKANT: Sorry?

Q: Plus, he allowed you to do that. Recognized that and let you—

REKANT: That was exactly it because it wasn’t just here is the space to do it, it was someone I trust and respect telling me that they trusted and respected me enough to do it, help me find that within myself and build on that. Again that’s how I mentioned the mentorship part because that’s obviously a lesson that stuck with me and a thing that I really hope to be able to do, as I mentioned I picked up a mentee just the other day, something that I hope to be able to do to help folks, and that I hope continues as I myself grow, and kind of learn spaces I might move into. That’s really important to help empower people to trust themselves.

Q: You were collecting all this guidance and giving guidance, did you share this guidance with other people besides the phone calls? Did you post this or—?

REKANT: Yes, the investigative guidelines were updated sometimes weekly. This was also an interesting place where you had to kind of know what the right cadence was. Sometimes there were some small questions and really niche things that do we need to publish new guidance here? No. Can we provide interpretation of people on the phone so the local department knows what to do until we publish new guidance in two weeks? Yes, I think that’s the way to go here. We’d update the investigative guidelines with some regularity.

Q: Did your horseshoe group, did that stay together? Or again, as it got more and more into it, did you all go home?

REKANT: Yes— the USDA sponsored spot comes with that return to USDA, so I have a commitment to come back. EIS was scheduled to end at the end of June of 2020. USDA and I had not figured out the right landing spot for me at the time, so I actually signed an extension to stay in Oregon through September, another couple of months.

Q: You’re in Portland?

REKANT: I was in Portland on the response up until September of 2020, through September 2020.

Q: That makes you—you were there for The Battle of Portland?

REKANT: Yes.

Q: Which is a whole other part of this—COVID.

REKANT: It really is. What’s kind of real interesting to me about that too is like—Portland is divided, as I mentioned, by the Willamette River. The health department is on the east side of the river and downtown is on the west side. There’s some neat bridges, there’s some great stuff downtown, but I feel like sometimes the river is a psychological barrier for folks to just like bike over, drive over, so I wasn’t downtown really all that often. We did see one protest come by the state health department and I walked through another one on my way home one day, but this was not the intensity of what was happening downtown around the courthouse, around the—oh gosh, I forget what the—

Q: Black Lives Matter?

REKANT: Yes, no, there was a particular government official who talked about criminals, and miscreants, and whatever else kinds of issues.

Q: Antifa?

REKANT: Yes, and I remember people, myself included, using that as kind of a guide to help figure out how much to donate to the causes that were doing the good work. But it wasn’t—while that was going on I was not geographically that far from it, but it really wasn’t part of my thoughts day to day. Partially because we were just so busy.

The way it did work its way into my thoughts is an issue in guidance. We had questions about guidance to give protesters because we don’t want people to congregate, we don’t want people to gather, we don’t want people to be yelling and spreading droplets around other people. But at the same time, like I said before, COVID-19 is not the only thing out there. It wasn’t infectious disease here but there are real problems that we at public health can provide input on, can really address, but can also importantly keep in our mind to have that care is really important. One part of this is just kind of the general optics of the government coming out and saying, hey, you shouldn’t protest. That obviously doesn’t resonate well for good reason. But for us to kind of give some kind of chilling effect to the protests in the name of COVID-19 safety, under the guise of COVID-19 safety, I think depending on what the guidance might have been, really isn’t what we wanted to do, is not the way we wanted to provide the best care. We did provide some messaging around protesting, but never did we say, at least as far as I can recall, never was it don’t protest, it was how to do this safely, how to take care of yourself, how to take care of others, because the people there, their goal wasn’t to spread COVID-19. There were perhaps some people who were trying to do some of that nonsense, but in general the people that were there protesting were not looking to do that, they were looking to solve ills, they were looking to address issues, and issues that we in public health care about, that we have to care about.

CSTEI think I was glad to be able to attend the CSTE [annual meeting] conference about a month ago, and one of the resolutions that was passed was defining, and examining, and really kind of in a cooperative coordinated way across the state health departments to look at violence related to law enforcement. Individuals affected—I forget the acronym they ended up using was, but violence, and injuries, and death related to encounters with law enforcement. It’s a very clear, to me, public health issue and one that we can’t sideline because there’s also a disease. It’s one that we have to keep all these things in mind. Again, that was also happening, that was helping shape some of the guidance, and frankly some of the messaging too. I think that was good for us to be able to talk to folks in governmental leadership about what our goals were. I don’t want to characterize them as not understanding how to do public health, but their goals were different than ours sometimes. That’s fine, that’s what their role is, and the government works together when it works well to help achieve as many of those different roles as we can. It also put me in an interesting situation as the sponsored officer as someone who knew I couldn’t stay in Oregon. As we touched on earlier, I loved my time there, it was an incredible experience, my family is back east, my girlfriend, now fiancé, was actually working at CDC headquarters for most of it. She was an EIS officer as well in the class ahead me assigned to Wisconsin. Prior to the pandemic we would fly back and forth to see each other. Then we went about five months without seeing each other and running this hectic schedule because first off, the time difference is tough to navigate in the first place, but she’s at CDC headquarters, and she was responding at the EOC [Emergency Operations Center] here in Atlanta. Finding that time to keep each other sane, to just catch up, and again, kind of provide care, was tough at times. I found some kind of curious and funny, silly mechanisms, I think, to work on staying sane early on. Like I said, seeing my friends every day was an incredible part of it. I don’t have this right now—I have the outline on my second screen.

But we have a bunch of TVs around the EOC, and on your second screen you do this as well, we would watch these nature cams. We had the bears at the park in Alaska, which became a really fun theme for us. We’d have that on in the background. You’re not focusing on it, you’re not seeing what bear is catching what, or who is Jacuzzi-ing, who is fighting, whatever else, but it was just this little bit of care for each other that we could do to have that. Sometimes it was a live cam of puppies at a shelter, or cats playing at a shelter, or birds eating fruit at a nature preserve, whatever it was, that was a neat bit of care for us. Fruit is a segue I’ll take too because I started having what I call my sanity citrus where I would bring an orange to work. One of the things about the job we talked about is it was constant. You were always sending an email, answering a phone, whatever it was, using your hands to do stuff. It turns out when you’re eating an orange by hand, you can’t pick up the phone without getting it dirty, you can’t type an email. For me it was a way to enforce just a few minutes of break. It’s important for me to take care of myself, which is a lesson I learned directly and indirectly from folks in Oregon from early responses as well, but for me it was a way to just take a step back, to step out of the response for just a moment and check in with how I was doing.

One of the other things, Oregon was great, especially early on, in providing food for us. Like I said, we were at work, and some of the places that provide food around the state office building closed down so we couldn’t necessarily go get lunch easily, and the state provided lunch for us for the first couple of months. There are two staircases in the building to get down to where the cafeteria was, and I took the wrong one intentionally because the wrong one put me outside. The wrong one in the middle of the day it was an extra, I don’t know, ninety seconds of walking, but I got outside. I also often used that time outside to send Amy, my partner, a note, just to say hi. But that was part of the—I had to engineer that into my days to help stay sane, frankly.

Q: It doesn’t sound like you were teleworking, you were actually going into the office.

REKANT: I lost that bit for a moment. I left Oregon in September of 2020, at the end of the month, we did not telework up until that point. We were going into the office all day every day, that horseshoe of a dozen or so of us, it was the same team the whole time. We started to bring some more people on a little later in that time when the state was able to step up a bit and expand the team, which itself was interesting. It was good, it was great to have more people on, but we ran into this issue of the pace being so fast sometimes that it would be great to train three more people that in a week could make this easier, but we can’t be anything but short-sighted, we’ve got something in front of us right now, and we can’t take that time. It took some more support, some good leadership from a bunch of folks, to find that space for us, to really make it clear to leadership in our group, leadership well above us in state government, how important this was, and why some of the things they might have become accustomed to, like a daily report, was going to take some time, was going to be delayed, or was going to have less information, that kind of thing. We started to expand the group a little bit and it was great to grow the team as we had capacity to do so.

Q: We mentioned just briefly COVID, and care, and health equity. Were there populations within Portland that needed a little bit more care in that respect? Because really— COVID has really shown a light on the importance of health equity, the importance of listening, and the importance of really—care.

REKANT: There definitely were. Some of that was in Portland, some of that was across the rest of the state. That part of Oregon in particular, lots of parts of Oregon, have pretty strong agriculture, and that means a workforce that sometimes is a little more transient or just in general is not as connected, is not as supported as other groups might have been. We did a lot of work reaching out to the federally qualified health centers, to some of these organizations that specifically provide care, in this particular instance to migrant workers, and try to connect specific resources, and say, hey, what we don’t want is people to be sick, of course, but we also don’t want these products to—fruit rotting on the vine, and grains going unprocessed, and whatever else. We want things to keep moving because those are really important economic-wise for folks to keep getting paid so they can keep the lights on and buy groceries, but also to make these things available. We all feel the crunch now of supply chain issues and that was another way that we were able to hopefully mitigate that a bit.

We focused a bit on some of those. I remember in particular there was a—I shouldn’t laugh, it’s not funny, but there was a testing event, and we were working hard to organize it. The focus was on agricultural workers, but because the resources we were able to mobilize to support this, I think testing was available Tuesday, Wednesday, Thursday of that week from eleven to three. Well, the population we’re looking to reach is not available then, so we had to rethink how we were going to do that. That approach we got a lot of testing, but not who we were trying to support directly. We had to really kind of consider where people were, had to meet them there. Again, provide that care, show that testing was available, but as something that’s not the only mechanism to show care. One of the things that I was taking part in, but not the biggest part of my response because it was happening a lot as I was starting to wind down and get ready to come back to USDA, was working with some of these cultural-focused organization, not about testing, but about how to disperse funds. One of the toughest things throughout this whole thing, and one of the talking points that I think has been said so many times and still not enough, has been how to enable people to make good decisions. We can give guidance all day long, but if they can’t follow it, for whatever reason, it doesn’t matter. If someone can’t quarantine because they have to go to work, for example, quarantine does no good, so how do we support them? How do we use—in this case it was purely financial sometimes. How do we support them to make good decisions. One of the ways to do that is to ask the people who know, to ask these culturally focused organizations how to support them, how to come to them, how to give these answers.

One of the things I’ve really come to appreciate. I long ago subscribed to the Oregon Health Authority You Tube channel. Every couple of weeks there’s a new set of messaging in a dozen languages, I think, in a variety of languages that some I had frankly never heard of before I went to Oregon, but these are populations that are present, these are folks that need our support. One of the ways to enable people to make good decisions is to give them good information. I can have the best scientific paper with the most answers in it, but if you can’t read it, you can’t use that information. If we can’t translate it into Karen, and Mam, and a whole bunch of other languages that I frankly don’t know or hadn’t heard of, people can’t use this information. I had actually learned this a bit in a clear way a year prior. There was a measles outbreak in Clark County Washington, right across the border, which was, at least in that area initially, largely contained within the Russian-speaking population of which there are plenty in that area. Which was, again, a surprise to me not knowing Oregon too much.

When I went to Oregon I remember I looked up the census page to see what was there and that’s what I knew about the state, which was not much. But understanding how to get out there, how to kind of find people where they can hear this messaging, where they can receive it, how we can support them to make good decisions, is really important. One of the things we are working on as a group here in the One Health coordination office is getting some behavioral science expertise on the team. Whether or not that’s an individual person for us, or access to others, we talk a lot about One Health and the connection between humans, animals, and their shared environment, which is One Health. We’ve had a good, comprehensive, US government definition of One Health. But as we think about this triangle, as I think about this triangle, especially of those three elements, they’re all happening in the context of humans making decisions. Of humans making choices and spreading diseases sometimes. You can provide whatever guidance, but someone’s got to make a choice.

One of the important benefits of our society is that freedom to make those choices. If we’re not enabling people to make good decisions, they’re not going to be able to follow—they’re not going to follow those and then the impacts that we want to have are going to be tougher to follow through. They’re really not going to manifest, and they’ll cause some additional problems. Working with those culturally focused organizations, working with the translators to—Oregon has a great push for something called REALD which is to have the data on race, ethnicity, language, and disability, to integrate that into everything we do. There actually was an executive order, I think, that was passed during the pandemic that said if you are receiving, I think it was the vaccine eventually because vaccines weren’t available at that time, but if you’re getting testing through a state sponsored program, you have to collect REALD information. One of the interesting things I learned about REALD in particular, one of the big tenets is its self-reported. You can look at me and say, oh, Steve is probably of this heritage, and you would be right because I think mine is pretty straight forward. But there are some people when you look and you’re like, we can make a guess, and the problems that come with that are really important.

My colleague Dr. Alex Wu, who, I get to say this officially, was assigned to the Northwest Portland Area Indian Health Board Tribal Epidemiology Center, which was across the water in Oregon. It was in Portland and Alex came over to work with us a couple times for taking calls, which is a bunch of incredible stories not for this conversation really with stuff that came in, and with our response as well. But [before the pandemic] one of Alex’s big projects working with the Native populations was to take the tribal registries, and take the disease reporting, and match things up, and look at where the race and ethnicity data was just wrong to better understand what the risks for his community, for the community he was supporting, and by getting that—having seen that work and frankly having seen Alex get very passionate about that work was quite moving. I know the importance of that was something I got to carry through with the rest of my time with EIS and is less so when we talk about animals. Certainly, in agriculture we don’t think about race and ethnicity in the same way, but again understanding the context of where people are. In addition to REALD, when I was getting ready to leave Oregon, one of the additional pushes for data collection was what are called SOGI data, which is short for Sexual Orientation and Gender Identity. REALD was, I think, a paradigm shift for people doing public health work and SOGI data was another step for a lot of people who just weren’t—just like myself, weren’t familiar with both how to collect that information, but how important it is to collect that information. We’re also, of course, seeing that play out in a big way currently with the Monkeypox outbreak and how important it is to understand who we’re trying to support and how to support them.

Q: After leaving Portland, you went back to USDA, you went to Atlanta?

REKANT: Yes, so my official duty station up until about eight months ago was Riverdale, Maryland. But while in Oregon we were all going into the office, since spring of 2020 USDA was, when possible, fully remote. There is a lot of USDA work that cannot be done remotely, a lot of people have to go in and face additional risks, but fortunately with a job like mine, I need a computer. Kind of end of list. With my partner at CDC headquarters and the flexibility to be in Atlanta with her, I came here. Fortunately, I’ve gotten to stay. But really one of the big challenges I had for a long time here was this kind of second level meta question of the uncertainty where we didn’t really know where the pandemic was going. When I was leaving Oregon, I was confident that USDA wouldn’t call me back to Maryland for three months. I had a good feeling, not a good feeling, I had some confidence that they wouldn’t call me back for a bit after that, but I wasn’t so confident that I was going to sign a year-long lease. I ended up in the situation of going—over the course of a year I lived in three apartment complexes and an extended stay hotel based on what was available and what kind of suited my needs because I had to go kind of month to month or two or three months at a time because I didn’t know. I wasn’t sure that I could stay.

I also was without a lot of my things. A lot of the things on my walls and are in my background now were in a storage unit because when I left Oregon, again fortunately USDA paid for the move, but I thought I might get the stuff back in two or three months, so it was going to stay in storage for a little bit. I left Oregon with—it was me and the cat, again, and whatever else I could fit in the car, and that was it. That uncertainty of not kind of knowing where I was going to be, not knowing if I could stay, it was great to get to be in the same place as my partner, and we were soaking that up for as much as we could, but over it all was this obviously cloud of the pandemic, and we were in this kind of odd situation of it would have been incredible if the pandemic just ended. But it was going to continue on, and it meant that we had the flexibility for me to be here, and the eventually USDA did a reevaluation, and my position has been reclassified as fully remote. My duty station is what you see.

Q: Wherever you are.

REKANT: Wherever I am

Q: Another wonderful lucky destiny and fate thing.

REKANT: Yes.

Q: You are now working at USDA on One Health. Can you explain to me what One Health is?

REKANT: I do feel I should pull up the official definition to make sure I get it right. I won’t do that now. But it is the understanding that humans, animals, and their shared environment all interact and influence each other, to know that that work is not contained with any specific sector, that that work has to be done at different levels of local, and regional, and national, and global. It’s been interesting to be on some calls talking about planetary health and the use of earth-observing satellites to do public health work, has really helped expand my understanding of what this work can even be. Being a veterinarian focusing on infectious disease a lot of the work is in animals with zoonotic diseases, but we really try to make sure the focus stays pretty broad and accounts for the environmental impact, environmental factors, and as I’ve touched on a little bit, the sociological parts of this. People making decisions underpin a lot of what we do.

Q: When you were in Oregon you were also—I said it wrong, Oregon. When you were in Oregon, didn’t you also coordinate care of people coming back from an Ebola outbreak in DRC [Democratic Republic of Congo]?

REKANT: I did. That was some new training for me as, again, to kind of learn a bit about contact tracing and what that work might be like. There was an outbreak of Ebola in the Democratic Republic of Congo. And Rwanda? I forgot where else it was. Oregon, we were not officially sending people, but there were some non-profits, some non-governmental organizations, some Good Samaritan organizations, that were sending people to respond to help provide care and support for the response that was happening, and then they came home. Some of those people came home to Oregon.

Q: During the pandemic?

REKANT: That was actually before. Fortunately, this was between measles and vaping, I think. It was in 2019.

Q: End of the year? November?

REKANT: It might have been kind of later in the year but not quite pandemic time. A lot of my job was working with the local health departments who were going to do this monitoring, so quarantine for someone coming back from an Ebola infected area was to do daily temperature checks to really be on the lookout for fever and other clinical signs because of how severe one case could be. We had to be especially vigilant. It wasn’t just coordinating that check in, it was coming up with a plan of okay, what happens if they have a fever, what happens if they have clinical signs, and working with the local health departments about people who were planning to travel in that time, and kind of passing off the monitoring in that time, and passing off the time as well, especially in some of these rural areas, to get someone, a potential Ebola patient, safely to a place that can help treat them, care for them. Actually, really the answer is that there are, I think, ten regional hospitals that are equipped to care for someone for more than seventy-two hours. The nearest one I think to anyone in Oregon is in Spokane, Washington, which is a bit of a hike. But there are some areas in Portland, around Portland, and I think in other parts of the state, there’s one in southern Oregon as well, that can help support someone for up to seventy-two hours.

I was fortunate enough to know one of the nursing faculty at a hospital there, a place where I’d actually given some lectures to nursing students for his class, who had access to the Ebola ward, the area prepared for people. I got to go tour, actually again with my colleague Dr. Wu, we got to go tour the facility and see what it was like to actually work in that temporary facility where you would care for someone potentially with Ebola for up to seventy-two hours. Fortunately, it was empty at the time. But to see that process—

Q: Did it stay empty?

REKANT: It did stay empty. Yes, fortunately as far as I know there were not any domestic cases from that outbreak.

Q: But this is kind of preparing you for what’s going to happen in a couple of months because you’re also—it’s like setting you up for COVID.

REKANT: It is. One of the lessons, and a phrase I’ve taken from Dr. Murphy in Virginia, is about the importance of peacetime relations. In this case when you see someone, when you call someone, they’re not a stranger. Yes, there were people in southern Oregon that we talked to a bunch because some of the volunteers were coming back there, well they knew who I was. After we had a couple of conversations about what their questions were, about what monitoring would look like, so when they heard me on calls giving guidance answers about COVID-19 a couple months later they knew who I was. They didn’t necessarily take it on faith like oh, Steve knows what we’re talking about, we’re good. But they were at least willing to kind of accept that might be the case and willing to work with me, willing to say we had questions before and Steve was responsive to our local concerns and context, so we have confidence now we can bring our concerns to him, to the state, to help get those answers addressed.

Q: Building relations, yes, that’s key. I want to return back to the present essentially and working with USDA and One Health. Where you are now, at least when we were talking before, you were working with SARS-CoV-2 in animals.

REKANT: Yes.

Q: Is that still an ongoing—

REKANT: Yes, that is still the majority of my work. I was even just yesterday doing some reporting on a new case of a dog that was confirmed as infected. Cats and dogs have been most of the cases, but a bit of that is the epidemiology, not necessarily the virus, but so much of the infection, so much of the virus, the reservoir as it were, is humans. In order to get exposed to the virus you have to be exposed to someone with it, and if there’s so much in the human population than cats and dogs get more exposed than whales and sea otters.

Q: Makes sense.

REKANT: That said, not whales or actually sea otters—well, I don’t know where Asian small-clawed otters live, but we have also seen cases in zoos and other wildlife—other facilities with animals under human care like zoos and aquariums. One of the things that’s been very exciting and takes up a lot of my time now is something that we’re calling the Zoo and Aquarium Serology Study, which is a project funded by the American Rescue Plan Act where USDA received $300 million to do surveillance for SARS-CoV-2 in susceptible animals. This is one of those projects that I helped dream up with one of my colleagues in USDA APHIS [Animal & Plant Health Inspection Service] Animal Care that we are now sending people out to go do this work. They are taking—we’re using banked serum samples from these zoo and aquarium animals from before the pandemic, from within the pandemic, intra-pandemic, and when animals have been vaccinated following vaccination, with the idea of being able to say if they’re serologically positive then there’s at least evidence that there was an exposure there before. We’ve identified cases at a lot of facilities, but it’s less than half of the facilities in our study where we’ve found PCR positive, active cases, in the lions, and tigers, and snow leopards, and Asian small-clawed otters, and gorillas, and coatimundis, and binturong, and fishing cats, and squirrel monkeys, and cougars, I think that’s the whole list.

Q: Sounds like all mammals.

REKANT: All mammals, yes. That’s part of with the study and one of the things we’ve been working on recently actually when the zoo or aquarium reaches out to us they say—hey, we’ve got these serum samples, what works for your study? We’ve been saying, mammals. Listen, this virus keeps surprising us, keeps showing that it’s going to infect maybe another animal. Manatees were recently diagnosed as infected in Brazil, and hippos were confirmed infected in Amsterdam at a zoo, so it’s just we want to get that breadth there. Seeing the species list from some of these facilities and seeing that just like us, you do an annual exam, and you get blood taken. Because the zoo community is really invested in answering questions about their animals and working together across the community, they often save these samples, and will work together to do some of these studies. One of the things that’s really exciting is we as USDA, who frankly our relationship with these facilities is usually as their regulator, we’re coming to them in a different capacity here. We’re working together to answer questions that we think with this financial support and with our national coordination, we’re able to help answer questions that we have, but also that they have as a community. We are testing serum samples to look for history of exposure, we’re going onsite to talk about biosecurity and practices that did, and frankly sometimes didn’t work or didn’t help. Which was interesting feedback from the zoos when we did a pilot with them, they said they spent a lot of time and effort doing barriers, and putting up signs, and masking for guests, and a whole bunch of other things. They’re like if those work, great, that’s really helpful to know. If those don’t work, we really want to know that too so next time we don’t have to spend the time, and effort, and just agita, of putting the stuff together. We’re doing that and we also have an arm of this which is testing wildlife because in addition to the animals I listed off, and then of course cats, dogs, ferrets, and not in this country but elsewhere hamsters that have tested positive.

Q: Guinea pigs?

REKANT: Not confirmed. I think in the lab maybe but not natural infection. We’ve identified a lot of places where white-tailed deer, wild white-tailed deer are infected. USDA did—Wildlife Services did a serological survey early on, this was a little over a year ago, and found a decent amount of serum positivity in the deer and have since taken a project across much of the country to look for active infection, and frankly has found it. There are a lot of questions about the role that wildlife might or might not play in this response. Alongside the zoo project we’re going to facilities, and we’re doing biosecurity evaluation, we’re testing samples. We’re also, where the facility is amenable to it, trapping and testing wildlife on and around the grounds, because maybe that squirrel monkey that tests serologically positive from a sample from August of 2020, the white-tailed deer we find positive outside of the facility in July of 2022, didn’t infect that monkey, but that positive deer could be basically a proxy for what disease pressure was coming from wildlife. We, at this point, more or less expect, and I think are somewhat confident in the fact that when an animal in a zoo or aquarium gets infected, it’s likely from a human caretaker. Likely not from a guest, but not impossible. But for a variety of reasons, we’re not definitely set up to answer that questions in a lot of these places, so we’re helping to understand what works.

Again, you’re coming back to the lesson from Oregon of what decisions we can make with the information we have and what decisions we have to make with information we don’t have. We’re not going to get a perfect answer, especially not for the range of species, but we’re hoping that while we might not be precise, that we’ll be accurate, we’ll be helpful with the answers that we get from the study. We can give them back to the zoos, of course, because we’re planning on working with them all to answer these questions, to say— How do we use this information? How do we apply this across the community? We have upwards of fifty facilities participating in this, but there are many more in this country that are not. There are zoos and aquaria all around the world that can use this information. How do we use our specific study that can be used by a zoo that’s participating, how they can take that and apply that to themselves, but how can we help others make these decisions and protect the animals and people there.

Q: Are the animals affected the same as humans? Do they come down with the same symptoms? Is there a mortality rate here?

REKANT: Some do. A lot of the—it’s an interesting question to try and answer because the surveillance system—testing is not as broadly available, not as broadly done, as what’s happening in humans. It is available, I think people don’t necessarily avail themselves of it, but it’s also relatively tough to get these samples sometimes. When I tested positive for COVID-19 now, oh gosh, two weeks ago, more than two weeks ago, I walked downstairs, I stuck a swab up my nose, I put it in the home test kit, and found my answer. The snow leopard is not necessarily so amenable to you sticking a swab up its nose or down its throat. We’ve actually confirmed a lot of the animals in zoos and aquariums by fecal testing. Coronavirus while not—it does have some gastrointestinal effects, but coronaviruses do tend to go to the gut, and that means we’re able to find it in rectal swabs and in fecal samples from animals sometimes.

Q: Then can it spread that way too?

REKANT: Unclear. One of the things we are honestly trying to figure out is kind of what transmission dynamics are in animals generally. We think in general fecal samples have less virus, so if you take nasal swab and a fecal sample from the same animal, you are likely to find a lot more virus in the nasal swab. That means that the fecal samples are less likely to be an issue. Then also, there is some capacity for aerosol spread with SARS-CoV-2, so just that it is in feces, and even if there is viable virus in feces, you still have to get exposed to it, you still have to have it infect you.

It’s not just that it’s there, it’s that it’s also infected and then affected you. We’re frankly working on those kinds of questions. We’ve had some of these facilities that have actually sent us serial samples over time. They’ll take fecal samples for, gosh, that one zoo I think was four or five months and sending us samples—they’re not positive the whole time, but they are, just like some humans test positive for quite a while on PCR, they are positive for more than the duration of the illness. There have been a few animals that have died. It’s not entirely clear, and we’re still looking into this, it’s not entirely clear if these are animals that died from SARS-CoV-2 or animals that died with SARS-CoV-2. Unfortunately, I had good training in this kind of messaging and the problem of this with my time in Oregon because we had experience with that a whole bunch. One of the things that became, this might have to come out of the transcript, one of the things that became kind of a sticking point for the folks on the epi team, and a bit of just a point of friction with our upper leadership, outside of the health department further up, is the level of detail that Oregon published about each death. There’s an important thing I learned in public health about what information the public benefits from. There’s some information, some level of regularity, that we need to give people so that they can use the information.

Somewhere along that spectrum we compromise an individual’s privacy in a way that doesn’t benefit the public more broadly. It’s not helpful to know in a public setting, for example, someone has a sexually transmitted infection, to put my name out in public as that person. That doesn’t do anyone any good except for my contacts and we have other public health mechanisms to follow up within that and to keep that private. But is it helpful to know how much disease is out there and what that risk might mean to other people generally? Yes. That’s kind of an extreme example, but for someone to feel seen I think in the numbers can be important, but we also don’t want people to be able to see themselves when it’s compromising. In Oregon we spent a lot of time messaging around some of these deaths. I remember one story in particular where it was known in the community that someone had, I believe, fallen off of a ladder and died, and they happened to test positive for COVID-19 after. We establish case definition, CSTE established national ones, and we adapt as necessary to the local context, and we have a case definition, and it’s a feature of public practice that the case definitions don’t always align perfectly with medical diagnoses. I think that’s a tough thing for folks to understand, frankly it’s a tough thing for me to understand early on. Because in this particular case, even as a general example, if someone falls off a ladder and dies, and tests positive for COVID-19, did they die from COVID-19? Probably not. Nosology, assigning cause of death, is an incredibly complicated science sometimes, and really can be a bit of an issue, can take a long time. Is it helpful for that individual to dig really deeply and understand the cause of death there? Yes. We’ve got clinical providers who can help with the family, can help provide that information. But at the public health level, it’s not our charge in the same way. What we have to do is take the information across the population. Epidemiology is literally the study of disease upon the people, epidemos, so we need use this at the population level. It’s important to work with our clinical community and marry that up, of course, but we have to take our context and apply that to the breadth. That’s a thing where, again, bringing you back to the animals, we see the signal sometimes when—in this particularly there have just been a bunch of reports of snow leopards that have died and tested positive.

From SARS-CoV-2, because of SARS-CoV-2, or with SARS-CoV-2 is unclear in some of these cases, but we work with our academic labs, we work with the zoo community to study this the best we can and if and when there is broader surveillance testing to understand are these just the highlights, are these the cases that exist, or is this the tip of the iceberg? What truly is the risk for these species? Especially when we start talking about some of the ones that are in zoos for conservation reasons, these provide a real threat to the population of that species potentially, and that’s why the zoo community works together often to answer these questions. They have Taxon[omic] Advisory Groups, TAGs, that focus on reptiles, and large felids, and apes, and whoever else it is, whatever group that frankly there’s enough interest in. With this particular outbreak, because of the importance of cats, the susceptibility of the cats and the importance thereof, our project team we’ve worked with the felid TAG to both understand the kind of work and also if they’re doing a study as well, understand how our studies can and do potentially interact, and how they complement each other, and also how not to step on each other’s toes. When we talk about these samples that are stored, the blood sample from that cougar from last May, you can’t get another one, that’s it, you can’t recreate that. What is the balance of using an irreplaceable sample to answer a question or holding onto it for the next question? Or can we use a little bit now and a little bit later? Working with the community, again, really asking them how we can help them answer those questions have been a big part of the zoo project.

I talked about Wildlife Services and their work on white-tailed deer, that is ongoing. Also, in mule deer and also wildlife work. We are starting to dip our toe into the companion animal realm as well. Cats and dogs, for example, are not species that—there are parts of USDA that do interact with companion animals with our Center for Biologics in particular, talking about veterinary vaccines, and testing, protocols, and equipment for that kind of thing, testing the tests.

Q: Do you work with sanctuaries and rehabs [rehabilitation] and things like that?

REKANT: That’s the kind of thing we’re trying to figure out is—I used this before, this idea of the “ur” question. I mentioned veterinary student day where [Dr.] Jennie McQuiston just told me to apply to EIS. My other big memory from that day was hearing then CDC director [Dr.] Tom Frieden give a talk where the thesis of the talk was basically that it’s important to ask the question so what with some frequency. We’ve gotten some information, so what, what do we do with this, what can someone else do with this. The best—it might not be the most precise but one of my favorite, I think my favorite definition of the word surveillance is data for action. Sorry, I just heard my cat.

Q: I hear your cat too.

REKANT: He is pretty vocal sometimes. Data for action. Well, we can collect data, but if you don’t know what you’re going to do with it, what are you doing, why are you doing that, because data collection is not free in a sense, it takes work, it takes time, it takes the people you’re collecting data from for as many surveys, spam calls as we get to answer a survey, right? It’s work. And if someone can justify why to answer, [coughs] excuse me. Someone can justify why it is worth my time to answer their survey, then I’ll answer it. That’s the so what, that’s the action you’re going to do with this. We’re thinking about, in this case it’s SARS-CoV-2, but keeping an eye on whatever the next one might be, and preventing that, or mitigating it coming with an early warning system, and thinking about where those places might be, where can we find those early detections. Dogs and cats are imported all the time in this country, is that a place we can maybe do some surveillance to affect a change. We just referenced my cat, is there benefit to testing my cat for some things, or is he kind of—he is indoor only, like many, many cats should be. He’s not spreading disease probably.

Q: But you are.

REKANT: But I might and who is out in the world? It’s me. If he’s going to sick, and as fortunately he did not as far as we can tell, but I got COVID-19 because I was out. Because I was out doing some things and admittedly took a calculated risk. I knew this was a potential outcome. Unfortunately, I was exposed and got infected, but fortunately when I came back, I had the support both with my partner, and—

Q: Your cat.

REKANT: No, I know. I can hear him through the headphones. He hears me talking and not paying attention to him and that causes much consternation. But fortunately, we are in a position where I could isolate, it seems like effectively, to protect both my partner and my cat from getting infected. Like we talked about earlier with enabling people to make good decisions, I couldn’t have done that some places that I lived, I couldn’t have done that without this job that lets me be remote, that lets me take sick leave, and that lets me not have to go in an office when I am well enough to work but maybe still infectious.

Q: Right, and earlier when you were more of a vagabond and you didn’t have a place to live, you were out there, and could have been potentially spreading it. This, I think, is a really good time to turn a little bit to your personal life. I know we’ve gone way over our time, but this is fascinating and you’re doing such good work.

REKANT: Thank you.

Q: Let’s just turn to personal life. In your own personal life, what has COVID done? How has it navigated through your life? You have family and they’ve come down with it as well?

REKANT: Fortunately, as far as I can tell, at least within my immediate family, so my brother who himself has a somewhat—he has an autoimmune condition which we think might compromise him somewhat, he fortunately has not gotten infected, neither him nor his wife. My parents, who again fortunately as far as we can tell have not tested positive, have not gotten sick. My sister, who works as a physical therapist in a hospital, she has tested positive, she has gotten quite sick, because again, this is a risk that our frontline healthcare workers are in some ways choosing and in some ways being forced to shoulder. Mercifully no, not that many people in my life have gotten at least known infected.

Q: Everybody is vaccinated in your family?

REKANT: Almost everyone is vaccinated in my family. In my immediate family, yes, and I say the almost. One of the ways in which my personal and professional lives kind of bleed together is when it was at least potentially safe enough to gather, I alluded to family in New Jersey, and the siblings are spread around a little bit, we’ve got some family, some aunts and uncles, and my grandmother also spread around, but close enough to gather for holidays as we do with some frequency, or as we did with some frequency. When it came time to think about that again, I’m the only epidemiologist in the family, at least by training, I’m working on them. So when it came time for questions about whether to gather and how to gather safely, those came to me. I got to consult on those questions because I referenced my grandmother who is vaccinated, but is certainly old enough, has health conditions that might open her up to potentially more severe disease if she were to get exposed, if she were to get infected. Very long complicated story about someone who was married to my aunt and no longer is, but they have a child, and he has influenced their child, my cousin, to resist getting vaccines. She actually has gotten infected with COVID-19 and so I believe has her mother. This is my dad’s sister. As the three of them, his brother as well, as they’re navigating who’s going to help take care of their mother, my grandmother, that kind of came into play, when it is safe for my aunt to get back in the mix there for just taking care.

Then when it’s time to gather for Thanksgiving or for Passover, I think those were the main ones that our family was looking to gather for, can our cousin safely attend? This was one of these things were fortunately a lot of the group realized, a lot of the family group, that I’m taking care of myself, but I’m doing this to take care of my community, and in this case that’s my family, that’s who I want to see. That perspective, I don’t know that she shared that perspective, and it’s an interesting thing that we think about a good bit. One of the things that I really appreciate about my upbringing is I do know my cousins. This is on my father’s side, but on my mother’s side I know my cousins quite well because we grew up going to holidays together. They were close enough to get to see them with some frequency. We’re not in regular communication now but we see each other at holidays, we catch up, and we get along. This cousin that’s not vaccinated is a good bit younger than the rest of the cohort of cousins and we kind of wonder, we kind of worry what her connection is going to be the family more broadly if she’s not part of these gatherings, if she doesn’t see her grandmother. But if we think that she is putting her grandmother at risk for a serious health outcome for a way that frankly is very easy for her to address, and is unquestionably in folks that are medically able, the smart decision, at some point your choice to prioritize yourself or your own needs over the group is going to have some consequences here.

In this particular case we came up with a plan. This is also someone who is in school, so is not able to quarantine. She is in her teens so is going to school every day. We know that the masking protocols maybe are not adhered to as closely as they should be, so not only is this someone that we can’t—we can’t say, hey, you should cloister for two weeks before Passover, and then it will be safe. This is someone who is consistently being potentially exposed, and how do we find, again, if not the safe way necessarily, but the safest way to accomplish what we want to accomplish. In the case of Passover this past year—with Thanksgiving rather the year—in this past year, I don’t think she attended. I think we talked about it enough and she was feeling put upon in a way we perhaps disagree with, but so it goes, that she didn’t attend the Thanksgiving. With Passover we put together a plan, again because she was having in-person school, and was still choosing not to get vaccinated, that all right, we’re going to test, and we’re going to stick with the test results. This was another issue that my partner and I ran into for Christmas this past year where her parents live a few hours away, we wanted to go visit them for the holiday. I’ve referenced Jewish and Christian holidays, I am Jewish, and she celebrates Christmas. But it’s one I’ve really come to appreciate and it’s not for them a religious holiday, but it’s really important to get the family together. I’ve alluded to kind of the five of us, my siblings, and my parents, and I, and cousins, and aunts, and uncles, and I have a relatively big family. My partner mostly grew up with her cousins, aunts, and uncles, but mostly it’s the three of them, she and her parents. Not being able to get together for holidays for a while was pretty tough. When it came time to go up for Christmas, we had to have this conversation a couple of times and say, we’re all going to test, and if someone is positive, we’re not going to spend time together. I think enabling people to make a good decision, a good public health decision, is sometimes at odds with making a, frankly, good mental health decision about how nice it would be to see people. Trying to keep that in mind, trying to keep that consideration, as we’re literally in their garage waiting for our fifteen minutes to elapse, looking at our little COVID lollipops, the card with the stick in it, and kind of thinking if this is positive, we are going home.

We might not want to, it’s going to be tough, but we know that the risk here is such that we should not stay. Fortunately, everyone was negative and it worked out, but it was really important for us to come to that decision ahead of time, to really think about okay, what are we going to do, what is the important thing to do here. That was a bit tough. There were some things early on in the pandemic, sadly each of my grandfathers passed away over the course of 2020. I think my maternal was the very end of 2019, but we all—the one day that I took off of the COVID response for the first couple of months was because it took an extra day because I was flying from Oregon back to New York for my grandfather’s funeral. Then at the end of the year my paternal step-grandfather, I guess, but the grandfather I knew. My biological grandfather died when my dad was young, and my grandmother’s second husband died when I was very young, and she married again, Mickey is the grandfather that I knew. He passed away in late 2020 and the whole thing was conducted—some people were local and able to go, but I Zoomed in. I called into the services, I called into the little bit of family gathering that could happen. Those were things that would have been great to be able to be there to comfort folks and to just kind of be with each other.

Q: What was that like to Zoom into something? I wanted to ask a reflective question about that but it kind of got there.

REKANT: Yes, it was tough in that—

Q: Did you feel isolated?

REKANT: Yes, I felt isolated. It didn’t feel real in the same way. I felt like I was apart from what was going on. I knew that I was doing what I could, and I knew that the decision I was making to not drive or fly up from Georgia for this evening of services and a long weekend or so of talking to people, of being around folks, I knew that was a good decision from a disease transmission standpoint, and I still felt like I was apart from it. Fortunately, like I said, a lot of folks are local enough there to feel that kind of connection and as much as I’ve been up for the adventure of going up to Connecticut, going down for work, going down to Virginia for school, back to Virginia for work, out to Oregon for a couple of years, and being down here, I know there are reasons it’s important, and I would make those same decisions again. But even when I was in vet school, really quite busy, I’d go home, I’d see my folks a couple of times a year. There’s a bit of this that I’m sure is just growing up, and becoming an adult, and spreading out, whatever else, but I think it’s been exacerbated a bit by not being able to get home, to not be able to have that same connection to a place that’s still important to me. I’m not going out around South Brunswick but that house, and those people, and all that, really do still resonate with me.

Q: How do you think this pandemic will resonate into future generations? As you mentioned there was the missed time at a funeral where you usually get together with family members you haven’t see in a long time, and wedding, or funerals, or those types of things where they all come together, you can reunite, and share the experience together. But there’s these lost milestones that are going to reverberate perhaps into the future.

REKANT: Yes, and actually my calculated choice when I did get COVID was going to a vet school wedding. One of my classmates from vet school who her herself was living in New Zealand for a while and I just hadn’t seen her or a lot of my classmates since our five-year vet school reunion, which was when I got to Oregon basically. It was about a month later. It’s been years. These are people that are really important to me. I don’t talk with all that regularly, but one of the things I have strong feelings about Meyers-Briggs, and introvert/extrovert, and very strong scales about that and whatever else, but it’s an important framework I think to use sometimes.

One of the things I really truly value which was great in Oregon, which was great in Virginia and part of the reason I moved there for that Select Agent job, is to be around people who know me, to be around people who like—not that I feel like I have to perform around new people or whatever else I’m getting more comfortable just kind of with my own thing, but these are people that I’ve forged really strong bonds, really strong memories with, and I mean the moment you see that friend walking up to the wedding venue for this thing, it’s just right back to it. These are people that know me and know my experience, know what I went through because they went through it, in a way that a lot of people don’t. I expect the same thing will happen next time I get to go visit my friends in Oregon if I go out there for a trip or if I see—I saw one at a conference recently and you connect in a different way. In a way that was more frequent when I could just drive to a wedding. I felt really pretty bad actually because I did specifically not go to one of my vet school friend’s weddings about a year ago because we had planned our first family vacation in about a year and I didn’t want to—we all wanted to go, we were all being very careful in the two weeks leading up to the vacation, and I just couldn’t have that week at the beach with the family, and be worried that I was going to bringing disease because of a decision I made right before it.

I had a long really heartfelt conversation with my friend and I still to this day feel bad about not being able to go. Choosing not to go. I think that’s also a tough thing to reckon with. I could have gone, and it might have been fine, it might have been safe. Like I said, I went to the wedding now a couple weeks ago, and I would make the same decision again. For me I was fortunate enough to be able to make that choice, but to choose not to do these things have been tough for a lot of the time.

Q: A lot of missed opportunity.

REKANT: A lot of missed opportunity and there’s part of it that I know are outside of my experience. I think about the vet students I talked to and how important it was for me to literally go in and see people doing this work. I have met vet students, I think now they’ve gone back in, but for the first year or so, they hadn’t ever been in the same room with their whole class. I don’t think I could have gotten through vet school that way. But there’s one story that just I can’t shake that has me a little bit worried. One of my supervisors in Oregon, her son, she tells a story about seeing his best friend around the neighborhood and like running to him, just like running, running, and then with about ten feet left, stops. These friends would normally just like have the most adorable four-year-old hug possible, but now he doesn’t know if his friend is safe to be around. I’m not a child psychologist, I don’t know this in a kind of particular—but that’s an important developmental time. It’s really important to know how to interact with people, to learn those things, especially that. That story still just breaks my heart for the moment and then the worry about what potentially comes from that. Again, I talk about introvert, extrovert, and whatever else, it’s good for me to be around people and to feel comfortable around them, for whatever the reason, and when that’s not the case—that’s not the case even now sometimes. Most of my friends in Atlanta or friends at CDC are frankly the EIS classmates that have come here. We meet for dinner, and we go outside, and that kind of thing, or we go to the drive-in movie theater, which is great, and has been a lot of fun, but we know that we’re—there’s still this bit of knowing we’re there because we don’t feel comfortable going to the movie theater inside or don’t feel comfortable getting together and going into a restaurant. You kind of have to retrain into some of those things, I think. I remember someone I know from when I was in college put something up, he lives internationally, and there was a time when the country was living in it really was in a lull.

It really was for the case rates and the amount of testing being done, as far as we can tell, safe to go outside, to be indoors, perhaps even without masks, and he recalled looking at people being uncomfortable at the restaurant, at the club he was at or something, and it’s like people aren’t ready, and it’s time now, and maybe that was a bit premature, so it might have been more pressure than they thought, well that’s a thing I worry about a bunch is when is it time, when it truly safe to do the things we used to do. It’s going to take a bit, I think, to readjust to that, to choose to do those things that didn’t feel safe for so long.

Q: Right, to hug someone. You have to turn and make sure—very social hug.

REKANT: Hugs are probably okay. There was a New York Times article early on about how to safely hug or is hugging okay. This was also an important thing for my friends in Oregon. After some of these long days, a hug feels pretty good, and it helps you kind of keep going, and reminds you of a whole bunch of things. For some people, it doesn’t do it for everyone. I remember very clearly talking to one of my co-workers, Meagan McLafferty, outside of the building one day and just like, I forget if I said it or she said it, but like man, I need a hug. Like hugs are safe, right? I think hugs are safe and also right now, whatever the risk is, it’s outweighed by the benefit of a hug.

Q: It’s wonderful, yes.

REKANT: But it’s also a tough place to get to. I think we needed that hug because we spent the whole day working on calls or hearing about people getting sick and dying.

Q: Yes, early on the interactions were so—there were these strange rituals that you would go through. When you came home some people would be wiping down their everything, groceries they bought before they came in. People would take their clothes off before they would go see their—change their clothes and see their family. It was a crazy ritual. You’d go for a walk, and you’d avoid people when you would walk. Everybody was so separate. You tried to form pods but then somebody would break the pod.

REKANT: Some of those articles looks into the idea that your bubble is a lot bigger than you think it is, really eye opening. Partially because of what control you do or don’t have, but also that reminder—I don’t know if this is exactly the right thing but as you can, I think, see in the background, I like putting together Legos, and off in the corner is 123 Sesame Street, which is a lovely set. But the reminder of people that you meet each day, that feels very weird to use the Sesame Street theme song in this interview, but these are the people in your neighborhood. In order to live your life, you’re going to run into people, you’re going to see folks. This was again, part of the lesson I learned about telework when I had the job in Virginia is when you don’t do that, when I go three or four days and the only in-person conversation I had was the cashier at the grocery store, that’s not good.

Q: [laughs] It’s true.

REKANT: And it caused me some serious mental distress over time before I kind of named it and realized what it was going to be, how to help address it.

Q: You have those tools to do that but not everybody has that.

REKANT: I didn’t then, so it took that learning experience. This was a discussion with my partner and with the folks at work, when I had the—my job got reclassified as fully remote, that wasn’t the decision, my job got reclassified as it could be fully remote if I want. That’s how flexible I can be if I want to. I know that I benefit from the structure of going to work, of being around people, of coming home, but I also know the benefit from the flexibility of living with my partner. I can’t necessarily do both of those things, so the choice that I made, that again I would make thousands times out of a thousand, is to be here, and I have to engineer some of the other things around it because—sometimes the hard way, sometimes I more practically went out and sought it, but I’ve learned those lessons.

I figured hey, this doesn’t work or this does work, this can be a problem if I don’t do certain things.

Q: What do you think will permanently change after the pandemic? If the pandemic is ever over? Or are we just going to slide into an endemic kind of situation?

REKANT: There are some places that are already declaring endemicity, which is interesting. Yes, I don’t know if it’s so established and so changing that there’s a fully past this. I think some of the flexibility that has been opened up are really quite nice. One of the reasons that USDA was so proactive, I think, in doing this reevaluation is that prior to this if you wanted to move up in USDA you could start in the field, but if you wanted to keep moving up you had to go to a couple of places, a couple of locations for headquarters. Obviously with CDC, if you want to work at CDC, you more or less have to be in Atlanta. There are a couple of other locations, of course. That’s not a great way to retain or attract talent. There are some really smart people who look at this like I have this set of skills, and I can do this job for USDA, maybe I want to do this job for USDA. I get if you’re someone like me, for example, you just get fulfillment out of public service, it just is part of it. But if you’re going to tell me I have to go to, I mean no ill will to Minneapolis, but Minneapolis, Minnesota where there’s a USDA headquarters, and I don’t want to go there because I want to be close to my family in New Jersey? Maybe I’m not staying with USDA, maybe I’m going to go get less fulfillment from work, but I’ll get my fulfillment from being close to family.

The analogy that I came to, I think I came up with it, although I’m sure others have, about fulfillment and something that my time in Virginia kind of caused a bit of a—spurred on this discovery, I don’t know what the word quite is, for me, the idea of this fulfillment dog sled. You’ve got the different dogs that are pulling the thing along. For a long time for me work or school, the work or school dog, was doing the pulling, was doing almost all of it, and the friendship, and the relationship, and the hobbies, and those kinds of dogs were doing some work as well, but without that big dog up front, the thing wasn’t going. The extension of that, and I kind of knew this, and wanted to keep things moving, so to torture the metaphor a little bit, that’s the dog that got fed. My time was maybe disproportionately spent on work or school in a way that it perhaps could have been spent on friends, and family, and relationships, and hobbies, but it was in the service of keeping that fulfillment sled moving forward. Whenever I ran into, in my case it was the job when I was in Virginia with Select Agent where it just wasn’t fulfilling in the same way that previous work, and school, and stuff like that would be, and I didn’t know how to redistribute my care and feeding of the different dogs, I guess. I had a bit of a crisis, I had to kind of build those things into my routine because some of those things weren’t moving forward in the same way they were before. Learning to, in this case, like I said, could work feel a bit better for me, could it move forward a bit, by going into an office? Yes, maybe. But would that impact the other things negatively? Yes, without question. I think the flexibility really is nice. Our team at One Health, there are five of us in our small group. There happens to be someone else at CDC at Atlanta, so you’re actually imbedded at CDC headquarters, but the other three people we’ve got someone in Raleigh, North Carolina, someone in Riverdale, Maryland, someone in Fort Collins, Colorado. If I went into the office, I would be on Teams calls from the office. I think that the flexibility and the access, I’ve done a whole lot more international work involved in that kind of thing than I would have ever done. That is great, that has opened up things, to get access to people that just weren’t going to be part of this before. What we’ve lost is the interstitial stuff.

Q: Right, that’s what I was going to ask you about, do you miss the parts where—I was going to say your soup club type things?

REKANT: Definitely. I remember walking back from meetings sometimes and just stopping by a friend’s cube and talking for a few minutes. Sometimes about work but sometimes not because part of it is in service to that peacetime relations thing, it’s important to know who you work with. Part of it is you can’t, some people can, I can’t focus on work eight straight hours and just work. Got to have the mental refresh. It’s really good for that kind of thing. It’s nice that our group chat on Teams has kind of become a place for that. It’s not always the most professional place, we kind of tell jokes, and send a GIF here and there. It’s always safe for work consumption but there will be a reference to something, and you realize, okay, I’ll go for a joke here. It’s nice to have that kind of thing. I think it’s made interactions intentionally in a way that I hope can be less so. If you want to talk to someone, you can’t just, in my case, just stand up and look over the cube wall, or even just like shout, hey Mike, I want to talk, got a second. You have to send them a Teams calls, they have to accept it, so it’s an intentional way. It’s not hard to do that, but it’s harder than it was, and it’s just that little extra bit of motivation to take that step like is it worth it to make this call, I don’t know.

Those kind of things and again the interstitial stuff where it’s one thing for me to be working and look at my Teams chats and see oh, some people look at Skype, as I did before, see a bunch of green dots, so oh, other people are working. That’s not the same as seeing someone else in the office like okay, I’m on this team and I’m not doing this alone. The flexibility is worth that trade-off, but I think as this becomes a more real part of the work, trying to engineer in those touch points, trying to have—one of the things I’d love, I feel bad because we haven’t done it for a while because other things have come up, but within our team we have a small group working on a project. We had, sometimes multiple times a week, but we for a while stuck with weekly calls that it wasn’t about work, it was just how are you doing, just checking in, making sure. Because it’s also tough to see, I guess kind of an extreme example would be if I broke my leg while I was out walking yesterday, you don’t know that. You see me from the shoulders up. Maybe I’m not so willing to go check it out, get it checked out, but if I was in the office you’d say, Steve, you look horrible, you should go get that checked out. Or even just the hey, how’s it going. Is that worth the cost of a Teams call? Maybe not. Some of those conversations, some of those little bits of checking in I think are lost. It’s important to do, I think it’s incumbent upon managers in particular, but also upon just individual people to try and engineer those things back in. I don’t think we have the best tools for that just yet.

Q: Then this isolation, you have your partner, and then you also have Zeke, so there’s that. Then there’s the people who went and got pandemic animals and now are returning them. Mental health has become another one of these huge themes that has been brought to light because of the pandemic and that’s going to be an ongoing topic for many years to come along with the whole missed opportunities, funerals, wedding, coming together. Empathy seems to have really become a difficult topic for a lot of people. I want to start to wrap up here because we’ve gone on a long time, but it’s been great. I wanted to ask you if you had anything that has been on your mind throughout the pandemic. That’s the question.

REKANT: I’m thinking about the conversation that I had with that student earlier this week that one of the most important lessons I learned, I don’t know how to fix this, but it helps set my expectation, like there’s the work, there’s the work that you’re doing, and there’s all the other stuff you have to do to support that work to make it possible. I often find that the second stuff, the support stuff, that’s what’s tough, that’s what is really difficult, and sometimes necessarily so. One of the things about the pandemic that just rankled me the whole time is that second stuff, the stuff to make it to the work, to take the work out into the world and make it actually do stuff, was made so much more difficult than it had to be, that was intentionally done, and it makes it really tough to come back and do the thing when you know that people are pulling against you. When you look at—

Q: Can you describe what you’re talking about?

REKANT: Yes, I think in general I mentioned the time when Dr. Messonnier talked about how serious this was, and we took that to heart, and our responses followed. But when there’s conflicting messaging about how serious this is and what our priorities are. Conflicting priorities are a reality, that’s important, it’s important to understand and acknowledge those. But I alluded to the access of testing, one of the things that we saw often, or we had to deal with a little bit with some of our hospitals, is we’re doing screening testing, or our CEOs want—I take that back, they ended up being pretty good about that kind of thing. People had to get the message about testing, and why I’ve talked about testing not being the only form of caring so much, is because it was talked about in a lot of circles as far up as the president about either the importance of not testing, which was also maddening, but to see people testing with a lot of frequency frankly above and beyond what the science was maybe saying, and to also look at the hierarchy of controls, the approach that looks at what is closest, what is the most approximate way to prevent this, is that often the least effective and the most work, how do we step back, how do we go up this hierarchy and mitigate the hazard, how do we remove the hazard, how do we replace it. Looking at people not taking an approach like that and choosing to make it tougher for other people when it didn’t impact the person making the choose was tough.

Q: Are you talking about the federal government and leadership at the beginning of the pandemic? And misinformation that would sometimes come out.

REKANT: I am. My public health side pandemic experience doesn’t stop in October 2020, but I really go to the animal side then. When I talk about the effects on humans and that kind of thing it’s mostly focused there. The work spent chasing down all the nonsense about hydroxychloroquine, and ivermectin, and bleach, and whatever else, there was some science behind some of these conversations, but they were taken and intentionally for often the gain of limited sets of folks, manipulated and misrepresented in a way that was causing serious illness, serious problems for people, but also on the public health side it was causing a lot of work that was unnecessary, was really making people clear out some of the stuff, some of the other stuff, to get to the work that’s got to be done. That was tough. Again, I touched on the different motivations. Truly, and I wrote this in my EIS essay, I’ve written this in other things when it is appropriate, service is important to me, it just resonates. I know it doesn’t resonate with everyone in the same way and that’s fine, that’s how the world is supposed to be, but it makes it really tough to understand peoples’ motivations when they’re explicitly pulling against that, when they’re not all rowing the boat in the same direction.

Q: Tough to navigate the boat.

REKANT: Yes.

Q: I’ll ask my last question, well, not my last question. What’s been the biggest personal challenge you’ve faced during this pandemic? If you had one.

REKANT: Yes, for me it has been the uncertainty and frankly the—this is a very personally focused response, but the come down. Yes, like I said, there are a bunch of decisions that I’ve made for non-work reasons that I would make over and over again. I’ve been thinking about EIS for a long time, and then I got there, and it’s a cliché, but it’s everything I had wanted and so much more. I had no idea what it was going to be. I had an incredible experience. I sometimes feel when I am talking to prospective EIS officers that I have to tone it down because I am selling them on the goods, they are not going to have as good of an experience as I did. I had an incredible experience. Some of those times, yes, I was working far too many hours, far too many days in a row, compromising other parts of my life sometimes, but I felt like fully optimized in a professional capacity in a way that was particular to the moment. I know this that I can’t recapture the feeling of professional growth on a literally daily basis, but that’s also tough. That fulfillment sled in some ways was really moving along. I might have been falling asleep at the wheel because I was too tired to direct it, but it was moving forward.

Another thing I touched on like feedback loops and the pace of things, the federal government is slower, it just is. It’s the cruise ship that’s going to carry a lot of people real far and takes a long time to turn. You can be more nimble at the state level. I really fell into—not fell, I really kind of took to that pace. I knew I couldn’t stay. Like I said, I had the USDA commitment, and it’s the work I want to do, but having seen some other parts of sometimes it’s work, sometimes it’s even stuff outside, having seen those things that are not recapturable has been tough sometimes. Even though they’re for good reasons. I never want to work how many ever hours in a pay period I was working again. If that’s happening something has gone terribly horribly wrong. That’s not good for obviously the broader world, but also for me, the people close to me. At the same time I knew what I was supposed to be doing and I felt really good about that. I felt very fulfilled by that work. I knew when that weekly LPHA call came on, Local Public Health Authority, I knew what I was there for, I knew what I could do, I knew that I was helping people, and it was really clear that I could get that done. Again, we talked about confidence, I was confident. It wasn’t just the feedback of like oh, thanks Steve, that was helpful, it was just the comfort of knowing without that response that I’m good at this, I’m helping, and this is just a great combination of my particular skills and approach and what the need is in this particular moment. There are other ways I’m trying to find that and really find it in kind of a different perspective, but it was clear and easy for some times there. Not the whole time in Oregon definitely, but some of the time having seen what that looks like after having not seen it before, has made it sometimes a little bit tough.

Q: Tough in what ways?

REKANT: I think to stay motivated. It’s really easy to come in and do hopefully good work, to work really hard, when you have that confidence, when you know where this all fits. Sometimes when you don’t have either the perspective to know it or the feedback to get that perspective, you kind of worry that you’re—I kind of worry that I’m going down a path that isn’t going to be helpful in some ways with a particular project or whatever else, where it’s a thing that’s important to me, but without the connection to the broader group in the same way, and without knowing that it’s also a priority for other people because—oh man, I’m going to invoke that again, I feel like I’ve done this a couple of days this week. [laughs] There’s a, I forget from what country, a proverb, I know it because the UVA basketball coach has used it a bunch, but this idea that if you want to go fast, go alone, and if you want to go far, go together. The problem I think I face sometimes is I see where I think we should go and the pace of not going fast can be kind of tough. Not only do I feel like I have to get momentum but sometimes people don’t know where—sometimes people don’t agree that’s where we’re supposed to go as an agency. Part of it is being able to make my case and be clear about hey, no, I think we should, and let’s talk about it. Part of it is accepting no, that’s not where we’re going to go as an agency and trying to figure out what that means for me personally, and finding the same kind of fulfillment knowing, even for often justifiable reasons, that we’re going to go in a slightly different direction. How does that resonate with me, how do I get the same fulfillment from the work part of it. Sometimes, and this is a thing that has been a good learning experience, sometimes the answer is not that sled dog that’s going to do the pulling this time. You’ve got to put some resources elsewhere and that’s how to move forward through this part.

Q: Well, good.

REKANT: Thanks.

Q: We’ve come to the end of a very interesting conversation. I just wanted to ask the last question which is— what else haven’t we covered that you would like to share. Which sled dog is pulling your sled today?

REKANT: There’s literally Legos off to my screen here so I’ll just hang out with the cat and get him away from the instructions a little bit, have some nice food. Yes, I’m not sure that there’s anything that’s really trying to push its way to the front that we haven’t talked about.

Q: Well, then thank you for your time and your stories.

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