Valerie Stevens

Q: Today is Friday, October 7, 2022, and this is Mary Hilpertshauser for the COVID-19 Oral History and Memory Archive Project. I’m in Atlanta, Georgia at the Centers for Disease Control and Prevention Headquarters in the CDC [Centers for Disease Control and Prevention] Library. I’ll be talking to Valerie Stevens, and we’ve one pre-interview before today. Valerie, do I have your permission to interview you and record this session?

STEVENS: You do.

Q: Okay, well thank you for that. For the record, can I ask you to say, my name is, then state your full name and then tell me what your current position is at CDC.

STEVENS: Sure, my name is Valerie Stevens. I’m currently a microbiologist here in NCEZID’s [National Center for Emerging and Zoonotic Infectious Diseases] DHQP [Division of Healthcare Quality Promotion], Clinical Environmental Microbiology Branch Outbreak Response Lab.

Q: What is DHQP?

STEVENS: DHQP is the Division of Healthcare Quality Programs.

Q: Promotion.

STEVENS: Promotion, promotion. Yes.

Q: Okay, so before we delve into the details, your path to getting here at CDC, and of course COVID, tell me a little bit about your family background and the community you grew up in.

STEVENS: I grew up in the metropolitan Atlanta area, Marietta, Georgia. I am the second of six children. I am first generation college, and I knew from a young age I wanted to do healthcare in some capacity, and I found I really liked science— I really excelled at it. I was lucky enough to go to a high school that is now a science magnet school and they let me skip a lot of English grammar classes and take extra science. And then from there I went to Georgia Tech, and I was in their Applied Biology Pilot Bioengineering Program and Cooperative Program. I had to work three jobs to pay my way through school. There was no money in my family for college, but it was something that I wanted to do. I was lucky enough that Georgia Tech had that kind of co-op program, and a co-op program is where if you’re in the top ten percent of your class, they would let you go to school a quarter, work a quarter, go to school a quarter, work a quarter. I worked for Georgia’s Department of Natural Resources in the Environmental Protection Division Water Quality Program, and I went around the state testing water as a scientist, and doing macroinvertebrate sampling and profiling which tells long-term stream quality based on the bugs, basically, that live in the water. I was lucky, all of my jobs, except for working for Disney as one of those extra jobs to pay for school, have been in science. I’ve been a scientist for a very long time, and the skills have layered upon themselves and given me a good depth of knowledge that helps me be able to respond to these really strange situations we find ourselves in at CDC, and in particular, in a full-time outbreak lab.

When I graduated from Georgia Tech, I took a job in science, and it was a food quality job. My husband at the time also played soccer, and by happenstance, Dr. Scott [F.] Dowell, he was one of the first doctors to do an Ebola outbreak, I just knew of Scott, and I guess as we got to know each other, he was like, you know what, I have something at work I think you would be a good fit for, and I didn’t know where he worked. I always wanted to work at CDC. He’s like, oh I work at CDC in atypical bacteria respiratory disease, and I’m like, I want in. I started out as an ORISE [Oak Ridge Institute for Science and Education] which is a kind of fellowship for recent graduates. It’s, I took a fifty percent pay cut because I really wanted to do the work, and I really wanted to work here, and I wanted to work here from the day in medical and bacteriology lab when they showed a Nova special about the Brazilian purpuric fever outbreak. I walked out of that class changed, and I was like, okay, I don’t want to be a doctor, that was what I thought I wanted to be. I want to be an outbreak investigator. This is a challenge, this is cool. That’s a pretty far shot when you don’t have, you know it’s there, you know there’s a couple people in the world that do it. That was now my new goal, and it was a strange little twist that this soccer friend had an in at CDC, and what was even more interesting is that when I got here, one of the PIs [principal investigators] I worked for, when I told her this story, Dr. [M.] Lucia Tondella, she was actually one of two people who in that special, her and her husband Leonard [W.] Mayer, they met on that outbreak. By some strange twist of fate, when I told her this story, she was like, oh that was me and Leonard in the Nova special. I went back and watched it, and my mouth dropped open. Yes, CDC’s a big, small place. When you’re in the labs, I really, I see the same faces for like almost twenty-plus years now. It’s a big place, but it’s kind of small in a strange way, we all kind of know each other.

Q: I think a lot of people within the laboratory system knows a lot of each other. I don’t think a lot of the communications people know a lot of the laboratory people. There are these separate nests, or we like to call them silos. I like to call them nests, but you have this group of people and they’re very tight. I think there should be some more cross-pollination.

STEVENS: That’s what I noticed when I started here too, is that the lab people, as you say, the lab people and the EIS [Epidemic Intelligence Service] officers that we would work with, especially on outbreaks, sometimes we had different priorities, and where I was a young person and willing to be flexible, I was kind of steered in the direction of, no, don’t give them everything they want, because then they’ll make us work all weekend. Yes, I think there needs to be more blending of these cultures, and they are definite cultures and groups, almost cliques. Some people are good at bridging those, and other groups are less willing to bridge. That is a challenge here at CDC sometimes is, groups understanding the challenges of each other, looking at the challenges of an EIS officer, what people are asking them for, and trying to understand that, versus just saying no because you feel they don’t understand the challenges in the lab. That is something we’re always trying to work on, especially in the lab I am now because we work so closely with public health departments and these EIS officers. They do things that make us crazy, but we just have to try to take a step back and understand why they’re doing it. I think things are getting better in that respect, or at least this group is better. Yes, there are these silos at CDC that need some cross-understanding, and what’s been helpful for our group is every year we have the EIS officers spend a week with us. While it doesn’t fix everything, it does help them understand the demands in the lab, and when I was deployed, and we’ll get to that, I learned a lot more about the demands that are on the clinicians and the doctors who are out in the field. It gives me more understanding to why they might send me something as a lab person, I’m going, what is this? I can’t do anything with this. It helps to understand where they’re coming from, so yes.

Q: Okay, so after your education, you were this microbiologist at CDC, and now we know how you got there. CDC’s public health, did you know that CDC was public health, or are you just looking at the lab section of it all?

STEVENS: I was honestly just looking at it from, ooh, outbreaks, lab, I like that, I’m good at that. Actually, when I was younger, you know, and trying to struggle to find who I was in the world, I wondered if public health was really for me, because sometimes I didn’t have the same perspective on things. That’s when, for some personal reasons, I needed to go make more money, and I left CDC, and I went into the private industry.

Q: When did that happen? You were a microbiologist here—

STEVENS: In 2006. In 2006, I had been here, I had been married, I had a daughter, I got divorced. There’s a lot of personal things that happened here. Then I just had to make a choice at a certain point, and I decided to leave, and I went to go work for Johnson & Johnson’s pharmaceutical division, Janssen.

Q: Compare that kind of work with what you were doing at CDC and how the lab was set up?

STEVENS: What was really shocking for me as here at CDC we’re always thinking. We’re always thinking, does it make sense what we’re doing for the question that we’re being asked? Science is always leading— science is always leading. With as many flaws as the system, as the federal agency has, the science always led the way. In industry, the lawyer leads the way. The science, it takes a back seat to what makes sense. That’s where I butted heads quite a bit with Johnson & Johnson people. First of all, supervisor knew less science than me so that was kind of challenging for me. The reports I would give, she didn’t understand. She would constantly ask me “dumb it down.” I’m like, I’ve dumbed it down as far as I can dumb it down. They’re doing protocols that make no scientific sense, because the regulatory agency, FDA [Food and Drug Administration], or DEA [Drug Enforcement Administration] tells them to do it. For me, that was really difficult, and where I learned the difference between a scientist and a tech. Because when I went there, I was their lead microbiologist. People in the lab were doing things technically wrong.

I had to argue with them, and show them the textbooks, what they were doing wrong. I was explaining when I was telling, this is why you do it this way. They stopped me, and said, no, you think, we do. I’m like, don’t you want to understand why so you can troubleshoot? They literally said to me, no, that’s your job. When I went and questioned this, yes, that’s the difference between a quality control technician and a scientist in that world. I spent most of my days signing papers, reading regulatory rules that I disagreed with scientifically, felt that if you’re only testing for five microorganisms in the vast world of things that can make you sick, this makes no sense. I was always just kind of fighting an uphill battle because I was trying to push science, and they were pushing regulations, and that was the breaking point. That and ethics. When you’re dealing with a company like Johnson & Johnson, you get paid on metrics, or your bonus, rather, is on metrics. The metrics are how fast you sign a paper, or just things to me that as a scientist kind of killed my spirit. When I wasn’t doing something that was going to help somebody’s health improve, it was just so Johnson & Johnson didn’t end up in a newspaper, it was just soul-crushing.

Then in these big quarterly meetings with the higher-ups, they would make jokes that were hurtful to my soul where this company subsidiary was called Noramco, and they made eighty percent of the narcotics in the United States. I didn’t know that when I took the job, it was interesting little twist. They do, and they were making jokes about how to make oxycodone, hydrocodone, and buprenorphine, they’re like, we’ll get you hooked, we’ll get you better, we’ll get you hooked again, literally saying this in meetings, and it was just like, I didn’t want to be part of it anymore. I felt a little trapped because I needed a job, a single mother at this point. That plus some flat out lies where my higher-up was concerned that because we didn’t have many macrobiological contaminations, that we would be made redundant. She started making up problems that didn’t exist. This was my name on it, not hers, if FDA comes and does reports. I took documentation of all this, took it to her HR [human resources], they did nothing, and suddenly my life was becoming extremely difficult for my boss, so I chose to leave.

I left and I went to a great company, super nice people, boring job. Indorama Ventures in Covington, and they make textiles. They basically make three different plastics of different coatings. Really all you were looking for was mold contamination. I set them up a nice lab, wrote them all protocols, and kept looking for another job. That’s when I found a contracting job opened up here, and as things happened, they were looking for the skills I had acquired from Johnson & Johnson and being in industry. Putting it all together, came back here as a contractor in 2014, ish, and started out in surveillance.

What we were doing was we were looking at resistance patterns for microbes, things that are resistant to different drugs, IV [intravenous therapy] testing, hundreds of samples from around the country, and looking to see if there was any spikes or trends that sent a signal that we needed something. Well as things went on, because I had this depth of skills in microbiology at this point, I had food micro, textiles, pharma, so I did FDA, I knew all these different, crazy things. I kept getting borrowed by the outbreak department. They would have an outbreak where the hospital was saying, maybe it’s this pharmaceutical. No one knew how to test pharmaceuticals. Well Valerie does. I got borrowed and borrowed and borrowed, until one day in a big branch meeting, I found out along with everybody else that I had to move into outbreak. That was one of those little management snafus where I’m sitting there, a whole room of fifty people turn around and look at me, I’m like, I don’t know what just happened. I had to ask after the meeting, what happened? I got moved to outbreak, I want to say, four or five years ago.

Q: This is the outbreak response laboratory?

STEVENS: Right, same branch, it’s still the Clinical Environmental Microbiology Branch, and what they do is they work with healthcare facilities, when they have outbreaks. There’s typically NICUs [Neonatal Intensive Care Units] and PICUs [Pediatric Intensive Care Units], and highly resistant infections like MRSA [methicillin-resistant Staphylococcus aureus], we see a lot of Pseudomonas.

I had been working with organisms, these gram-negative or gut bacteria. Actually, bacteria are strange, right? They have this neat ability to pick up extra pieces of DNA [deoxyribonucleic acid], they’re called plasmids. If a bacterium gets enough what we call selective pressure put on it, which is kind of like, think of it, when you get sick, and you get prescribed antibiotics, those microbes that are making you sick are not exactly the same. Some of them are going to have a weakness that the anti-microbial is going to take advantage of and kill, and some of them learn to pick up and change their DNA just slightly so they can avoid that. If you don’t finish your antibiotics, you kill the weak ones and you let the mutants survive. They multiply up to big populations, and then you can pass it on to somebody else. Now, that person has the same infection, but now the drug won’t work. Those are the type of things that we’re always looking for and see in the, we’re looking for the pan-resistant infection. Putting all of my stuff together, I know how to work with highly resistant infections, and through the hospital pharma stuff. I just got “voluntold” into outbreak. Right now, my job is, we’ll get a weird situation, and I hear it, I listen to the EIS officers talk about what’s going on, and I just have to make up a protocol scientifically that will answer that particular question. Every day is something different. I can think I’m coming here and doing XYZ, and I do ABC. That’s why I love the job.

That is what is so different in industry. Industry I could tell you what I’m doing on a Tuesday at 2PM, and it’s scientifically not a challenge, as much as I really like the people at Indorama, they were nice people, good people. Boring for me, and I’ve learned a scientist, you either are a scientist or a technician. I didn’t know that existed when I first started at CDC. I thought everybody was a scientist who wanted to know. Nope, not everybody who puts a lab jacket on knows why they’re doing something. That’s what makes CDC so different than I would say the vast majority of scientists who are out there calling themselves scientists. They’re not really doing science— they’re performing a task, a technical task. They don’t know why, if something went wrong, I wouldn’t know how to troubleshoot it. That’s what was so neat about my education at Georgia Tech, they did not ever just want you to do, they wanted you to know why. Our tests were never ABC or multiple choice, it was, here’s a problem, fix it. It teaches you to think that way, and I learned after going in industry, I liked that— I’m good at that. Now I’m pretty much in what I would consider my golden ticket job. I have bad days. I have people that make me roll my eyes daily. The work is really interesting, and the neat thing is, you know you’re helping somebody. You know everything you’re doing, at least you’re giving them an answer. We end up giving facilities who have struggled with, like a burn unit who struggled for two years on why they had an Acinetobacter baumannii consistent infection.

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

STEVENS: Okay. You know, when we hear these stories, it’s very easy. We usually can go right in there and tell them, it’s here, here, here, this is what you’re doing wrong, here’s your remediation. The problem we have is not the science. Just like COVID, it’s not the science. It’s getting the people to buy into the science and to follow it through correctly. That requires people to trust us, and to be willing to try and understand the science.

Q: Which is a great segue into COVID, before we get to COVID, I really want to have you explain some of the outbreaks that you have worked on. I know that early on that you worked with Legionella.

STEVENS: Correct.

Q: Maybe some anthrax?

STEVENS: Correct.

Q: Maybe SARS [severe acute respiratory syndrome]?

STEVENS: Correct.

Q: Okay, so pick one of those, or all three. Tell me how those went down.

STEVENS: Okay, so when I first started here in ’97, I was in atypical bacterial respiratory disease branch, which was then NCID [National Center for Infectious Disease], I think it’s NCIRD [National Center for Immunization and Respiratory Disease] now, right? They did atypical causes of pneumonia that were bacterial in nature. Started with chlamydia, everybody takes a giant step back when you tell them you work with chlamydia. There are three types of chlamydia— two are respiratory. One, most people have had, and they don’t know they had it, it’s like a bronchitis. The other one is called psittacosis— it’s a leading cause of people to have spontaneous abortions, it’s very dangerous, and it’s through birds, typically, they also call it parrot fever, it’s not very typical in the United States because the USDA [United States Department of Agriculture] looks out for that.

Then there’s Legionella and Mycoplasma. What these all in common is they don’t have the same vulnerabilities that most organisms that cause pneumonia have, and so those drugs don’t work on them. Chlamydia used to be considered a virus because it doesn’t have a cell wall and things like a bacteria does, so that the only drugs we have for them are macrolides which only basically freeze the microbe, don’t let it replicate, they’re called static drugs, and they allow your immune system to catch up. Same thing for Mycoplasma, no cell wall. Legionella’s a little different too, it doesn’t have the same vulnerabilities, and it uses Zithromax, another macrolide. All of these are strange reasons for somebody to have pneumonia, and by the time it came to that, it was kind of like a dumping ground, the doctors were like, we don’t know, what do we give this person? We would do a combination of different testing things, and then of course there’s Legionella outbreaks, and that’s one of my favorite stations over in the museum is to tell people some of the little secret things about working in the Legionella lab that we’ve learned over time, and that you’ll find Legionella in your house— you’ll find it everywhere. The reason you don’t have as much Legionella disease is that when Legionella gets cranky, and it’s not liking its little biofilm home that it makes on pipes, is it’ll actually turn on a gene called the flaA [flagellin] gene to grow a tail, and it runs away from home. When it’s mobile, when it’s in that mobile phase, that’s when it can make you sick, that’s the only time it can make you sick. That’s why you don’t have as much, and that’s why we can come up with remediations by keeping that biofilm controlled, it won’t be starved for nutrients and decide it needs to run away and find a new home. There are these funny things that you learn from outbreaks by being very observant and seeing what’s different in these microbes. Now that we have a lot more tools for whole-genome sequencing and looking at the actual genes, we learn these things like oh, it’s turned on a gene it didn’t have on before, what’s it doing when it turns on that gene? It grows a tail? Why does it need a tail? It’s going to go somewhere else.

That’s what’s so fun about it, is you know you’re helping people directly in the outbreak. Then you’re gleaning information from them that you can use to help prevent another outbreak. There’s the disease control, and then the prevention part. I started out in that, doing those outbreaks. Again, it was the same system, they saw me working in chlamydia, they saw I really like outbreaks, nobody else wanted to work on the weekend, and so I was in Legionella. I got volunteered into Legionella and did the outbreaks, which is what I always wanted to do.

There are a lot of changes I would say in the lab from then. The campus is completely different now than it was in ’97. In ’97, any Joe Schmo off the street could walk right in the Building 1, you needed no clearance, you just waved hi to the guard. We’ve always had our fair share of science deniers who are angry, and I’ve never really understood why, other than I think they have fallen for some charlatans who try to give them a reason why they have something challenging in their life, or a child who’s got challenges in their life. It’s easier to blame somebody else and to look at your own genetics and go, wow, that one just came up difficult. I actually have had somebody jump out at my car, I had a red Saturn back in the ‘90s, jump out at my car dressed as the grim reaper. I’ll never forget, he just banged on my windshield. There were no guard stations when you first drove in, you just drove in and parked. That was a little concerning. I appreciate now that we have these safeguards to keep the people who are angry at us, away. I never speak directly to them because I don’t think it’s helpful. Plus, there’s a CDC policy that we’re not supposed to. It’s not that we have anything secret. I think that’s important for people to know, everything I do in the lab, every single thing I do, every single email I send, they can look at it, it’s Freedom of Information Act [FOIA]. They just have to ask for it, no one’s hiding anything. We don’t speak directly to the public because we’re just not trained in how to make it understandable.

That is one of the biggest challenges we have in the lab is we forget how much science we know. Sometimes when we’re just babbling off to each other, I’ve had people tell me, it’s like you’re speaking a different language. To me it's very clear. Our communications people are the ones that, I call them the translators, and the normal people are the scientists, so they can kind of make sense, because science is not where you can take a little piece of information. There’s always context around it. That was one of the big communication snafus in COVID, in my opinion. Back then, we had no real security on campus— that has been improved.

One of the horror stories, I want to go and put it on record, is when I started as the ORISE, I was the grunt. Go clean the fridge out, grunt! No problem. I went into a walk-in fridge that had all these water samples from Legionella outbreaks, et cetera. I’m cleaning out, cleaning out. Then I find this little, tiny vial full of old blood that was kind of oozing out the top, because anyway. If you don’t prep blood properly, it’s not going to stay in the tube— it’s going to expand. I turned it on its side, and it said – Yersinia pestis, and if you don’t know, that is black plague. I dropped it in the autoclave bag, changed my gloves, and went to go sit down for a little while. I just reminded myself, remember where you are. I taught that to every person who’s coming after me.

Sometimes we’re so complacent with, I work with stuff that can kill the healthiest person in a minute, every day. I’m not that great, but I’m very, very careful. I don’t think I’m smarter than anybody else, but I think I’m very mindful of what I’m doing. I struggle sometimes with some people who get a little complacent. It’s very important you always stop and remember what you’re working with. This is the CDC, we do have some extremely dangerous organisms, and we do need to study them, but you need to slow down. That’s important to slow down, remember where you are. That story of finding the black plague is kind of what I tell people, well we have a lot more biosecurity now. Now if you tried to do something like that, like when I went to Building 15 to go put stuff in the deep-freeze, there are cameras following me. There’s a lot of security now. It’s still important to remember what we work and stop, slow down, and just remember how dangerous this is and be careful. Safety people have put a lot of things in place to kind of like dummy-proof. It’s still ultimately up to the scientists and human to remember where you are, slow down, it’s important, it doesn’t need to get out of here.

Q: Why was there black plague in there?

STEVENS: What happened was I told my then supervisor, Dr. [Barry S.] Fields, and he goes oh, we used to work with that. They sent that out to Fort Collins, [Colorado] just throw it away. It used to be in the atypical respiratory branch, I guess they consider plague atypical. All that stuff is now considered insect vector-borne and was transferred out to Fort Collins who handles that. It was literally just sloppiness— it was just lab sloppiness. I still deal with some of that today, we do have a lot more things in place. We have a whole quality system now. Back when I started, we didn’t have written protocols. Nope, I had a notebook that I handwrote everything in, I still have that notebook. That was how you were taught. There was a PI [principal investigator] there, and you took notes. Now we have written protocols that we follow, just like in industry.

Q: It sounds like it was very academic run.

STEVENS: It was very, as soon as he’s gone through this culture thing, I think as the people who were here in the very beginning, and they built those labs up there, they were smart people, but they weren’t trained in the rigor of SOPs [standard operating practices], things that I learned in industry. Now again, I’ve taken the industry, okay, I know how to do an SOP and write point one, two, three, four, five, here, send it, you know, all of that stuff. They were just so used to, this is how we do it, that they’re resistant to, I don’t want to have to write everything down, I already know what I’m doing. As they retired, the newer people were just kind of like bringing that culture. CDC’s definitely moving in the right direction. It still has a ways to go. But it’s just, again, slow down, remember where you are, it’s important that you do things correctly and be careful. Writing it down and having SOPs is just part of that. It’s a culture of change, it’s the older people who were here maybe when CDC first started, as they retire and we bring in new people, it's important to teach them things correctly. But it is, it’s a change.

Q: Tell me what it’s like to work on an outbreak when you were deployed.

STEVENS: Okay, so yes, during COVID—

Q: Before we get to COVID.

STEVENS: Okay, which outbreak? The first SARS?

Q: Yes, SARS, the first SARS, 2003 we’re talking about.

STEVENS: 2003, I had a young daughter at the time, but they brought me back, because we would get just hundreds of blood samples.

Q: How do you get hundreds of blood samples? How are they sent?

STEVENS: So, they get sent here through, they used to call it the DASH [Data and Specimen Handling] system, data, handling, specimen handling. Now it’s called STATTs, Specimen Triage and Tracking [Team], I think is what they call it. Everything goes into the loading docks here at CDC. They have these different departments, so now I’m in Unit 154, that’s the highly resistant infections outbreak, Legionella would be another one, like 18, or I’m just guessing numbers. Everything that’s submitted from the state public health system, so things to come to get tested for CDC have to go through the state, unless it’s a very specific situation. Most of the time, things will come in from the state public health, states have first jurisdiction on what’s going on in their state. When they decide they can’t do it, they need help, X, Y, Z, they know how to submit things through STATT to the right unit here at CDC, so they know, okay, Legionella’s unit X, resistant infections are Y. They send it in a STATT to that unit, STATT takes it, makes sure things are packaged correctly, logs it in to our LIMS [Laboratory Information Management System] system, and LIMS is a type of lab information system, it’s like a big database. It’s a way that we can track cradle-to-grave. Something came in, what unit to go to, what tests were done, results reported out as this big database. It goes into STATT, we get a notice on STATT, a package to pick up. We go to pick it up in Building 18, you go, the lab buildings are in the core of this campus.

The way the new campus has been designed is the labs that have the things you don’t want to get out are in the middle. Then we have administration buildings around us. When specimens come in, they come in through the loading dock. The loading dock is underground, kind of backs, and it goes underground, goes through underground tunnels that are protected, and then up into the building, then we transport things only underground. Once it comes in here, it is in this core lab triangle basically, transported underground, so no terrorists can come and grab things, and then back up into the labs. All the labs have reverse air pressure, so if you, you know when you open a door, don’t let the air conditioning out, type thing. Ours are reverse engineered. Everything in the lab, if you open the door, air’s rushing in. Then we’re working in these containment hoods where the air then goes up through several HEPA [high efficiency particulate air] filters and then a furnace and then vented out. Everything here goes in, kind of like a vacuum. Even the airborne microbes, if they were to escape what our normal control would be, they’re still going to get captured, there’s no way for them to get out because the air pressure is reverse, and they have these indicators on each door. If that indicator is not blowing in, we don’t work. I’ve had those days where the air’s down. We don’t touch anything because it’s just part of our safety protocols now. When things come in, that’s how they get tested, then they get sent out to different labs.

There’s only, as I understand it, two full-time outbreak labs here. There are the resistant infections healthcare-associated, that’s us, and then there’s the foodborne. We do tend to work together quite a bit and cross over. Other than that, most labs are like specialist labs, like I was in Legionella. There’s doing a lot of research surveillance, and they deal with outbreaks as they pop up. Again, the protocol is, for the state to have given up, and then they make a panic call, it’s always Friday in the afternoon before holiday, so I’m expecting something to happen today. They basically wait until the last minute and they— we need help. Yes, that’s kind of the system to get something in here. I would love to have people just send me stuff, you know, something interesting, but because of the way we’re funded, we have to go through the protocol of, it’s got to be approved by the state— the state sends it to us. Anything the state sends us, we’re like fine, no problem. If a private facility is having a problem, they’ve still got to involve the state and get their okay, or our EIS officers will be dispatched out there for what they call an Epi-Aid [epidemiologic assistance]. Again, the state is in control. They have first jurisdiction.

Q: Okay, so if I like to find something growing in my backyard, I have to call—

STEVENS: The state.

Q: —the state, and then the state, if they don’t understand what’s growing in my background, they’ll go to you guys?

STEVENS: Yes.

Q: Okay. It’s the same thing we work internationally too, you have to go through the ministry of health. Somebody in Uganda finds something growing in their backyard, they have to go through their ministry of health, or through their thing, and then maybe call us.

STEVENS: Right, so the one thing that’s frustrating at times is we don’t have power. We have very, very limited situations where we have the law, the Code of Federal Regulations, the CFRs backing anything we want to do. We are public health, we say pretty please, this is the best thing for you. In outbreak situations, we can go in there, we can show them where it is, we can find it, we can give our remediations. We can’t make them do it. Sometimes that works for us. Sometimes when these facilities are in the middle of like lawsuit, they will not let FDA in, but they’ll let us in because we’re not regulatory. We’re not going to get them in trouble— we’re just going to try to help them. It’s a plus and minus kind of thing, you know. It can be a little frustrating. Most of the time people do want to do the right thing, they just don’t want to get in trouble with the lawyer. I did find this to be a giant negative during the pandemic. It’s like, the outbreak rhythm is the same. When I saw it coming over, I knew it was going to go one of two ways.

Q: You’re talking about COVID?

STEVENS: I don’t want to talk about COVID now, but I mean—

Q: Why don’t you talk about COVID now?

STEVENS: Outbreaks have a rhythm. You could see it, it’s very clear.

Q: You can see it.

STEVENS: I can see it, and I know it’s going to happen if I do this, I know it’s going to happen if I do that.

Q: Let’s stop right here.

STEVENS: Okay.

Q: How did you start hearing about COVID? Before it was even called COVID, it was called something else in Wuhan. Do all labs know each other really well, in the world? Is there a laboratory—

STEVENS: No, that’s not true. I actually found out about it the same way you guys did, from the news. I didn’t hear any—

Q: News?

STEVENS: Nope, heard about it on the news. Heard a lot of things first on the news, to be honest. There’s not a lot held back here. I know, Dr. Schuchat, Dr. Anne Schuchat, who was our acting agency lead I think at the beginning, she’s actually the one that technically hired me here. She was the branch chief of DBMD [Division of Bacterial Disease Mycotic Diseases] when I started back in ’97. Back then, again, the culture was different, and we knew each other really well. She came to my sorority house and had dinner. She’s a nice lady, but she always had science lead the way, so I had a lot of faith in her. They had early conversations because they see the signals coming in. We have a surveillance system here, when people go to the doctor, and you’re diagnosed with something, right, there’s codes. Some diseases are what we call reportable, and so you get this little blip on the database. Well, there’s a normal amount of flu cases in an October, that’s, you know. These databases, these monitoring databases watch for aberrations. We know certain fluctuations, you know, flu’s going to go up starting in October, peak in February. We also know there’s a certain baseline of bronchitis, pertussis, all these things that we watch for. Yes, there was an aberration showing up in China.

Now the problem was, China is a little more complicated I think than people realize. Back in 2003 when we had that first SARS outbreak, and we had these hundreds of samples and stuff coming over, and we were finding what the causative agent was, and we found that it was a virus, not a bacteria, and it was a coronavirus. I remember back then, I was talking about this going, if this ever was to mutate such that it was more contagious and it got out, this would be bad, really bad. There were recommendations, again, just recommendations, given to China from us, based on what we can postulate, this is how it happened, and these are the recommendations, and they were supposed to make changes on these wet markets, and holding the line to illegal wildlife importation knowing that there was a high risk that this can mutate and become human-to-human transmission. Well because WHO [World Health Organization] is then charge based on giving recommendations, and countries take them. Then there were some sections and some recommendations put on China, and they didn’t follow them. There was no enforcement, and they ended up allowing these wet markets, again, because the extreme elite in China would go, and want these products, and they just, kind of just turned a blind eye. It happened, exactly what we said was going to happen, happened.

What I learned about it, I was like, well this is bad, this is bad. If, I was watching it for a while going, okay, I’m going to just watch it, because we have to rely on them to be honest with us. We can’t go in there. At that point, our staff that’s oversees, as I have understood it, have been greatly reduced, from like fifteen to a small number, I don’t know the deal over there, just know they’ve been reduced. We don’t have eyes on the situation, we have to rely on them. Well, this was a great embarrassment, plus they had broken the rules that they were supposed to stick to from the first SARS. A totalitarian government, and I’m watching it escape them, I’m like, okay, here it comes, you know. I told my family, I told my friends, okay. If you hear one case, it’s already too late, because that’s two weeks after they got it, they’ve spread it everywhere. If it comes in and they don’t put stops on travel right now, which we’ve always said, there’s no such thing as a closed border. You just can’t do that— microbes don’t need a passport. That’s why you have to communicate and cooperate with other countries that maybe we don’t have the best relationships with, but people are people and microbes don’t care about nationality or what your politics are. Yes, once it got out of a totalitarian government, I knew this was going to be bad.

When people decided, they didn’t want to listen to how to protect themselves and close down, I had to be honest with my family, I said, well it’s either going to be three months or two-and-a-half years, because it’s either going to be get contained, or it’s going to burn itself out, and that’s what’s going to happen. Outbreaks have a rhythm. Even Ebola, microbes are going to take one of two paths. They’re always going to change, that’s just how they do. They only have one chromosome, and any changes is big, you know? It's like a copy error, if I had you write a sentence fifty times, you might make an error. Well, an error in one-chromosome organism can code for something really bad. In the case of something like Ebola, it burned hot, and it burnt out, because you’re going to kill all of your hosts, and it’ll go back into its reservoir. Everything has what’s called a reservoir, that’s its home where it lives in communion and harmony, and it causes no damage. Even Ebola has a reservoir.

Q: Do we know that reservoir?

STEVENS: We suspect that it’s a bat.

Q: A type of bat, or?

STEVENS: A fruit bat, these, they’re really big like flying fox bats. We can tell by their genome, they’re called beta, well in the case of COVID, they’re beta coronaviruses. The reason anything was coming from a bat is difficult because bats have this ability to push on the interferon gene which allows a microbe who can live in high interferon to totally escape our interferon. Again, the selective pressure, the microbe adapts to this environment that’s harsher immunewise than ours. When we get something that’s descended from a bat as its reservoir, it’s bad news for us, because a bat’s immune system has this high level of interferon that we don’t have, and interferon is one of these compounds in your immune system that’s a first line of defense, it’s like a mass-killer. If it can evade that, then you’ve got problems, because it's setting up shop and duplicating, and that’s exactly what COVID did. Again, the two different ways a microbe can decide to go around is, like Ebola, burns hot and fast, boom, and then goes back into its reservoir. COVID took a different route. COVID’s a slow burn. Slow burn’s the worst— slow burn’s harder because it’s infecting people that may not show it, and then it’ll pop up in somebody and it’ll kill them. The slow burn is what we’ve always said is what’s bad. While Ebola might be scarier, I’d rather have Ebola than a slow burn, because it’s just hiding, and it’ll pop up. It’s hiding, and it’ll pop up, and it’s changing all the way. Now what it seemed to do, I’m pretty happy what it’s doing right now. It’s becoming more infectious but less deadly. It could have become more deadly and less infectious. I’d rather have more infectious and less deadly, as a microbiologist. The route it’s taken is, we’re going to have to live with it now. The cat’s out of the bag. I don’t honestly know if it would ever have been containable. I’m kind of thinking no. I don’t have an opinion on that yet, I’d have to look at more science.

What I do know is where we are, and where we are is, we’re going to have to be dealing with vaccines everywhere just like, every year as we do flu, until we get a vaccine that’s targeting a universal enough gene that’s stable that we don’t have to do that, and our immune system recognizes it.

With vaccines, I don’t want to get too worked up, but vaccines, when they’re really effective, what they do is they tick off your immune system enough to make it develop memory. Part of the problem with our first vaccines, where they were great for a little while, cause then your body drops protection. The reason it does that is it doesn’t see it as a big threat. Why spend the energy? It’s homeostasis, your body wants to use as little energy as possible, lazy at its core. When you get something that’ll really tick off your immune system and make it think this is a big threat, you’re walking a tightrope. You don’t want it to go so crazy it causes what you call a cytokine storm, which is your body will literally kill itself. That happens in flu season every year, cytokine storms, some people getting actually ill. You don’t want that, but you want it mad enough that it’s going to actually put energy into developing memory cells that will sit in your immune library and wait. Otherwise, it just goes, okay, we already did that, we’re done, we’re not writing a novel about it and sticking it in the library. We want it to develop the memory cells.

Q: Is that what you’re talking about mRNA [messenger ribonucleic acid]?

STEVENS: No, mRNA is messenger RNA, so these vaccines are different than older vaccines.

Q: So those are the older ones you were talking about?

STEVENS: Yes, so but the new ones, as in COVID, all COVID vaccines so far have been mRNA vaccines, well at least the ones we use. I think those are brilliant.

Q: Can you talk about those?

STEVENS: Sure, why not? I’m sorry, I do tend to drift around.

Q: No, we’re good.

STEVENS: Okay, so messenger RNA vaccines are interesting. The older vaccines, we just take the actual whole virus and try to weaken it so your body can win the war. It’s a little dicey, cause there’s some codes there that you don’t it to express, so that whole genome expresses all of the things that the virus and bacteria can use to make you sick. It’s in there pumping out proteins and different things it wants. Those proteins could make you very sick. What’s interesting about the mRNA vaccines that I think’s brilliant is it takes just this tiny little part of a code, so you’ve got the genome, and then when it wants to replicate, it unzips, and then it makes a reverse code, like a mirror image, right? That’s called messenger RNA. Then the messenger RNA goes, and it replicates again in tRNA [transfer ribonucleic acid], and then it actually makes the proteins. Well messenger RNA, it’s very specific for one little thing in the case of these COVID vaccines. It only codes for the spike protein. Doesn’t code for all the other things it uses to mess up your body, just the spike protein, and the reason it went for the spike protein is because, think of it like a lock and key. It’s got this little spike, and that’s how it puts the key in there and enters your cell. If you lock out, the way it gets in the cell—

Q: Then you’re locking—

STEVENS: —then you can’t get infected, right, your cells can’t get infected. It was very specific for just the way the virus was using to get into our cells and making antibody to block it. I liked that, you don’t have all the other proteins and things from bacteria or the virus that can make you sick, it’s not replicating. It’s not even a whole dead piece, because your body’s going to react to all of those things that we call epitopes, getting into the science. It was very specific— I liked it— it was very specific. The only problem with it is you can’t tell how much of an immune response you’re going to get from a person and populations until you actually do it. We know that’s the key, that’s why you start. That was a great place to start. I was one of the first people to get the COVID vaccine. Was I nervous? Sure, I’m a human being, I have. I also was a scientist, and I’m like.

Q: How did you feel when you got that vaccine, knowing that it was only a six-month—window.

STEVENS: Yes. When I got it, they didn’t know that yet, because I was one of the first people, so they didn’t know it was six months. They didn’t know anything, really, other than, I knew the science— I trust the science. Okay, give me a shot. I got it here, and was I nervous? Yes. I was nervous because I had my own medical issues. I’ve gotten migraines and cluster headaches. I also knew it wasn’t going to give me COVID— it was impossible to give me COVID. The first shot I only really, I got a headache, and I got a fever. The second one, the second dose is—you’re telling your body you want to tick off your immune system, you’re challenging it again, and that’s going to tick off the immune system. That’s why people had strong reaction to the second dose. There are two different types of vaccines then. There was the Pfizer and the Moderna, and I knew the difference between the two, and I don’t think that was widely known.

The Pfizer had three micrograms of messenger RNA per shot. The Moderna had about thirty. It was packing a wallop. I chose the wallop. The second shot was hard. That was good. When I have a reaction like that, and my daughter had it too when she was able to get hers, she was miserable in the second one, but we knew this was your immune response, it was a little tiny taste of what COVID would be like. It was just over, and like, for me it was a weird, fifty-four hours almost on the dot, and it was like somebody flipped the switch, I’m fine, just stops, whatever I’m having. You just know if you’re getting that response, that’s good. If you’re miserable, that’s good— Somebody’s calling. I thought we put it on do not disturb.

Anyway, if you’re feeling terrible, that’s great, because you’re not actually sick, but your body’s making these cells, and if it’s ticked off enough, it’s going to say, I ain’t doing this again, and it’ll develop these memory cells. Then what people need to know is, if you go and get a blood test, and you find your antibody titer, people think, well you’re only protected if you have a high antibody titer. That’s not true— you don’t want that. You do want to see an antibody rise so that you see that you had immune reaction, but your body is not going to put energy into keeping circulating antibodies all the time. What you want is for it to have done that, which kicks off the memory cells to be fully developed. Then if you get challenged again, it remembers, it doesn’t have to go through the learning process in making the antibody. It already has the map in that memory cell, and it starts kicking those antibodies out and you don’t get sick.

Q: How long does that memory last?

STEVENS: It can last your lifetime if it’s a good vaccine. Those are when we tell people like, you know when you have the recommended, this is when you use booster. That’s based on the surveillance and testing people to see if they were challenged will they have an antibody reaction, will they react properly? Through those experiments and watching over time, they learn that.

A lot of things with COVID we’re still learning. It’s really hard for me to hear criticism of “the science changed.” How does science change? That’s all science does. Science always changes. If you’re a scientist and you say it’s always this, you’re not a good scientist. You should know it’s usually this. Then if something’s strange, you find out why. Science is always changing and evolving. With COVID, it’s a new disease. We had some reference from the first SARS, but it’s a new thing. It’s got its own pros and cons, and how people respond to these vaccines. All we can do is watch. There was a communication gap there. As a scientist down in the core.

Q: Let’s talk about that real quick. When, in the very beginning, when we found out we were having this new novel virus coming over and we were waiting for it to arrive, Nancy Messonnier put out this wonderful--- she was out there and she was telling people, yes.

STEVENS: That’s going to change.

Q: Things are going to change—

STEVENS: It’s going to get rough—

Q: I think a lot of people in leadership didn’t want to hear that.

STEVENS: That was a real eye-opener because, because I’ve always felt like CDC always let the science, led the way. I never felt obstructed until COVID. Nancy was right, when I heard it, I wasn’t surprised, same thing I told my family. Either it’s going to get contained, or it’s going to run wild, and life’s going to get rough. Yes, I actually have an email, we were gag-ordered as scientists to not talk about anything in COVID, it was sent from HHS [Health and Human Services]. I learned a lot about the politics that I never had, I guess I’d been sheltered from, or I don’t know, things we were saying as subject matter experts, and I was considered a subject matter expert, which is kind of scary on its own. We weren’t allowed to talk about it. The recommendations that I would pass up the chain to whomever my superior was and their superior, it always seemed to change when it goes to the White House person, they didn’t want to hear it. One morning, we sat there, and heard something completely contrary to what we had told them. They put CDC recommends X, and we had recommended Y. We just sat there for an hour meeting completely dumbfounded with our mouths open, but we were gag-ordered.

We couldn’t go outside the structure and say anything to anybody, not on social media, not on your own time. They covered this, well they said it was covered under the Hatch Act, that COVID was politically divisive, and we could not comment on it whether on our personal time or on company time. That was really— I don’t understand why you would gag order your subject matter experts and say they can’t talk. The science was never hard. What to do was never hard. It was getting people to hear and accept, yes, you know what, something bad’s happening, and this is how we protect ourselves.

To me, those years were the hardest years I’ve ever served in a federal service, because you would look on social media, and you would see all of this ridiculous non-scientific garbage, and you couldn’t say anything. You felt powerless, and even if you talked to your close friends and didn’t have a paper trail, it was like, I feel that I felt like a voice screaming into a tidal wave. I couldn’t get— everything I’d say here, instead of it going up and out like it always had, stopped, dead stopped. The director at the time, he was not a fighter. What was it, [Robert] Redfield. My opinion on him was he was weak. He would know when we were telling him the science that we were saying the truth, but he was unwilling to tell that truth to the White House and make them understand it and accept it. It was so incredibly frustrating, on so many levels. All of those deployments, it was always, why am I doing this, if it’s just going to get stopped at this cork, at the top of the chain, subject matter experts telling it up the chain to managers who are not scientists, and then to politicians who are not scientists, and then they just change it, because it’s not something they want politically.

Q: Do you think, well they always said, they don’t want to scare anybody.

STEVENS: You know what, and I’m sorry, I think truth is always the best, and I know that not everybody agrees with me in that, but being an outbreak person, I’ll tell it to you straight, I’ll say if it’s deadly, I’ll say your odds. I feel like the nicest thing you can always do for somebody is shoot them straight and let them make their own decisions, right? I felt handicapped during the COVID pandemic that I did my best, and I always told the truth and pushed it up, but it never seemed to go out like it used to go out.

Q: How do you think Dr. [Anthony S.] Fauci got where—

STEVENS: I was really surprised to see NIH [National Institutes of Health] take the lead instead of CDC. I felt like we got hamstrung by them not wanting to hear what Nancy or any of that, like oh, CC’s going to say things that are negative, let’s just do this.

Q: For the record, let’s say who Nancy Messonnier is.

STEVENS: Nancy Messonnier was the head of NCIRD, the National Centers for Immunization and Respiratory Diseases. Yes, so she’s the head of that center, right?

Q: That’s where SARS had come out of all, anything that’s respiratory.

STEVENS: Yes, I’d known her for decades. Very reputable, straight-shooter scientist.

Q: She’s the flu lady.

STEVENS: Yes, she’s absolutely the flu lady.

Q: Her and Nancy [J.] Cox.

STEVENS: Right, and those two know what it’s like to have highly infectious respiratory human-to-human transmission epidemic, pandemic. They’re the experts, world, period, shooting it straight. And because that wasn’t wanted, that message that things are going to get rough, we got taken out of the table. CDC was removed from the table. We were no longer on the news. We were hamstrung and put in the corner. Naughty, naughty CDC, don’t make people angry, don’t make them scared. You know, I think that was the wrong thing to do because I feel like any leader should tell their people the truth, period, whether it’s hard truths, or an easy truth. You never go wrong with just shooting it straight. That’s one of the things I love about science is that it’s not emotional— it’s not political— it is what it is. It doesn’t emote, it doesn’t have an opinion, it doesn’t have anything other than what it is. Yes, it’s scary to have a disease you can’t see that’s killing people that we don’t know anything about. The worst thing you can do is have no trust. You don’t tell somebody the truth, they find out, people aren’t stupid.

Q: NIH took that lead?

STEVENS: Yes, NIH was I guess, the Institutes of Allergy, I don’t know, I don’t know Dr. Fauci— I don’t know him from Adam. In the beginning when I listened to him, I could still stomach listening to anything on the news, I didn’t disagree with what he was saying. I felt like he was straight-shooting people. I think he got scapegoated in this whole thing too. You know, some of the stuff, people, again, not understanding how diseases evolve and how the science evolves. I think they just, it became too politically divisive. Somehow people made an apolitical virus very politically divisive, and personally had destroyed a lot of my relationships. I was always extremely proud of my career and what I had done and where I worked, I still am. There are some people who hate me for it, automatically. They think it’s a joke now. It’s not a joke. Our work was never bad— we were hamstrung. Everything can always in retrospect be better. There were things I found the communications that I would have strong recommendations on. In the beginning, we were just shoved aside. We were pushed out of the conversation.

Q: I think a lot of things, besides the hamstrung in the communications, the test.

STEVENS: Yes, okay, so I was deployed about that.

Q: Let’s talk about that test, the failed test.

STEVENS: After my first deployment during operations with the clinical team giving advice on what they should do in hospitals, I was asked to go on a field deployment where they would be testing these brand-new rapid antigen kits. Now we know it as the Binax test, right? What we were doing is we were going out to Arizona to these mass-testing centers, and we would be getting people who would do both the rapid test, and we would do a standard PCR [polymerase chain reaction] test, that is a highly technical test that requires forty-eight hours turnaround, to see could these rapid antigen tests that give results in fifteen minutes be something to help screen people so they could be around each other? What was— so we went out there testing, there’s hundreds of people a day.

Q: When was this? What, where are we?

STEVENS: No, okay, so this was November 2020. There was no vaccine yet. They were looking for something that was better than a forty-eight hour, very technical PCR test.

Q: Okay, can you talk about, before we get to those personal tests, remember CDC had put out a test.

STEVENS: Yes, okay.

Q: That was right at the very beginning, we had a test.

STEVENS: Right at the very beginning in February 2020.

Q: In testing, anybody who had COVID went to CDC.

STEVENS: Right, so in February of 2020, then [Donald] Trump came over here. He was scheduled to go to my lab, which is a hot lab, had COVID. The last minute he decided he was not going to go in there because the lighting wasn’t good. Anyway, he went to a chemical lab that had no live agent N23 and told the public that we had a test for anybody who wanted one, which was a massive lie, we did not. There was nothing then. What there was, there was a test developed in China. They did offer a different group at CDC. They decided not to take it, they made their own. They did not do proper quality control checks on it before they sent it out. Straight up bad science, no excuse for it. Those didn’t work. Then my group was tasked with fixing it. We had some people in our group who developed the right primers by looking at the sequence that China gave us. We used to look at the sequence, and it’s a whole thing. They did their thing, and they fixed it, and they made the proper primers, and now we had a PCR. Then, it went back to that other group, with our test now, because again, talking about jurisdiction, NCIRD owns this outbreak, because it’s a respiratory disease. We are NCEZID, that’s zoonotic infections. But we had the expertise, we did it. We gave it to them, and kept our cell, my group, I was a surge lab. They got overwhelmed with samples, our group would do it. That’s when the testing actually started, and that was a lag of about six to eight weeks. Now we’re on spring of 2020. Now we have a working PCR test, the primers are published and given to anybody who knows how to do PCR, so everybody can do it now.

It’s still a PCR test, and that means it takes a scientist and it takes time, and it’s expensive. It’s not exactly something that if you’re like Joe Schmo who wants to open their shop, and so do my employees have COVID, it wasn’t practical to deploy at schools— anything. That’s where private industry came in. They were developing antigen tests, which just detect if you actually have the virus in you. There are certain proteins on the surface that we can bind to a dye and make it show up like a pregnancy test type thing, so all right, simple. It’s fifteen minutes, and it’ll tell you do you have COVID, you actually have the virus. It doesn’t tell you anything else other than that. You have a couple questions, how sensitive is it, how many viral particles, how precise is it, will it bind with other respiratory. Our team, the AZ3 Team was tasked with going out to Arizona, had mass testing centers they had developed with the PCR test that was free for their people, and we were going to piggyback onto what Arizona was doing, and add the option of a free antigen test so we could evaluate, is this something that we can deploy to schools and do a quick fifteen-minute test—yes, you can come in. The administration was asking us, we want to deploy these everywhere, so is a screening test that we can open again. There was a big fight over that. Still no vaccine. Okay, we had boxes and cases of these tests, we hauled out, every day we’d be at a different mass testing center. No vaccine, so we’re in scrubs, and masks. We would have to take breathing breaks, because we were sweating through like face shields and three masks. Yes, and so we were finding as we were doing these antigen kits, these were not going to be the savior. These were missing early infections and late infections, you had to basically be coughing and spewing everywhere for this to test positive. Not a popular answer, again. Again, it’s like, we told them, publish a paper. These are not cross-reacting with anything, so they have a degree of precision, but they’re not very sensitive. They’re going to miss the person who is infectious and can get anybody else infected but are not sick yet. It took a great deal of virus for the antigen to turn positive.

Q: If you were already coughing and sick, you probably knew you already had it. This wasn’t going to tell you anything different.

STEVENS: The insidious thing of these slow-burn viral respiratory things is that you are most infectious before you know you’re sick. That is the, can I say, screw you from the microbes. They’re going to survive. That’s why I always tell people, you were infectious before you knew you were sick. If you know you’re sick, that’s great, but you’ve already infected everybody around you. There’s an infectivity index called the R-naught in science. What it tells you is every time that infected person is around somebody, how many people can get it, and can they also infect? In the beginning, we suspected COVID, based on what the epidemiology was suspected, it was around three. Well now we know it’s closer to five to eight, depending on which variant. Every person that’s sick and doesn’t know their sick, they’re infecting eight people, and those eight people infect eight people. You do the math, and you see why it explodes, that’s why the Omicron is so great at spreading. It’s just, highly infectious. Some bacteria or some viruses just change their genome so that they are able to get into our body faster or blow up in numbers They have their survival mechanism. All we can do is follow it. That deployment was six weeks, very hard six weeks of being in the desert where it’s ninety degrees in November.

Q: Wearing many layers.

STEVENS: I’m sitting there, having to scream to people, because I’m screaming through masks and a face shield, right? It was November, so everybody was coming to get tested so they could go to their family functions. I could not educate them fast enough, or to a degree where they felt they accepted the science. Didn’t matter what I said. If they were negative that day, super. You can be positive tomorrow— this doesn’t help you for Thanksgiving. As much as I told them that, it didn’t matter. This is what we’re going to do.

Q: Was it due to like, you think they were tired of being quarantined, and alone?

STEVENS: I think they didn’t believe anything we were saying. I think they thought it wasn’t as bad as, mostly what we would get is, I don’t know anybody who has COVID. I don’t know anybody who has COVID. That’s just like in November, right? The Alpha strain, the first strain that came through was bad, but it didn’t infect as many as we see now, right? I heard that all the time even from friends, I don’t know anybody who has COVID. People didn’t even believe it was real. They thought, well if I test negative, we’re all going to test, this was the common reason people came to this mass testing centers in November. Well, we’re being safe because everybody’s going to test, and then we’ll fly and have ours. To me as a microbiologist I’m going, this is completely useless. This, because the way this virus works is information for this hour, this second in time. You’re in line with 50,000 other people that could be sick, getting infected. Here, it’s not going to show up. Then you go to an airport, which is a giant petri dish. You’re in an airplane which is a giant petri dish, sharing air with everybody. You’ve got all these chin diapers on, people who are wearing masks below their nose, when you breathe through your nose, and the virus goes in, that’s how you get infected, that’s through your nose, not your mouth.

Q: Speaking of the nose and testing.

STEVENS: —Frustrating and pointless.

Q: Can you explain to me why everybody had to, when you did the basic PCR test, why do you have to shove the Q-tip so far back into your brain—

STEVENS: Okay so again, this was, these were protocols based on what worked in other atypical respiratory pathogens. It was the best sample protocol. When you have really difficult to work with respiratory pathogen, an NP [nasopharyngeal] swab is standard. What happens is these microbes go into your nose, and they go up and colonize your nasopharynx. It feels like you’re touching your brain, right, it’s like way out in there. When I started in atypical, the tests were always NP swabs, not the nasal swabs, because until you get a test that’s sensitive enough to work with less virus there, most of it’s going to be in the nasopharynx.

Q: You have to get to the motherlode?

STEVENS: Right. Then at that point, we’re at the beginning, you have to go, what’s the best sample? We don’t know if the test is precise enough to work with the nasal swab, but we know all the difficult ones so far, they’ll work with NP swabs, so that’s why it was an NP swab. That’s that horrible, flexible thing, that’s way up your nose. Yes, then we always have the issue of compliance, right? You’re like, okay, well that might be the best sample, but is anybody going to do it? That’s why we really need a test that were sensitive enough to work with less viral load that would be in the font of your nose.

Q: Have you gotten there?

STEVENS: I feel like they’ve gotten better. The feedback we gave, Binax, that’s to Abbott, Binax Abbott for that, they have improved their sensitivity in that antigen test. These were the first ones. These were like, I gave you guys a box of those.

Q: You did, yes. You said these don’t work, I’m like, oh great, fabulous.

STEVENS: No, they don’t. Now they’re a lot better, plus what we’re dealing with now is a variant that replicates much better. Where you might have, let’s just use round numbers, ten viral copies in your nose from the original strain, Omicron’s going to have ten billion. It’s just the way it replicates, it’s just, boom. The tests are now better. They got feedback, and the companies have a lot of money on the line, they wanted a better test. They want to be known as the best test. Now every Joe Schmo’s got a test because it’s not a difficult thing to manufacture. What’s hard is getting that science and knowing, okay, what do we got to do to put this thing together? Now they got a good formula, now there’s a decent antigen test. I always tell people, PCR’s still going to be better. It’s going to find small amounts and it can replicate, it’ll tell you, definitely if you’ve been exposed. An antigen test is less sensitive, but it’s still a good, down, and dirty.

Q: The reason we were testing early one is, A, we didn’t have a vaccine, but wanted to make sure that we were not asymptomatic.

STEVENS: Yes, we were doing a lot of that too, like why are some people testing positive, and they’re like, I’m fine. That’s just what some bacteria do, or viruses do. That’s why I call it the slow burn ones, you know. Some people, their immune system will just shut it down. Other people, and that’s still science, we have to figure out why. That’s the interesting thing, for long term. Now that the pandemic is “over”—

Q: Is it over?

STEVENS: Well, here’s what I tell people. This is—outbreaks have a rhythm.

Q: This is October.

STEVENS: Outbreaks have a rhythm, right? Now we’re dealing with something that’s endemic. Endemic means it’s here, and it’s going to have its seasons, everything, Legionella, Ebola, everything has these weird seasons. These are all living things, they don’t talk to us, but they’re living things, and they respond to their environment. We’re learning what COVID cycles are, it cycles in summer, and then it cycles in the winter season, and that’s because of our behaviors. The summer is more interesting scientifically, I’m not sure why. The winter cycle up with COVID is because people do things like they travel, they’re indoors, they’re with immunocompromised loved ones more.

Q: Family gatherings.

STEVENS: Yes, so you’re dealing with a lot of people issues there, that’s why it cycles up. What was the question again, so what about the, I forget what the question was, I’m sorry, I drift off too much. It was about the COVID, oh, how the outbreak went in general. Okay, so is it over? Speaking of the pandemic, is it over? Mostly. The way a pandemic will work is you’ll have that, boom, right?

Q: First wave, yes.

STEVENS: Then you’ve got these, as it changes, and your body, it’s going around the globe, and it’s changing, and you’re having the surges based on how it’s changing. I remember, it could go one of two ways, fast burn or slow burn, high infectivity and low lethality, or high lethality and low infectivity. What’s done is it’s done this, boom, boom, boom, and we’re down here. I tell people, we’re going to have this lethal blip with pandemics petering out. I call it the slow end decline— I’ve got a playlist in my iPhone for different times in my life, I usually used to it by quarter. I had a pandemic playlist, and now I have one called, “End of Pandemic: The Slow Decline,” because that’s where we are. As things decline into endemic status, we’re going to have blip, blip, blip. It has settled into the high-infectivity, low-lethality, which is good for us.

Q: Are we coming into the blip again now that we’re going into October?

STEVENS: Absolutely. I think we’re going to cycle a lot. I think it’s going to slow into a cycle that ticks up with flu a little bit in the winter. I think you’re going to see it tick in the summer, and I’m not sure why— I don’t know why. I don’t know why it upcycles, but it does. Every summer we have a tick, we have a, bloop. The Delta surge. I’m glad Delta went away because Delta was terrifying.

Q: Yes, it was.

STEVENS: It was hard.

Q: Do you think our laboratory science has made an impact on the overall flow of this pandemic?

STEVENS: I was disappointed in how the labs responded to the pandemic. I feel like private industry did better in that regard. When I was deployed, I was actually not in the Lab Task Force, I was in the Clinical Task Force, and then the Vaccine Task Force [VTF], and I was actually, outside person working with the lab as a partner which was interesting. They did not have a good handle on workflows, and reporting. There needed to be a lot of infrastructure built, and that was a struggle. When I would have, like say my reinfections deployment, when I was doing surveillance at the very beginning, could somebody get reinfected with COVID was the big question. We were asking the lab, our labs here, to use that STATT system I talked about, sample comes in, it gets assigned to a unit, they get results. That’s a well tried-and-true system, but when they did these task forces, they didn’t really utilize, they didn’t tap into that fully. They let the samples come in, but then they went to the Lab Task Force. Then the Lab Task Force was spinning those samples out, and no one knew, it was like the three stooges, to be honest. Who’s doing serology? Oh, it’s this person. You contact that person, no I don’t do that, it’s this person. It was, I felt like I was who, who, who the heck is in charge here? It was a lot of chasing down, did your lab do this? Where are the results? They didn’t have the recordkeeping. I felt like it was an embarrassment, as a lab person that wasn’t deployed to the Lab Task Force, I’m like, oh come on, man, you know?

Q: How did that settle out?

STEVENS: I don’t feel like it ever did. I feel like what happened is, in 2021, when I was sent to the Vaccine Task Force, and I still was somewhat dealing with the lab, they kind of settled into a rhythm. The problem with the deployments there was they were six weeks, or thirty days, and by the time somebody learned their job, they were gone. This high turnover for a long pandemic did not work. The structure was, when the EOC, the Emergency Operation Center was deployed, you’re not supposed to be deployed for more than sixty days. Most supervisors would only approve thirty days. I was core outbreak, so I had an argument to say, this is my niche, and I’m supposed to be deployed. I was deployed for months at a time, so I got to be good at my job. The handicap was, in the Lab Task Force in particular, they’re doing thirty-day rotations, no one knew who was doing, there was no stop infrastructure system, and a consistent leader. There needed to be consistency— there was a flaw in the ointment, so to speak, where you have a pandemic, and by nature, a pandemic is not a flareup like other emergency operation deployments. You needed to have a minimum of sixty-day deployments for somebody to learn their job and then actually be good at it. There was way too much turnover.

The way we dealt with it in my core deployment team, the clinical, we would use the same people over and over. They would rotate in and out, in and out, in and out. They did learn it— they were gone again because their supervisor would make them, but then we had, a rotating, person A was here, gone, person B was here, then person A came back, then person B came back. We kept doing this, and that’s why I kept going back to the same team, because I knew the job. In the Lab Task Force, I felt like they were never recycling people, it was always somebody new, and they didn’t have infrastructure that they needed for a long pandemic. This should have all been done by, there’s an office of preparedness, and they got some learning, I’m sure, out of this. There also was a huge problem with, of supervisors denying deployments. If CDC’s main operation mission at that point was COVID, there shouldn’t have been obstruction by supervisors because they have their own PMAP [Performance Management Appraisal Program] and things they need to get done. Either it’s a priority to CDC or it’s not. I was asked to deploy for monkeypox [mpox], and my supervisor stood in the way. This was something during COVID by the second year. We were dealing with so much burnout from the people who would—

Q: That’s what I was going to ask you, yes.

STEVENS: Of course, A, B, A, B, those people were so burnt out, and supervisors were so resistant, that we were having to go to EIS officers, or US Public Health [Service] officers who cannot be, they have to deploy, if you ask them to, they have to.

Q: What about the LLS [Laboratory Leadership Service] people?

STEVENS: No, they don’t have to. The Laboratory Leadership? I’ve had interesting interactions with them. Some are completely incompetent and weird, and other ones are great. My experience with the person who was LLS on the AZ3 Team was she was grossly incompetent. I’ll leave it at that, I’ll leave it at that, she’s grossly incompetent.

Q: You had to rely on EIS officers to backfill?

STEVENS: Oh yes. By the second year, by 2021, most of my operations was getting clinicians to have to deploy for either the vaccine education or the clinical education. Those poor guys were just fried, just so tired. It is—I was fried too. You would work, oh god, there were times I worked seventy-two-hours straight, I didn’t get any sleep. You couldn’t even report those hours, because it’s illegal, but you had to do them.

Q: What were you doing during those seventy-two hours? Give an example.

STEVENS: There would be the reason I had to do that one was because of problem with the Laboratory Task Force. They couldn’t find the results, and I was having to do investigations between, it was the Navajo nation, and they’re set up to try and test their people for COVID, and the people here in the Laboratory Task Force, and it was just gross incompetence, and I was having to unravel all of this nonsense and try to figure out where the samples went, where the results were.

Yes, people might turn off their phones at 6:00 pm but I still had to figure it out, and I had to have it done before seven AM, and so I worked all night long to get an answer, because it was intense during the day. You would look up, and it would be six hours later. My daughter was home from college during this. I don’t remember, but she said she saw me in the living room just crying, and I don’t even remember that I was just so burnt out, tired, frustrated. Feeling like I’m working so hard but I’m getting nowhere. It was very difficult, mentally, to feel like you’re getting somewhere. I don’t mind working hard at outbreaks— I do it every day. I get somewhere, and somebody listens to me when I find the results. I don’t feel like I’m banging my head against the wall, but COVID was a giant bang your head against the wall. There needed to be better infrastructure when the EOC deploys. Because when somebody comes in, is never deployed before, like a massive response, like a pandemic, they don’t know what to do— they don’t know how to log their averages. All these things they have to do, and the reason I was in operations is I sat down, and I took my own time after work, and I made all these links, and these books and things so just did this, did this, did this. I had to develop that on the fly, while I was doing that job, to help other people downstream understand the infrastructure, when that should have already been done. We had been saying for years, there’s a pandemic coming, period, end of discussion. Why weren’t these things ready? I don’t know. I mean, I’ve been here a long time and I adapted pretty quick, but I also know all the people who were hired just for COVID as contractors. It was a complete disaster. They didn’t know anything about CDC. They didn’t know how to talk to anybody here. Then we had some that didn’t even bother to dial in, because it’s remote. It was, what happened was their work ended up piling onto people who would do it, and it was an overburden to compensate for people who were just either untrained or unwilling to work. It was a combination of both. It was tough. I feel like I aged in dog years those three years.

Q: During the pandemic, we had leadership changes.

STEVENS: Yes, we did.

Q: At the federal level, and at the directorship level as well. Did you see a lot of changes because of these leadership changes?

STEVENS: Yes, it was really, really historic. With the gag order email and the ignoring of all the science, getting corked at the political level, when [Robert R] Redfield left, I’ll use names, when Redfield left, he was weak. He knew we were saying the right science, but he was too weak to stand up to the administration who didn’t want to hear that. It had become so politically divisive at that point, it was just, it wasn’t about the science. It was somebody who already made their camp and put their foot firmly in the sand. Well, when [Joseph R.] Biden was elected in that January, we had within six weeks, we had a worldwide conference here on COVID, so much was done in six weeks that wasn’t done in the past year-and-a-half, we got somewhere. We still had infrastructure problems with getting the vaccine deployed out, but we at least at that point felt like the cork was gone. I don’t feel like they had any scientific guidance for us, but we had somebody who removed the cork, the political cork, and was letting us do our job. If we failed, it was on us.

Getting the vaccine out was harder, because again, we already had lost the messaging war, and it was political at that point. There’s always, I think things that should have been place as far as how do we deploy mass vaccines? How do we deploy mass drugs? Still, we need to have that in place. We were building the plane as we were flying it. We didn’t really have industry experts who knew how to do this. I felt like it would have been a great time to ask industry to step in and help us. I know supply chain working for Johnson & Johnson, who had a whole person who did nothing but supply chain, Steve Anderson, who’s great at it. I was like, call Steve. We really probably would have benefited from partnering with industry. Sometimes I feel like government is too, no it’s government we’re not going to partner with industry. The United States is an interesting mixed economy, right? I feel like we should have been able to ask industry, hey, you guys are supply chain experts, help us.

I still think that there’s an opportunity to do that. We didn’t take it— we tried to build our own infrastructure and get the vaccines out, and while I was working with the team that was dealing with answering emails, technical emails, phone, clinicians across the world. I have opinions about the answers, I feel like the messaging and how CDC communicates with the outside, I’m not a communications person, but I can tell you what I see. I think people don’t go to our website because it’s boring. I think they don’t hear us because they don’t believe us because we lost a lot of trust. Without trust, you can’t do public health. I feel like we would have really benefited by one of these people who’s got a Twitter or something, make a funny tweet. The one thing people always remember is the FDA getting snarky about ivermectin. Great, that’s awesome, the message got out. Sometimes I feel like people here are so serious and take themselves so seriously, they want to be solemn. That’s not how you get the message out to people, I’m sorry, you have to meet people where they are. Meet them where they are.

Q: Did you work on [Operation] Warp Speed?

STEVENS: Yes.

Q: You did?

STEVENS: Yes.

Q: What was that like?

STEVENS: Horrible.

Q: Why?

STEVENS: Beating your head against the wall.

Q: Really?

STEVENS: Yes.

Q: You got the vaccine out in Warp Speed.

STEVENS: Did we?

Q: How did the vaccine come out in such little time? In the past, vaccines came out, it took years.

STEVENS: The messenger RNA technology, it’s a lot easier to do. I can make it in a lab. What happened—

Q: Is it trustworthy?

STEVENS: Do you trust me? The science was never the hard part. The hard part was the communications and the trust, and that got shut down early, got sidelined, hamstrung, put in the corner. Naughty, naughty CDC don’t tell us negative stuff. With the messenger RNA, it’s this little, tiny piece of nucleic acids. We can have a computer, we just tell them sequences, like, programming a book, right? This is the sequence we want, make it, and it makes it. They used to use things called Taq [Thermus aquaticus] polymerase and things that can, the enzymes that will do it for us, we found from these different bacteria that live in thermal vents. It’s a whole thing. We know, it’s like cooking at this point. Here’s the recipe, trying to give us a sequence. The messenger R spike protein, we had that. Making the vaccine is just like cooking. You just make it, they can, there’s the GMP [good manufacturing practice] and the quality control and all that stuff. Making it up, there’s the GMP and the quality control and all that stuff. Making it up was again on private industry, and they did a good job. Then deploying it came to us, and we really needed supply chain people. It was just people trying their best to learn a skill they didn’t have. We had subject matter experts like me, but I am not, I’m a COVID expert. I’m not a supply chain expert. I don’t know how you get a trucking company to take something to Tucson [Arizona]. I don’t know how many doses this state needs. You had a whole lot of jurisdictional issues too.

Q: Oh yes, we could bring that up.

STEVENS: Certain states.

Q: There’s so much to this, I mean there’s a disproportionate effect on marginalized populations, there’s the racial and ethnic minorities. When Dr. [Rochelle] Walensky began her tenure, and I think that was right around the Delta surge.

STEVENS: Yes, it was.

Q: There were so many talks about health equity, and what was the focus points for the labs when you were talking about it?

STEVENS: We don’t actually focus on that, because we don’t care who the person is.

Q: The science.

STEVENS: Right, we don’t ever get involved in that, so when I deal with a person, I just know it’s a human being, I know nothing else about them. All the health equity and stuff, those go to health analysts, and health scientists, and that’s whole ‘nother department. The pros and cons of working here is we’re hyper experts, right? I can be really good at finding a resistant bacteria, finding its mechanism, telling you how to fix it. I can’t tell you anything about why does this person get access to the vaccine and this person doesn’t. It’s a lot of culture, as I understand it. We do go to classes about it, required testing, training. It’s a new skill for me, to be honest. I never really gave it much thought, and I don’t mean that about it, I just didn’t think about it. I just brought the science, here you go, I don’t care who has it. I do understand a little bit more now that some people are more trusting. I’ve learned that there’s certain cultures of less trust, they won’t go get it. Other people have no access or understanding of what it is. It’s a lot of stuff that’s not really something that somebody like me would be any good at. It needs to be something like a social worker, somebody who can bridge those things.

We need bridges here from our experts to actual people. There’s a whole other way that I guess me as a scientist, I call them the normal people, but they just think different, they make different choices because they don’t think like I do. I know I’m a little weird, I see things different.

Q: You see it from a scientific space.

STEVENS: Right, I see it from almost like, I don’t feel like a Vulcan or anything, but I do think, I make those decisions very unemotionally. Even with my daughter, when the COVID vaccine, I’m like, yes, you’re getting it, we’re done. As I understand it now, there’s a lot more complexities some groups, I know that we’ve found retrospectively that the Latino, they refuse to not gather. I saw it in my own neighborhood. They had a lot more COVID. They just refused to make changes in their cultural practices. That’s just not my area of expertise. Again, sometimes in the pandemic I was asked to do jobs I was just grossly not qualified for. I did my best, but it was—

Q: Okay, so I want to turn toward, that’s the beginning of pandemic state lab reporting, it was a little uneven. Some states were slower than others to report in cases and causing delays and reporting on up. Is it a matter of underfunding, understaffed or overwhelmed, or those surveillance systems?

STEVENS: Okay, so it’s a combination. This, that was not new. As I do outbreaks all the time, certain states have got it together, and they’re well-funded, and have great people. Other states are like, they’ll just tell you, we don’t know what we’re doing. Two people, like Kansas, they struggle. Our group, my branch has set up a network, ARLN network, Antimicrobial Resistance Laboratory Network, for every region in the United States to have an expert in a state lab. We brought them here, we trained them, and we sent them out, because we were overwhelmed with too many highly resistant infections. We needed there to be regional experts. Those states are very well-funded and know what they’re doing. The others, other states, and it’s a political thing, how much do you want to fund your public health? I am sometimes shocked at the lack of knowledge. We’re dealing with an outbreak from the American Red Cross platelet bags since 2019. Puerto Rico, is a US territory, right? They have this facility that is contaminating platelet bags since 2019, consistently. Their public health lab, like yesterday, sent four more contaminated specimens. They don’t even know how to streak out a plate, basic, basic stuff. It’s contaminated, it takes me an entire week to separate it out and clean it up. They just don’t know what they’re doing. We can’t fix that for them. We can offer them education, we can say we can teach you a routine or whatever, but it’s very rare that they would have the money like they did for ARLN to have these people come here and get trained and go back out. Some states are just better than others, and we have no control over that, we just try our best to work with it, and COVID was no different, it wasn’t surprising. Some states are great, other ones are, yes.

Q: During a pandemic of this nature, don’t you think— what are your thoughts on maybe enacting a federal surveillance system for all of the states, so that, almost like sending out an EIS officer instead of they go into each public health lab and help them level up?

STEVENS: For COVID, or just for other surveillance?

Q: Just for when we have something as huge as COVID.

STEVENS: I know they tried to do something similar, but we didn’t have enough people, just not enough people that were experts. The EIS officers whose job it is to go out there, they are not subject matter experts on the lab— they don’t have a clue. They spend, like I said, only one week with us, and that’s unusual, they don’t even usually get that much lab. They’re just doctors or epidemiologists. They go in a lab, they’re just like— we would need a lab expert to go out there to train. We don’t have that mechanism. Would it be good, absolutely. It would require funding. Right now, we don’t have any funding to travel anywhere. I haven’t traveled anywhere in decades, other than the deployment. They don’t pay for us to go anywhere.

Q: We used to do that. We used to bring in lots of people and have—

STEVENS: We did, we did, I trained a lot of people, in fact, I trained a lot of Chinese scientists on first SARS on how to do testing for different things. I was shown reading. We used to always have foreign scientists in the lab who were learning, but I don’t know what happened. When I left and came back, that just wasn’t a thing anymore.

Q: Yes, well part of CDC’s original, way back in the ‘50s, we would bring in classes and classes of people to learn techniques and then take that back to the public health, to their own public health laboratories.

STEVENS: That’s right, they even did, after the first SARS, they tried to send me to Malaysia for year, and what was it called? Global Disease Detection, we had a different name for it. Yes, so we were bring sent everywhere to teach them how to do surveillance for, I don’t know why that stopped.

Q: Education used to be part of our mission.

STEVENS: Yes, I mean, I’m trying to think of the last time, we have LLS fellows now— a guy from Ireland, he’s nice. We don’t seem to do as much of that as we used to. My lab does a lot of political tours, we have a fishbowl lab, where they just, a monkey in the cage, look at me work!

Q: Oh, you mean you’re on a tour?

STEVENS: Yes, they have these tours, political tours. I think I saw Nancy Pelosi a couple months ago. Is she here? Because it looked like her. I was working in the lab, and it’s a fishbowl lab, so there’s these giant windows, and it’s set up for tours, so like, you know, they can go around in a circle.

Q: I think I’ve been there, yes.

STEVENS: [Michael] Mike Bell loves to take them to our lab, because he used to work there. I’m in the outbreak lab so I’m either really busy or really board, and I was really busy that day, and I had a stack of plates. I don’t know who they were, but they were taking pictures even. Normally they don’t take pictures here, but they said they were allowed to take pictures, so these must have been high up. I could feel the eyes burning on the side of my head as I’m sitting there looking at plates, felt like a monkey in a cage. These were politicians, and most people scatter like a cockroach when the light comes on, they don’t want to be in the lab when the tourists come through. I am the complete opposite mindset, as much as I don’t like it, being looked at like that, if you’re a politician, and these are usually people like Congress and whatever, and you come to CDC to see that we have this resistant infection problem or COVID problem, and you go to labs and they’re all dark, do they seem real busy to you? Yeah, I make it a point, I’m going to work, you can watch me work.

Q: Was there social distancing in the lab? Did you have to distance yourselves?

STEVENS: For two years I really didn’t work in the lab— I really didn’t. The labs were basically nonexistent.

Q: You tele-worked?

STEVENS: Yes, because remember, I do hospital-acquired infections. No one was doing anything with COVID.

Q: That’s another question, because the entire agency went into COVID mode, I mean, did that affect the labs and what you were actually working on? Did you just have to balance your regular work and accommodate COVID, or was it COVID first, and then, hey maybe I’ll get extra time, I’ll work on this other black plague?

STEVENS: Right, it was split down the middle for our branch, I can speak for our branch. In our branch, we have surveillance, we have reference, and we have outbreak. Reference is the things— the state labs send you something. They kept working— they were deployed. They kept working, and they spaced how they were in the lab to maximize.

Q: Okay, so there was some social distancing?

STEVENS: Absolutely. You were only allowed like one person in the lab at a time. They rotated, that was reference. Surveillance also did the same thing. They kept with their surveillance— it wasn’t going to drop. People like me in outbreak, or people who were just research got deployed to COVID. I was outbreak, and I got deployed to COVID, so our labs basically shut down. There were no outbreaks that came in, there just weren’t. Now we’re getting a back flood of everything that went sideways they weren’t looking at during the pandemic. During the pandemic, we just didn’t get states having outbreaks that they brought to our attention.

Q: Everything went on hold in that respect?

STEVENS: Correct, and it didn’t get better, the hospital was just overwhelmed. Now we’re seeing the deluge of what happens when the hospital’s overcrowded and not getting cleaned properly. Now we’ve got all sorts of fun stuff coming down the pipeline.

Q: There’s going to be a few papers on the outcome of that?

STEVENS: We don’t write papers, usually.

Q: Not you, but somebody will, I’m sure.

STEVENS: Not usually. I try to keep records for some of our more interesting outbreaks, like you know, there was one where these people were taking mobile vaccines to remote, big, like industry in I think it was Kentucky, I forget what they called themselves. Anyway, they were carrying the vaccines in the same cooler they had their lunch. They ended up contaminating, we have pictures of vaccines in pickle jars and stuff. They were contaminating them, and they ended up giving a lot of people bacteria infections, because they were eating. People have a habit, when I was teaching, I would tell people, people are creatures of habit, and it’s interesting. They’ll go eat, and then they’ll go to the bathroom, right, lunch, go to the bathroom, then go back to work. They think everybody else’s hands are dirty, but they don’t have to wash theirs, and don’t wash their hands. They have “magic hand syndrome”, as I call it, people who put gloves on and touch everything thinking that the gloves suddenly sterilize themselves every time you touch. Again, it’s not sound microbiology We found these people were giving people infections from fecal bacteria, yes. Fun stuff.

Q: Ask you, something that’s kind of a big buzzword is the genome sequencing. Tell me more about that. Do you encounter that in your work?

STEVENS: Oh, we do it every day.

Q: Okay, so tell me more about genome, and was it handy for COVID?

STEVENS: Yes. I’m going to give you a better example of why it’s good. An outbreak, that’s in a NICU, the little neonates, obviously they have almost no immune system, they’re very, very vulnerable. Well, there was an ICU [Intensive Care Units] where they were dying from this E. coli infection that had a highly resistant plasmid in it, I don’t remember the plasmid name. The mother, one of the mothers was suing the hospital, saying the hospital was negligent, and really wanting to know where it came from. Hospital was insisting they had nothing wrong. CDC’s kind of like the moderator, comes in. We’re not regulatory, and we’re going to help you find where it came from. With their whole genome sequencing, sometimes we can do a biological clock and show you the flow of infection. Sometimes you have to be careful what you wish for, because as a mother, I understand this, well I don’t understand, but I can imagine, it was horrible. She’s so insistent that it was somebody else had done something negligent. What we found in our sampling was, we went to the breast pump, the common breast pump, and we found the E. coli, and we had found the E. coli in different kids, some had survived, some hadn’t. You could look at the sequence, the whole genome sequencing needs, remember they just have one chromosome, we unwind it, and it has a specific sequence, there’s adenosine, tyrosine, all these different amino acids. We do a sequence. As things copy multiple times, every time it passes, it copies, you have a copy error, so the more copy errors, it’s like a biological clock. One copy error is closer to the original than ten, right? If you wind the clock back after sequencing, what we found on the breast pump, what we found on the mother, what we found on the neonate, what we found on the other neonates and the other parents, the mother who was asking, or suing the hospital was the originator of the fecal bacteria, the E. coli that got into the common breast pump that infected everybody. That’s an example of whole-genome sequencing, we look at every sequence, and then every SNP, [single nucleotide polymorphism], a SNP is a change, it’s a clock.

Q: How long does it take?

STEVENS: A week, about a week. Then we have bioinformaticians that will look at the sequence and they analyze it in a computer, and they’re the ones that can do that biological clock and do the back-tracing, so, that’s whole-genome sequencing. We use it all the time in outbreaks to see, is the strain from the hospital related to the patients, is there a patient zero? That’s how we can trace things back is looking exactly at that fingerprint. We used to have less specific things that we could use, PFGE [pulsed-field gel electrophoresis] testing, western blot testing. Now the whole-genome sequencing is very precise, extremely expensive. Very expensive, thousands of dollars for a test. It’s a lot of money. When we decided to do whole-genome sequencing, I’ll get the samples, I’ll purify it all, and I’ll pass it off to them to put through the actual machine, and then it goes, the information goes to the bioinformatician, and then we get it back and talk to the epidemiologist, and we tell him the information we’ve gleaned from it. Are these things, sometimes you can have two patients that both have like say a Pseudomonas infection, completely unrelated. What’s interesting is if you do whole-genome sequencing and you see they’re very related, and it’s the same as a common piece of hospital equipment, then it’s a real— a reasonable thing to say, there was an infected process there, the patient infected the machine, or the machine infected the next patient, so you know, you have a reasonable explanation as to why things happened.

You can say they’re completely unrelated and go clean your hospital. The core problem for us in hospitals that we’re seeing the deluge from COVID is that they cut staff starting with the cleaning staff, or they have the same staff do ten times more, and they’re not scientists, they don’t know that a quaternary ammonia compound needs two-minute contact time versus bleach that needs thirty seconds. They don’t know that the bleach that they made up yesterday is oxidized, dump it out and make new. They’re not scientists. They just spray, wipe, move on. Yes, so sometimes bacteria can survive, and they get again resistant, the more you challenge them, they just get nastier and nastier. I’ll always have a job.

Q: All right, I think I want to turn to, we’ve talked about misinformation and how that has an effect on everybody’s job. I do want to turn now towards more personal at the time of COVID, and family and households, and you had said that you had informed your family early on, this is going to be a slow burn, buckle up. Were you worried for other family members during this time? Were they all in one place? You grew up in Marietta, so that’s local to here. Is all your family in one spot?

STEVENS: They are, and I have a very interesting family story from the pandemic. Yes, I was worried about some, so again, I was second of six kids. My mother is an antivaxxer science denier. My dad is, he tries to stay out of my mother’s crosshairs, but he listens. I have my sister Sharon who is number five, has something called Lennox-Gastaut syndrome, and requires twenty-four hour care. I was always extremely worried, if she got sick, her condition’s such that even if she’s not sick and she sneezes, she just thinks it’s funny to see how far she can spray it, it’s a whole thing. I knew if she got sick, we got a problem. My mom, again, science denier, very— she’s a former nun, so we’re dealing with somebody who’s extremely religious, extremely religious. My siblings all follow in line except for me. When I told them what was going down, at first, they listened. Then when it got political, they stopped. I would always tell them before a wave, I knew it was coming, I sent them a message, and I finally stopped sending them because they didn’t care. They don’t want to hear it. They weren’t going to do anything. They weren’t going to get vaccinated— they didn’t care. I was worried, because I knew if my sister Sharon got sick, it was going to be hospital time. Again, the pandemic and the stress of being deployed, my blood pressure went up to 240/190. I ended up going to the hospital, and they sent me home because there was nobody who could deal with me, they said try to relax, and not stroke out. Normally I would be admitted for something that bad, but it was during the Delta surge, and I was deployed on the Delta surge, and seeing all these children die, and it was really hard, and my blood pressure was going sky high.

I remember right when I saw the Delta coming, I was trying to be a good daughter, I invited my mother over to my house, because I hadn’t seen her in a long time, but it was such, the community levels, I would be fine, I was vaccinated, even though she wasn’t. Be in a house and watch, what was it, I like old ‘60s movies, I think it was Tammy Tell Me True or something silly. Anyway, and I remember trying one more time to convince her of getting vaccinated and protecting Sharon and X, Y, Z. She just was like no, I’m fine, it’s my free choice, I’ll be fine. I had seen Delta, and I told her, I said mom, you have two choices this time. You can’t do what you did before that, but I’m telling you as your daughter and as a scientist, you gave birth to me, I’m not lying to you, because she had flat out told me CDC lies. I said to her, I am CDC. You’re telling me I lied. You gave birth to me, you don’t believe I’m telling you the truth, I’m telling you this right now. You have two choices. This wave is coming, it’s going to get you, you’ll get sick, or you’ll get the vaccine, pick one, because it will find you. It’s kind of like one of those weird points in my life where I remember those were the last words, I said to her as she was walking out the door getting in her car, I said, it will find you, mom. This one will find you. Because you thought, well I’m fine the first time.

No, not this one. She had not changed going to church, and all these other things that I knew were mass spreader events, because they’re singing, and it’d become again politically divisive. If you were Christian, you were anti-COVID, which I have a big issue with. Again, so last thing I said to her, and then I just had this weird feeling while I was again deployed one morning, and I was like, I need to call them, they’re sick, I know they’re sick, I know it, I know they’re sick. Called them and they were sick. My dad had listened and gotten partially vaccinated. He had gotten his first shot, and he was actually, on the Friday, he was the first one to get sick. He was due to get the next shot on Saturday, but he had gotten something. He was sick for twenty-four hours. My sister, and my mom, and my other siblings who got sick were sick for two months, and my sister was hospitalized. Just what I told them would happen, and they still, when she was very sick, she’s like, yes, I’m getting the vaccine, I’m definitely getting the vaccine. She got better, no vaccine. She thinks she’s protected now. I kept telling her, it doesn’t work that way. When it changes, it’s like a whole new signal, you need another, you need a booster, you need to deal with this new strain that’s come through. No, I’m fine.

I cannot get my own family to listen to me. It’s been very hurtful in the fact that, I no longer believe they are proud of me, or they respect me. Again, first generation college, I went to Georgia Tech, graduated top ten percent of my class, bioengineering. They do not listen to me. They do not listen to me. I knew what was coming every step of the way. My daughter and I did not have trouble during the pandemic, as far as, I always had enough supplies because, believe it or not, I have had a pandemic kit for like, fifteen, twenty years. I had N95s that still said Revco on it, yes.

Q: Ooh, still good?

STEVENS: They seemed fine. I drug it around for years in this little plastic bucket. Pandemic kit, batteries, food, medicine.

Q: You were prepared.

STEVENS: I was.

Q: Totally prepared.

STEVENS: Everybody laughed at my kit for years. They’re like, what’s that?

Q: You never had to go out for new stuff? When we were all in lockdown, what was that like?

STEVENS: It was weird, you know again, another rhythm of outbreaks. I was just, two weeks when I saw things going, okay, in two weeks, this is going to be bad, so I went and go to Costco or whatever.

Q: Get your pallet of food?

STEVENS: Yes, I basically turned my garage into a storage facility, because I have this tiny 900-square-foot house. We never wanted for anything, I always stayed a step ahead of it, because I saw it coming. Again, at the beginning, I really tried to warn people who would listen to me. Then I just stopped because I was tired of fighting with people. I didn’t want to do it anymore. I felt a responsibility anytime I saw it to correct things. It was so draining. It was screaming into the wind. I could not get anybody to listen. I knew what was happening, so I protected me and my daughter, and both of us to this day are fine.

Q: Did she come home from school because it was closed for COVID?

STEVENS: Yes, we paid a ton of money for this theater school in Chicago, and she came home the second semester of her freshman year, and she didn’t go back until her junior year. I feel bad that she missed that part of her learning, but the school shut down, and beginning where there’s no— I had an agreement with her, she said, you’re coming home until there’s a vaccine. There’s a vaccine, go out. She’s been brought up by a mother who does outbreaks. She knows the rhythm. It was interesting, because her classes that were online but in Chicago, those people were much more supportive of what we were doing than I found here in the South, much more interested and just willing to listen. In fact, the school asked me a lot of things. I said, well I can’t tell you as an official CDC employee, but I can tell you as a scientist what I would do, and what I wouldn’t do. I felt like they were more receptive to the science and trusting than here in the South. I really felt a lot of resistance down here, but I didn’t feel it up in Chicago.

Q: Why do you think it got so politicized?

STEVENS: I think it was a political tool for the Trump administration. I’ll just name names, I don’t care. I felt like it was an election time, and to have something negative going on would in their eyes erroneously be blamed on them to allow it to happen when it was just a biological instance, there was nobody. Could it have been handled better, absolutely, I really feel like it could have been. The fact that there was a pandemic was just an act of what China did, and not going by the recommendations that we said after the first SARS.

It happened again, just like we said it would, if they didn’t do certain things and that’s all a matter of record, I mean people can look that up. It became so divisive so quickly because the science was not allowed to lead, and it became a— Oh, these people are just trying to wreck your life. Listen to me, follow me, elect me, listen to me. You’re fine, you’re fine, you’re fine. You know, again, the truth is really the best way, a good leader tells the truth, doesn’t tell somebody what they want to hear, even when he got sick. To get the type of experimental treatment he had, that man would have died if he wasn’t the president. He was sick, very sick. To tell people a lie like—Oh, don’t be afraid of this. I was hoping when he got sick that it would be a learning moment where he’d go, you know what, you guys get a vaccine, this is not something to play around with. He went the other way and doubled down the other way. Every time he did that, circumvented us, plugged the story or changed what we said, was all for political gain, at the expense of people’s lives, and it really upset me. Then for some reason it became like Christians against non-Christians, which makes no sense again, as the science doesn’t care what your religion is. It’s like— Oh well, if you’re Christian then you don’t believe in COVID, you’re not going to get a vaccine, I used to be in church group where I would tell them the science of certain things and how it corresponded with, they don’t talk to me. I used to be their president. They don’t talk to me.

Q: There’s been a lot of relationship changes over COVID?

STEVENS: Oh yes, my role is completely different now, and it’s confusing for me. Because I was brought up again by a highly religious former nun. I always had a lot of faith. I was a scientist, but I reconciled it to my faith. Now what I’ve seen, a priest I used to really admire, flat out lies, and I’m like, what else are you lying to me about? I actually haven’t been to church in three years, and I don’t know how I feel about that. I don’t feel like those people want me there. I feel ostracized, and yeah— if they know I’m from CDC, they immediately shut me out. Even the nicest lady I ever worked for, I called her, and I explained everything to her, and I think she’s kind, but she doesn’t want to deal with everybody’s else’s fallout in having me around. I am just a giant— I don’t understand it. It doesn’t make sense if you look, again, I’m a scientist, I look at things as they are. If you look at what in my opinion Christ would have said—yeah, I don’t understand it, it doesn’t make sense. It somehow got that way, again, with the messaging and the communications. The science was not allowed to be talked about. I think it’s scary for people who aren’t scientists to know there’s something out there they can’t see that can kill them, and they have the guy they elected telling them everything’s fine, it’s just a trick by the opposition. It just became something it didn’t need to be. It became an embarrassment— it’s going to go down in American history as an absolute debacle.

Q: The mental health, how’s your mental health?

STEVENS: Well, it was something I told people too, again outbreaks have rhythm. At the back end of every outbreak, the people who survive have mental health challenges. I knew it was going to be.

Q: This is a huge tidal wave of mental health problems. We’ve already had—

STEVENS: In all kinds of different ways, just like people like me who had family who doesn’t talk to them anymore. I mean, again, one of six kids, nobody talks to me. I haven’t seen my siblings or been at, if I, last thing I went to, with a mask on and everybody else didn’t have a mask on, I literally sat there, and nobody said a word to me. I am an outcast in my own family, from my job.

Q: How are you dealing with that?

STEVENS: I don’t know how I’m dealing with that. I just deal with it. I can’t change that I tried, I told them the truth, they didn’t want to listen. I’ve told my sister who is an antivaxxer, if my niece gets pertussis, I’ll call Child Protective Services [CPS], this is BS. I’m just a straight shooter with people, and if they don’t like it, they usually walk away. I think I intimidate people is what I’ve been told, because I will look them in the eye and tell them the truth. People really don’t like that. I don’t understand why because I appreciate that.

Again, I think I think a little different. I don’t know how my mental health’s doing— I think I’m really struggling at the end of being polite so much. I needed a couple months to just stare at the grass.

Q: Have you done that for yourself?

STEVENS: Haven’t really been able to. I took a week off and I just kind of stared at the grass. I have given up over 200 hours of annual leave because I just, all the overtime I got, they couldn’t pay, they ran out of money the first summer during COVID to pay us for overtime, and then it had to be paid by your home department, and they wouldn’t let you deploy if you had overtime, so I just lost it. I still have like 270 leave hours, and I don’t take any of it because, I still have outbreaks, they’re just coming one after another.

Q: You still need your self-care. You have a dog.

STEVENS: I do have a sweet puppy.

Q: I know that’s some source of self-care, a little bit downloading your problems into their brain where they just look at you.

STEVENS: He’s the best. I love my Mulberry. He is, yes, every afternoon we have after-work decompression puppy snuggle. He just knows, he’ll just come up and let me put my head on him. At night he farts on my face, but that’s a dog. The husband used to do that too, so.

Q: Just feels comfortable with you.

STEVENS: Light a candle and keep working. That’s a good point, he really does help tremendously. I don’t know, with my family, I just, a coping skill I have is I’m not fighting it. I don’t care. My conscience is clear, I didn’t do anything wrong, I never lied to them. They don’t like the story, they don’t have any respect for me, okay. It doesn’t bother me, I guess. Maybe I’m just really good at shoving it down, I’m an Irish Catholic, I don’t know.

Q: Possibly. There’s going to be lots for repercussion for future generations. There’s going to be those missed parts that your daughter has— from that 1918 [flu] pandemic, there was so much repercussions from that up and to the generations down, and how that reverberates. Do you have any kind of inclinations on how this is going to reverberate into future generations?

STEVENS: Yes, sadly I do. At least I have my guesses. I really feel like we lost decades of trust. I feel like our mission to help people has been seriously set back. I think it’s going to take a full generation for people to start trusting us again.

Q: That’s like twenty years.

STEVENS: Yes, absolutely. It’s weird, I think we need to change our transparency for people and meet them where they are. We’ve always been transparent -- but we don’t meet people where they are. They don’t understand what we say. Our website’s boring. It’s supposed to be written for a sixth-grade level, but I don’t think most people understand sixth-grade science. I think we need to make it so it’s fun for them, and I don’t know, I don’t know how to say it other than I really feel like we need to meet people where they are. If they’re enjoying TikToks and funny ways of getting information out, great. Let’s hire somebody who can bridge the gap. Here’s the science, can you make it funny and viral? Super, that’s what I really said during the pandemic, we need to be doing TikToks on, you know, wearing a mask the right way. Be engaging, meet them where they, but we have so many people who I think are so stuffy and so full of themselves, and they want to be the strait-laced scientist. I’ll tell you what, I probably know more science than them. I don’t mind talking to people in the way that brings them in, because either your mission is to educate them and help them, or not.

Q: It’s part of prevention.

STEVENS: Right, I mean, I think a lot of people, especially the ones who were like, the uniforms are so full of themselves. They’re so full of themselves, and they want their, I’m a serious scientist, and I’m going to do X, Y, Z. You know what, I can flip a hat on a dime, why can’t they? I don’t understand. You have to meet people where they are if you really care about getting the message out. We have a big uphill battle, where I feel like we were respected. We are now a joke to people, which is hurtful to me, because I’ve dedicated my whole life here and I do really love this agency and what we do. I hope we take some lessons from COVID, and take some opportunities to change, and not be this unchanging institution, but be an institution that serves people, and helps them where they are. They don’t need to know all the science I do, that’s my job. I have to distill it and get it to them in a way that’s useful. They don’t need to know all the dang—you know, the details on the flaA gene turns on with this operon.

They don’t need to know that. They just need to know, don’t go to the community pool. They need to distill down and deliver it in a way that will reach people. To be honest, people need to be where they are, and right now, it’s like these TikToks and things that can catch on. You can still educate people and make it entertaining. The agency needs to change and get in line with that. My opinion.

Q: Okay, and that’s what we’re here for. We’ve kind of really come to the time, and I wanted to ask, is there anything we haven’t covered that you want to put into the historical record? We’ve gone through your mental health, we’ve gone through the misinformation, equity is not something that was part of it, your own health, reverberations for generations to come, the vaccine, masking.

STEVENS: I think it still boils down to what I just said. I really feel like I would like to see the agency change its messaging and communication to where we could get a group of people who are not subject matter experts like me, but I could work with them and say, here’s what I’m trying to say. Can you make it something that people will listen to? We need to get our communication so that it’s useful. We know so much, but we don’t get it out, so what good is it? That’s my bottom-line thing is I feel like we could take these lessons from COVID. I don’t know how you prevent the political part that happened because I don’t understand it. I don’t understand how that happened. I saw what happened, but I just didn’t understand it. A bad leader is a bad leader. I would like to say one more thing too. If we have a true public health emergency, and we’re operating in the EOC, I would like to see a law instituted where we could have temporary powers to not have to wait for the state for certain things, we are now in charge. This is what you do. If we had laws, we could have had better control over this. Then we give up those powers when the microbe has gone back into its reservoir. Temporary, yes, CDC’s now going to tell you what to do, and we aren’t going to argue about it.

Q: Temporary control over public health at the federal level?

STEVENS: Yes.

Q: Rather than the state running it?

STEVENS: Right, I would like to see if we truly have an emergency and we have elected to turn on the EOC, I would like to see some code of federal regulations give us some power, instead of saying pretty please. We don’t have to argue with people about stuff, this is what you do. That would have worked so much better. Then you give up the power when the threat’s over. It’s not like I want to be a regulatory agency— I really don’t. We couldn’t do our job effectively without any muscles. Yes, I’d love to see that happen.

Q: Okay, thank you for being with me today, and thank you for being so honest.

STEVENS: Of course, no problem. Thank you.

[END OF INTERVIEW]