Maureen Miller

Q: Hi, today is 3/25/2022, and this is Heather Rodriguez for the COVID-19 Oral History and Memory Archive Project. I'm in Newnan, Georgia, and I'll be talking to Dr. Maureen Miller, who is in Atlanta, Georgia. We are recording through Zoom. Dr. Miller, welcome to the project.

MILLER: Yeah, thank you, Heather. Nice to be here.

Q: Good. Thank you. Do we have your permission to interview and record this session?

MILLER: Yes.

Q: Great. Awesome. Well, let's begin with a little bit of background information. So, where are you from, and where were you born? Oh, I'm sorry, excuse me, when were you born and where are you from? Excuse me.

MILLER: Yeah, sure. So, I was born in November 1983, in Fairfax, Virginia, which is a few miles outside Washington, DC [District of Columbia].

Q: Nice, also born in November, so.

MILLER: Oh, that's nice synergy, nice synergy.

Q: Yeah. Great, so where did you go to school at?

MILLER: Uh, school for what? School.

Q: Oh college, let's start with college. Yeah.

MILLER: Okay, yeah, sure. I went to undergraduate degree at Yale. I studied history there and graduated in 2006.

Q: Oh, great! What got you interested in public health, then?

MILLER: Sure. So, my interest in public health started with a job I got immediately after my Yale graduation. Uh, I was in the program Teach for America, assigned to a school in the Bronx, in New York City. I was teaching science and health classes there, uh, based on a new curriculum that former CDC [Centers for Disease Control and Prevention] Director Tom Frieden had advocated for in the public schools. I admit I don't know exactly what he did, but it was based on principles of his tenure at the NYC DOH [New York City Department of Health and Mental Hygiene] to try to educate the children about chronic disease prevention, and parts of the body, and things like that. Uh, but the kids that I were teaching in the classes had a lot of struggles related to multiple social 00:02:00vulnerability factors, um, families that were really, really struggling.

And I noticed that my class, which was usually in the middle of the day, like around the lunch break, uh, would have a lot of absences of students. Uh, many of them had asthma, a few of them, according to their education plans for special education, had significant lead poisoning burden, and I thought, I enjoy working with these kids, but I'm struggling as a classroom manager, there's no way I can meet the needs of these families within this job as a teacher, and so I decided as a result of that to apply to medical school, and, uh, I ended up in the period where I took my pre-med classes working in environmental health research with another CDC NIOSH [National Institute of Occupational Safety and Health] alum, Phil Landrigan, who has been at Mt. Sinai School of Medicine in New York, on issues related to, um, chronic environmental exposures in children.

Q: When did you enter med school, what year was that?

MILLER: Sure, so I entered med school in summer 2009. I went to NYU [New York University].

Q: That's a big switch from being a teacher to going to med school.

MILLER: Yeah, very big switch, and then most of my classmates, for whatever reason, came right out of their undergraduate educations, and so I felt, even though I was only three years older than most of them, I felt like I had, like, lived a lifetime in this really rough school in between then, and so it was a big, big adjustment to go to medical school.

Q: Yeah, I can imagine. And from there, did you specialize in public health, or did you, tell me a little bit more about the journey to getting into public health from med school.

MILLER: Sure. So, I had a bit of a roundabout way into public health. Um, NYU Medical School has a really close relationship with Bellevue Hospital Center, the largest public health hospital in New York, and, uh, part of a network 00:04:00of--it's, like, the tertiary referral for the community hospitals in the other boroughs of the city. So, we would see a lot of complex microbiology workups, uh, other chronic disease consultations, and hereditary blood disorders that you wouldn't see other places, just because of the unique nature of the immigrant population in the city, as well as a lot of, um, problems affiliated with our poison control center. So, public health was really operating at any point in my NYU education.

But, uh, the way the curriculum is structured, NYU has a small public health school that is less focused on the interest I had in environmental health, so I requested a sabbatical between my third and fourth year to go to Harvard to study environmental and occupational health. Uh, so, while I was finished with my clinical clerkships, and thinking about residency, I did a year at Harvard researching, um, say, OSHA [Occupational Safety and Health Administration] regulations, health conditions in the workplace, um, chronic environmental 00:05:00exposures, like I was doing before, social determinants of health.

Got an MPH [Master of Public Health].

Q: So, your background is really just in, like, I mean it's really in public health, but really focusing on, like, this, not environmental health, but like in occupational health and everything. So tell me a little bit more about like, what did you do when you got out of school then?

MILLER: Sure, that's where the story starts to flip around a little bit. Yeah, that, I mean, like it might be a bit of a ride here, so please if you need clarification, let me know.

Q: Of course, thank you.

MILLER: Yeah, sure. So when I finished my degree at Harvard, I came back from NYU to complete medical school. That's, like, while not a common path, not totally out of the question. So, like, I was basically just finishing classes that I had missed the previous year. And from that, I knew that I still liked 00:06:00environmental health, and I still liked to work with children, so I applied to become a pediatrician in the residency match. Applied all over the country, had some really nice interviews, again, like, expressing this interest in doing children's environmental health research in the urban context. Most pediatrics residencies though are really inpatient focused, as opposed to outpatient focused, and so when I was explaining this to some people, it was a relatively unique pitch, I guess, to these places.

And, um, again, the residency match process is really nerve wracking, so I came off really excited about my work, and also nervous about being in an interview, and so when the residency match algorithm came around it said, like, you did not match for a position. Which was quite a surprise to some people that I had worked with, because I was, like, a decent enough student, didn't really seem to have other red flags. And from there, I had to, like, scramble for a job. 00:07:00There's a part of the residency match after, like, everybody is sorted into their positions, kinda like Harry Potter, where they try to fill positions that aren't filled, and I couldn't even get a position in that, because people were saying like, why do you, like, why is a candidate like you in this pool?

So, while I was doing that, I started to explore some other interests in public health that I had had. I, I mean, I called--I, I mean it sounds crazy now, like, I probably called like a hundred different people about like, what I should do with my life after this, saying like, I have this passion for public health, I've wanted to do this my whole life, I don't know what to do. Because public health preventative medicine residency typically requires another residency first, like internal medicine or pediatrics. You can't go straight into most preventive medicine programs. Everybody was asking me, like, well then why don't you do preventive medicine, and I was like, well, there's bureaucracy, like they will not let me do preventive medicine.

Like basically, we were trying to figure out different options, I talked to 00:08:00people at CDC, I talked to people at FDA [Food and Drug Administration], I talked to people at state health departments, like this whole like, really, like, kind of crazy swath of people and would like, travel around the country. I felt like I was like a peddler in, like, one of those, like, nineteenth century circuses or something. Or like, the Wizard of Oz where they, like, go around in the cart, trying to like, basically trying to get a job. Then finally, like, NYU itself, where I had been all along, had an opening in their pathology lab, and so because of NYU's, like, unique characteristics, they do a lot of public health work in their pathology residency, just 'cause they're getting weird workups for like, molecular microbiology and other things. So, it wasn't the environmental work that I really wanted to do, but they did do lead poisoning screening, and other stuff, and the people were nice, so I was, like, sure, what the heck? I then became an anatomic and clinical pathologist.

Q: Wow. So how long were you in that role?

MILLER: Sure. So, that residency is four years long, two for the anatomic, which is like surgery and autopsy, and then two for clinical, which is more like this public health laboratory work, which involves every single lab in the hospital. Uh, so, the lab that I liked best as it turned out, was the transfusion medicine lab, like running the hospital blood bank. After those four years, I then elected to take a fifth year at Emory [Department of Pathology], doing blood banking research, hoping to become a transfusion medicine epidemiologist.

Q: So what years were, like, what year did you enter the residency again?

MILLER: Sure, so I entered the NYU residency in 2014, and then finished in 2018. And then I did the Emory fellowship in transfusion medicine from 2018 to 2019.

Q: Yeah. What inspired you to start working at CDC then? I mean, Emory is obviously very close to CDC.

MILLER: Yeah! Yeah, my, I-I-I--

Q: That might have a big role in it, but, but just curious.

MILLER: Exactly, it, well it's funny that you say that, because I had never lived in Atlanta before moving for the Emory job, and then I said, oh, there's an apartment complex across from CDC, like, I'm from New York, I'm used to paying for a lot for my apartment, so, like, I'll just buy, er, not buy, excuse me, rent in this building across from CDC. Like, I basically have been commuting the one mile down Clifton Road for, like, the past four years or so. The particular fellowship that I was in at Emory did a lot of work with Grady, which is in Midtown, you probably know, and is further away, as well as some of the hospitals in the northern suburbs of Atlanta. So, like despite the Emory affiliation, I was really all over the place, I was like at every single Emory-affiliated hospital in the metro [metropolitan Atlanta] area.

Q: Tell me a little bit more about what were you doing when you were at Emory? Like bring me, kind of like a little bit more detail into like, what your role was there, and, like, what were you doing, exactly, and if you could make it 00:11:00kind of simple for people who maybe don't have a medical background.

MILLER: Oh yeah, sure, sure!

Q: Thank you.

MILLER: Yeah, no problem, I know the second you mention pathology, like, even other doctors are like...

Q: They're like "Oh no."

MILLER: Yeah, yeah, it's kind of their own fault for not marketing themselves well. My title there was fellow So, pathology is the specialty that runs the hospital labs. The hospital lab that I was responsible for was the blood bank, and not just the blood bank at the main hospital, but at every single satellite hospital, both public and private, for the Emory network. As a transfusion medicine fellow, I was responsible for supervising people who were inpatients, who got, say, like, if they hemorrhaged, or if they were anemic, we gave them blood. If they were a cancer patient, we gave them various, uh, pharmaceutical products that would help them, or really for a lot of other patients with 00:12:00chronic disease.

Uh, then we also had an outpatient side, in addition to this inpatient side, where people would come in with cancer or other blood disorders, or neurologic conditions, and we would give them various blood components to make them feel better, uh, based on, like, a large evidence base. But they would come in and basically we'd take fluid out of them, put fluid back in, then that was more or less my job. It was, like, a work with those patient management questions, and then with the blood bank that was giving them the blood and giving them the drugs and stuff.

So, my job in that doesn't sound necessarily directly related to public health, but because you're supervising so many people at the same time in the lab, you're looking at a lot of population level information, and a lot of, like, groups of hundreds of people getting the same thing at the same time, and that's epidemiology, so it's just a question of, like, figuring out how to use the 00:13:00information you have about the patients you already have to think about, like, well how can we use the patterns of treatment to treat them better the next time.

Q: Wow.

MILLER: And then CDC, I should say like, some people that I had worked with overlapped with CDC on the research, because CDC has a blood disorders division and a blood safety division, so that's where the crossover came.

Q: So when did you apply to be in EIS [Epidemic Intelligence Service]?

MILLER: Sure, so I applied to be in EIS I believe in Novem--maybe earlier, like fall of my year at Emory. So, I mean basically immediately after I got to Emory, I applied. Uh, I had been writing my application for a while, but this was the first year I thought I was eligible. Like, I think I mentioned earlier in the interview, I had met people in New York City with pretty significant CDC histories, and I just--I really knew before I even got into medical school that 00:14:00I wanted to be an epidemiologist, but then other people told me, like, you should be a doctor in order to do the epidemiology most effectively.

But I knew I wanted to work with people in some way, in a way where I would get to be involved in global health research, but I was, like, waffling about the best way to do that, and then--I have to say I was actually really skeptical about working in government, too. Because I mean, like, I had some professors who were skeptical of the way the government ran some things in public health, and thought that, like, outside pressure, say, like during the AIDS epidemic, could improve care. So, it was a bit of, like, angst involved in like, deciding CDC versus non-CDC. But having grown up in Washington, DC, and then having known these other people, I had a lot of respect for civil servants, and I knew they were coming from the right place. And then they told me, like, even if you want to go outside later, it's good to learn how things are done on the inside.

So that's how I applied here, but I knew it was very competitive, so I wanted to make sure that I had, like, the strongest application so that I would get in. So, I really, like, ran it by a lot of people.

Q: Yeah. When you came into, excuse me, when you came into CDC as an EIS officer, what class were you in?

MILLER: I was in the 2019 class. Uh, that was actually kind of funny, too. I got waitlisted for EIS, and I was, like, devastated, I remember being on the Emory campus crying, it's like, what am I going to do? I was used to rejection from before, but the--I mean, I have no idea why it happened, but I remember at my interview, I literally walked in -- past [EIS] Director Eric Pevsner, like, almost smashed him in the hallway. Then, like, five minutes later, we were doing the interview, he's cool, he was fine with it, but I just thought, like, this was an omen for something.

Q: Yeah. What were you matched with, with your EIS officer in 2019? Because the program must have started in what, July 2019 then?

MILLER: Yeah, I think so, that sounds right.

Q: Yeah.

MILLER: Yeah, because it was at the end of my fellowship in June 2019, so that's right.

Q: Yeah.

MILLER: The match process, like I'm sure other people have told you about the whole EIS conference week, where people do like the frantic interviews for positions. I thought I wanted to be a field officer in a state at first. Like, after a year at Emory, even though I had had a good experience working with the people at Emory, I was just, like, I'm done with Atlanta, I miss my family in the Northeast, and I was, like, hellbent on getting a state position in the Northeast. Then, after talking with more people that week, like, more and more the headquarters position in Atlanta sounded like they were better for my medical career, like, more aligned with what I had previously been doing.

And so the blood disorders--excuse me, there are two separate CDC groups that work with blood, one is called blood disorders, and the other is called BOOTS, Blood, Organ, and Other Tissue Safety. So, neither of those groups was recruiting my year, and I was like, what am I going to do? There was, however, a position in the cancer division who was interested in the fact that I had, um, the experience reading pathology tissue slides--like, pathology management in the hospital is a lot of like, when a patient has cancer, and the surgeon takes out the cancer, the pathologists diagnose it. And that is really useful for a lot of cancer registry information. So, like, they wanted a pathologist who knew how to interpret, um, the way cervical cancer tissue looked on pathology, so, uh, I ended up matching to that position. So, I'm trying to remember the exact acronym now, but I was in the chronic diseases center, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch.

Q: Oh!

MILLER: I know, like, the name's just kill me.

Q: Oh, the CDC names are--

MILLER: Yeah, yeah.

Q: --they just go on forever, don't they?

MILLER: I got my EIS branding too, I should say (holding coffee mug with EIS logo to video screen).

Q: I know! Representing.

MILLER: Yeah.

Q: Okay. What were you doing, so that brings you up to like, I mean that's just--

MILLER: That's just like the tip of the iceberg.

Q: I know! Really just the end of, the beginning of your EIS training. I mean, you were in the cancer division, you're, you know, the long name that you said that I can't repeat, I'm very sorry.

MILLER: It's okay. Cancer prevention. We'll go with that.

Q: Cancer prevention, thank you. So you were in cancer prevention.

MILLER: Yeah.

Q: Yeah, working as an EIS officer, getting your training in. What were your first kind of roles before we roll into like, December 2019? What were you doing?

MILLER: Sure. I was in a headquarters desk job, basically. Not heavy field 00:19:00experience at all. We were supervising several of what they call NOFOs [notice of funding opportunity], uh, basically, like, grants to external partners to do research on cervical cancer related to HPV infection, and then whether HPV vaccination could potentially prevent cervical cancer, as has been shown before. So, I was working on data from various projects related to HPV-associated cancer. I was also working on some projects related to what's called early onset colorectal cancer. Uh, it's been shown recently that adolescents and young adults are getting colorectal cancer more than they did previously, uh, because it's such a prevalent disease in the US overall, there's been a lot of interest in it at CDC. Uh, so, my basic job was to develop analytic epidemiology projects under mentorship about these two areas, and then, uh, to be, like, the pathology 00:20:00jack of all trades for the department.

Like, if somebody wanted to know about like, how a certain cancer worked, or how a certain cancer looked on pathology, or whether a result on a report sounded right, they would send stuff over to me, and be, like, "Does this make sense to you?" It ended up being kind of fun, that, although I was in this one little office, I ended up finding a lot about this really big division, I got to meet everybody, I feel like. It was a really nice experience.

Q: That just brings you up to December 2020.

MILLER: Sort of, sort of!

Q: Yeah, a little bit, yeah.

MILLER: Yeah, yeah, um, like I don't know how much you want to get into it here, but a lot of my work got cut short, first of all, because I had to take my medical boards in transfusion medicine, and second of all, because of the vaping, what they call EVALI [e-cigarette, or vaping, product use-associated lung injury] the e-cigarette or vaping associated lung injury epidemic that was seen in basically every state in the country. I worked in New Jersey and 00:21:00Pennsylvania, reading charts for that. Um, my primary role on that was in reading autopsy reports, and in liaising with state departments trying to figure out how to collect a high volume of cases in a short amount of time.

Q: You really worked on that response for the EVALI one, right?

MILLER: Yeah, yeah, exactly! Yeah. So I was on that response for about probably close to three months, and everybody in my EIS class was doing it, that was just, like, the expectation, and the chronic diseases center had never really run a response on its own site before, which is at Chamblee, like different campus than main CDC campus. So, we were all in a cafeteria room, basically, like trying to put together an equivalent of the main campus EOC [emergency operations center] situation room on the fly.

Q: Right.

MILLER: So that was actually pretty cool to witness, but we were working with the Office of Smoking and Health, and basically everybody else in there, and so you would have to have, like, an EIS party every day, like people would bring in 00:22:00breakfast and then we'd just like, call the states frantically.

Q: Tell me a little bit more about like the EVALI response. So, tell me like, can you elaborate a little bit about like, what your role was?

MILLER: Sure. So, my official title was EIS officer on what was called Epi-Surv, standing for Epidemiology and Surveillance Team. I came on, I think, about two weeks into it. I was among the pool that they were recruiting for the first multistate investigation in the Midwest, but because of my transfusion medical boards, I couldn't go. So, like, I was aware of the investigation, like, literally, from day one. But I couldn't come onboard until about like, two weeks in, while I was wrapping up my medical boards. Uh, once I was there, though, I was in this room that I described before that they had set up as this temporary emergency operations center, and, uh, my job was to work with states on their 00:23:00case counts, uh, and to develop a case definition of what is EVALI.

The reason that they had me somewhat involved in that is because a lot of these people were diagnosing it from lung pathology slides, and I had read lung pathology slides in residency, so like I wasn't the one developing everything as the expert, but, like, I had more of a backroom role. Other EIS officers were more directly involved in field investigation, although I did go to two state offices, like, once the investigation expanded from the Midwest. I went on the first non-Midwest investigation to investigate the case clusters in the Northeast. Which would involve interviewing people who said they had it, and, like, calling them in their hospital beds and stuff.

Q: Which state did you go to, which state was that?

MILLER: Sure, I went to Pennsylvania first for about a week, and then was reassigned to New Jersey for close to three weeks.

Q: Oh. Okay. Tell me about your, can--do you mind if I ask about your personal life?

MILLER: Yeah, sure.

Q: Okay. Tell me about what was your personal life--like, your non-job-related life--before the pandemic hit?

MILLER: Sure. I had been in Atlanta for about a year when I joined EIS. The fellowship that I had done previously was a twenty-four seven gig. I got called at three o'clock in the morning all the time about patients, so I basically had no social life of any kind in Atlanta. Um, without getting into too many details, I had had a really devastating breakup when I moved from New York to Atlanta, and, so, like, I was living alone, socializing with nobody but work people. It sucked.

Q: Yeah.

MILLER: But I mean, that's, I have to say, like, pretty typical of medical training. But like, I remember being really absorbed and focused in my work, 00:25:00because I didn't have other stuff going on.

So, like, my life in Atlanta would be like, go to a Pilates studio in the morning for exercise or like, do other exercises at home, go to work, go to get takeout or go to a restaurant in my car alone, and then come back alone, and then watch TV or read. Um, I think probably the most unusual thing that I was doing that might not be typical of other EIS officers was that I had worked as a professional writer prior to--uh, well basically since I graduated from college, I was never like a full-timer, but I would just like, write poetry and stuff like that, write fiction. So that's how I occupied a lot of my time.

Q: Amazing, are you published?

MILLER: Yeah. That's, uh, I mean that's another discussion, but yeah.

Q: Oh congratulations, that's fine. Yeah. All right. This pretty much brings us right up to, let's just say that we're now going to start with the COVID-19 pandemic.

MILLER: Yup.

Q: So, when did you first hear about COVID-19?

MILLER: I have to say, it's a little bit vague. I do know that it was at some point in December or January, that 2019--2020 changeover. I learned about it from media reports that other EIS officers were circulating. Uh, one of the other EIS officers in my class is from Taiwan originally, and, so, then he just like, had been interested in the China/Taiwan political relationship, and then had, like, and also happened to be in the influenza division for his EIS assignment, and so, had awareness of this going on. I don't know sort of, like, when he became aware of it, but then he had sent a link via text message around saying, like, "Hey, did you hear about this?"

A lot of us were speculating about, like, if we would become involved, when we 00:27:00would become involved if so, but it was like, very hypothetical at that point. This is over the Christmas holiday too, so I was home with my family. I'm very close to my family, so I had sort of like shut off CDC for a week, and then, like, everybody's, like, "Oh, something else might be going on -- something."

Q: Yeah. Was it on their radar when you were home with your family at this time?

MILLER: They were aware that something was going on in China, but I don't recall, uh, the specifics. We had just heard, I mean we're big news junkies, like they had read it in The New York Times or something. I know that I told them.

Q: When did you really become involved with the pandemic response, then?

MILLER: Sure. I was among the first group of EIS officers to be involved. The first people to get into it were those who were in the flu division, er, NCIRD 00:28:00[National Center for Immunization and Respiratory Diseases] is the center, like influenza and respiratory diseases, so those people were first, as were the Seattle-based officers. I came in basically as the very, literally like the very first recruit to replace one of them. They wanted to send one of them to Seattle who was then ultimately on the first New England Journal [of Medicine] publication, but in order for her to go out to Seattle, they needed somebody to replace her in the EOC, and they wanted an MD, and because of my cancer job, I had projects that could basically be put on hold last-minute, and plus I had this pathology experience, which was relevant to, like, potentially interpreting test results once there was testing.

So they picked me for the Epi-Aid [epidemiologic assistance]. I don't know if it was called an Epi-Aid, like the, just, technicality, the bureaucracy. But basically like, they needed somebody who could work a night shift right away, and I was, like, I've been doing a 00:29:00night shift ever since I've been in Atlanta, fine, go! January, it was either the twenty-first or the twenty-second, I remember, I was in my desk at the cancer division in Chamblee, and then Mike Gronostaj [now Mike Cherry] who works for the Epidemiology Workforce Branch, supervising EIS officers, is like hey, can you work like, nights tonight? I said, why not? Then I went like, three hours later to the EOC, the emergency operations center.

Q: Yeah, so this was right around when the first cases were coming into the US.

MILLER: Yeah, the first case was confirmed the day after I was there.

Q: Tell me what was that like, in the--because you were in the EOC, just tell me what was it like just being in the EOC during these early days? And what were you, you know, just explain a little bit more about like, what your role was there, too.

MILLER: Sure. I will say that because I didn't work there regularly, I may have some of the locations and things wrong, but, so this is just more like, general recollection.

Q: That's okay.

MILLER: Uh, so, the emergency operations center is in, like, a large building behind the main entrance of CDC. Uh, CDC was going under a lot of construction at the time, and I remember thinking of it as the Yellow Brick Road [from The Wizard of Oz], just because, like, you could not make a straight entrance into CDC, you had to, like, go around these things, and they had these orange and white barriers up, like the construction things that kind of look like Creamsicles or something. Just, it looked very magical in a way that it did not feel magical in subsequent days. Uh, so once you got into the EOC itself, there's a situation room there which is kind of like the one that you'll see on TV if they do, like, "inside CDC" filming. We were not there yet, there were people there, but like I was not working there. I was working in an office that I believe is in the measles division of NCIRD [National Center for Immunization and Respiratory Diseases], the respiratory diseases group.

I remember that, um, pathology is a lot about cells, like looking at cells on 00:31:00slides, so somebody had made like an angry neutrophil, the white blood cell that fights off infection, and so it had a little "N" on its head. So, I worked in a cubicle where somebody had the angry "N" coming out, and then there would be a conference room next to that with about ten people with a bunch of clementine oranges. I remember like, just eating clementines anxiously while they were getting stuff done.

Um, I was working, I am a civilian employee of CDC, but most of the people on the investigation at that time were [US Public Health Service] Commissioned Corps officers, so like, everybody's in their khaki uniform, I was sitting there in like, my pajamas practically. Being there at night, around like ten o'clock at night, just hanging out. I had heard that other people I worked with were on cots. I never saw the cots, but, like, I hope they give interviews, because that sounded pretty cool.

Q: They were sleeping on cots, or is that a--

MILLER: Yeah.

Q: --oh, okay. I wasn't sure if that was an acronym.

MILLER: Yeah. I was not. Oh, no, no, no! Knowing this place, it very well could be.

Q: It could be.

MILLER: Yeah, but so, like, I was able, I live right across from CDC at Emory Point, so like I was able to go home. But I kept joking to people that I've made my own EOC at home. Because I can just do my whole job by the phone. For the first five days or so though, I was over there at really weird hours, when there would only be like ten other people there, all the lights would be dark for the energy saving stuff, and I would just pace the hallway with the vending machine over and over again, trying not to sit down. But, like, you could tell right away that, like, the people were anxious.

Q: Yeah, it sounds tense.

MILLER: Yeah, I mean I will say I am an anxious person by personality. They seemed really calm about it, but I mean there was definitely like, people knew that--I shouldn't, like, project about what other people were thinking, but I could tell that they were thinking a lot about strategy in a way that--like, I 00:33:00had never done infectious diseases epidemiology, I was all chronic diseases epidemiology, and so, like, when they were describing certain language, like--well I don't think they were getting into attack rates yet, but certain concepts of infectious diseases epidemiology and containment were very unfamiliar to me, and so I was just, like, letting it wash all over me, and letting them talk. They would project stuff on a screen, listing cases, but, like, I have very clear memories of case number one, case number five, like that kind of stuff.

Q: Yeah. But what about like those conversations around containment and everything? Was CDC, tell me a little bit more about like, what were those conversations like? Were they hopeful, were they--you know, they were being strategic, so tell me a little bit more. I guess just unpack that, if you can.

MILLER: I'm not sure that I can, honestly. A lot of that was happening above me 00:34:00that I mean like, Hannah Kirking, who was really deeply involved in the investigation, she was in the room, she was among the more senior people there, as was Sara Oliver, who has become primarily a vaccine representative, but, like, they are not senior leadership. So, I mean, I was not seeing anything that was say, happening in Bob [Robert] Redfield or Anne Schuchat's office. That was way above my pay grade. Although, like, we were physically around where they would be, but not like, working with them directly.

Q: Yeah.

MILLER: I think the most interaction I had with it was because I knew nothing about coronaviruses, I was set up with this woman, I believe her name is Eileen, her last name escapes me [Eileen Schneider]. But she was a subject matter expert in MERS [Middle East respiratory syndrome] the previous coronavirus in the Middle East. Whenever I would be calling people who thought they had cases of coronavirus at, like, three o'clock in the morning, we would call each other and email back and forth, where she would basically like, tell me what to say, 00:35:00kind of like in a broadcast news thing, where, like, they're in your ear, telling you what to say.

And that's just for standardizing the message more than anything. I mean, my job was really to, like, get the case histories, like had the person been to Wuhan, or Hubei province, where Wuhan is? Like, did the person have a fever, what other symptoms do they have? I personally, in my role, was more focused on clinical case investigation and characterization than the mitigation. What I do know, though, is that the Seattle people were interested in making sure that, like, the case didn't spread around, that the case in the hospital didn't spread around the hospital, and that they began to talk about quarantine hotels eventually, which I was, like, peripherally involved with later. But I'm talking more about, like, the first week as opposed to the first month. Things changed very, very, very fast.

Q: Yeah. So I know that you were eventually involved in the medical on-call room.

MILLER: Yes.

Q: Yeah. Tell me about, like, how you transitioned over from your role kind of working night shifts, you know, to this medical on-call role.

MILLER: Sure. The way I got the medical on-call role was just because of what they needed in this measles conference room at the time. It's called that just because the people who work in measles were, like, among the first assigned to the investigation. So I--they gave me a separate cubicle and said like, the New York City people have some potential cases, call them, because like, they knew I had trained in New York, and I said sure. So I ended up doing like, de facto workups, like recording information about symptoms people had, and potential exposures, and then reporting that back to uh, the people senior to me in this conference room, and then they decided, like, oh, we've got more than we can 00:37:00really handle, we're going to make a whole unit for this, so that was then called PUI for patients under investigation.

For the first month or two of the response, they had a larger conference room set up in the ground floor of where that situation room is. The situation room is on the third floor. There were some ground floor conference rooms. And my particular conference room was a bunch of people in uniform other than me, and headsets, like I'm wearing, looking like they were doing like, a telethon on television, like processing cases. By on-call, we were working, like, eight-hour shifts on and off, where various health departments would call us saying we think we have a case, or hospitals. Or even like single providers, you would get like, rural providers saying like, we think we have somebody, we don't know what this is, they would then call. That was more like in the later part of that 00:38:00month than at first. But like, we were getting calls from, like, Seattle, California, Texas, Boston, New York, mostly major metropolitan jurisdictions.

Q: When you say later that month, do you mean January, or do you mean February or March?

MILLER: Sure so I started January 22nd, and then worked until's Day [February 20], took a little break to go back to cancer division, and then did, like, around St. Patrick's Day [March 17] to April. So, I'm primarily talking about like, the January/February--so, like, February, I guess. February 2020.

Q: Tell me a little bit more, can you explain a little bit more about like, what were people calling in, they are just calling about, like, you know, patients under investigation? What were these calls like?

MILLER: Sure. So, I will say that they didn't come to me directly. They were 00:39:00routed through a group that I think is called CDC INFO, but there's like a switchboard where people would screen callers to make sure they're legit or not, I guess. Then we would say, like, "Call on switchboard from--" hypothetically, like, Rhode Island, Illinois, whatever. Oftentimes it would be people in your EIS class. We would be like, haven't talked to you since EVALI, the vaping stuff, how are you? Because like, people had been so busy, nobody had time to keep in touch.

You would sometimes get calls from your own classmates from EIS, you would get calls from people who had interviewed you for jobs through the EIS match before, like state epidemiologists, or calls from providers who had all been vetted through this situation room switchboard, and then, uh, you got, like, I'm trying 00:40:00to remember exactly when this was created. But they created, like, a protocol for what you would ask.

It would be like, was this person in Wuhan or Hubei province? Was this person in other parts of China, Beijing I think was the primary area of concern at the time. Then clinical symptoms, like did they have fever, did they have shortness of breath, are they on a ventilator or not? Yada, yada, yada, I don't have the whole list. But you would just, um, go down, take information based on a protocol, and input it in a spreadsheet where, like, you would do as an MD on the wards, you would write what they call a one-liner, in residency, explaining, like, how old is the patient, what are the symptoms of the patient, does the patient have any more, other medical conditions you need to know about? We would then basically make triages based on this of probable versus, like, less likely cases.

In the beginning it was all adults. Then you started to hear about children and babies, and that's when people started getting really worried. But I think there were a couple interesting things going on in that room, but I remember that it was set up kind of like a normal classroom or business conference room.

But kind of like the poster I have on the back here (gestures to poster with map of New York City on wall), there was a big placard that was a map of China, and so you would have, like, basically telling people where the locations were, because like, I had been to Shanghai before the pandemic, but really didn't know very much about the geography of China, and, so, then, like, you would have conversations with the people on the calls, like, is that really near Wuhan? Is that near another city in China that might have a case cluster? There was just a lot of confusion. And I remember--I don't remember who it was, but there was one guy from the [US Public Health Service] Commission Corps who then like, would quiz geography, kind of like you would do in like a high school classroom where 00:42:00he would just, like, review the provinces and start, like, scribbling them so he could do the calls faster. But it looked like you were doing, like, a geography bee in school. It was really weird.

Then, there was a whiteboard where it would say like, somebody would write out the cases, and like I mean, I don't really talk about this a lot with people for, like, CDC standards of, like, what they share with the public, but I remember I was case number eight, from a hospital in Boston, I should say. I shouldn't get more specific. But, like, I remember thinking I was cool--that, like, I was in the first ten cases, which I mean it's not cool at all, it was horrible, but like it made me feel like I was part of an emerging, like, team effort, and, so, that was nice. People would bring snacks in the room. There would be little signs, like, people would do hot dog folds of eight and a half by eleven printer paper with like, magic marker, like clinician number four, clinician number five, clinician number seven, and people would get their favorite desks. Um, as things 00:43:00started to--as we started to learn more about COVID, people would have a bottle of hand sanitizer there, and people would frantically--

Q: Oh, yeah.

MILLER: But that was more like March than February. But what I think--I'm probably, like, meandering--there was a point when the calls were hopeful, and then the calls got desperate, and then the calls started--like, I always think I'm going to get to the point where I don't start crying when I talk about--

Q: It's okay. Do you want to take a second?

MILLER: I'll be okay. Thank you, I think it's important to, like, see that it's still emotional, I just hope that I don't look melodramatic, but--

Q: It's okay.

MILLER: --it's, I had people scream at me on the phone, I had people cry on the phone. There was one time on a day shift where--I think it was a California 00:44:00epidemiologist--one of the largest state epidemiologists had a child in, like they were working from their house, and the child was practicing the flute, playing "Twinkle, Twinkle Little Star" in the background while they're calling about a patient saying like, should we quarantine this person? We think that there's community transmission, like, was this a problem? This woman is, like, getting all this angst about it, and then being the mom in the background at the same time. I mean I don't have children myself, but I was just like, oh my God, what must that be like?

Then the Seattle group--I hope this isn't identifiable--but the one thing that I will never, ever, ever, ever forget was like, right before the New England Journal [of Medicine] case report came out from Seattle, this woman was navigating that, and navigating new cases in quarantine hotels coming in at the same time. And that particular night, I was not in the patient on-call room, I was in my apartment, just because like, I told them like, I don't need to be 00:45:00there to record in a spreadsheet.

This woman goes to me, like, "I just want my Reuben," like, talking about a Reuben sandwich, like she hadn't eaten for hours, and hours, and hours, and, like, I almost started crying when I heard. I just--I didn't know what to say, but I was in text message with them saying we're working on it, we're working on it, we're working on it, and everything was like, we'll get back to you, we're working on it, and then I don't feel a lot of the time like we were able to help them, and whenever I think about, any time I see a COVID data tracker in the news, like 800,000 deaths, 900,000 deaths, a million deaths, I think of her saying, "I just want my Reuben!" Because that was case, like, four. Yeah. Anyway, but it's--sorry.

Q: I mean this is an intense environment, it sounds like, and this is also when 00:46:00we're learning a lot of things about the virus, so you go from is it, you know, you brought up the issue of like, community transmission, so you know, where that wasn't quite as clear in the beginning, is it community transmittable, you know, is it not? Tell me about what is it like working in this operations center, answering these calls, you have all the, you know, along with all of this influx of new information about the virus itself coming in.

MILLER: Sure. Well, it was hard, first of all, as a trained laboratorian--like, a lab medicine person. I was not on what they called the lab task force that was supervising the testing protocol. The medical on-call room that I was in was basically determining who would get sent a test from the CDC. I didn't know how decision making was being done in the lab task force. I remember asking at one point like, can I like, go with them? Like, even if they don't need me for help, just for educational purposes? They were like, maybe not best time to do that. 00:47:00It was only much later that I was able to reconstruct why, and I will leave that to, like, media reports, but I would, you would have to email them on everything, and it would feel like this whole black box going on in the background with the lab people, and then what was called the global migration group [Global Migration Task Force], which was working on the cruise ship-related investigations, and the airports.

But you would just feel like all this stuff was happening beyond you, and then I remember somebody saying to me at one point, because I said, like, "We need the answer to this now so that I can call back this epidemiologist, uh what do I do?" I said, like, "Can I just knock on their door?" They were like, no, don't do that. I don't remember who said that, or what, or if it would have made a difference, but I was just, like, that's--it was so antithetical to what I learned from the hospital, like, even if you knew you were being--I should say, do you mind if I use language here? Like, uh--.

Q: Yeah, go ahead.

MILLER: I was going to say, like, if you're being like annoying as shit, you as 00:48:00the resident, it's okay to be as annoying as shit if you think it's going to help save somebody's life, even if nobody else likes it. That was kind of, like, it was really, did not compute with me, having done this, like, hemorrhage care in my previous job that you couldn't just, like, knock on the door and say like, "What's going on?" I mean, I didn't end up doing it, it was fine, but I just remember, like, sitting at my computer station, being, like, that's interesting, and trying, I had no idea what was going on, but just thinking like, that is odd.

Then the community transmission stuff that you were talking about before, a lot of that was happening above me in a separate room, like the discussions about like what CDC thought about that question scientifically. It is something I was hearing a lot about from the epidemiologists themselves--and again, not being an infectious diseases epidemiologist, I was, like, that sounds plausible, but like, I didn't want to--A, I didn't want to impute an opinion, like, uh, I 00:49:00didn't want somebody to think my personal opinion was a CDC opinion. I didn't want to, like, misconstrue what CDC's, um, guidance was on that. And that was really unclear to me in that room, and we were just kind of like, defer, defer, defer.

And we would have a data tracker up from Johns Hopkins, which I was also kind of, like, why isn't it CDC? But it was from Johns Hopkins, with cases going up, up, up, up, up, and then people would comment, like as they were looking at that board next to the China province board saying like oh, community transmission, interesting question. And, uh, uh I will say, the story that I'm about to tell, I cannot corroborate that it happened, I was not present for it happening--I will never know whether this is actually true or not--but I finished my work for this particular cycle of deployment around President's Day [February 20] weekend. And I was--uh, President's Day weekend, 2020.

And somebody told me, I don't know who, that Bob [Robert] Redfield had stopped by the room to say hello at a time when not a lot of people were there, and was eating a cookie, because we had good snacks in the room. Everybody from the other task forces was always like, we want to hang out in the PUI, patients under investigation, room. And that he was, like, musing about the issue of community transmission while looking at that map in the front of our room. I just think, like, I would have been very curious to hear what he thought about that question at that time. That was around the time the New England Journal [of Medicine] published an article from a German team speculating about like, asymptomatic transmission, and I remember that being a big topic of discussion in the room, but again, like, I felt like I wasn't medically qualified to comment on it.

But I know that it was something people were interested in. I wish I could say why. And I definitely knew that we were not being, like, we were told that there 00:51:00were very strict criteria to give tests. And I remember really being upset in cases where I could not give people tests where, like, if I were doing this in a hospital, I probably would have. Just out of conservative, like test everybody.

Q: What--

MILLER: But the tests, just, like, there wasn't the supply.

Q: That was during the testing shortage?

MILLER: Yeah.

Q: Or was it also CDC's kind of case definition was--because during the early days it was only restricted to people who had traveled to Wuhan, right? And then it opens up--the more that the pandemic spreads, and the more that we know about the virus. Was that during the testing shortage that you found this conundrum 00:52:00going on, or was it during the case definition, or a little bit of both?

MILLER: I would say a little bit of both. I think it was a chicken/egg thing. I think people who were subject matter experts in this area might have a better answer for you, but it was my subjective impression that the case definition was following however many tests they had. I did not know why they didn't have tests, I did not know how many tests they had, or anything about the tests that they were using. But I did know that, like, the case definitions seemed to change as there was, like, rumors about changes in the testing supply. Uh, uh, like I said, I can't prove any of that, but that was just my impression.

What I do think, in retrospect, was a little bit unusual about it, though, is--when I heard that, when I learned, many months later, that there were tests 00:53:00in other countries that could have served as diagnostic tests, I remember thinking it was curious that that wasn't explored as more of an option. I mean, I'm not trying to glorify myself or anything, I'm just saying, as somebody who trained in a pathology lab, like, they do a lot of what are designated by FDA as laboratory-developed tests, and it is not unusual to bring in tests like that in certain areas of hospital practice. So, I just didn't know how public health practice worked differently.

And, like, honestly, I should say, this is very speculative, I do not know what the right answer was in that case, but I know that the case definition--when we were reading revisions of case definitions, I knew that there were simultaneous discussions of changes in laboratory activities. I don't know what those were, but, there--I definitely had, like, a vague awareness of some relationship between the two.

Q: I have another question. A little bit more about what you said when you were 00:54:00talking about using the Johns Hopkins case count, the global case count things from Johns Hopkins, very popular in the early days of the pandemic, rather than a CDC-- why do you think that was? You know, using this Johns Hopkins one, rather than a CDC case count?

MILLER: No clue, honestly. I know it was pretty. I mean it was very easy to read, very intelligible, but as to why it was CDC or not, no clue.

Q: Okay. I wasn't sure. Okay. Well, then you went back, so after President's Day [February 20], after you end your deployment here, and you're back in your home office kind of thing with cancer prevention, tell me a little bit about, like, what is going on with cancer prevention then? Because it's almost like, you would imagine that things would be, like, almost in upheaval. So, but maybe that's just me projecting a little bit, but I'm curious, what was it like?

MILLER: Yeah, I will say that it wasn't quite to that point yet.

My direct EIS supervisor is from China, had a very young child, and so was concerned about her own family--not in Wuhan, she's from the Beijing area--but like, was thinking about that, then also had this toddler that she had to take care of, so she could not deploy for the response because she had a child to take care of. She also, her--like, she's more of an analytic epidemiologist, they were not doing a lot of data viz [data visualization] and stuff like that at the time, so it was like not as much her wheelhouse.

But then other people that I worked with at other points in the supervision chain were all [US Public Health Service] Commissioned Corps, and so then they were all getting deployed to the COVID response, basically to replace me, and they were like oh, how's it going? It was very surreal, because these were people who had like, probably twenty years on me, in some cases, and they were, like, Maureen, you are now the expert in the novel coronavirus, tell me all about--and I was, like, 00:56:00I don't know what I'm talking about. The reason that they got assigned there is because they needed clinical hours to satisfy their uniformed services requirements, and so you would get like continuing medical education, or whatever the term is for taking the calls. They were all sent over there.

Eventually, like, because they knew me, like when it became clear that this was going to be a much longer-term operation, the EIS sent out an announcement saying, like, EIS needs to be on this full-time, and my previous bosses are like oh, Maureen, we'll just have her back. So I, I got my previous job working alongside like, people who were supposed to be my EIS supervisors, um, where--and it ended up being fun, like we had late nights together, but I got no work done in those couple weeks, like, related to the cancer work. I would send 00:57:00emails and stuff, but I was just like, not only really tired, but just, like, emotionally a wreck.

The other reason for that is because um, I trained in New York City, and that was when it was becoming evident that New York was having some serious problems with COVID. And, um, I just kept, like, talking to people I used to work with frantically, saying, like, can I help you here? Which was really, like, we kind of weren't allowed to do that. But I mean, I tried to be vague about it, but I was just like, if I can ask around to get you something, like, uh, uh, yeah.

Q: Yeah. Tell me a little bit more about what were your friends and colleagues kind of seeing in New York at the time? So, what were you hearing about that kind of made you anxious, or you know, kind of, tell me that.

MILLER: I think the timeline's going to get a little bit conflated here, but I 00:58:00do know that in February 2020, I believe the second weekend, I went up for my sister's birthday, which is the seventh, and we saw the Broadway show Moulin Rouge, which, like, I like the movie, the show not so good! But uh, uh, yeah, just like, for future reference if you're interested. But I remember, like, being in that theater, thinking, like--and I mean, no mask policy had been made yet, I had friends who had like, been interested in SARS [severe acute respiratory syndrome] and stuff who were kind of, like, why aren't people wearing masks?

Regardless of whether--I don't even remember whether I thought masks were justified or not, but I was in this crowded theater just like on--I want to say tenterhooks, I was so tense, and my mom was like, what is wrong with you? After, and it was because like I couldn't tell everybody that I thought, like, the little COVID in New York was going to become big COVID--I didn't predict that 00:59:00big--but just, I felt like I was keeping a secret from my family the whole weekend, and at that particular time, there were people I knew from EIS doing the quarantine stations, and the repatriation stations at the Air Force bases. So, like, everybody, I shouldn't say everybody, but a lot of people in CDC who I knew were all over the country, trying to, like, screen people out, and quarantine them.

The reason that that wasn't my job was because, like, I--well, actually, my occupational health appointment, screening for field appointments for COVID is an interesting story, but that's kind of, like, not as relevant to what you asked. I'm trying to remember, I feel like I'm losing track of your question, what was your question again?

Q: That's all right, well, let's talk about your occupation. Your deployment story. Do you want to talk about that?

MILLER: Sure. When I was in that patient on-call room in early February 2020, they realized that they needed to start deploying people to Air Force bases to 01:00:00repatriate people from cruise ships where there had been outbreaks, and quarantine them so that they didn't infect the rest of the country.

Um, so, like, they were preferencing MDs, just because they needed to do, um, clinical screening, and so I volunteered. I went over to the occupational health office on the main campus, very nervous about it, because I mean, like, I had taken all these phone calls by now about people who were terrified about, like, being on ventilators and stuff, and talking about how they couldn't get people back to China--like I was involved in some calls about like, potentially repatriating Chinese nationals back to China once they were, um, completed their isolation period, when you could still do that.

So, I went over to this appointment, and somebody who had been in, I believe, the 2001 class of EIS, the anthrax class, was the person examining me. I told 01:01:00her that, like, I had a history of asthma and reflux--you can probably tell from me talking actually. I said, like, I want to go, I feel a duty to go, but I'm nervous about going--and I broke down crying, saying--and then she said like, it's okay, like there are people on anthrax who shouldn't have gone on anthrax, it's really--she was very understanding, she was like, she looked really badass, she had like, combat boots on from her [US Public Health Service] Commissioned Corps outfit, and had this bouffant on, so, like, so it was just, it's a very memorable impression. But she was very calm, very even, and said, like, you don't have to go, if you want to go I'll sign you off to go, if you don't want to go, I won't sign you off to go.

And, so, finally, like I was--I called it to somebody FOMO-virus [fear of missing out], because then all the other EIS officers across the country would be doing these really cool investigations and stuff, and I had been like, excluded because I made that decision that I--I realized I should have been 01:02:00clear, I was supposed to go on the nursing home investigation in Seattle. Which was like the very first major field investigation of COVID beyond the first case. A bunch of the EIS had gone out there to swab people in nursing homes and investigate the cluster in I believe Kirkland. But I felt like such a coward, I was so angry at myself. I mean I'm still angry at myself really now for doing it. But I mean, I just knew that if I was crying like that, I wouldn't be effective.

And, like, especially if you had to be swabbing people, like, I have a hand tremor sometimes in here, so I thought people would be able to see me trembling and not react well, because they would know I was scared, and people--like, everybody in EIS, fine with it, like, said you're helping other ways, but I didn't feel like I was helping other ways, I felt like I had, like, defeated the whole purpose of being in the operation. Because I hadn't done any international 01:03:00travel with EIS. I had a very atypical EIS experience, and so I feel like what are people going to think of me? Then, I don't know why I was so concerned with what other people think of me, but that was it. So basically, like, I told them I'm nervous to go, and they said, you don't have to go. I worked at home the whole time, literally the whole pandemic.

Q: Do you need a second?

MILLER: I'm okay, thank you though.

Q: Okay, no problem. Let's talk a little bit more about your work then, when you were working from home. You said you're too nervous to go, which is fine, and now you are working from home for, you said the entire pandemic. What were you doing after you, you know, your next deployment. After you're back with cancer and then, you know, you work on your next deployment, when EIS says everyone kind of needs to be on COVID response, on the COVID response, excuse me.

MILLER: Sure. So, while I was still working in that room in March, I had heard from medical journals that they were interested in giving COVID patients convalescent plasma, which is a blood treatment, like, plasma from, has the antibodies in the blood. They were interested in giving plasma from people who had already been sick from COVID-19 and had antibodies to the virus to people who were in ICUs [intensive care units] to try to make them better faster, like during the period when they hadn't made their own antibodies. And, uh, I knew from my Emory experience who head of the blood safety group was at CDC, so I sent him an email, I'd never met him before, and I said, like, hey, Sridhar [Basavaraju], can I help you with this? Because I thought that CDC would probably be involved. He said well, we don't know yet, but we're working on something. That actually was probably the closest that I got during that period to, like, senior leadership at all.

Just because like, I remember being cc'd on an email where like, Anne Schuchat was saying yes, we should investigate plasma, or something like that. I thought, oh, I'm important now, that's kind of cool! She, coincidentally, like, when she was put on the incident manager role, she had visited the, um, room in March, and I remember her saying, like, how things are going, and the first thing out of my mouth was not like, "Hello, thank you for coming," but I said, "Oh, a lot of people are dying!" That may have been a paraphrase of that, but I think I said, "We're starting to see deaths." Uh, so, I'm not necessarily proud of that. I mean, it was factual, but-- and sort of going onto the next person after that.

Anyway, that was the moment where I was like, maybe I shouldn't be working in the PUI [patients under investigation] room, let's go onto plasma, and they got funding, so they were taking a case registry of everybody in the Seattle area who had gotten sick so far, 01:06:00trying to find the right donors, like the best donors to give the plasma to people. The CDC, because of various bureaucracy issues, is, like, the only group that could get information on who had tested positive for SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2] and, like, how severe their illness was. The thought was that if you'd had more severe illness, you would have more antibodies.

Um, so, I would make calls to those people to, like, assess their, um, viability for donation, and then work with a blood center, and then we would then use that plasma not only for the patients, but for a clinical trial with FDA [Food and Drug Administration] and NIH [National Institutes of Health] of something made out of the plasma, which was called hyperimmune globulin, which basically like purifies the plasma so you get only the antibodies and not the other random stuff that's in there. I worked for several months in figuring out how to work with the Washington [State] 01:07:00Department of Health and the major blood donor center out there, which is called Bloodworks Northwest, and how to get a potentially lifesaving treatment to people, which was later proven to not work.

Q: I imagine that your clinical experience played a big role in this.

MILLER: Yeah, I have to say, I was much happier in that role, because I felt like I was using the knowledge that I had previously. It was really slow going, and it was definitely a really weird role compared to some of the other ones people had. Like, I wasn't doing contact tracing, I wasn't doing mitigation, I wasn't doing like laboratory surveillance, so when other people in EIS would talk about things like Ct [cycle threshold] count, or, like, contact tracing modeling, other technicalities, I was like, I have no idea what you're talking about. The questions that people had, like once my family and friends started having questions, I could not answer their questions from the kind of stuff I was doing.

And this was the point where, like, things were getting really, really bad in 01:08:00New York, and you would see the ice trucks. Me, being a pathologist, I knew people who were forensic examiners, and I was thinking like, they were told that they couldn't examine the bodies, because they didn't want to get people sick, and they were, like, well how are we going to figure out how this disease works if we can't get into the bodies? And they were--it was just, like, a quagmire of things. But like, I still haven't been to New York City after that. For a while it was because of just safety concerns, but I think like, I've developed, like, a psychological aversion to going to New York now, I feel like I'm not truly a doctor anymore. Because, like, I wasn't on the ground. Like, I haven't autopsied a single case, haven't done a single clinical workup for a COVID patient ever, other than my CDC job.

I wanted to moonlight [locum tenens], but like there were issues getting moonlighting, like pathology as a specialty typically doesn't have moonlighters.

Q: Tell me--

MILLER: But yeah, I don't feel like a true doctor.

Q: Tell me a little bit more about that feeling. Is it, you know, why do you not feel like a true doctor? Is it just, can you expand upon that, or do you want to?

MILLER: Yeah, I can. I think I mentioned before, I was interested in writing, and of course because people were really worried about their patients, and had a sense of urgency to help them, people were writing a lot on social media, and for print publications, and broadcast, about what was going on, saying like, we need help, we need help, we need help. Then a lot of them were talking about the experience of being in ICUs, including people--like, acquaintances of mine from NYU who had been at Bellevue. They talked often about not being able to touch people, or calling people and stuff, and I was just thinking like, well I haven't done any of that. Like that's--and I will say other people from CDC feel 01:10:00differently than me on this question, but like, I feel an enormous sense of guilt for like, what I couldn't do for these people.

I started to think, when I hear these stories, why did I not pound on that door to find out what's going on? Why did I not, like, drive tests up there, why did I not, like, go to OSHA [Occupational Safety and Health Administration] to get masks? Like, I mean they're kind of insane, I mean some of these things, like even if I had done that, it wouldn't have stopped anything, it couldn't have happened. But I mean, I have PTSD [post-traumatic stress disorder] from it, for sure. It drives my parents crazy when I say this, but I'm putting it on this record, because I think that a lot of CDC people who might feel this way might feel reluctant to put this on the record.

People worked their asses off. People were still working 24/7 to the--like, sacrificing many other components of their life to make sure that people get--well, people, the people here are not mal-intentioned at all, and they've done many wonderful things that it would seriously be nice for the public to 01:11:00know about, that I think could help rehabilitate the reputation of the agency, if people knew just how far people had gone to get them help.

I think that in terms of contribution--uh, having worked in New York, like, just--and this is a month ago--like, not remotely, a college classmate of mine who's a doctor in New York, I hope he doesn't listen to this, said something on Twitter saying like, everybody at CDC should resign for supporting a policy--I won't say what policy it is. And I just thought, like, I've known you for twenty years, and you, I literally wrote his medical school application. I, like, rewrote it for him--he was a good student--but I just thought like, are you--I still haven't talked to him after that, I thought like, are you ever going to 01:12:00speak to me again?

I interviewed for jobs at one point after EIS at blood banks, and I won't say where, but a blood bank and laboratory director that I interviewed with said to me, like, kind of, like, explain yourself for continuing to work here. I was really taken aback by it, and I defended what we did here to the extent that I could, but that's been really rough. It's really hard knowing from very close personal experience, how many good things did happen here that those haven't, for whatever reason, been communicated to other people.

I will say, there are policy decisions that I disagreed with that have happened here, but I, like--and maybe I should take pride in what I've done, sorry, this isn't psychotherapy, but I, basically like, I just feel like I wish I had done 01:13:00more, like, every moment that I am fooling around, watching TV, or on, like, the Internet, like reading my friend on Twitter, I think like, why am I not, like, doing some CDC project? I hope people continue to trust the CDC in some capacity, but, like, yeah, anyway, that's a whole longer discussion.

Q: It looks like CDC had, I mean especially, let's go back a little bit to the early days of the pandemic, back to like, you know, you working in the blood bank and everything. There was a lot of politicization that, I have mispronounced that word, excuse me.

MILLER: No, it's good, you're good to go.

Q: Okay, thank you. But CDC, especially in the early COVID response, and the Trump administration early on. What do you make of that? Did that affect you at all during your work? I mean, did you, or do you have personal thoughts on it 01:14:00that you would like to share, or did you see it in other areas of CDC? Just, I mean, what do you think of that?

MILLER: That's really hard to talk about. I will say a couple thoughts. First of all, I used to live really near Trump Tower, well before coming to CDC, like he was omnipresent in New York, like even when I was a kid not living there, like I read People magazine every week, I feel very intimately involved with the life of Donald Trump, as so many of us do--watched The Apprentice, whatever. When he came to the CDC in early March [2020], I remember watching the motorcade coming in, and thinking should I go over there? Probably shouldn't go over there. Probably shouldn't go over there, I'm going to say something I regret. I mean like, I could have gotten in, I had been doing it enough where like, the security guards knew I was involved, like I could have probably, like, 01:15:00not attracted suspicion for going there.

But then I remember--and again, I live across the street from CDC--watching it on Fox News, which I deliberate--I don't normally watch Fox News, but I deliberately chose to watch it there. In the one where he's holding up the little eight and a half by eleven paper with the virus electron microscopy on it, and talking to Bob [Robert] Redfield and Alex Azar, and just thinking like-- face drop. Similar reaction for the subsequent White House press conference where he was talking about like, drinking bleach, because one of my primary mentors at NYU and Bellevue is a toxicologist who then wrote an op-ed in the New England Journal [of Medicine] being like, bleach does not work. Thinking like oh my god, what are the people that I know in toxicology going to think when they hear this?

He was just omni--I guess the most significant politicization moment that I remember was when I was in the patient under investigation room, I believe in 01:16:00January, even, whatever the day was where Alex Azar said like, it's a public health emergency, we're closing the borders, I remember being in the room telling other people in the room, like, I had seen it come up on Twitter or something, like saying, like, announcing this decision, and then people were, like, that's an interesting decision, trying not to be political about it.

Uh, so, there was a lot of that going on. The rest I think--I have, like, personal opinions about it that I don't think are really worth getting into. I definitely have personal opinions about the New York stuff, because, like, I had known, like, about city-state tensions in public health management in New York prior to the pandemic, so the [Andrew] Cuomo stuff like, was just driving me crazy during a lot of it. But I would watch all the press conferences every single day, I remember texting my EIS classmates during particularly, like, piquant press conferences saying oh, something really 01:17:00interesting is going on right now, maybe, like, you want to watch--and the reason I say that is not to be gossipy, but a lot of times they would change policy on the spot and not, like, notify people. I was sort of like, you might want to hear that like, they're changing policy right now. Or, like, changing guidance right now without involvement--so yeah, that, very interesting.

I think, I had told you, when we talked previously, that--being from Washington DC, I happened to be home the weekend that President Trump was hospitalized for COVID. I remember driving around Walter Reed Hospital with them, just seeing like all the Trump supporters and Trump non-supporters and media fracas at the hospital, and I mean that stretched--it's busy traffic-wise, but like there are never people there, other than commuters, like I've never seen anything like it in my life. It looked like a circus, and so that was really surreal.

But you see, like, the NIH [National Institutes of Health] has protesters across the street. At Walter Reed, you've got things going on, just very--I was thinking about some tangential point, but, like, uh, uh, this was the same weekend as the Supreme Court nomination of Amy Coney Barrett, and my sister, who went to law school at Notre Dame, had taken a class with her, and was sort of, like, commenting on like, the circus around the nomination, and then when everybody at that--I shouldn't say everybody, when a large group of people who were at that nomination party got sick, including the President, I just remember thinking, like, I never thought I would ever see anything like this in my life. Grew up in Washington my whole life, like, seen crazy weird things, was in DC on 9/11, like just so weird, so. Unprecedented.

And I will say, it's not necessarily specific to Trump, either. Like, I have 01:19:00opinions about the Biden administration, but things have gotten better in the change of administration. I will let some force much higher than me decide what happens to the people involved. I wish them well. I pray for them.

Q: Good. OK. Good. Let's backtrack a little bit, or actually a lot of bit.

MILLER: Yeah, sorry, sorry!

Q: No, no, no, you're fine. I appreciate all of your, I appreciate your response and talking about the subject so openly, I really do. So tell me a little bit more about this convalescent plasma. You said it didn't work. The treatment didn't work? I thought it did work, am I--maybe I'm just, I might not be caught up kind of thing, so--

MILLER: No, no, no, no, you're correct! Evidence is mixed, I should say. Like, there have been random--yeah, no, but, like, that's nice, that means you're schooling me, so that's good. There have been randomized control trials who say that there is a small benefit in more severely ill patients from convalescent 01:20:00plasma. What I am referring to--uh, well, first of all, evidence is mixed on convalescent plasma itself, but what doesn't, or hasn't yet been shown to work is the hyperimmune globulin, so, like, the purified product made out of the plasma is no better than, like, placebo, basically. So, they spent thousands of dollars, months of manpower, to get a result that was not necessarily the one that we were hoping they would get.

I mean, it was a Hail Mary. They were really, really, really hoping this would work. And I mean, this is another thing where, like, clinicians would call the blood banks, being like please, please, please, please, please, please, please. Understandably, just because they didn't have any other options until very recently. Yeah, I'm proud that we worked on it, but then you think just sort of--like, I wrote basically an after-action kind of paper about how that 01:21:00particular trial went. Um, it's published in the journal Transfusion, I guess I'll defer anybody to that if they're really wonky and interested. But I mean, like, I think it was valiant that they did that, but resources could have been directed in different places and in multiple places at the same time.

Q: Yeah, I think, like, I mean people calling into the blood bank for this convalescent plasma, I mean it really just underscores how desperate the situation really was in the beginning, right?

MILLER: Yeah.

Q: Yeah.

MILLER: I just--well, that, uh, like, that's my first experience with what I now believe to be long COVID. I would call potential donors of convalescent plasma and they would say I'm feeling really spacey today, and I was thinking like oh, that's probably just because they've been in the ICU, but in retrospect, I wonder if some of them have long COVID. With brain fog.

Q: So what was your next deployment? So after you, after the blood bank and 01:22:00convalescent plasma study?

MILLER: Sure. I think that was--well there was an intermediate role doing blood stuff, working on what's called the MASS-D seroprevalence study, multistate assessment of, you think after now I'd remember the acronym [multistate assessment of SARS-CoV-2 seroprevalence in blood donors], but basically a national survey taking people--taking samples of people's blood from blood donations over time to figure out who was being infected with COVID--like, a nationally representative sample of the country. I helped develop how they selected people for it, how they would perform analysis of the data. Then at the same time, I was working on a pediatric study based on an Atlanta pediatrics practice, trying to figure out how COVID risk factors varied in children in the 01:23:00practice, based on their testing results from the first wave of the pandemic.

Q: What was the result of the seroprevalence study, the national one?

MILLER: Sure. I will say that's really in progress. It's had multiple publications come out of it, but I'll do some highlights. First of all, the advantage of this study is that it can get a record of mild and asymptomatic infections, so most things that are reported to, like, state public health, particularly in the first wave of the pandemic, are for, um, like, severe infections, people who ended up in the hospital. This, because it's blood donors, are people who are, like, walking in off the street and might have thought they were healthy, or not known they were infected. So, it has a really, like, broader pool of information, and from that information, we've seen health disparities in it, how Hispanic and non-Hispanic Black people have had higher 01:24:00seroprevalence, meaning record of past infection.

And it's also thought, based on our research, that various social vulnerability factors like living rurally versus in an urban environment, or other socioeconomic things, correlate with whether you had a past infection or not. And the one that I'm working on now that we're really interested in describing more has to do with what are called NPIs, or non-pharmaceutical interventions. These non-pharmaceutical interventions, like mask mandates, gathering bans--meaning, like don't want big groups of people together, social distancing--or, uh, closing bars and restaurants, that has a relationship to past infections too. We're showing that, like, if you wore a mask, if you were in a place with gathering bans, if you were in a place that was closing bars 01:25:00down, there was, there appears to have been lower seroprevalence, meaning that--let me make sure that's clear.

So, basically, if you have policies in place to prevent COVID, then there is fewer people who get infected, basically. So what I'm saying, in short, is that masks work. These policies that are supposed to prevent COVID are, in fact, preventing COVID over a period of almost a year. And it's not just, like, in certain places, it's all over the US, so we're going to publish that result in July [2022]. We're pretty excited.

Q: Yeah, that really backs it up with some hard data as well.

MILLER: Yeah, I have to say, like, I've got to think about how to present that hard data better after talking to you, but it's basically, like, confirming what we previously thought with hard data.

Q: That's amazing, so, great. Tell me a little bit more about this pediatric study that you--

MILLER: Sure, so very different direction. We went from big, whole country study 01:26:00to study of one clinic, it's a practice of about 35,000 patients in Atlanta at three different clinics. We were looking at, like, basically outpatient, well children who were getting tested for COVID. In summer 2020, if somebody wanted to go back to occupational therapy for their autism, or wanted to go to summer camp, or wanted to go back to school, some of the facilities that they worked with were asking for testing. Uh, so, we were using that testing data then to figure out, like, what's called a case control study. People who got COVID versus people who didn't get COVID, did they have different risk factors for getting COVID? Were their testing patterns different, and so on, and so forth.

Uh, we also looked at trends over time, and so we would be able to see, in a study that I published, that the older part of this cohort--like, zero to 01:27:00eighteen years old, more like the adolescent group--seemed to be getting more testing, and more positive tests, so, like, evidence of infection during, like, the like, holidays and parties. We could use that evidence then to say that it's really important to try to prevent transmission of COVID when you're, like, doing a Halloween party, or when you're doing, like, a summer event indoors, that kind of thing.

Uh, well, I should also mention that our current project with this data is pretty interesting, too. We're looking at children with disabilities. The CDC really wants to give more information to the community of people with disabilities about how to protect themselves from COVID. We're looking at data from that practice on the children who had disabilities and COVID to try to do some analysis of, like, who tested positive versus not, and why, and what kind 01:28:00of implications that would have for preventing COVID in the future.

Q: Tell me a little bit more about the timeline. So when did you start working on the seroprevalence study, and the pediatrics study, I guess?

MILLER: Sure. It was mostly simultaneous, which I was able to do because I was home. Uh, the seroprevalence study started in July 2020, and then continues till today. Uh, the pediatric study was either August or September 2020, and continues on and off through today.

Q: That brings you really, like, almost to, I mean it's during the summer of 2020, so tell me a little bit more about, like, your personal life during all of this. So, your family had heard about it by now, for sure. They were in New 01:29:00York, or were they in Virginia?

MILLER: They were in Virginia. So, my sister lives in New York, and my parents were in Virginia. My brother was in Boston.

Q: So these are all major cities that have--

MILLER: Yeah.

Q: --big case rates. Tell me about like, you know, did they ask you, they had asked you questions and stuff about COVID-19? You know, what was kind of going on, I guess?

MILLER: I will say, my parents were kind of hands-off about it for the most part, just because my mother had worked for the Federal Trade Commission, and for the Carter [James E. Carter] White House, and was used to the government culture of, like, you'll tell us, like, "don't ask, don't--" bad choice of words--but, like, need to--like, information being on a need to know basis. Then my father, who did not work for the government but was a forensic accountant who does like, fraud and bribery investigations, is the same way, that just, like, culturally, in the family, because of that, and then 01:30:00being from an Irish Catholic family that loves secrecy. It's kind of like, when Maureen wants to say something, we're happy to hear it.

My brother--being in Boston, the case rates did have spikes there, but was slightly lower, and so Andrew--I didn't ask permission to use his name, well, he's on the record now!--basically he was just like, my fiancée--now, wife--and I, are having a great time, but then he had to plan a wedding that eventually happened in September 2021, and Andrew was preoccupied with, like-- "Is Massachusetts giving the right guidance for the wedding? Are we going to have to cancel the wedding?" Like, a lot of that.

Then my sister being in New York, like, she lives there alone, totally had to shut down, she works as a consultant and didn't have to, like--lawyer, then became consultant, so she didn't really have to go anywhere, but it was very isolating for her. She lives in Midtown too, which is where all the hospitals 01:31:00are, so she could hear all the ambulances and everything. She was there, like, in the periods where they were dinging on all the walls and stuff, so she saw all of it. But I kept telling her like, don't go in the grocery store, don't go, like get a mask, get this kind of mask, that kind of stuff. I mean we had been roommates when I lived in New York, but I felt weird, like, being the doctor and being prescriptive with her. It's not really normally part of our relationship.

I guess the biggest thing--in Virginia, my grandmother was in a nursing home for dementia during the early part of the pandemic, and the nursing home shutdown, and my mother was just beside herself, and didn't know what to do. And I mean, like, kept texting me pictures of signs, because Nana had glaucoma, and, like, couldn't see the signs, and was having, like, trouble processing the situation, and then eventually died in the nursing home alone in May [2020], and they had to--her husband was in the Navy, so she was buried at Arlington National 01:32:00Cemetery, but the cemetery was so overwhelmed with cases that she couldn't be buried for like a year and a half [August 2021].

Like, being a pathologist, I was thinking, like--"What are they going to do with the embalmment? What are they going to do with the body disposition?" It was just weird, because, I mean, to think of my own grandmother that way, as a case instead of a person, it was just--and I remember, I last saw her in March 2020, and, like, I mean she's always had a grip anyway, but she gripped my hand like this (grabs wrist and hand on video recording), I think she sort of was intuiting what was going on, but like the very last time I saw her she was just, like, vise grip on my hand.

That weekend, coincidentally, I was canvassing--I guess I might as well say it, like, I was canvassing for Bernie Sanders, people at CDC, I respect all political views--but, like, I happened to be canvassing for Bernie, and, like, every--I remember a guy came to the door, like, in gloves and mask, and that was the first point where I was like yeah, this is getting really bad. 01:33:00Then I moved back to Atlanta and didn't leave Atlanta for months after that. Totally alone. It was horrible. I had panic attacks. I couldn't like--I stopped going to grocery stores. I actually, at one point, I was going on a, in--I think March, around St. Patrick's Day [March 17], I went to go running in Lullwater Preserve, which is like a nature area near Emory campus and CDC. And, um, the run itself was fine, but in front of the Emory clinic I just, like, had vomited on the steps, which is atypical of me during the run, and somebody saw me, just because--it was just a stress response, and just like, I just knew like, that COVID was getting really bad then, and I apologize if that's TMI [too much information], but just to give context for how stressful this was.

Q: Was it just, like, what you saw, or just the run just itself like kind of, 01:34:00what prompted the stress response, I guess?

MILLER: I don't exactly remember what I was thinking about immediately before it, but the general thing was, like, there are a lot of cases and people in New York are starting to get sick, like it was, I remember when it was like, a cluster that I thought would eventually be controlled, and this was the point at which like, the President was starting to appear more involved, and it seemed that things were going to go out of control. And it was the first incident that, like, gave signal for me having problems later, I developed panic attacks that I hadn't had previously. I actually went to Emory in I think August 2020 for consultation about one panic attack, because I thought I had COVID. Uh, yeah, it got really bad.

See, and then, like, the EIS is very respectful of people's mental health, but, like, I think there hasn't been either time or interest in having very frank 01:35:00discussions of how difficult it's been on some of us. And I mean, there are a lot of people I work with who have seen way worse things than I have, who were like, working in the field and stuff, but yeah, I just--maybe I'm oversensitive, I don't know, I'm quite embarrassed about a lot of symptoms that I have, but yeah, I have significant psychiatric symptoms as a result of them.

Q: Do you mind speaking a little bit more--I know that this might be uncomfortable--about kind of like, you said that EIS is respectful of mental health, but that other people have seen worse, so like, what, can you tell me a little bit about like, what were you hearing, what was like, the talk around the EIS that was really, you know, indicative of this mental health issue going on?

MILLER: I will say that I don't want to speak for other people, so I'm going to 01:36:00be very general. Um, a lot of people in the EIS are parents of very young children, and were complaining about burnout, and sharing workloads with spouses who were either working home, or not working at home. Some of them had to travel a lot, and were away from their families, which was a concern.

But because of my own history, I started making a Zoom group around March 2020 to May 2020, uh-- for people to talk about the fact that things were really rough, but most of the conversation then, without, like, interfering with confidentiality, related to, like, struggles of parenting, and managing family and burnout. There were people working, like, seven days a week for months, and months, and months. Then some people got sick too--I personally did not, because I live alone, and go crazy, but, I mean, crazy trying to prevent exposure.

Q: That's good that, like, you started this mental health group, though. Did it continue, or did it just kind of end in May?

MILLER: It pretty much petered out, and I mean I don't want to take credit for that, there were others who thought it was a good idea too, but the reason I did it is because when I was in residency at NYU, two of my medical school classmates died by suicide, and that was the response of NYU to those incidents, which were horrible. I was just applying lessons that I had seen previously to this new context, and I thought, why isn't CDC doing that routinely? They eventually did appear to adopt programs like that, to their credit. But just, like, they didn't exist at the time [2020]. I don't think people really--I shouldn't speak for other people. I did not get the subjective sense that, it seemed that COVID would be a relatively, like, attenuated response, as opposed 01:38:00to the journey it has become.

Q: Let's talk a little bit about telework. It kind of goes into like, bridging into your personal life, and I think like a lot for EIS officers, too, when they're talking about this burnout. How did telework really affect you working on all of these responses, doing them remotely, so.

MILLER: Yeah, so first of all, without the blur here (referring to the background), you are seeing the room where it happened from April 2020 on. Like, this is COVID central. It's like my own EOC. I remember thinking before even joining CDC, I had debated becoming a freelance writer at one point, and I was like, I would never be able to freelance, I need the stimulation of the office. I'm introverted, but just, like, introvert to a fault almost, so, like, I thought I needed to be around people in order to like, 01:39:00push myself to not be a homebody. And so it has been really difficult. I've hardly even seen people I was with in--like the EIS officers in Atlanta, we used to have a lunch on the chronic disease center campus [CDC Chamblee] during the vaping epidemic where we would like, compare notes and just hang out, outdoors at a little bench.

But all of that went by the wayside during COVID, we've had maybe like one party a year since then, maybe two. I remember during, between Delta and Omicron, I went for drinks with an EIS classmate at the food hall at Inman Park, and it was a bar, it's called the Ticonderoga Club, so it's got, like, kind of like a maritime theme. While I was there, I remember we were like grabbing each other's hand. I started crying at one point. Just, we, we're so unused to seeing other people. I mean, we weren't worried as much at that point about like, COVID 01:40:00exposure, because rates were low and we had masks and stuff.

But just to get a sense of, like, how emotional it is for us to see one another--Eric Pevzner, the head of the EIS, would do these like nine p.m. late night chats to like, check in with us, which for everything else that has gone on with the response, I think he's one of the unsung heroes of this whole thing. Like, he really, like, rallied when he didn't have to, so that--even though I've had, like, differences of opinion and him about how to, like, approach, like, supporting the EIS during COVID, like, I'm impressed with him personally.

But yeah, I don't see, like telework. Like, I talk to the EIS all the time on various tech platforms. I don't see people. I forget how tall they are. I don't--like, sometimes I don't even recognize them when I run into them on the street, because, like, the coffee place across the street from me, General Muir, has a lot of CDC people. That's interesting to go there, just like people hang 01:41:00out, but then you'll think, like, it'll seem so normal to see them at first, and then you'll realize, like, I haven't seen them in eight months. That's kind of wild. Yeah, but that's pretty much it. I telework. I got horrible--not carpal tunnel, it's a different nerve, but, like, repetitive stress injury from typing, and then like, having come from this occupational health background, I was, like, I spent years trying to learn about how to prevent this stuff, and now just like, hand pain, back pain, neck pain, it's all over the place, so.

Q: The irony.

MILLER: Not great, yeah. I do find that I have a lot of trouble with eye contact now, because I'm so used to looking at the screen. Like, it's hard to look when you're on the screen, but like my therapist, for example, when I would go back to the appointment with her, like I'm looking this way, she's looking here, I think that's a direct result of telework. I will say, the one thing that I would 01:42:00have liked to do more with telework is to work in DC or New York. I know a lot of nice people in Atlanta. I really do not like Atlanta as a city, and I miss my social network in other places so, like, I feel like other EIS officers took more advantage of working in different cities than I did, and I wish I had, like, worked someplace else. I worked at my parents' house [Virginia] for a while. But yeah.

Q: Do you see like, telework culture, and telework kind of sticking around for CDC?

MILLER: No. I mean I think it should, and I don't think it'll stick around, I think it should, though. I mean, I think it's important to have in-person meetings like once a week, or something like that, but no, particularly with the field and international nature of the work, I see no need for it. And I think it'll help CDC recruitment, if you can get people from other cities. There are a lot of people who don't want to relocate here, who are really smart and really interesting.

Q: Absolutely. So going back a little bit to after your seroprevalence study and 01:43:00the pediatrics study that kind of happen simultaneously, what was your next deployment for an EIS? Or did you go back to your home office, to cancer prevention?

MILLER: At that point, I went back to my home office from October 2020 to probably February 2021.

Uh, I was working on the first chronic diseases center study related to COVID. Uh--we were working with Kaiser Permanente Southern California on their cancer screening, to figure out whether people were getting cervical cancer screening during COVID. So, we worked with a team at this large health network, which is kind of like the state-of-the-art health in America, has very diverse patient population and, like, a well integrated system, so has the best of all worlds. 01:44:00Basically, seeing like, even with all of that stuff, and telehealth and everything, are people coming in to get their Pap smears and HPV [human papillomavirus] tests to determine, uh, whether they have cervical cancer or not? Or if they should be screened more closely.

And it turned out that there were these really precipitous drops in screening during the first lockdown in California [2020]. I got to learn a lot about a state-specific policy, I got to learn a lot more about like, the math of epidemiology, and, uh, I got to write an MMWR [Morbidity and Mortality Weekly Report] about it that's been cited a bunch of times, so I'm really proud of that project. I would say that, like, that and the plasma, that's the proudest work that I've done on the response.

But then of course, like when you're in the office everybody's like oh, how's it going with COVID, and asking questions about COVID, so I mean it's, a lot of my 01:45:00work was editing a manuscript, but I just felt like my job by that point had become to be just an all-COVID, all the time person. Which is too bad. I really like cancer research, I think it's interesting, and it's really important.

Q: Yeah. Well it's interesting to see how even when working at your home office, how it still centers around COVID, about how much of the CDC work is really, even off the response, is still COVID-centered, or COVID-centric I guess, yeah.

MILLER: Every--yeah, sorry, I didn't mean to interrupt--but, like, everybody was gone, my direct supervisor was there pretty much the whole time, her mother, who had been in Beijing, had then come over to the US by that point, but she was consumed with caretaking. But all of my other bosses were on the COVID response all the time. Yeah, I mean it was just very ad hoc arrangement.

Q: How many--

MILLER: It felt really secondary.

Q: Yeah. How many people were missing from your office?

MILLER: That I don't know, I know that my secondary EIS supervisor and my team 01:46:00lead were both constantly on the response, because they were [US Public Health Service] Commissioned Corps.

Q: Wow. Let's talk a little bit about, like, we've already talked a lot about these kind of larger, overarching themes in the pandemic. Kind of like, you know, like the politicization and the public, you know, the presidential, the two terms between the two--excuse me, the differences between the two presidential terms, so, you know, between Trump and Biden, yeah.

MILLER: Yeah.

Q: So, talk about like COVID-19 variants and everything. Were you on the response when any of the COVID-19 variants came onto the scene?

MILLER: I was definitely on when Delta came onto the scene. I was in--I was past EIS when Omicron came, so my post-EIS job in post-COVID conditions actually 01:47:00continues to be with COVID work, but is more like, tangentially related to investigation of variants, because we're concerned about like, chronic effects of infection, long haulers. Like, people with long COVID could be from any variant, potentially. So we're not at a point yet where we could distinguish who's getting post-COVID from, say, a Delta variant, versus an Omicron, versus a BA.2. But yeah, I've been on for pretty much every variant surge.

Q: Sorry, I'm trying to gather my notes here.

MILLER: No, sure.

Q: Your EIS officer training ended in July 2021, correct?

MILLER: That's correct.

Q: Yeah.

MILLER: Yeah sorry, June 2021, but yes.

Q: June 2021, okay, got you. So now you're out of the EIS program, and you're just working in cancer screenings, or cancer prevention?

MILLER: Yeah, I really, this starts to get more into bureaucracy, so I was on what's called a lateral reassignment from the cancer prevention branch to the COVID-19 response so like I wasn't working on cancer issues, but like I was contractually working on cancer for a while, if that makes sense.

So I, by that point, was doing research into long COVID, which at CDC is called post-COVID conditions. Um, the reason for that is because the NIH [National Institutes of Health] offered me a job at their blood bank, but NIH funding preferentially goes to the infectious division, as opposed to the blood bank right now, so I am currently here, like, waiting to get funding for an NIH job in medical epidemiology.

Q: Got you. Tell me a little bit about like, what have you like, done with 01:49:00working with these post-COVID-19 conditions, with, so what has been some of the project? I guess just take me kind of like into your role and really explain it to me. Do you mind?

MILLER: Yeah, sure. My job title is senior service fellow, which is a one-year term fellowship specifically related to COVID work. I think it was funded under the stimulus, the COVID relief package [Coronavirus Aid, Relief, and Economic Security Act], but I'm not sure. But my job on that is to supervise a project called the Long COVID and Fatiguing Illnesses Recovery Program. What that program is, is a collaboration with a federally qualified health center, which is, like, a safety net community clinic in San Diego. We are trying to use a telehealth mentoring program, using experts in long COVID from all around the country to basically pilot into the nurse practitioners and MDs who are working 01:50:00at this San Diego clinic, to give them the resources of a big academic medical center like, um, the major metro areas of the world, Boston, New York, Baltimore, Seattle, wherever, Seattle being our primary collaborator to this group in this community clinic.

So we're really trying to reach medically underserved patients who have long COVID and other say, chronic fatigue syndrome, what's called ME/CFS, myalgic encephalomyelitis/chronic fatigue syndrome, and other fatiguing illnesses from infectious causes that we're still trying to understand, who sometimes have conditions that their doctors might not understand, or might not recognize, but with the support of these subject matter experts, knowing that long COVID is going to be a big source of these problems and already is, helping give really 01:51:00close education to people working with Medicaid patients to get them the best care they possibly can, and the best long-term management for long COVID and other similar diseases that they possibly can.

My work on some other manuscripts as well, primarily related to COVID and disabilities, trying to figure out whether post-COVID conditions are present in adults with disabilities. But those are more under development, and I don't want to comment on them as much, just because we're still working on them. I work, though, for a pathologist, the reason I got the job is because a pathologist who had worked with the cancer division knew me and just said like hey, if you want to wait out this job, work with me.

Q: Gotcha.

MILLER: I also continued the blood donor work. I mean, my job's kind of weird right now, I'm basically, like, I'm paid by this particular division in what's called NCEZID, National Center for Emerging and Zoonotic Infectious Diseases, 01:52:00which does chronic viral diseases research, but I'm kind of like a jack of all trades, so basically like it's a means for me to continue doing my other COVID projects with this day job working on post-COVID conditions. It is weird, though. Like, everybody in the EIS is basically treated like a COVID subject matter expert now, it's like I heard like the term battlefield promotion, I'm not sure if that's right, but it's like every, our EIS class is special, I don't know if that's a good thing or a bad thing, but we're definitely different.

Q: Yeah. Do you feel like an EIS officer subject matter, or EIS officer, excuse me, do you feel like a COVID-19 subject matter expert?

MILLER: Depends on the area of COVID that you're talking about. In blood donation I'd say sure. I mean, I know many people who know more than I do, but, 01:53:00like, I am really engaged in that world. Post-COVID [conditions], increasingly. I mean--like, I review for medical journals and stuff, so other people think I am. I mean, I never feel like an expert at anything, so it's hard to say. But I definitely don't feel like an expert at the questions people actually care about, like vaccination, masks, and stuff. Like, when say, like, my relatives will ask questions about stuff, or my friends, I'll just say like, CDC website, CDC website, CDC website.

So that does not feel like a subject matter expert. But then like, people will ask some technical--like, it's weird. I kind of go on autopilot when people mention it, that somebody will ask a question, and I'll just be like, yeah, this, this, and this, and this. Which--I'm rolling my eyes now, but I mean, it's important. But it's, like, it's almost like I can't engage with the person in the moment, I just think like, I don't want to think about COVID anymore, but it is important that you know about COVID. But it's like--you're almost, like, out 01:54:00of your body talking about it.

Q: Yeah. Do you feel comfortable keeping on going?

MILLER: Yeah, I think so, just knowing that we should close out at four.

Q: Yeah, okay.

MILLER: Thank you, I appreciate you, you've asked some really good questions.

Q: Oh, of course, thank you. Well I appreciate all your answers, they've all been great, so that's true, it sounded like I was a little short there. That's true. Okay. Reflections. Let's talk about, so you were talking about this a little bit, where it's almost like CDC's reputation has not only taken a hit with the public, but also with the public health community just at large. So, what do you make of that? Do you think, like, maybe there's a remedy, you know, that CDC could restore its reputation? Do you think maybe it's a lot of media 01:55:00hype, and its reputation has been more badly hurt for the public? What do you think?

MILLER: First of all, I don't think it's hype at all. I--we just had an incident management update today that showed some survey data saying that this is a real phenomenon, so I think even within senior leadership at CDC, this is recognized as an issue. Um, I will say, I don't know how they're managing it. I will also say that I disagree with some of the way it's being managed. I mean, I'm not out to burn bridges or anything, I'm happy to engage my opinions about this with anybody else, and I've been probably, like, blunt to a fault about some of the things I see going on.

Uh, first thing that I think we need to do to restore trust with the public is putting interviews like the one I'm giving to you in front of the public, to see what it's been like for us to experience this. Both the good and the bad. I 01:56:00think it would really change impressions of how things are going here. I think some people just like, aren't interested in engaging it at all, which, fine--as my blood bank director at NYU used to say, "God bless 'em!" --but I don't--I do think that there is like, I've heard it called "moveable middle."

Like, I think that there are people who really don't have any idea what the CDC does, that if they heard people like us, and watched their faces react to it, and, like, heard the quality of their voices as they talked about it, or, like, even see them cry or something like that, that might change their opinions, for both state and municipal people, and us, and tribal--like, people have no idea how complex the public health system actually is. And I think--this one might be a little bit beyond us, but people just want to say like, we're done, like COVID's over. COVID is not over, COVID's never going to be over in my lifetime--I should clarify, I mean the aftermath of the trauma of COVID, I 01:57:00cannot predict the course of infection. But I think that we're going to be living with the psychiatric aftereffects and the social and cultural aftereffects of COVID, for the rest of my life.

So that's something CDC is going to have to deal with. I had opinions about how CDC could modernize as an agency before. I do like that they're paying attention to modernization issues, such as data modernization and laboratory modernization, particularly as a pathologist, uh, but I think that it's not going far enough fast enough. The same thing with the health equity and the diversity, equity, and inclusion for the employees, that this agency needs to diversify. The trust issues would be resolved to some extent if people saw people who looked like them, and knew what they were going through in their communities, and they don't. They have a bunch of people like me who grew up in the Northeast, who just, like, have pre-disposition to trust what the CDC says, 01:58:00and that's not what everybody feels like.

I do think that this response has made it very clear how important, uh, clear communication from a director is, that I mean, like, I will never know what was going through the minds of any of these people as it was happening, but like, I remember when we began EIS, before this even happened, that they would show us videos of, say, Anne Schuchat or other communicators, like, saying how to be clear.

That actually, like one of my enduring impressions of the pandemic is of Anne Schuchat herself, who was walking--like, she walked--when she was here before her retirement, she would walk to her office on Clifton Road sometimes, and because I lived here, I happened to see her a couple times. She didn't know who I was from anybody. But you just, like, I got the sense from her body posture 01:59:00and stuff like that, that, like, this was really weighing on her. I can't speak for her otherwise, but just, like, my impression watching her walk around. And I just thought when I saw that--like, I cannot imagine what it must have been like.

I don't think anybody involved was perfect--I certainly don't think what I did was perfect--but I really am hesitant to designate good guys and bad guys on the response. Like, there seems like, like deify good leadership, like, demonize bad leadership, that's not going to be an effective way to respond to this. We need to do really, like, thorough, critical review of what we did, admit everybody made mistakes, make what amounts to a public apology, I think. I don't think it'll win everybody over, but I think admitting that we were wrong about some stuff would make a huge, huge, huge difference in restoring public trust, and I 02:00:00frankly have not seen that yet, and I hope that happens in the future. There are pros and cons to doing it, though.

Q: Do you have any other things that you wanted to say now, now at the end of the interview?

MILLER: Yeah, probably a couple.

Q: Go ahead.

MILLER: Without getting into details, this really, like, this instituted a spiritual crisis in me and a lot of my friends about faith in government. Faith in God, even. I mean I have a beautiful view of the Appalachian foothills and so you would see the sunset sometimes, and just think, like, how can this look so beautiful when all these really, like, inconceivable--or seemingly inconceivable--things be happening at the same time. That's--so, I think that 02:01:00there hasn't been as much attention, whether you believe in God or not, to like, the spiritual experience of the pandemic, and I hope that there's more attention to that in the future. I'm Catholic, so, like, that's where I'm coming from. I guess, like, Catholic guilt is what's going on.

I remember I was--this is like, kind of like a weird moment, but, like, speaking to the spiritual question, I was, in September 2021, which was like a nadir of cases, like went up to north Georgia, just, like, planning to hike around. On audiobook, when I was, like, driving up into the mountains, trying to find my hotel, I was listening to an audiobook of a novel by Jonathan Franzen called Crossroads, which was, like, a bestseller at the time. The plot of the book takes place in the early 1970s and is about a reverend and his wife who are 02:02:00having marital difficulties and trouble raising their children.

But the wife character in the book, who is a Catholic convert, has a history of--without spoiling the book, things in her life that she doesn't want revealed to other people, and things that she feels like she has to be secret about, because she's so ashamed of what happened. I remember as I was driving around the mountains, listening to this book. I'm not one to get teary during a lot of things, but I just broke down in tears listening to this. I thought, "What in this book is so affecting?" Because I mean, like--it's also atypical of his writing, which is a whole other discussion, but that idea of like, having to live, like, almost a double life, I think, like this particular character, felt that she had to conceal her true feelings from the people closest around her.

That feeling, I think, was something that I experienced during the pandemic. Just because, like, I mean I am in an intelligence service, like, it is my job to make sure that people are getting the information that they need, and the information that needs to keep them safe, but that might not include, like, the information like I'm giving you in this interview.

And I think that in some ways, exposing, without getting gratuitous about it, but, like, telling the story of what happened in a way to, like, have an open discussion of it, is going to be very healing for a lot of people here, whether or not they realize it. And I think that, I mean, although that was a silly way to come to that realization, I thought, like, well, maybe other people are 02:04:00having moments like that with other sorts of triggers. Like, maybe they saw something pretty in nature that made them think that. Maybe they had a moment with their kid that made them think that.

But, like--this might be, I'll say, like, specific to me, but, like, it just made me think like, that character could forgive herself for the bad things that happened, it didn't mean that the bad things didn't happen, but, like, I think a lot of people at CDC are really hard on themselves about what happened, and I mean, they should look at it critically, but, like--I'm almost trying to convince myself as I talk. Like, the CDC is a good thing for the American people. Like, I come from the tradition of being interested in Ralph Nader reforming the government in the '70s, but he believed that it could be, with outside pressure, things could happen within to make it better. Like he--not all critics of government think that government is beyond help.

If there are people within government who are willing to be--look at things closely, and be critical of the way things are going, and yet have that just, like, bone-deep faith that things can be improved despite it, and that idealism is still okay to have here, that is what's going to make things better. I can't say fix them. But, like, if people are able to forgive themselves for what happened, and forgive their survivor's guilt, and say that, like, that must be forgiven, so that the agency itself can survive, that might be a fix. I don't know. That's really like, philosophical and rambling, but yeah.

Q: Yeah.

MILLER: I think so many people did so many good things here. I just hope that the public can find out about them eventually, and I'm glad that the EIS is expanding, because I think the EIS is a great force for good in this country, 02:06:00whether or not people know it.

Q: Cool. Well, did you want to talk about anything else?

MILLER: I mean, I really--I've probably said more things than I should have. Maybe that's the best. But I think that--I hope more people at CDC will go out of their comfort zone and say more than they usually would about this in order to, like, have the best interests of the country in mind. And thank you so much for doing this too, this has been great. I mean like, this has been helpful to me, I hope it's helping other people as you do it.

Q: No, this is an amazing interview. Thank you so much, Dr. Miller. That's going to end our interview.

MILLER: Yeah, sure. I should also say that like, this is, because, like, I cannot sit still. Like, that's a telework effect. But thank you so much.

Q: No problem. Thank you.

[END OF INTERVIEW]