Dr. John Brooks

Dr. John T. Brooks

Q: This is Sam Robson, here with John Brooks. Today's date is January 13th, [2016], and we're in the audio recording studio at CDC's [United States Centers for Disease Control and Prevention] Roybal Campus. I'm interviewing John as part of the Ebola Response Oral History Project at CDC, and we'll be discussing his life and career briefly, but really focusing on his response to the 2014 epidemic. John, for the record, could you please state your full name and current position with CDC?

BROOKS: My name is John T. Brooks. T stands for Trow, T-R-O-W, and I am now the senior medical advisor to the Division of HIV/AIDS [human immunodeficiency virus/acquired immune deficiency syndrome] Prevention.

Q: Very briefly, what was your role in the response?

BROOKS: I was in the response at two different times, but basically in the same role, it just took a different name. Originally, it was as the lead of the Medical Care Task Force. That was from the middle of August until the end of October. And then I came back, and I led the Domestic Task Force in March and April. That would be March/April 2015.

Q: Okay. Now backing drastically up, if that's alright. When were you born? [laughter]

BROOKS: When did my parents meet? No. [laughter] I was born January 1961 in Baltimore. That's in Maryland.

Q: Can you tell me briefly, because I like to kind of establish a little background first, about your youth?

BROOKS: My dad was actually in Baltimore as a waiter or a sous chef at the Belvedere Hotel, and my mom was always a homemaker, and then he ended up getting a job with IBM [International Business Machines Corporation]. We moved around a couple of times; Winston-Salem, North Carolina, and then ended up in the DC [District of Columbia] area and I grew up in the Washington, DC area. First, in the suburbs in Chevy Chase, and then later we moved downtown to a neighborhood called Logan Circle in the early 1970s, which it was very transitional at the time. I sometime joke that that's where I got my early interest in public health because there was a lot of prostitution and drug use all around our area. Then I 00:02:00went away to boarding school and spent my life after that pretty much in New England with a stint after college. I went to high school at Phillips Exeter [Academy], a boarding school in New Hampshire, and then Wesleyan University in Connecticut. Then I moved, I took a half a year off, studied German overseas for about half a semester. Started college at Wesleyan, double-majored in earth science and in German, and then did some graduate research in Germany on a scholarship called the German Academic Exchange Service, or Deutscher Akademischer Austausch Dienst, studying soil chemistry.

Came back to the US, worked for a law firm as a science consultant in the area of toxic exposure and learned that I could be a physician. I didn't pursue medicine as a career as an undergrad for two reasons. First, because I couldn't stand the pre-meds, and I understand they were trying very hard, but it was so competitive. I was very interested in the subject matter and I wanted to spend 00:03:00my time on that and not worry about grades and competing. I guess I was also very intimidated. That's a back-handed way of saying I felt intimidated. But geology was great. You got to travel, you were out of doors, you got to see the big picture of things. You look at a landscape and try to figure out, I wonder why the mountains are here and why the creek went this way and what are these rocks doing here? What does that mean? I really loved that. German, I had failed German in high school, so I had this personal vendetta that I am going to learn that language. It was coincident that I ended up in Germany.

But I came back, and in the course of this job at the law firm, I really began to understand that I could be a physician. It wasn't that high a hurdle. We were hiring physicians and then using them as expert witnesses. I had to learn the subject matter they were going to talk about. I was like, this isn't as hard as I thought it was. I was inspired to consider medicine. I volunteered at an HIV clinic and a Planned Parenthood clinic in DC-made sure I could manage the clinical encounter. I really liked it actually and I ended up going to the medical school of Harvard [University]. I think I was the second-oldest person 00:04:00in my class. I turned thirty in my first year. I knew when I went that I wanted to be an infectious disease doctor. Internal medicine if-I've always loved infectious diseases. There was a wonderful book called The Microbe Hunters that I read when I was in seventh grade and it completely captured my imagination about the discovery of germ theory. It was all about [Robert H. H.] Koch and [Louis] Pasteur and [Ignaz P.] Semmelweis and all these people. I loved it!

I completed medical school, then did an internship and residency in internal medicine. I did half a year as the HIV fellow for the hospital I trained at, Brigham and Women's Hospital in Boston, and then a year of infectious disease fellowship. I decided I didn't want to be a laboratorian. I had learned my first year of medical school that it wasn't in my future when I worked in the lab and I killed all the cell lines by mistake. Oh well. [laughs] I wasn't very skilled. I'm not the surgeon type. I came to the CDC where I was in the EIS [Epidemic 00:05:00Intelligence Service] program in the Foodborne and Diarrheal Diseases Branch, which was fantastic.

Q: Can you tell me about deciding to apply for EIS and go that direction?

BROOKS: Yeah. I'm not quite sure, I can't remember when I first became aware that the EIS program existed. I remember in medical school, colleagues, a couple of colleagues had done this rotation you can do as a third and fourth-year medical student at CDC, and I had known sort of having read books about infectious disease and epidemiology, I kind of knew about the program, but I didn't know the details. As an ID [infectious disease] fellow, I began really researching the program more and I realized, this is really what I want to do. I didn't want to get an MPH [Master of Public Health]. I kind of felt I was old enough and had enough training that I wanted to do something that was a lot more practical and I think that was the great appeal. It turned out it was a good bet I made because I learned-particularly in that position in foodborne, I had the 00:06:00opportunity to carry out a lot of different kinds of investigation very quickly that helped me understand some of the principles, not only of epidemiology in outbreak investigation and control, but also statistics. I mean I really was one of these people who came to EIS with, I know if p is supposed to be less than 0.05, but I really don't know what that means. I just look for it in a paper to make sure it's okay. [laughs] Now I know. I better know. But it was great. I was able to do case-control studies, cohort studies, large reviews of data sets. Respond to the public. I carried the botulism beeper occasionally and so you had to respond to calls about botulism, or take phone duty. It was great.

Now, I work in HIV, which has always been my passion. That was part of one of the reasons I wanted to also go back to medical school. I was a young adult, kind of sexual debut, working right when all of this was happening. In DC in the 00:07:00late eighties it was devastating. In fact, I remember when my parents-my parents used to live in an apartment adjacent to the Hinckley Hilton. What's that, the Hilton in DC where they shot Reagan?

Q: I don't know.

BROOKS: It's kind of a cool building. I think it's called the Capitol Hilton. But their apartment was adjacent to it and the second large international AIDS meeting was held there sometime in the early eighties and I remember this stunning presentation about the discovery of a new drug called ddC [zalcitabine]. And ddC, just to show you how things have changed, ddC is no longer available, it's no longer manufactured because there's such better therapy available. But at the time, that was like amazing. So during my medical school training is when this highly active antiretroviral therapy became standard of care. In 1996, I was at a meeting in Geneva and they announced this 00:08:00new class of drugs. It wasn't '96, sorry, it was a little earlier, take that back-but they'd announced this new class of drugs and it was extraordinary. Then it was Sustiva, or efavirenz, and they were non-nucleoside reverse transcriptase inhibitors. Then there was the presentation in Vancouver combining three medicines together. A principle that is used in a lot of infectious disease, especially tuberculosis. You hit the organism at three different places with three different drugs. Oh my God, this really was like creating a Lazarus effect in all kinds of patients. That was just as I was finishing fellowship. I was kind of the very end of this period when everybody was dying of opportunistic infections or cancers, and I spent a lot of time with patients working on life planning. What are you going to do when you pass and you have children, or what are you going to do when you have a spouse, and have you thought about hospice 00:09:00and this kind of thing? Many people were doing well, but there were also very many who weren't, and I had plenty of patients die.

Q: Can you tell me about some who stick out in your memory?

BROOKS: Oh yeah, there's two, one in particular. One great patient. She's dead, I don't know if I can use her name.

Q: Don't.

BROOKS: I won't, but she was very tall, definitely over six-foot, tall, skinny black woman who I met on the floor of the hospital. She had been admitted because she had almost died from a nosebleed. This is her admitting diagnosis. She had been diagnosed with HIV as a result of her workup for the nosebleed. She was this elegant, lovely, tall woman from North Carolina in her maybe late twenties, early thirties. She had been a women's professional basketball player at one time and she had Creamsicle orange fingernails. This incredible color. I kind of like go, "What happened?" She goes, "Well, I was just picking my nose and it just started bleeding and it just wouldn't clot and it wouldn't clot and 00:10:00it wouldn't clot." And so one of the workups for why is somebody bleeding so much is to get a bone marrow biopsy. On the biopsy, the gram stain showed a microorganism called mycobacterium avium complex and that's an infection of the bone marrow, but that organism is a classic late-stage AIDS presentation. Or we would say now a late stage of HIV disease presentation.

She was diagnosed and I was meeting her for the first time in the hospital and I got to know her very well over the course of a couple of years managing her care. She ultimately died of renal failure, but it was a lot of fun knowing her. She had great stories and a really fascinating background. She had a biblical name and she didn't know what it meant at all. At one time, I was in New York City and it was in the west side somewhere and I came across a Judaica store. I went in there and there was a children's book about a person whose name she carried. I brought this to her and it really moved her. She was like, "Oh, 00:11:00that's where my name comes from?" No one had ever explained to her who the character was in the Old Testament that her name was taken from. It was really interesting. I was very sad actually. That was one of the people who really touched me because I felt like I really, I really liked her. It's not that I don't-you like everybody you take care of. Well, not everybody. But there are people that you really feel bonded to for some reason. Her passing was very sad for me.

Q: Did she pass while under your care?

BROOKS: Oh yeah. In fact, I was actually in the hospital getting an appendectomy. No, sorry, tonsillectomy. I was getting a tonsillectomy right around the time that she was being-oh no, I'm sorry, it was an appendectomy. I was sick, I was really sick. I had my tonsils and my appendix out. It was my appendectomy and she was admitted at the same time on the floor just above me. She died just right after I was discharged, but I got to see her a couple of times and be with her and talk about things. I guess why she really bonded with 00:12:00me, she was very alone. She didn't have children, she didn't have immediate family. She was from North Carolina in Boston in the middle of the winter. I was like, oh, she's really getting along. So anyway.

Q: Can you tell me about the other person too?

BROOKS: The other guy was just a young man who despite everything we could do to try and help him, the medicines just never worked and he kept getting one infection after another and just keep declining and keep declining and he really wanted to live. He was having a very hard time adjusting to the idea that his-mortality-as any of us would I think. Some people have a little more grace when they kind of come to that moment in their life. He hadn't had the privilege of really getting to that point, so I tried very hard to-I was always visiting and talking to him. When we had appointments, which can be pretty quick if it's 00:13:00just a follow-up. "Tell me more about what's going on in your life and what are your thoughts and how can I help you out?" I remember him because I think he died very uncomfortably from an infection called cytomegalovirus pneumonia. Again, this would never affect people who were immunocompetent.

Now, all these diseases, all these diseases that I used to see over and over and over as an intern, resident and doctor, you don't see them much anymore. The cytomegalovirus, which can infect the eye and destroy the retina and cause blindness, which used to be a terrible problem, it's almost completely gone away. In fact, the company that used to make a special little drug insert that you could place into the eye that would elute the drug you needed to suppress the virus and preserve your sight, there's so little disease anymore that it's no longer profitable to manufacture that. I got my eyes checked yesterday to get 00:14:00refracted, I had to get new glasses and I asked the optometrist, "Have you ever seen somebody who has one of these CMV [cytomegalovirus] implants in their eyes?" Nope, you don't see them anymore. It's amazing. I mean that is progress.

Q: Yeah, no absolutely.

BROOKS: So now I work in the division of HIV and most of my effort is focused on trying to get our numbers of new infections in the United States down to zero. We'd really like to push it down. There's been a real-there has been a real sea change in what we are able to do to attack this epidemic. I'm optimistic that over time we will bring this under control. The advent of a medical intervention that we can provide people that will protect them and protect the people that they are intimate with from getting HIV is incredible. It's like the discovery of the birth control pill I often say. I don't have to depend on barrier methods 00:15:00or changing my behavior. There's medicine I can take that's pretty benign. I mean there's a lot of argument around that, but honestly, compared to other medicines and their side effects, it's got a pretty benign profile. You can monitor for the problems it causes. We can use this and really maybe bring this epidemic to its knees.

Q: That's brilliant. Can you remind me a bit of the timeline? What years were you in EIS?

BROOKS: Let's see, that would have been '98 to '99, '99 to 2000. Then 2000 to 2001, I spent a year in the Foodborne and Diarrheal Diseases Branch as a one-year sort of doing additional work for them. Then I moved over to the Division of HIV/AIDS Prevention, first in surveillance, then in a position in the epidemiology branch running a large prospective cohort study-a number of prospective cohort studies actually. Then in the last year I moved up to the Office of the Director, where I am the senior medical advisor now.

The other big events at CDC that I've been involved in-first, anthrax. I was, for a period of time, right after the cases in DC occurred, I took over from Rich [Richard E.] Besser as-running sort of a team down there. It was very early, just a couple of days after the postal workers became ill. It was good for me because I'd lived in DC for a long time and when people mention an address or a place, I knew it right away, so that was helpful. I didn't have to relearn, where are all these places? Then after that, I guess it would be SARS [severe acute respiratory syndrome]. I was the domestic epidemiology lead for a period of time with great, great colleagues. And then Katrina. After Hurricane 00:17:00Katrina occurred, right after it occurred, I went down to Baton Rouge, where in an abandoned big box store-I think it was an abandoned Home Depot-they had set up this big response center. I was in charge of conducting surveillance for disease at all of the evacuation centers. I can't remember the number. We published an MMWR [Morbidity and Mortality Weekly Report] about it, it has the exact number. It was basically collecting data from all these places to see, are there outbreaks of respiratory or gastrointestinal disease that we have to worry about? People were in very close quarters, the sanitation was compromised in many places. After that, I avoided monkeypox. [laughs]

Q: You avoided monkeypox?

BROOKS: Yeah. Well no, I mean because it came right around-I'd kind of done anthrax.

Q: Oh, sure.

BROOKS: And during the whole H1N1 thing, I think that was 2009, I was sort of the HIV expert, but I didn't really need to be involved day-to-day. When this 00:18:00came along, Ebola, I was in my regular job, team lead of the Epidemiology Research Team in the epi [epidemiology] branch and we had an EIS officer and he's from Togo. A call went out in January or February of '14, if I recall correctly, that they needed French-speaking or people who are familiar with-especially French speakers, because there had been a cluster of Ebola cases in Guinea. I was like, "Oh man, KP [Kpandja Djawe], you've got to do this. It's a once-in-a-lifetime experience. You're perfectly suited for it." He'd already been helping with some other responses in West Africa, where they needed either someone with West African expertise or French speaker. I think it was a great experience. He came back and everything was getting under control. I was like, wow, that was amazing. You really had this seminal experience for your career. Then he finished EIS in June, took a job with Polio Eradication Group, and then 00:19:00these signals started coming in, oh, there's more Ebola. It's coming back. Then there was the Samaritan's Purse folks, who somebody got sick and there were all these conversations about how we are going to repatriate the folks that have been exposed in addition to the person, the two people who were ill that had to be brought back and treated. What are we going to do to these people who may be incubating disease? How do we get them back to the States? Where are they going to stay? I remember just correspondence with e-mail with some friends about this saying, really, do you really think the Emory Conference Center [Hotel] is going to be the right place? [laughter] I think CDC would warm up to that, but I don't know if DeKalb County would be really into this idea, let alone the neighbors. I kind of even right then was thinking, wow, this is not going to be a-with these 00:20:00two cases, Nancy Writebol and-

Q: Kent Brantly.

BROOKS: Thank you, yeah. Just really noble people. I mean really, that is doing God's work. They are-wonderful that they were there, but man, the reception they got. I mean, they weren't seen-I'd have to go back and look at media and things, but my impression was they weren't necessarily seen as heroes or helping, that they were bringing something dangerous back to this country. I was like, wow, that is sort of the antithetical position that I'm in, which is of course, I see myself running to the problem and trying to help. I just didn't anticipate that kind of a response.

Q: Right. So at this point, you are still on HIV-

BROOKS: Yes.

Q: -medical response lead-okay.

BROOKS: Then in August, friends of mine who are in the Emergency Operations 00:21:00Center-I'm going to have so much trouble remembering names now-but Inger [K.] Damon and-I can look it up. They e-mailed me and said, "We need some help with the Ebola response. We've got everything set up, but we don't have a Medical Care Task Force." That's the group that's responsible for basically mitigation, so writing guidelines, understanding all the medications, all the therapeutic methods, medical therapeutic methods you might use to prevent or treat disease, that kind of stuff. I sort of naively said, "Oh sure, it sounds like it's not much going on anyway on the domestic side. I think that wouldn't be too bad." Oh 00:22:00man [laughs], in retrospect, I'm glad I did it. Now, looking back, it really was a lot of fun and I felt very alive. It was a very vital experience and I learned a ton! I learned so much about how amazing this agency is. I had no idea of not only the breadth of expertise, but the incredibly high quality of people who choose to work here. It really was heartening. And to see how people could come together and work and make this thing happen. That was amazing.

Q: When you think about that, all of the amazing people you saw at CDC, are there some people who stand out for you?

BROOKS: Oh, God-really, it's hard to say that there is any individual because I was just pleasantly surprised over and over by the people I met and how they would stand up to the task and if you-you know the stories-if you give them 00:23:00enough rope, they will use it to build what you need. You just have to let them go and trust they're going to do it and monitor closely. I think 95% of the people that chose to work on the response were cut from that kind of cloth. Remember, they chose to be in that response. They weren't people who were pulled in and dragged in because they didn't want to be there. So you were attracting a certain kind of person. We did have a couple of times where we had people who were, we had to sort of say, thank you but no thank you for your contribution. But I think that happens in any situation.

Q: What kind of things would lead to having to say something like that?

BROOKS: Oh, a person who we were asking to do one task and they start spinning off doing something that interests them more and they're going on and on and they're building a whole activity around something and that's not what we need. They were speaking on behalf of the agency when it wasn't really-their heart was 00:24:00in the right place, but it may not have been the most diplomatic way to move forward. It's like, you're so helpful and we really appreciate your contribution, but maybe it's a good time for parting the ways. Take a break and maybe come back in a couple of months.

Q: So you start full-time in Ebola in August?

BROOKS: I think it was August. In fact, let me look, I've got the day here. The day I came, it would have been probably August 14th. I can't remember when I got the e-mail, but the first thing I did-like a good EIS officer, which you learn-you get your book, I taped into it my card, phone numbers that were important, then maps of the affected area, my little team structure, which at the time, Medical Care Task Force had one, two, three, four, five, maybe six 00:25:00teams, all of which were staffed by one or two people. I'll just tell you, by the time I left, that Medical Care Task Force had grown to over a hundred and fifty people. So that would have been seventy-five days maybe and became a very large activity. I kind of eased in over a couple of days and then started moving along and we realized, oh yeah, we need to really build. We didn't have-one of the teams was the Healthcare Infection Control Team, which is basically a large part of the Division of Healthcare Quality Promotion, DHQP. That's the group that writes all the guidelines. David [T.] Kuhar, fantastic guy, Rachel [M.] Smith, another great person, had been working on some guidelines and we started talking. Do we need to revisit these guidelines? What do we need to do to help people get ready? What do we need to think about in case a case shows up in the United States in order to help the medical care system be ready to accept and 00:26:00respond? But of course, that was never going to happen. I mean my God, what's the likelihood? I mean, it's just not going to happen. [laughs] It's over there.

At that point in August, I was like okay, so we're kind of getting it together. Some of the early things that came to light for us were, is we mentioned very early, it was really clear that this was on fire in West Africa. I can't remember when all three countries were declared affected by Ebola. I think all three were already involved by the time I came on board-Liberia, Sierra Leone, Guinea-but I remember watching this. You don't have to be a PhD epidemiologist, just have a little bit of epi insight to see this is growing really fast and they don't have a system. Their infrastructure is not in a place where they're 00:27:00going to be able to exert the controls that you need to control it and they're panicking. The reason it may have moved to Monrovia and-the capital of Sierra Leone-

Q: Freetown?

BROOKS: Thank you, Freetown. All these words, I'm probably suppressing them. [laughter] But all of a sudden it blossoms in these two towns. You're like, holy crap. High-density population, this could be bad. I met Martin [I.] Meltzer, who does a lot of the modeling around here, and he was talking about doing some projections of what the case load might look like if we don't get it under control quickly. One of the first big things I was asked to do, two things I was asked to do. First was calculate how much supply will be needed to treat all these people in ETUs, Ebola treatment units. His team and a bunch of other 00:28:00people, we sat around and, using guides from Medecins Sans Frontieres where they have a very beautiful, nice, good kind of document that explains how to build an Ebola treatment unit, how to respond to an Ebola outbreak, that lists all the things you'll need. So we kind of took that as a template, calculated the rate at which new infections were occurring. What would the total number be? How much of all these things would we need with wastage and blah, blah, blah and cost? It was astronomical. The team that did this by the way spent twenty-four hours straight online looking up prices and finding, are there really supplies right now? Because of course, what if we said we needed a million pairs of latex gloves, but the inventory doesn't exist right now? What are we going to do? A good example, these things called PAPRs [powered air purifying respirator], oh God, I'm going to totally get it wrong now. I used to know it like the back of 00:29:00my hand-personal air purifying respirator, I hope that's right. It's a hood that you wear, a self-contained hood that clears the air for you. It is designed more for the North American and European environment. It could work in an African environment I guess, but it's probably too high tech. But anyway, what if we needed ten thousand PAPRs in the United States for some reason? Oh my God, there's no supply like that available. I got a little sinking stomach looking at these numbers. I don't have this in my book, because a lot of these were spreadsheets, but I just remember looking and the values were huge, like millions of dollars and things and it was like, wow! Martin then came up with this estimate that I guess ultimately became an MMWR that showed this very steep curve that launched off sometime in December, in January, off into the stratosphere to millions of people sick and dying. And I was like, this is bad.

That was one of the calculations between the task force. The other thing that I was tasked with doing was developing an Ebola training center for Americans-or anybody really from the West, but it was designed for US citizens, but I'm sure they would have-I think we did accept some Canadians and other foreign nationals-where we could train people to work safely and care for patients in an Ebola treatment unit. I was really proud of the team that pulled that off. There was just some-Mike [Michael A.] Jhung, J-H-U-N-G, Matt [Matthew R.] Moore, my God there's so many-I hate to say individual names because there were so many people who made just incredible contributions to this.

Q: But it's helpful for the record.

BROOKS: I could find them somewhere. I'm just wondering if I have some. It was amazing! So what we had to do, our goal was in as quickly as possible-so I set 00:31:00three weeks, twenty-one days-to get a place up and running, where you could go and be trained to work in an Ebola treatment unit. Now, Medecins Sans Frontieres and I think the WHOs [World Health Organization] also had places where you could be trained to do this. So we used those as a model. I think by the time that we were planning this training center, there had been some infections among healthcare workers that were working in WHO-sponsored or supported ETUs, but there had never been a case in a Medecins Sans Frontieres unit. They were just known for following extraordinarily strict protocols and so we decided to follow their model. We sent three people over to Belgium, like on a weekend. We decided Thursday, you have to go. They left on Sunday. They joined a training course for three days. Linda [Martha L.] Quick, Rob [Robert V.] Tauxe, and Billy [William] 00:32:00Fischer, great guy. I think he's F-I-S-H-E-R. He is a critical care pulmonologist who specializes in respiratory diseases like Ebola, or I'm sorry, viruses like Ebola. It can be respiratory. To go learn how-Billy had a lot of experience with Ebola previously, so we brought him on as sort of an expert consultant. Go take this course and find out the secret sauce. What are they doing that's protecting people? Medecins Sans Frontieres was happy to have us because we could begin to spread the wealth. It was evident there's going to be a huge-at that time we thought there was going to be an enormous need for personnel, and so we wanted to be able to train. Our goal was to train fifty people every week. I don't think we ever-we may have gotten there, I don't know. Anyway, they came back, shared what they learned. We got all the materials from WHO-sorry, from Medecins Sans Frontieres-and then created this team. This part 00:33:00of the team, you go and your job is to find the place we're going to do this and start working on all the logistics. Where we're going to do it, how we're going to house people, how we're going to travel people, how do we let people know the course is available? The nice part was we did get sort of a carte blanche on I don't care what it costs, you have a blank check right now because this is so high priority. Then another group were tasked with develop the curriculum and brought in some-I didn't even know these people existed at our agency, these curriculum experts, who came in and were fantastic at how to develop a curriculum and then using some of the materials from MSF [Medecins Sans Frontieres] that we'd gotten, plus other things we thought were important to build. We built this curriculum. Then there were the people who were managing the applications. Who wanted to take the course, managing all of this? It was amazing. It was amazing. It ended up that we used a FEMA [Federal Emergency Management Agency] facility in Anniston, Alabama, that's a training center, and we did it. It got set up. I'd hazard to guess what the number of people that 00:34:00were involved in that effort was, but gosh, I think forty to fifty might be a reasonable estimate.

Q: Excuse me, involved in setting it up?

BROOKS: Yeah. All of the logistics of finding the place, setting it up, putting the curriculum together. There was a weekend when a bunch of subject matter experts, so me, Jeremy Sobel helped. He was fantastic working on this. David Kuhar. Oh, who else was there? I want to say maybe Inger. They had all the slides they were going to use. We had all the curriculum set up and we went through, I think Matt [Matthew J.] Arduino might have helped. We went through slide by slide for the content, to make sure it was accurate. It was things like, how do you put on and take off your personal protective equipment? How do 00:35:00you set up, Mary [J. W.] Choi helped with this. How do you set up an ETU, I mean physically design it, so people move through it? How do you, if you're in a situation where you feel unsafe, how do you say no and not move forward? How do you manage a dead body? How do you manage waste? All this stuff that would be important we thought for Americans and others going overseas to train needed to know. And he course took off. We had a lot of interest. I can't remember now the total number of people trained. We did ultimately develop a really nice package that is kind of the course in a box that you can ask for and purchase. Or you can probably get it for free from the CDC. It's all available online as well. But I was really proud of the work that we did on that. We trained a lot of 00:36:00people who went overseas and helped. That was the fastest I had seen anything happen here. That was a great experience to really see something move from concept to action that quickly. And it was well-timed, because it was right around then that this person in Dallas showed up.

Q: Mr. [Thomas E.] Duncan.

BROOKS: Yes. I'm trying to look at the, oh yes, I have things in here. Okay, so I'll talk about something else first. One of the things our team was also responsible for was managing the repatriation of persons who either were diagnosed with Ebola, were thought to have Ebola or had been exposed and were at risk of developing Ebola. To manage their repatriation to the United States where they could be watched, either treated if they were ill and if not ill, kept in a place where in the event they developed symptoms, they could be moved 00:37:00very rapidly to an Ebola treatment unit or isolation unit here in the United States. That was a really interesting experience getting phone calls about so-and-so's had a needle stick. One of my jobs when I was an infectious disease fellow was to be the needle stick beeper person. In a hospital system, particularly at the time I was working there in the late nineties, people would have needle sticks and they'd be very worried about HIV and hepatitis and so I think that really served me well in this respect. Having experience kind of talking somebody through the panic of I've just been stuck by a needle and I'm going to die of HIV and I was like well, you've been stuck by a needle. I don't know if you're going to die of HIV or not, but you've only been stuck by a needle right now and here are the things we can do right now to help protect you. This kind of thing. We'd hear somebody had been stuck by a needle, I'd get their name and phone number. They'd be moving towards the US embassy in the 00:38:00country they were in so they could be transported out of the country back to the US. Get their story, try to assess their risk, try and reassure them.

Then, we were working at the same time-we had an amazing story. We were working at the same time to offer them anything we could that might prevent them from getting disease. This kept changing over the course of the epidemic, but back in September there was a product that was a small interfering RNA [ribonucleic acid] product, so it would basically mess up the virus and it couldn't replicate itself essentially. It hadn't really been used much in people at all. I think it's been demonstrated to have some safety. Its effectiveness was not really well known with the animal model, but anyway, it was an option and it turns out that Emory University, because they had the Ebola treatment unit at Emory, was a part of this potential clinical trial. I think they had an arrangement with FDA [Food and Drug Administration] that they could enroll people into a trial to try this product on a compassionate basis, something like that.

This woman had had a needle stick. She was going to board the plane in Sierra Leone sometime within the next forty-eight hours. The flight was leaving, Phoenix Air [Group], which did these transports, is just outside of Atlanta. Their airport was just north of here and we thought, damn it, can we get some of this drug on the plane so when it arrives the ICU [intensive care unit]-level trained nurses that staff the plane can administer the drug to her? We can call her on the phone. We'll tell her ahead of time it's coming, call her on the phone, have the principle investigator, Mark [J.] Mulligan at Emory talk to her on the phone. If she wants to do it, consent her and then administer the product and monitor her on the plane. The plane basically can deliver ICU-level care. So I said to somebody, well, do we have anybody who can run over to the pharmacy and drive this out to the airbase? I'm shaking my head no. I was like, are you 00:40:00kidding? This was a Saturday or something, early morning on a Saturday and I was like, damn it. So I said, okay, I'm going to do it. I'm just going to do it. I called the pharmacy, Susan Rogers, lovely pharmacist. I spoke to Mark Mulligan first I think, we talked to Susan. I talked to the person who had the needle stick. Everybody was yes, let's try this. "Susan, start packing that stuff up, I'm going to come over there in my Prius in just a minute and we're going to drive out to Cartersville and deliver this." I called Phoenix Air, I said, "Please do not take off until we get this to you." We needed dry ice, one of the assistants that was helping Inger was like, "I know where to get dry ice at Publix" and so she went and got dry ice and then we were on my cell phone and I was like "Okay, we're now leaving Emory." She said "Okay, I'm five blocks away. I'll meet you at this intersection and give you the dry ice," and off we went, like speeding. I mean speeding down 75. I thought, if we get pulled over by the police, I don't know what kind of story I'm going to tell. [laughs] But we made it. We made it, we got the stuff on the plane. She got the drug. Flew over there and it-the system worked. I don't know if the drug really had any effect because 00:41:00she never developed disease. Thankfully, she never got ill, but it was pretty extraordinary.

We were doing things like that. Like later, trying to make sure to pre-position a vaccine candidate in country, in case somebody had a needle stick they could get vaccine, or be able to get it to people so when they board the plane they could get their first injection. A number of people were in that sort of a situation.

Q: Yeah, I was going to ask, so the situation where you were quickly driving the supplies to the plane so it could take off and get her the early treatment. Is that something that was repeated?

BROOKS: No. After that event we got better at it and because Emory was running the clinical trial, it wasn't a CDC sponsored event, so I was really volunteering my time as it were. Technically, it was up to Emory as the institution conducting the clinical trial to get it there, but I just couldn't 00:42:00sit there and think about this woman who is sweating bullets. Inevitably, the people by the way we were transporting back, the ones that were coming back to the United States, were mostly medical professionals. They had been working in ETUs and so they understood the risk they faced. They had witnessed people dying of this horrible thing and often they were people who worked in the world of Ebola virus research anyway. What I'm getting at is they were well-informed customers. When we could send someone, I felt like they really understood the risk, even if it was tempered by some panic on their part. They understood better than probably anybody else what they were getting into.

I can talk about Dallas I guess a little bit.

Q: If you'd like to. I have a couple of just clarifying questions. Just to run through them and then let's get to Dallas. When you were training people in 00:43:00Anniston, obviously, CDC is public health and we weren't sending CDC doctors over to West Africa, which is a big misconception potentially that people can have. So where were the doctors you were training going when they went to West Africa?

BROOKS: We weren't directing where they go, we were offering the opportunity for people who may be going with an organization like Samaritan's Purse or they're with-I almost remember the name of the organization, GORD [GOARN, Global Outbreak Alert and Response Network] or something. WHO's-

Q: I think it is GORD.

BROOKS: GORD maybe? Global Outbreak Response something. Anyway, there may have been an American physician who was hired by them to go work over there and they wanted to train now rather than wait to be trained there or there were people with other organizations, Partners In Health, other NGOs [non-governmental organization] that were responding and we could arrange for them to get training. We trained, I'm trying to remember the name of this lovely New York Times reporter. First of all, she was in the first training group and it freaked 00:44:00me out because I was like oh my God, no, press. I like the press, but I like the press when they help us and this was an opportunity for the press to take a look at something and say we really didn't do a good job. Which-she was only there because she was volunteering to work at an ETU. I was amazed. I can't believe I forgot her name. She's a great person, really admirable for what she did. That's where most of the people came from.

We didn't have CDC staff going. Now eventually, Commissioned Corps officers may have been asked to join an ETU that was US-sponsored in Monrovia if I remember correctly. Set up by the military, run by the surgeon general's office and the Public Health Service. We were also responsible for training those classes when that came along.

Q: Let's see, timeline, that would be sometime in October probably?

BROOKS: Yes. We were trying to line up the training to match when the unit would be open, so it was sometime in October. God, I have all these notes about what's 00:45:00the infusion rate for that drug and how cold does it have to be and what are potential reactions. This is great, I tried to throw into the box that went over there for this young woman who had a needle stick, chocolate, wine and some bleach wipes because she thought there were people there that would really like them.

Q: Aw.

BROOKS: I know. I didn't make it. I was really sad.

Q: We're sitting here with some notebooks that John had kept while in the response.

BROOKS: All these notes about how this drug worked, that's amazing. So I'm just trying to see if I can find the-oh yeah, so here, this is the stuff about the ETU training in Liberia. And this was September 2nd. This is Martin Meltzer's, I taped this into my book, Martin Meltzer's prediction of where things would go if we didn't control stuff right away.

Q: The 1.4 million projection for Liberia?

BROOKS: Yeah, and it looks like right around November it was not going to look pretty if we didn't get involved. Yeah. OK, you ask me the questions-

Q: Let's talk about Dallas because I'm guessing the work that you did before and after Dallas changed; the work that you were doing changed.

BROOKS: A little bit. What happened was, whereas everything I've talked about now was-basically our focus, although with the Medical Care Task Force our focus was really on helping out in West Africa. We wanted to understand, what are the drug products that are available? How can we bring Americans who are ill or exposed back safely and then manage their care in hospitals that are already prepared to deal with it? There were four containment units. I don't know if that's the right word, I kind of don't like that word. But there were four places in the United States that have received funds from the CDC and I think also NIH [National Institutes of Health], to be able to take care of people who 00:47:00had these kinds of diseases like Ebola. The idea was mostly around people who may have been exposed in the course of a laboratory event. So naturally Emory next to CDC, NIH's clinical trial unit-well, Building 10 has an intensive care unit at NIH, that was a place. Nebraska at Omaha, I'm not quite sure why, but I think they do a lot of research in this area, and then there is the Rocky Mountain labs near Hamilton, Montana. That's where the VDRL [Venereal Disease Research Laboratory] test for syphilis-that was discovered there. Rocky Mountain Spotted Fever, which is a disease which really is more prevalent in the Southeast United States-it was discovered there and that's where it got its name at the Hamilton labs. Anyway, they may be dealing with some of these organisms. USAMRIID [US Army Medical Research Institute of Infectious Diseases] may as well, but the Army already has their own set up. So there were these four places. Now, the place in Montana had two beds, but had staff that could only manage one patient at a time and they were pretty remote anyway, so that was kind of off the table. Speaking to them, they basically said look, we would love 00:48:00to help, but we just aren't ready. Omaha was totally there. Emory was there. NIH was getting there. They hadn't really thought about this, but when the task came, they really stood up to it and were great.

The difference is that these were places that had already thought about the possibility, had trained for what to do. Were mentally there that yeah, somebody comes in with Ebola virus, okay, it's freaky, this is a bad thing, it could kill you, but I have practiced. I have practiced. I think that's one of the huge lessons learned from this entire event. I have practiced and I feel like I am in control. I can manage this. It's scary, but I can manage this. And I am with a team of people who have all trained with me who can support me in managing this and we have worked through all these details, like-how do you handle the blood 00:49:00specimens? Can I send a blood specimen to just the regular lab to be tested for its hemoglobin level and creatinine level to see his measure of kidney function or does that specimen pose an infection risk to everybody working in the lab? Oh yes, suddenly these issues started popping up once this Dallas case-and maybe just before this too. Because some people were anticipating it would happen, rightfully so they were concerned, but it really took off with Dallas. Suddenly, all of these amazing things popped up that you had to think about. How are we going to manage specimens? What if I had to get an X-ray on that person? What do I do with a radiology tech? How am I going to take care of all the waste that's being generated? This discussion morphed not just around actually treating patients, but when we began screening people. So if somebody comes back from West Africa, they've got a fever, they're not feeling great, oh my God, maybe they got Ebola. Likelihood's quite low, but what do I do until I've ruled out 00:50:00that Ebola is the culprit and/or that they have an alternative explanation that explains what's going on?

Q: Can you briefly explain some of the eventual solutions that you came up with for some of these, like the waste, blood, X-ray?

BROOKS: So for the blood, in the containment units they basically have labs within the unit that are dedicated to servicing those patients. They have a way of managing the waste. They can pack it up and store it. I'll come to the waste one in a minute. [laughs] Now, what if you're evaluating a patient with Ebola? One of the things, I've got them here, copies of some of the things we did. We had to come up with communication tools and messages and guidance very quickly for if a person comes into your clinic. And we had to aim at different audiences. So we needed to talk to people at the front end of medicine who may encounter somebody in a primary-care setting, a doc-in-the-box setting, an emergency room setting. What do you need to do? You must establish two key questions. Have you traveled to this area, and has it been less than twenty-one 00:51:00days? No, coming back from Trinidad and Tobago is okay. You've been back for five weeks, that's okay. But people are scared. You have to really help them. Anyway, we developed all of this guidance and that was very quick.

Sorry, I was going to show you-this was one of the things we developed for an outpatient clinic. And here's another version, sort of the same thing.

Q: Actually, really easy-to-see flow charts.

BROOKS: Yeah, they were basically flow chart algorithms that would help. I mean they were a little dense in terms of the text if you ask me personally. We tried to develop lower things, less cluttered, a much clearer-

Q: Concise.

BROOKS: Very concise and very directive, but we were turning these around quick, quick, quick, quick. Within a day, we would be morphing these quickly and then 00:52:00getting them cleared and trying to get them posted on our website so people could use them. Then we'd host webinars or all kinds of nursing, physician groups telling them yeah, here are the materials. We developed a slide set all about what is Ebola virus disease and how is it transmitted. How do you prevent its transmission? What do you do if you might have been exposed? That kind of thing. So that popped up, this whole need to educate people quickly popped up. I think there was some hubris, people might say in retrospect that we also assumed that every place could handle a patient who walked in with potential Ebola virus disease or even if they had Ebola virus disease. It's true they could have technically handled it, with the infection control measures that are present in a hospital. The equipment, the way rooms are set up. The way you behave. All of the things you would need to do in terms of behavior and technology are there. You could manage it. The problem was people hadn't practiced. People hadn't 00:53:00thought about it and they weren't mentally ready and I think that's part of the huge panic that occurred in Dallas.

That was an amazing group of people who dealt with this guy and the family and folks who came in. It's hard to say what I would have done if I'd been in their shoes. Some of the issues that were coming up were, like if I'm evaluating someone for Ebola-let's say you come to me and you've got a fever. I'm going to send a blood specimen to see if you have Ebola virus disease. Probably today we wouldn't recommend that unless we really thought-

Q: It was likely?

BROOKS: Likely, sure. But we may have done that a couple of times. How do I transport that specimen safely? How do I handle the specimen? What laboratory can run it? So we had to set up a system. It was kind of existing, we had to really bring it on line where specimens could be sent to labs all over the 00:54:00country that could accept the specimen and test it. There is a whole testing network that had been previously set up but that had to be brought online. Not so much brought online but turned on. Great, great, great thing.

The waste was probably the most difficult issue. It was incredible. So one, once you begin evaluating people who might have Ebola virus disease. The gloves, all the stuff you had, you may have to dispose of that. Okay, that's going to have to go somewhere to be incinerated or buried and there are rules about where it has to go. We could deal with that. There are ways that must be handled. It has to be sterilized or burned or all this kind of stuff. The hospitals that were treating people in particular were developing tons-not tons, but huge volumes of waste-boxes and boxes of this stuff. And we couldn't get it transported off the premises. Why? Because at the time, Department of Transportation rules required 00:55:00that things that were potentially contaminated with Ebola had to be handled in a very special way. It just became an enormous time suck, basically, working with our colleagues across a number of federal agencies to try and find a way to get this stuff where we could ship it. I remember at one point we were kind of laughing because the body of a person who died of Ebola could be put in a coffin and taken right to the mortuary on America's highways. That's probably the most infectious item for getting disease that we know of. But, a pair of gloves is going to sit in a box and can't get on a truck for I don't know how long, it was like what is going on? I was calling colleagues at NIH. How much trash have you got? At one point, we had filled up a small building with boxes. Emory had a way 00:56:00of managing it with these giant sterilizers, these giant steam sterilizers. It's terrible I can't remember the name of what those are called right now. I think Nebraska had some way of managing it too.

But most hospitals you may recall used to have incinerators. That was great, you just burn the stuff up. But they've been getting rid of them because they produce pollution and so they steam, under high steam pressure, sterilize these things. You can't use the little tiny sterilizer you might see in your dentist office. You need one-you can have boxes, big ones-that you can put boxes into. Nobody has those. Emory happened to have one, but very few people have those. Could we hire a company to back up a truck with one of these sterilizers? Nobody has it.

Then, once we finally got to the point where we could move the material, then we got pushed back from the disposal sites. Oh, you cannot put those ashes from Ebola-contaminated material in our ash pit. Why? Because they pose an infectious 00:57:00risk. And I was like, [no]. There were states that said no, you can't transport it across our state. It was insane. I understand the concern, I can certainly understand from a scientific perspective if you don't know enough about the disease and aren't informed you could be scared. I can understand from a political perspective that you might buy some political credibility perhaps by looking tough on this. But it was a hassle. It was a huge hassle and Dana Meaney-Delman, you've got to talk to her. That woman, I swear to God, she deserves a Congressional Medal of Honor for what she did to make this all work. We spent a ton of time doing that.

Q: Who was Dana?

BROOKS: She was my assistant, I guess you would say deputy team lead. She might 00:58:00as well have been the team lead. Basically, it grew so fast, we ended up doing a lot of work in parallel. We would touch base in the morning and the afternoon and maybe at ten o'clock at night. That was another thing that was really amazing. This was a time of my life when I was getting here to CDC around 6:30 to make sure I got a parking space. [laughs]

Q: That's a whole 'nother thing.

BROOKS: Whole 'nother story. But you know, because I had to be here. Then I would go home at 10:00, maybe 8:00 is a good night, but I'd be on the computer until 10:00 or 11:00 and then I'd be woken up, especially right during all of the Dallas stuff and from that point forward. It would be routine to get phone calls in the middle of the night about different issues. The NSC [National Security Council], the White House became very concerned of course, reasonably so and so they're pinging our leadership, Dr. [Thomas R.] Frieden and folks and that's coming down to us. When somebody was being repatriated, they wanted all 00:59:00the details and I can see why they would want all the details, but we did have a system in place to do that. At one point you're kind of saying, could you just quit calling me for an hour so I can finish the job and I'll call back with the details. And have one person call me, I don't need four or five different people. I know everybody's working toward the same good end, but man, this is making it hard. When people are stressed it can make people angry. People were good. We didn't have a whole lot of tempers flare. I don't think I ever lost it once. [laughs]

Q: That's remarkable.

BROOKS: I never cried. I did have one day I was so pissed off. I don't know what I did, I think I just took a walk. It was over this transport thing. I was like, I cannot believe that there is not somebody who can't just say, yes, you can put this on American highways. I mean there's got to be somebody who has the authority in an emergency to say, we can change the rule or we can make some 01:00:00temporary amendment now, because it's got to be right this minute.

Q: Was there one case that was particularly really difficult, like Mr. Duncan's case?

BROOKS: No, it was just the whole general topic area.

Q: Was it mostly like theoretical, like planning for the future, or was it really like who actually came over and dealing with real waste that was really generated?

BROOKS: There was real waste. NIH and here at Emory and at Omaha too, there was a lot of waste being generated caring for these people. I believe the estimated cost maybe of the material alone was somewhere in the area of five hundred dollars to six hundred thousand dollars to care for a patient. It was huge volumes of material.

Mr. Duncan was a very interesting story. So there was another team, another task force actually who managed all the incoming calls about people who might 01:01:00actually have Ebola virus disease and were kind of screening them and helping them work them up and make a decision, pursue alternative diagnoses, etcetera. They weren't part of my task force, but we were all in the same area up there. I remember on a Sunday there was a call from Texas about a guy who'd come in that Friday with kind of generic diarrhea, vomiting, fever from West Africa. No known exposure. In fact, when they called on Sunday-I think they might have first contacted on Sunday, maybe Saturday, I can't remember. He had reappeared at the hospital on Sunday sicker and he was much, much sicker. They obtained the West African history then, although everyone knows now in retrospect it was in the chart, blah, blah, blah, we're human beings, but it was still a bad oversight. It might have made a difference, I'm not sure. But anyway, he comes in a lot 01:02:00sicker Sunday. They get the laboratories back on him and God damn it, he has got all the laboratory changes you hear occur in a person who's really got Ebola. What day was it? October-do you happen to know the day?

Q: Did he go into the hospital in late September and pass away on October 9th or something?

BROOKS: I began taking pretty tight notes right around that time because I knew, oh, this was not going to be good. [flips notebook pages]

Q: September 25th, he arrived complaining about the symptoms.

BROOKS: Yeah, so here I've got September 24th. September 25th. Right.

Q: And then unfortunately he passes away on October 8th. So it's in that couple 01:03:00weeks there. He returned to the hospital September 30th.

BROOKS: I've got my notes. These must have been from September 28th. What day of the week is September 28th? Was that a Sunday? Do you have a calendar?

Q: I can look it up.

BROOKS: I have here that he presented on the 24th with a fever of 103. On the 26th he had GI-it was a Wednesday. He arrived on the 20th from Liberia. The 24th, a Wednesday, he developed a fever of 103 measured at home. The 26th, a Friday, goes into the hospital with GI [gastrointestinal] distress, vomiting, diarrhea, cramps, and he had two telltale laboratory findings either on that day or on Sunday the 28th. His white blood count had gone down, which if you've got an infection it should go up. His platelet count was very low and again, when you're really sick, it shouldn't go down. Malaria smear was negative. It was 01:04:00from 10:40 am on Monday.

Q: So since these notes are in your notebook, you must have been paying a lot of attention to the progress.

BROOKS: Yeah, because I knew that if this guy had the real disease, my whole team's life has been changed-task force big time. And I'm a physician and I wanted to make sure. When I got that I was like God damn it, he has got it! He's got it. This has got to be the real thing. I remember that Sunday night talking about it. I took these notes on Monday and then we had a meeting on Monday at 7:20 pm.

Q: The 29th?

BROOKS: Yeah, Monday the 29th. Me and a couple of other people were-who was it? It was me and I'm going to have trouble remembering people's names now. [scans 01:05:00notebook, laughs] "Darth Vader's on the phone." There was somebody whose voice on the phone sounded like Darth Vader. [laughter] Maybe when I get the transcript I can add the names.

Q: Yeah, that's what we'll do. So no worries.

BROOKS: We were sitting around and thinking okay, they are going to draw a lab specimen today, Monday. They are sending it to the lab. We'll probably know earliest Tuesday, maybe Wednesday morning what the result is. What are we going to do when that result comes back as positive? We had a long, long, long, long discussion about-LRN, the Laboratory Research Network is the lab network that managed this, thanks. How are we going to organize the-obviously we're going to 01:06:00have to send an Epi-Aid team, who are we going to choose to go on the team? Some of my best friends went on that team. Some of the best people at CDC were on that team ultimately. You should try and speak to all of them, Stephanie [J.] Schrag, Dave Kuhar and Alex [Alexander J.] Kallen, K-A-L-L-E-N. The men are both infectious disease doctors. Stephanie is probably one of the smartest epidemiologists I have ever met in my entire life. They, with some really good EIS officers were ultimately pulled together to do this. David led the team on very short notice and we got that together. But then it was like okay, how are we going to manage specimens? How are we going to manage some communications? What do we need to start thinking about right now to get ready?

Were people aware in the press that this guy was there on Monday? I can't 01:07:00remember when it kind of came to light. But I remember we were thinking the whole time we need to be transparent. That was really clear. We absolutely could not appear to be-because people will assume the worst about you. I've certainly heard from my own family, CDC totally F'd up on this one. My uncle was telling me, "The CDC totally bit the farm" or "screwed the monkey on this one." I was like, "You don't know what I did. You don't know what I was involved in, do you?" I goes uh-uh. I said "Okay, it doesn't matter, good to get the feedback." [laughs]

Anyway, it was just a bad night. I was there to like 1:00 am, 2:00 am and then I'm trying to say, I wrote in my book, I remember I wrote really clearly somewhere the moment that I learned-oh yeah. 2:53 pm on the 30th I opened an 01:08:00e-mail that said his test was positive. That day, the team was gone. Alex, David, Stephanie Schrag, Dave Daigle D-A-I-G-L-E, fantastic communications person and then EIS officers, Michelle Chevalier, Charnetta [L.] Smith, Lauren [H.] Epstein, Jennifer [C.] Hunter-got them together. We sat down in the EOC [Emergency Operations Center] conference room, kind of talked through everything we knew about the details of the case. How the teams were going to be divided up. David in infection control, Alex medical, Stephanie epi investigation. What they were going to do. How to manage the press. Dave was there-he's a master at that, but I think he probably has never seen anything like this either. You should interview him if you haven't had a chance. What they needed in terms of 01:09:00PPE [personal protective equipment], which they could get there. They weren't going overseas. We didn't have to worry about filling their luggage. They could get what they needed there. We were on the phone with Ed [Edward L.] Goodman, who was the infectious disease doctor at the hospital, and some of the other people there, getting them ready and talking to them about: how were they going to handle this? What are they going to tell people? What are they going to tell their staff? What if everybody walks out of the hospital and they're afraid to come to work? What's their backup plan? How are they going to manage this patient? All this kind of stuff. Where are they going to get supplies if they run out? Dallas Pres [Texas Health Presbyterian Hospital Dallas], there are many hospitals, have they spoken to the other hospitals in town and asked, could we use your supply? Those other hospitals on the other hand were worried, if this is the first guy in Dallas, maybe there are more, maybe we should hoard our supply because what if we have a case walk in our door? So you have this balancing act of trying to get people to work together, but also maintain your ability to have everybody capable of responding.

It was right around Monday I think the additional history on this guy began to come out that he previously denied any known-known exposure to Ebola. I think, at least I believe in my heart of hearts he was probably honest. He might have suspected later, but he said that he had-that a nurse had gotten a history from him after he'd been admitted that a woman had died in childbirth and he'd helped her. She had returned I think from a hospital sick, he'd helped her from the car to her house maybe, it might have even been his daughter, and he also assisted with her burial. I don't think he was thinking Ebola. It's clear he didn't flee the country because he was worried about Ebola, because his plans to come here had been laid months and months ahead. He bought the ticket, he was arranging to marry this woman. That had all been arranged far in advance, so he wasn't trying 01:11:00to get away like the guy who went to Nigeria. That's another story.

So that was pretty bad. Then for the next week, I don't remember much. [laughter] My notes get really thick, but it was just constant, constant calls, more history, speaking with the media. What are we going to do in terms of PPE? All the unions are upset now. How are we going to make sure that the unions are trained? What are we going to do with airplanes? What if a person like this Mr. Duncan had been on an airplane? How do you sterilize the airplane? Oh, and by the way, all the crap Mr. Duncan is putting out is being flushed down the toilet. Is that safe in the public sewer system? We began having all of these very, very specific issues that in retrospect, you could have anticipated somebody would have asked, but you just sort of think we now know, we're better 01:12:00prepared. But how do you manage the sewage? Well, these containment centers had thought about that. At Emory they thought about it, but there was an effort at one point. I remember DeKalb County was going to cut off their water supply and it took a couple of phone calls to have them keep it on. But what do you do with the poop going down the toilet? The used blood specimens? When they're vomiting, stuff like that? It was a lot.

Q: I have to ask because I'm curious now, what does happen?

BROOKS: So, Matt [Matthew J.] Arduino, this amazing guy in DHQP whose area of expertise is sort of all these exposure things, began working really hard on okay, how do you clean an airplane? How do you clean it? How do you clean a 01:13:00truck? How do you clean a bus, a car? We began writing guidance also for West Africa. You know, how do you clean a car properly? How do you sterilize a room where someone's been sitting and they turned out to have Ebola? The stool one, you know you basically sit down and say, let's go through all the literature and come up with and decide what we think the truth is and then make that case. With sewage it turns out that it was probably safe to flush sewage down the regular toilet for a couple of reasons. First, even though there may be a high concentration of viruses diluted very quickly, it is going through a system that many people aren't exposed to. The only people you might worry about being exposed could be people who work in plumbing or in sanitation, who may be at the sanitation plant. Nonetheless, the changes in pH that occur may not favor this virus. It's kind of a puny virus as viruses go. There's a lot of competition out 01:14:00there in terms of bacteria in the water and they're eating everything they can see. So, viruses are a source of food for some of these things. Ebola won't kill an amoeba, but it will be a source of nutrition.

There were some other things about it, but it made people feel pretty comfortable that it was safe, but nobody had done tests. Nobody had ever dumped Ebola into the public sewage system and then sampled it later to see what would happen. Were we going to do that and what would you do if you got a positive result? What would that mean and how would you communicate that? Do you really want to look at that? We had to come up with guidance for plumbers and other sanitation workers. All these people who were in these places where an exposure could occur, we had to develop guidance. So you can imagine it began this huge enterprise of people doing research and writing and then putting this stuff up as quickly as we could. Guidance for cabin crews. Guidance for home healthcare workers. So let's say you're a home healthcare nurse here and you're taking care 01:15:00of a client whose daughter has come back from West Africa and the daughter is now sick with something and your client's got a fever. What do you do?

Q: I can imagine with just all of these different spheres in which really you don't have a whole lot of experience-

BROOKS: None.

Q: -but suddenly you have to learn all of the intricacies.

BROOKS: How do we prepare the police and EMTs [emergency medical technicians] to respond? How is that community organized, anyway? It's a very fractured-it's not like I can speak to the head of "National EMT Organization" and it gets communicated down to everybody. All of these places are organized in a patchwork way that works, but it can make communication difficult.

God, what else were we thinking about? We had all of these funny scenarios we were thinking through. I say funny now because in retrospect, that was so unlikely, but at the time you're like, what if this happened? We were so burned by Duncan that another event would be very bad. It happened that two weeks maybe 01:16:00after Duncan, maybe three, Duncan's thing occurred-I can't remember exactly-I had previously had an engagement to give a talk in California for an HIV training course and I couldn't get out of it. That was one thing that I really couldn't get out of. Dana, thankfully, was willing to cover. I remember I took off on the plane to Los Angeles, we landed and I had a text message from a friend of mine who's in the media who said, "Did you hear about that guy admitted to the hospital in New York with Ebola?" I was like, no way! [laughs] I gave the talk, got on a plane and came back pretty quick. But that was a much better case. He probably went to the most prepared place in the country. New York City, God, they are the best. I mean there are some good places. Marci 01:17:00Layton, she has it under control. They had already in the summer planned, even done some trainings about the possibility, because they've got to be ready for anything in New York. They managed this guy and they managed him very, very well.

One other funny anecdote I guess, I didn't even talk about the spring-this is all just around Duncan-because I came back for two months in the spring. How much time do you guys have?

Q: I have all of the time in the world, but I know that you don't.

BROOKS: Because I like to talk.

Q: And I like to listen.

BROOKS: Well that's good, we're a perfect match.

BROOKS: Just a couple of funny things that occurred. So you know, the two nurses in Dallas developed symptoms and I believe it was the second woman who was transferred to Emory.

Q: Amber?

BROOKS: Thank you, Amber. It was funny, I actually didn't know Duncan's name until it was in the media I think. I didn't know these women's-I didn't know 01:18:00many people's name. Now, I did know the very specific names, phone numbers, social security numbers of all the people we repatriated and that's in this book and that's why I have to be careful. Although, some of them have now disclosed that they came back and had problems, but there are a couple who never did and they deserve the right to have that privacy reserved.

When they had to get them out of Dallas because they were overwhelmed-they were really overwhelmed. That was a bad day. I remember coming to work and oh, the nurses are ill. We're moving them out. One is going to NIH and one is going to Emory. I'm like, oh God, that's a lot of work for us because our team helped with a lot of that logistics. I was at work until like 10:30 that night and I was last to leave and I was dead tired. It had been a really bad seven or ten days. I'm pulling out of the parking lot and in the distance I can hear these 01:19:00sirens and I realize, that is the parade of vehicles and the ambulance bringing this young woman. She either came into Cartersville or PDK, Peachtree DeKalb Airport. I think it was Cartersville, but anyway, bringing her to Emory Hospital. That path runs right by the entrance to the CDC and I was like oh God, I'm never going to get home. I am never going to get home. I thought okay, I've got to get out of the parking lot and get off campus before that train of a hundred vehicles starts coming by, and I missed it. I'm sitting there at the entrance going onto Clifton Road watching one police vehicle and fire truck after another go by blaring and there goes this poor young woman, who was probably absolutely terrified. I just kind of said to myself, I know I'm so angry about this, but thank God we have a system in our country where this woman can get the highest level of care available and ten more minutes of my life is nothing compared to what she's going to have to put in. So I kind of calmed 01:20:00down. [laughs] It was the crowning moment. All day long I've been working to get this person to Emory and there she goes, feet away from me in a vehicle. She just had to wave goodbye as I'm going home [laughs]. She did well too. She did very well. Those folks, the care that they delivered at Emory-I wonder if you ever get to speak to them.

Q: I would hope so.

BROOKS: I mean those nurses in the unit are amazing, amazing people.

Q: I'll have to see if I can get in contact.

BROOKS: Some other domestic issues that came up during this which were fun to deal with, that as Duncan occurred and we began to-was it Craig Spencer I think is the guy in New York-and then more we began to screen people coming into the country and then have a system where we followed people for twenty-one days. That later was my responsibility on my second go-round, but the first go-round 01:21:00that was somebody else's team. If I was involved, what would we do if one of these people had to go to a unit and all this kind of stuff? Also, trying to manage all of that. We had to begin sort of planning for, where are we going to house all of these people? We want to keep them close to Ebola treatment centers that are capable of treating people, so that's basically Emory, Omaha and NIH. That's not to say that other places weren't capable. Some places were probably extremely capable. Clearly, New York, the hospitals there were capable. That's a great chapter in that hospital's history. Bellevue [Hospital]. It was Bellevue, but we had a team. I don't know if you knew this.

At that time, after Duncan, we had teams going out to hospitals. They were teams 01:22:00that were going to help hospitals prepare, so they were starting with the most likely places. The cities, the major hospitals in the five cities where all persons returning from West Africa had to be directed to come through. So it was DC [Washington Dulles International Airport], Newark [Liberty International Airport], [John F.] Kennedy [International Aiport], [Chicago] O'Hare [International Airport] maybe. Was it Chicago?

Q: The five airports?

BROOKS: Yeah. Was it Chicago? I can't remember. I should remember this now.

Q: I should remember it too.

BROOKS: I know it was Dulles, LaGuardia [Airport], Kennedy, Newark maybe. I'm missing one.

Q: Hartsfield-Jackson [Atlanta International Airport].

BROOKS: Oh thank you. Right, duh, right here at home. Anyway, there were teams-I think it was Chicago-that were up there working with the hospital, so that if a person flew in and they had to be brought off the plane to the hospital, where 01:23:00would they go? How would they manage them? We had a team that was at Mount Sinai [Hospital] that day, and a very good colleague of mine in infectious diseases, Judy [Judith A.] Aberg, who just finished being president of the HIV Medical Association for a year, e-mailed me and said, "You're not going to believe it." This is when I just arrived to California. "Your team that was at the hospital had to run over to Bellevue for something." I was like, "Well, I'm glad they were there." That was so fortuitous. There was another team I think that was in New Jersey working with some of the hospitals near Newark that could be pulled in. But that was a lucky break.

Thinking through all of this. Where are we going to put people? How do we protect their confidentiality? How would we transport them? If they developed symptoms at home, how do we transport them to the place where they're going to be cared for? There was a lot going on there and it involved a lot of agencies. The ASPR, [Office of the Assistant] Secretary for Preparedness and Response, that office was very involved in helping think through a lot of these things. There was one nice story, one really nice story. There was a fellow who had a 01:24:00pretty serious exposure in Sierra Leone. Came back, had to be housed here in Atlanta over the holidays and was a resident from another state and really wanted to go home and see his wife. We really recommended, look, if you develop Ebola, I think you would want to be as close to this place as possible. We can send you back to your home, which was in a major American city that had good hospitals, but that hospital was probably not going to be swinging its doors wide open saying, come on in. I wouldn't be surprised if they said go back to Omaha or Atlanta.

Anyway, then what do you do with the transportation? That's a whole complicated matter. We can deal with Phoenix Air, we have those planes, that's okay. They can get permission to land at the airport maybe, but the bigger thing, what about the ambulance? So we said, would you consider please spending twenty-one days here? His sponsoring organization offered to fly his wife here to Atlanta, 01:25:00but they needed a place to put him and we looked and we looked and we looked and we looked and we couldn't find-nobody-it's the responsibility of the county health department, so Georgia state health department [Georgia Department of Public Health], to do this with Fulton and DeKalb County. They just had no hits and I can't remember how he heard about it, but I think it was a friend of a friend said, "I have somebody who's at the Presbyterian Church on Peachtree and they've got a house out on Lake Lanier that they've just finished and it's furnished and empty. He's the kind of person who might really be open to this." So I called him up, I explained, he said, "You know, I am so angry at all these people who don't understand this and are panicked. Sure, he can stay at our house." I know, huh? I was like, God, I love you! You're amazing, you're amazing! These people spent twenty-one days out at this place where the community was empty, on a lake where they could walk around and be outside and there were arrangements made to bring them food. The house by the way was 01:26:00completely wired. It had Wi-Fi and all the cable was intact. I think there was even a boat, but it was kind of chilly. It was in December if I recall correctly. I was like, wow, there are really good people out there. How do I find these people? Because that became an issue in the spring.

Q: I imagine.

BROOKS: So I was here in the spring.

Q: So what happens in that interim period between the first time you're working on Ebola and the spring?

BROOKS: I go back to my regular job. I try to recover. I got really sick. I think a number of people-I'm not blaming the response for this, but I got really sick with flu on October 31st, Halloween. I was coming home from work, felt feverish, stopped at CVS [Pharmacy] and bought a thermometer. My fever was 104, I was like holy mackerel. I had a bad case of flu and I had gotten the vaccine, but I probably had the H3N2 strain that was not covered by the vaccine that 01:27:00year. I think it was a very early case. I won't say-it wasn't confirmed flu, I never got a nasal swab, but I felt like I had been hit by a truck and had a high fever. I think it kind of fit the bill. Then I got pneumonia later. That's a bad sign. Now you know you're in your fifties when you get a bacterial pneumonia on top of the flu. I'm like, that's not supposed to happen to healthy people. Oh, I'm over fifty, right. So I was laid up, but that was when I was planning to kind of transition anyway, but it did make for a very rough transition unfortunately.

Q: What do you mean?

BROOKS: Because the person who was coming in to take over for me was planning to come in right about that time, but I wasn't able to be with her, Denise [J] Jamieson for a couple of days. I think she was kind of thrown to the lions pretty quickly. But she's great, she got it together and was on it.

Q: So you recover-

BROOKS: I recover. I made a commitment to come back for another two-month stint in March and April and of course by that time, everything was getting-over the 01:28:00course of the winter-there's some early signs things were looking better in West Africa. All the domestic stuff, thanks to the work of many, many people after me, it was really coming under control. We had these systems down for monitoring and evaluation for the following people for twenty-one days in the country and all that kind of stuff. So I come back and it's now the Domestic Task Force and in the interim it had become-there had been a whole administration set up, doing everything to make it work smooth as silk. It was great. Some terrific people managing, it was a well-oiled machine. I was really impressed. Cyndy [Cynthia G.] Whitney was the person just ahead of me and she did a great job.

Come back and I'm thinking it's going to be two months, I'm really going to be able to focus now on some of the domestic stuff. What had happened is that area 01:29:00of monitoring people for twenty-one days and assessing cases as they come in-once people are in the country, medical evaluation of people who may have disease-that all was now under the Domestic Task Force.

BROOKS: Everything was going along just fine and dandy there, a repatriation now and then. There was one or two things that needed a little activity. Okay, not a big deal. I was going home at a reasonable hour. I was getting home at like eight o'clock. I was still coming early because of the parking [laughs], but I actually had time to go get a lunch and maybe talk to somebody at lunch.

Everything was going along just dandy, and then it was sometime in the middle of 01:30:00March 13th, 14th, 15th, in an ETU in Port Loko, Sierra Leone, which was being run by Partners In Health. There was an exposure event that occurred that may have led to a large number of staff having been exposed and all of them need to be repatriated. I can't remember the exact number. I think it was twenty-five perhaps.

Q: They were all American?

BROOKS: Yeah. They all had to come back here. It was sort of a complicated story how the exposure took place. Oliver [W.] Morgan was the guy in country in Sierra 01:31:00Leone with-Laura [S.] Edison, maybe, I can't remember. The woman who was helping him was amazing. This is telling, isn't it? I can remember the names of the men and I can't remember the names of the women. This is bad. It was a mess. It was right around Easter because the Peeps were in the store, marshmallow Peep candies were in the store. I remember that because we used them later to kind of model what we were going to do. So we had to get all these twenty-five people or so back to this country as quickly as possible and then put them, or as we 01:32:00called it "nest" them, around containment units with Ebola treatment unit experience. So basically, we had to somehow house twenty-five people for twenty-one days in Atlanta, Omaha and Maryland somewhere.

Partners In Health, what an amazing organization. The hospital I trained at is where they kind of started and Paul [E.] Farmer and Jim [Yong] Kim were residents just ahead of me in my class and I've remained pretty good friends with Paul. We're certainly social friends and e-mail back and forth and when we see each other it's like oh my God, how have you been? But it's more like following up on what's going on with the infectious disease program at the Brigham and some of what he's been doing-writing books and saving the world-and what I'm kind of doing, writing some paper for a small journal. But I'm satisfied, I'm happy and I'm glad he's doing what he does. It's great work. It's an organization that attracts people of a certain type. They are very dedicated. They may be very outspoken.

First there was a lot of fear. They were really scared. Yes, they want to come home. But then there began to be a lot of second-guessing. Why do you have to wait twenty-one days? They're smart people. They would look up all the research, and "We don't understand why you made the decision twenty-one days. Maybe seventeen is adequate."

"Do I really have to stay somewhere for twenty-one days? What's the data that it's based on?"

"I don't want to go to Omaha. I'd really like to go to Maryland where I can be closer to my family."

"Is it possible that you can have me go back to Seattle instead of having to go to one of these places? Because Seattle is where my family is."

I was like, look, when you signed up-I didn't say it quite so directly, but part of the philosophy is here, when you signed up for this stint, working in an ETU, there was an understanding-and I think it might have been explicitly in the contract that they signed with Partners In Health-that if there is an exposure you have to come back. You have to let us manage that care.

Partners In Health's press people, their doctor who manages their employees-just 01:34:00a great organization. And they were struggling also to communicate to the staff that had volunteered to work to help manage all of this. These are scared and eventually could be very angry people. It was twenty-one days, it was a lot of work first of all to get them all places to stay here. Luckily in Omaha, there is a residential facility affiliated with the containment unit that was like a hotel-type place. I don't want to make a mistake, but it might have been partly used also for families of patients that are visiting somebody who is sick-it could have been bone marrow transplant patients in there, but I don't think so-and they could put them there. Okay, very good. In Maryland, I think they used a Holiday Inn. There was a Holiday Inn that worked with NIH for a long time and they found a Holiday Inn that was willing to do it. In Atlanta, it was like 01:35:00impossible. I think they must have approached-first they approached every hotel, rental agency, no, no, no, no, no. Private people, no, no, no, no, no. We have at our house sort of a grandmother suite in the basement. I was like look, I'd be very happy to put somebody there, but it's not the right thing to do. It's kind of crossing a line with our agency. We did eventually find places.

Then there was the countdown. Every day we would talk to them. They want to break out, as it were. They want to get out and do stuff. In Omaha, there were all these complaints: "They only let us out for a couple of hours a day to walk around to get fresh air and exercise." I was like it's not prison. The Holiday Inn was something like that too. "I want to go shopping." At least keep six feet between you and other people. The whole time, by the way, the risk for any real 01:36:00disease with every day is becoming lower and lower and lower and lower. So to manage all of this I remember we bought a bunch of colored Peeps-pink and blue and yellow and kind of arranged them on maps and had them moving on the planes, coming over because we're nesting all these Peeps. When they flew in here to PDK, we live close to the airport. I woke up early that morning to go make sure the flight came in. It was like 6:30, I ran over there. It was really interesting. That was a pretty weird experience.

There was a lot of concern about how would this make Partners In Health look because frankly, when they went and inspected that ETU, it really wasn't up to grade if you will. Now, that's in the context of the fact that Partners In Health was volunteering to work in one of the only ETUs that an American organization had no say in how it was organized. They were helping the 01:37:00government run a government ETU, which wasn't built for the purpose of being an ETU. I think it was a school or some other building and they sort of converted it. Partners In Health couldn't dictate to the government what to do. They were there to help the government and it was a difficult balancing act. Apparently, some of the folks in the government were a little slack around how they did use PPE. So I think they were doing the right thing. They were trying very, very hard and caught in a difficult situation.

I thought it was going to be a piece of cake for two months, right? No problem. These next two months, I've got this down, no problem. And it was again, oh my God, calls at 2:00 in the morning. Why did you send them here? Why are they coming there? That was when I had the experience of dealing with angry state governments. They were like, why do we have to deal with this? We didn't choose 01:38:00to do this. It was a difficult negotiation and people were stressed out. This one state health department person-at some point, we're in a big meeting on a conference call and I'm in a room with a lot of people-like called me out as totally ruining everything or not helping and then I got this nasty-gram e-mail later about what an awful, awful thing I had done to her. I was like okay, I've got to let that one go. I don't know what her stress was, but I felt really bad. It's okay, they all did well.

We had it down to the minute they could leave. They were arranging their flights and they were at the threshold of the door. When the clock hit midnight, they were gone. It was interesting. Another one, we had one of these people who 01:39:00wasn't part of this group. Another person who was nesting, let's say, somewhere in Texas and wanted to desperately go visit her boyfriend, I think it was in Seattle. We recommended not flying. No, don't get into that one. Because they find out that you're on your twenty-one day period, the whole plane will go freak out. Let's not do that, for your good too, but maybe you can drive. Okay, but if you're going to drive you're going to be driving across these states and we're monitoring you for twenty-one days. At the time-I think this has pretty much been pulled back now-but at the time, every state health department was responsible for monitoring people in their state during this twenty-one day period. Well, she's now about to cross a bunch of state lines. So, we need to call the states you plan to drive through and arrange for them to know that you're passing through, that you're a low risk and how to contact you and where you should go along the way if you develop a fever, and you're going to measure your temperature every twelve hours, you've got to call it into this person. I mean we did a lot of extra work to try and accommodate what she wanted. Because 01:40:00it's horrible. You really feel bad saying, "We are not quarantining people." We want them to cooperate because we think it is in their best interest and some of these people see that as being very-not ungracious, but, you're just sort of saying it, but you mean something else.

Q: Oh. Almost euphemistic kind of?

BROOKS: Yeah. Sort of like oh, I'm so sorry, but really you're not.

Q: Oh, sure sure sure. Insincere.

BROOKS: Insincere. Actually, I was totally sincere. I was thinking about what if I were in that situation. My God, what would I want? Because that's how you deal with this kind of thing. You put yourself in that situation and you think, what is it I would want? What would bother me, and what would make me feel as if my 01:41:00autonomy was being respected? So we tried, we tried really hard and I think some people felt very burned, but over time, the great tincture of time hopefully calmed things down.

So I wanted to tell you those words. There was a whole new vocabulary I learned working in the EOC. They are the best people on earth. The people who work there, man, I had no idea about this talent. I had no idea we had this whole OPHPR [Office of Public Health Preparedness and Response] group that does the emergency operations stuff and how incredibly talented they were. I'm really reassured that we could really respond competently if this ever happened again.

[glancing through notebook] Some things that I had kind of heard before, not really, but "optics." What about the optics on that? Okay. "Learnings," what were our learnings here? You mean what did we learn from this? [laughs] Suddenly, turning all these words into nouns. "We're going to lean forward." I'd 01:42:00sort of heard that before, okay. Oh yeah, "Are we documentizing this properly?" Wow, that was a good one. "Has that questionnaire been culturized?" Which means that you've taken the questionnaire that we developed in the United States and tested it out on the target audience to make sure it fits. "That's not in our lane." Right? Okay. [laughs] This is a good one: "Has that document been domesticated?" Which was, have you tested it out here to make sure that people can use it? "We are doing something that is notional." So, we're kind of thinking about it, it's kind of about to be real, but we're not sure, so we're kind of exploring. It's a notional thing. "Bureaucratic purgatory," I had a lot of that. "Did you socialize that?" That's becoming more common I think. We would say something like, oh, we're developing this guideline. Okay, we need to socialize that. We need to pass that around to a bunch of people to kind of 01:43:00throw it at them and see how they're going to respond to it. To get an early feeling for it. To me, socializing had to do with something in the 20th century, it was a political movement I think.

"Let me dial in here." There was a call from the NSC and this person kept saying, "I've heard you tell me this part of the story, now let me dial in here," which means let me get a little bit more detail. "I need you, by the way, to jet something for me" or "I need to go jet something," like a jet. Of course, my first image was: is it airmail? I don't know. No, jetting means to write it down and send it off. "We need to ground-truth this." Yes. Ground-truthing means I've heard a rumor that something's happening and we need to get to the bottom of it. What's going on? We've got to get the full picture. I want the true story. Get the truth from the ground.

This is a word that's coming into the American vernacular all over the place now: "curated." It's not just a curated art show, it's like "This is my curated 01:44:00collection of jelly beans." I'm like, whatever. The way this word is being abused is pretty funny. "I have a curated data set for you." I was like okay, how is that different from a regular data set? "What is the operational tempo?" That's a good one. "Consequence management." I think that's just being prepared. Oh, this is a lovely one: "Maybe we could engage the animal clubs." What are the animal clubs? Do you have any idea? The [Benevolent and Protective Order of] Elks, the [Loyal Order of] Moose. [laughter] So, these benevolent organizations are-I guess is a term in Washington, I don't know. They're kind of as a group referred to as the animal clubs.

"I need you to turn the crank on that." Which basically means I need you to work faster or speed it up. There was a lot of football vernacular among the people at HHS [Health and Human Services] I heard. "We've got to bring this over the finish line." This kind of thing. "Oh, you better watch the tick tock on that 01:45:00one." You ever heard that? [laughter] Yeah. Or "Man, there's a lot of tick tock there." [laughter] I didn't know what was going on, but it's a term used I think among communication specialists in particular that you're under a deadline and you got to watch what's going on, it's moving quickly. Oh, "What's the suspense on that?" [laughter] You give me something and you say-I know, I thought this was crazy too! I said, "I need you to help me with something" and she turned around, "What's your suspense on that?" I was like, what the hell? It turns out "suspense" is, what is your deadline or when is it due? I would just love to know what the etymology of how that word came up.

Oh, "con-ops", concept of operations. That's a term that's actually been used quite a long time in the government, but I had never heard it before. I guess it's something in big responses. "You've got to run that to ground." Again, 01:46:00that's kind of like ground-truthing, but run to ground means you need to just test it out and make sure it works. And then lastly, "There are no audibles." No audibles means there's no changes that people are proposing. Basically, it's saying I'm not hearing anybody saying we need to change.

Q: That is brilliant.

BROOKS: Aren't there some real good ones in there? Um, did I have any in this book? I tried to write down some of the others because they were-[laughs] Oh yeah. Well this one is a little racy, but "They're cracking our ass!" [laughter] What is cracking somebody's ass? It basically means they are like whipping us, they're torturing us. Somebody once said "Yeah, we're architecting a response to this question." Architecting a response? "Preparing" is a great word. I think "writing" is a good word. [laughs] But "architecting" implies that it's a considerably more complicated process, which indeed, some of these responses were almost architected in so far as the people you had to think about, the 01:47:00constituencies you needed to pass it through. There was a whole system, by which-you want to write a message and get it out, you had to really work the system. Especially the clearances with HHS and the White House and this kind of stuff, a lot of sensitivities. I try to be a very plain English writer, but it was a great experience. I never would have learned this kind of stuff.

What other stuff do you need to know about?

Q: Tell me briefly about what happens after you're done, transitioning back.

BROOKS: So, I go back to my regular job. Oh God, this is funny. Funny you should ask. Before I went back to work on the response in March, there's a big HIV conference every year in the United States called CROI, the Conference on 01:48:00Retroviruses and Opportunistic Infections. It's usually held in the late part of January to the late part of February sometime. Last year it was in Seattle. I attend every year, big conference for me. The last day of the conference, where I was talking to people about Ebola and what it was like and what had they done. I was really interested-we had given all this guidance and I was with all of the other colleagues, many of them were infectious disease doctors in charge of this kind of thing at their hospital, infection control. So what did you guys really do? I was actually impressed how many of them had actually trotted out the PPE, had everybody try it on, talk through systems. That's awesome. I was really happy. Of course maybe I was with the cream of the crop, I don't know. But nonetheless, somebody had listened and was operationalizing it, sorry, putting it into action. Excuse me. See, I'm guilty of my own sin.

I got wind right at the last day, I got a phone call from somebody here at CDC 01:49:00and then Judy [Judith] Feinberg, a doctor in Cincinnati, also said there had been a news report about an unusual cluster of HIV infections in a small town in southeastern Indiana-I was like, oh, that's interesting-among IV [intravenous] drug users. And I go, well, that's not news necessarily. Unfortunately, people who inject drugs are at risk for HIV, so whatever. Come back to work, go through two months of this Ebola thing and as I'm getting to the end in April-actually earlier, maybe it was even March-it became evident that there was an outbreak of HIV in southeast Indiana, that to date has infected 185 injection drug users in this community of about 4,200 people. It's a very sad story, but the state health department has done an incredible job, together with some of my CDC colleagues, helping bring this under control and help the people there. I came 01:50:00out of Ebola and went right into the position of being the incident manager for this emergency response that was being run out of our National Center for HIV, STDs [sexually transmitted diseases], tuberculosis, viral hepatitis. I think I got them all in there, probably the wrong order [National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention]. It was kind of like out of that pan into another one. But it was good. I had a lot of experience.

I had a lot of experience that I could bring to the-this is the way that the whole Ebola experience helped me. One, I felt much more confident in what I was doing, speaking to the press, any of these things. I felt I could manage it. Secondly, I knew many more people across the agency that I would never have had the opportunity to meet. I know people, just because of the kind of work that I do, in the National Center for Immunization and Respiratory Disease. Some of the people at NCEZID [National Center for Emerging and Zoonotic Infectious Diseases], I'll know them. That's where foodborne is. You stay friends. But all 01:51:00these people like in chronic disease, injury prevention, emergency public health response-some amazing places, I never met these people and they are great. Now I knew people and kind of had a better understanding of the landscape of CDC. So in this response, if I needed it I kind of knew who to call. I kind of knew how to pace myself better too. What needed to be done, how to prioritize things, how to condense what you need to say in the messages you are passing up to the people above you, so that they get the information they need rather than-they get the wheat, not a lot of chaff that's going to confuse, distract them. What they need that's going to be actionable. And then just giving people rein to go. Here's what I need you to do, show me how good you are, because I know you're good. It's great. That was a great response. Unfortunately, it was tough because 01:52:00it really sapped our center, which was okay because for Ebola the brunt of that was born by NCIRD [National Center for Immunization and Respiratory Diseases] and the-Center for Vector-Borne and Emerging Infection in Water-I can never remember these acronyms. I'm so sorry Beth [P. Bell], she's going to kill me.

Q: We'll put it in the transcript.

BROOKS: We'll put it in the transcript, that's right. Sorry Beth! [laughter] So they were burned out. I think they were burned out. Global Migration and Quarantine, DHQP [Division of Healthcare Quality Promotion], man, they were hurting. We had done our part, but I don't think our whole-our center had been, luckily-we were able to respond to this, but some of the people then began to feel what it was like to work full-time at Ebola. It was very hard being in the field there too. In some ways it's a very different picture. I had the domestic experience, which helped a ton to understand the health department, that kind of 01:53:00stuff, but also understanding how you deal with what's happening with the epidemic is happening on the ground in West Africa. Now you've got this epidemic happening on the ground in a place that's, wow, a lot of layers of government and of interest in a very controversial subject.

That's what I did and now that's what I'm kind of doing. A year later, CROI coming up in February, I'm going to be giving a big plenary talk about the Indiana outbreak. So it's kind of funny that a year after I first heard about it we're kind of closing up. A whole story happened between two conferences. You just got the very beginning and I'm going to tell you what the end was. Hopefully, God willing, God willing that's the end.

Q: Well, I don't want to hold you here forever, but this has been a real delight listening to your experience. John, is there anything else-take a moment and think back-that you really want on the record. We can always add things on the 01:54:00transcript, but having things in your voice is really valuable too.

BROOKS: Sure. Yeah. So, two people. I mean, there were so many people that did an incredible job here, but I just want to say Inger Damon is an extraordinary person and we've known each other ever since I've been here at CDC. We both volunteer together at the HIV clinic at the VAs [Veterans Administration medical centers], we keep up our clinical skills. I've known her peripherally that way and her husband probably more because he used to be in hepatitis B and then was in polio. I really admire her leadership style. I think she garnered the trust and everybody wanted to work for Inger. That's rare that you feel everybody feels like they really want to work for you. I don't understand-I haven't yet under-she's just that kind of person. I'd love to be able to emulate that. I'm 01:55:00not that kind of person like she is, but everybody can find their way. She was just incredible and a pillar of strength.

And I will say I really love Tom Frieden. I'd never had the chance to work with him before. He is great. I wish I could keep as much stuff organized as clearly as he does in his head. I can see now that when you're working at that level, you're getting the inputs that allow you to keep on top of immigration law, managing IDU [injection drug use] trouble, making sure you know about this vaccination policy, dealing with this constituency group-you can do it. It seems overwhelming, but with the right infrastructure around you, you can get an organization to be successful. He's a really great guy. What I mean to say is, 01:56:00he inspires people to want to work for him and that's a really great quality about people.

Those would be the two people I'd want to make sure that's on the record. They were incredible and I really loved working-there wasn't anybody I didn't like working with. Even the people who we had to let go, they were fun in how crazy they were. [laughs] There was never a dull moment. Never a dull moment.

Q: It takes a special personality to be able to find that amusement and enjoy everybody.

BROOKS: No it doesn't.

Q: It does.

BROOKS: No no no. If you don't start to live that way, it's going to be a pretty dark day when death comes. You want to be able to stand there and when that bus comes around the corner that it's got your name on it and it's heading right at you, I don't want to be sitting there going damn, I wish I'd done that. You ought to be ready to say, well, okay, that's it. The other thing I would say is 01:57:00this is a great place to work. It's a great place to work. Sure, it's the government and everybody can give you stories about all the crap and you're probably learning now that you've got to put up with. It's slow death by training. How many, my God, how much training do I have to take? But in all the difficulty with travel and rules and rules and rules, and you can't always say what you want to say, but you have an incredible opportunity. You have an incredible opportunity to make change that really helps people and it doesn't matter how badly people may speak of this agency or what you're doing, I think you can be assured that what you're doing is intended to help people and often has a very profound impact on people. So it's a great agency to work for. I really encourage people to think about it. In this environment today, it's hard to attract talent because we don't have the highest paying salaries. It's hard 01:58:00work. You may not think about it, but a lot of people here go home at 6:30. They get to work at 8:30 and go home at 6:30. The picture of people coming to work at 9:00, taking a one-hour lunch and going home at 4:00, that's the exception. The rule is there are people here because they want to be here. That's what makes it a great place to work.

That's all.

Q: Okay. Well, thank you very much John. This has been an absolute pleasure.

BROOKS: Oops [laughter]. Rolling over the paper.

Q: Alright, I think we're done.

BROOKS: Alright, thanks.

END