Dr. Lyle Petersen

Dr. Lyle R. Petersen

Q: This is Sam Robson, here today with Dr. Lyle Petersen. Today's date is October 17th, 2016, and we're recording in Dr. Petersen's office here in the CDC's [United States Centers for Disease Control and Prevention] EOC [Emergency Operations Center], in the Roybal Campus of Atlanta, Georgia. I'm interviewing Dr. Petersen as part of our CDC Ebola Response Oral History Project. Dr. Petersen, thanks so much for taking the time for this interview. For the record, could you state your full name and your current position with CDC?

PETERSEN: My full name is Lyle R. Petersen. My position is I'm the director of the

Division of Vector-Borne Diseases, and the last ten months I've also been the incident manager for the Zika response.

Q: Thanks so much. And Dr. Petersen, let me recite some facts I got off of CDC Connects, [laughs] if that's okay.

PETERSEN: Okay.

Q: Verify them. You got your medical training in California, right?

PETERSEN: Right.

Q: You were Epidemic Intelligence Service class of '85?

PETERSEN: Right.

Q: Okay. Came to CDC afterwards, worked first in HIV/AIDS [human immunodeficiency virus/acquired immune deficiency syndrome], and then, since then, you got a master's at public health over at the Rollins School [of Public Health] at Emory [University], and you've been in Vector-Borne Diseases since 2000. Is that--

PETERSEN: Correct.

Q: Okay. Cool. Thank you. Do you remember what you were doing immediately before your work in the Zika response? In the Ebola response? [laughter] I'm already doing it! I am so sorry. The Ebola response.

PETERSEN: What happened was, I was busy dealing with the chikungunya virus outbreak in the Americas, and I had gone to the Infectious Disease Society of America meeting there and gave a plenary talk and attended the meeting. I came back on a Saturday, and then on Sunday, was sitting there drinking coffee in my 00:02:00family room with my wife, and I picked up the New York Times and saw that there was a nurse infected with Ebola in Dallas. I told my wife, "This isn't good." Not one hour later, I got called by the EOC here in Atlanta--my supervisor, Beth Bell, who said, "Please get on the next plane and go to Dallas." So I headed off to Dallas that afternoon.

Q: What was some early information that you got about the situation in Dallas?

PETERSEN: Well, we just knew that a nurse had been infected in Dallas. I really didn't have a lot of other information--probably no more than you could get out 00:03:00of the New York Times at the time. But I knew it was quite a serious situation, and since I had had a lot of experience running emergency responses, that seemed like a natural thing for me to do is to jump into that one as well.

Q: When you talk about experience running emergency responses, are you talking about chikungunya? Or what other responses are you--

PETERSEN: Well, I've been around at CDC, it seems, probably forever at this point. Throughout the course of it, I spent five years in Germany at one point in my career, starting a German CDC. I basically ran all of the national responses in Germany for five years, and then after I came back to CDC from Germany, I was in charge of the New York City anthrax investigation. After that, 00:04:00I was the deputy incident manager for the H1N1 flu [influenza] response, and I also worked at the White House as well at that point, as far as H1N1. So I had a variety of [experiences] running large responses, and I think it was kind of natural for them to send me to Dallas, which was quite a political and very complicated situation.

Q: Can you just take it from there? What happens when you arrive in Dallas?

PETERSEN: What happened when I arrived at Dallas is that my role wasn't completely defined, and so I spent some time over at the emergency operations center that had been set up there in Dallas. I spent about a day there figuring 00:05:00out what was going on there, and then I headed over to the hospital where the nurses were and met up with the team there. I realized they were very overwhelmed, so I moved my location to the hospital as my base of operations. Talked it over with David [T.] Kuhar, who was running the response, and he was trying to do all the technical parts, and lead the team, and doing infection control, and taking care of the nurses, and trying to do the investigation, but really didn't have the bandwidth to try and run the whole response in its entirety. So I talked it over with him, and he asked me if I would take over the 00:06:00whole response so he could actually do his work with infection control and the other technical duties. At that point, I took over running the response as a whole.

Q: Were you expecting that?

PETERSEN: Yeah, I half expected it. One of the things I did not want to do is just march in there and take over without getting some consensus from the team that was already there about what needed to be done and who should lead it.

Q: Mm-hmm. When you say--I mean, you could tell the team was stressed. What kinds of things were you seeing? Were people just telling you they were stressed? Was it in the atmosphere?

PETERSEN: It was pretty obvious they were stressed. They were working very, very hard, doing a very good job, but working very hard, but there were a lot of other inputs coming into the response. The media was intense; the county judge 00:07:00[Clay Jenkins], who is the highest preparedness official in Dallas, was hanging around; the mayor [Michael S. Rawlings] was there; CDC Atlanta was calling all the time. Dr. [Thomas R.] Frieden, of course, was under a lot of pressure at that point and calling down to the team. Simply, there wasn't enough of a structure to deal with all that, so one of my first duties after I took over leading the response was set up an incident command structure at the hospital in Dallas, and brought in a lot more team members, set up a structure of team meetings and divvied the work out into teams, and also set up a physical structure there in the hospital to actually run this. One of the surprising 00:08:00things was that--and I don't blame the team there, they were just simply overwhelmed--was that--I was talking to CDC Atlanta and Dr. Frieden on a cell speaker phone on a card table there, and I thought, this isn't going to do. So I brought in some people there that could actually work and organize a whole infrastructure there in the hospital. Fortunately, they had an empty hospital ward that they were converting to offices. There was no furniture in there, but the hospital was great. They brought in furniture, they brought in phones. They brought in everything that we--it made life a lot easier.

Q: I think in my conversations with David, he's mentioned that the locations of the response before you arrived were a little bit disparate. Is that right? That coming in and actually centralizing things in the hospital was a change, was a 00:09:00big move.

PETERSEN: It was a change, and what had happened was the county and FEMA [Federal Emergency Management Agency] and others had set up [in another part of town] an incident command structure [in their EOC, emergency operations center, that] that they had used for other responses there in the county. But where the action really was at was at the hospital, and that's where a lot of the focus of activity needed to be, so we shifted some focus over from [the EOC] to the hospital. Along with me, the commissioner of health [David L. Lakey], who was at the previous emergency operations center, was spending his time there. He then moved over to the hospital as well because that's really where most of the 00:10:00actual parts of running the response itself, as far as infection control and dealing with all the medical issues and epi [epidemiology] issues, needed to take place.

Q: So you set up the incident command structure. How did things proceed?

PETERSEN: It was pretty chaotic, I have to say. There were a lot of inputs. The challenge for me was to figure out what had been done, and a part of it was that at first, there were kind of confusing and overlapping case definitions because things were evolving and things were changing, and there were a whole lot of people to follow up and categorize contacts within the hospital, but [also] contacts out of the hospital. There were about 180 contacts that needed to be 00:11:00followed up at one point or another, and there were all the issues with infection control in the hospital, there were the issues of dealing with the press, there were the issues of trying to get other hospitals to prepare the--because we didn't know how many other people were going to show up with Ebola. There were a lot of other people under investigation, just randomly, who had come back from West Africa, and then people, you know, with malaria, and the laboratories wouldn't--the hospital staff wouldn't deal with them in fear that they had Ebola. So there were all those issues. There was the White House that wanted to know what was going on, there was Atlanta that wanted to know what was going on. And then there were all the local public health officials--Mayor Rawlings and the county judge were both up for re-election. There was just a lot 00:12:00going on, a lot of inputs coming in, and it just didn't even allow any time to even try to think. The demands were just in every which direction, and so trying to develop a structure to deal with all that was a pretty top priority in the beginning.

Q: You mentioned that a couple people were running for election in an already politicized environment. What effect do you think that had?

PETERSEN: The local officials certainly wanted to look like they were out in front of it, so they wanted to be on the media. There was a constant demand for information, and one of the more amusing things that happened was that after we 00:13:00moved into our new little emergency command center in the hospital, I picked out a room with a desk and a phone, put my name on the door, and the next thing I know, the county judge had taken the next office and stuck his card on the door, the mayor had stuck his card on another door. So not only did I have to run this response, but I had all the local officials in there with me who wanted to know everything that was going on. Obviously, it was not an ideal situation, but it worked out in the end, but it was interesting.

Q: That's interesting--one of the things I've talked about with Carmen [S. Villar] here--chief of staff, Barb [Barbara J.] Marston--is that here in 00:14:00Atlanta, that process of shielding the staff from constant questions from literally everywhere was a big issue. Were you becoming that person who just took all the questions? How did you deal with all of those, I don't know, questions coming from everywhere, but you have staff who need to just do their jobs?

PETERSEN: That's the beauty of having an incident command structure, is that all these inputs, a lot of them were coming in to me, and I could triage them to different people to take care of, so the teams themselves could actually spend their time doing what they needed to get done.

Q: Can you describe some of the individuals who you worked with most?

PETERSEN: Yeah. The county judge I worked with quite a lot.

Q: This is Clay Jenkins?

PETERSEN: Clay Jenkins, who is quite a character. He's very media savvy and has a lot of connections around Dallas, really wanted to do the right thing. He was a pretty good presence there, and I think one of the funniest things that happened was, after the second nurse got infected and we confirmed her test results, it was like eleven thirty at night. We were waiting around for the test results, sitting in a room, and all of a sudden, Clay Jenkins barges in the room and says, "What do we do now?" I said, "What do you mean?" "Well," he goes, "the second nurse," and I said, "How did you know that?" And he said, "Uh, my job is to know things." [laughs] That was the atmosphere there. Mayor Rawlings is a 00:16:00very big guy--he used to be CEO [chief executive officer] of a national pizza chain, so he's used to running things. He was a pretty big presence, literally, and they had a constant need to get information because they were dealing with the public, and it was always a bit of a challenge because those two really wanted to know what was going on, minute by minute. But obviously, I couldn't spend all my time briefing them. Even when I first showed up, I set up my little office, and I was sitting in the chair, trying to figure things out, and Clay Jenkins comes in and Mayor Rawlings comes in, and they both sit down on both 00:17:00sides of me--so I was sort of trapped between them--and they said, "We need to have meetings with you four times a day." I said, "Let's see, I got two hours of sleep last night, and if I meet with you for thirty minutes four times a day, that means I will get no sleep. I think we need to come out with a better [solution] here." We did work it out to twice a day meetings, and that worked out.

I also worked with David Lakey, who was the state health commissioner, who was a really smart guy and I really enjoyed working with him. He was very hands-on and very practical, and for a state health commissioner to spend full time down there really helped because he could get things done there in the state. That was a really good person to work with. I also worked a lot with the hospital 00:18:00administration, and the senior medical staff there, and they were very supportive of what we did. Fortunately, they wanted to do the right thing, and so I had a good working relationship with them as well. They were very helpful. All in all, the people I worked with were great, and it was one of the reasons the response was so successful, I think.

Q: Are there any other challenges that you overcame, or turning points that you remember from that that really stand out to you?

PETERSEN: There were a few crazy situations. As I mentioned, there were a lot of inputs coming in from every which direction. Tom Frieden would have these 00:19:00congressional briefings, and so I'd get calls from him at 3:00 am, and he'd be asking me things. There was a lot of that. I remember about the second day I was there, everything was going on all at once. My phone was going off, people were asking me questions, and I'm trying to get my bearings of what to do. I thought to myself, this could not get any crazier than it is, and not five minutes later, the president calls me. I thought, this is really crazy. It was kind of a highlight, actually. The president did call. He just thanked everybody there for doing a good job, which I think was really a big morale booster because the team was under a lot of stress at the time.

Another crazy thing I had to deal with was the press. There were literally news 00:20:00helicopters flying around in circles around the hospital all day long, and a lot of the national press had parked out at the same hotel that I was staying in because it was the closest hotel, so there was absolutely no getting away from them--and I could not even eat breakfast without having to watch what I said because I was surrounded by reporters in the hotel. Going into the hospital--I had to sneak in through a lower parking deck into the hospital so I wouldn't get accosted by reporters when walking in. It was just a very intense situation.

Q: Was it like that for the entire duration, the entire--I don't know--few weeks that you were there?

PETERSEN: I was there for several months.

Q: For several months!

PETERSEN: But it was not like that the whole time. The hospital had a desire to take care of the nurses in the hospital itself. By then, the infection control was well worked out, things were going pretty well. The hospital said, these are our nurses. We want to take care of them. They certainly had the ability to do so there. But things were just so crazy with the media, I basically told the hospital administration, you need to get this beyond you so you can recover. You're not going to be able to recover with all of this going on. At that point, we made the decision to send both nurses--one to the NIH [National Institutes of Health] and one to Emory [University Hospital]--to finish their care there, 00:22:00which immediately calmed down the situation tremendously. The news story had gotten away from the hospital at that point. That, I think, was the right decision, and that way the hospital could recover, the nurses were at units that were designed to take care of Ebola patients, and we could focus on other activity, such as the tracing of contacts and getting other hospitals in the area prepared and the like.

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