L0025222 Plague doctor
Credit: Wellcome Library, London. Wellcome Images
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Plague doctor: ein Kleydung under den Todt.
Aesculape
Published: 1932
Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

By Kristine Hansbery
Director of WSLH Proficiency Testing

With the recent Covid-19 outbreak our nation is realizing the importance of having a strong public health presence both to avert disaster and protect the wellbeing of our public. During these tumultuous times I am reminded of the words of Jon Snow from Game of Thrones, not to be confused with the “father” of epidemiology, John Snow. However, the John Snow of public health would probably agree with the Game of Thrones Jon Snow, that “There is only one war that matters. The Great War. And it is here.” Yes, the fight against the Coronavirus has become our great war and it is indeed here.

So, why is public health such an important part of this war against the pandemic? Using a historical lens, we can better understand the important role public health labs play in supporting clinical labs in this fight.

Tracing the conceptualization of “public health” and how it has translated into actions in the United Kingdom and the United States can illuminate the important role public health labs play in supporting clinical labs. In particular, the role of public health labs today in providing statistical analysis and reporting to prevent and respond to epidemics is salient to elucidate historically.

John Snow, the father of epidemiology, first made his mark on disease prevention with the “Broad Street pump.” In late August of 1853, cholera broke out in the Broad Street area of London. Snow believed the outbreak was linked to the communal pump located there. To prove his theory, he tracked and recorded incidences of cholera in and around the pump. This was the beginning of using statistics to define disease patterns so interventions could be performed.

The rise of epidemiology and subsequent interventions to stop the spread of disease, gave rise to the creation of government entities who could implement and enforce such mediations for the overall health of the public. The first public agency for health in the United States was the New York City Health Department, which was founded in 1866. This event in history marked the very beginning of the concept of “public health” in the United States. At the end of the 19th century, newly established state and local health departments in the United States began to establish laboratories to develop and apply the new scientific knowledge. (Winslow, 1923)

The early part of the 20th century in the United States saw the creation of federal programs of disease control, research and epidemiology, including the establishment of the Communicable Disease Center in 1946, now known as the Center for Disease Control and prevention (CDC). During this time, state and federal passed regulations to incorporate the concepts of sanitation and disease control using the scientific findings of public health labs.

Today, public health labs all over the U.S. work together under the CDC’s Laboratory Response Network (LRN) in order to quickly and efficiently respond to emerging infections and other public health emergencies. The Wisconsin State Lab of Hygiene (WSLH), which is the home of my organization WSLH Proficiency Testing, works closely with the CDC to provide reference and specialized testing services. Currently the Communicable Disease Division of WSLH is providing validations to help prepare clinical laboratories for Covid-19 testing.

What this dive into the history of public health has taught us is that the rise of epidemiology may have provided the foundation for public health, but social values, including community intervention and health goals, have brought about its system as we know it today. Collaborative partnerships and networks between public health labs and clinical labs will need to continue to grow to adapt and respond to today’s challenges in maintaining the health of our communities.