UI College of Public Health alumnus Aaron Reinke (19MPH) joins Alexis and Steve to talk about his experiences at the Black Hawk County Health Department in eastern Iowa and discuss what it’s like as an epidemiologist – especially a relatively new one – at the local level during a global pandemic.

Alexis Clark:

Hello, everyone. Welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Alexis Clark and I’m joined today by Steve Sonnier. If this is your first time with us, welcome. We’re a student-run podcast that talks about major issues in public health and how they are relevant to anyone, both in and out of the field of public health. Today, we’re delighted to talk with University of Iowa CPH alum, Aaron Reinke, who obtained his MPH in epidemiology in 2019. He currently serves as an epidemiologist at Black Hawk County Health Department. Thanks for coming on the show.

Aaron Reinke:

I appreciate you having me on. I appreciate it.

Steve Sonnier:

So, Aaron, can you tell us a bit about your path into public health? How did you end up in your current role at Black Hawk County Public Health?

Aaron Reinke:

Yeah, so I began my education at The Iowa State University and I was majoring in biology and I took the pre-med route just because I didn’t know if that was something I wanted to do, but I wanted to cover my bases a little bit. But I didn’t really know what I wanted to do with biology and really, I didn’t know what I wanted to do until my last year. I just happened to come across a talk and it was an ambassador from the WHO and he was talking about polio, smallpox, and really all the initiatives that the WHO was doing. I realized, “Oh, wow, I really like infectious disease. I really like seeing all these different efforts going on throughout the world.” So then, I took a virology class and it was a lot more in-depth about the specific diseases and I really liked that, but I wanted to do more than just study and research disease.

Aaron Reinke:

I wanted to see more about how they spread and everything. Then my professor was like, “Oh, that’s epidemiology,” and I was like, “What is that?” So then, I learned about epidemiology through just random chances and then, I saw that the University of Iowa, they had a program, an MPH program, and then I went for it and I knew I wanted to do infectious disease. I studied a lot of pandemic stuff and that really got me excited. Then, throughout my grad school experience, I was focused on the infectious diseases, so I didn’t really branch out until really the last semester. But then once I graduated, I didn’t know really what I wanted to do, but I knew that I wanted to get my hand in a bunch of different pots.

Aaron Reinke:

So what I did was interned with the workforce development piece, so the Midwestern Public Health Training Center and that was something that I didn’t know if I would like, but I really enjoyed that piece too. Then, I also did work with emergency preparedness at the State Hygienic Lab. Again, I really liked that and it was something that I didn’t initially think that that was going to be my focus, but throughout my grad school education, I realized that I needed to start branching outside specifically infectious disease and I fell in love with both of those. Then I found out local public health really does all of these different things. There’s a bunch of stuff that I learned in my MPH program, but I didn’t know about until really, I started working in these different fields that this actually encompasses epidemiology at the well, so then I landed here in Black Hawk County.

Alexis Clark:

I think most of us don’t really know what epidemiology is really like, just like you did until a professor had brought it up to you. So what does your current role look like on a day-to-day basis?

Aaron Reinke:

So COVID really changed my schedule a lot. So at first, it was really just understanding the different scopes of our community health initiatives, as well as the different data sources that I would need to be pulling information from. I would need to be creating myself by doing surveys, really just getting the idea of the community and what we’re working for, like equity issues, issues to do with just the community at large, the outside of infectious disease because when I started on, the main focus was really these initiatives outside of infectious disease. So really only 10 to 15% of my job as an infectious disease epi was really focusing on doing those investigations with the reportable diseases in Iowa, and then COVID hit.

Aaron Reinke:

Then that became like 25% of the time and then it became 50% of time and now it’s like 120% of the time that I’m [inaudible 00:05:09]. So it’s one of those things that it changes depending on what initiatives are happening in the community and, really, what outbreaks are happening because, 10% of the time, really took up a lot of time when there was an E.coli outbreak or a flu outbreak outside of this. So, really, when I come into the day, I am working on managing all the different COVID investigations. I’m cleaning data through the early mornings and then I update the different numbers on all of our websites and then just create the different graphics that we use, post them on our websites, post little things on our social medias.

Aaron Reinke:

Then, from pretty much then on, it’s vaccine planning. Sometimes, there’s different days, like Mondays and Wednesdays are very heavily vaccine planning as well as Fridays. But the Tuesdays and Thursdays, I have a little time to focus on all the other things that we’re doing outside of COVID, so like community health planning and equality improvement projects. Emergency preparedness is a huge thing that we do every Tuesday and then communication meetings, going through all the different things, like are people taking away what we thought we were; going through the chronic disease grants that I’m part of, so all the fun stuff outside of COVID really doesn’t happen until I finally get free time.

Steve Sonnier:

It seems like it’s a Jack of all trades kind of thing. You’ve got to be ready to respond and do everything in that role.

Aaron Reinke:

Exactly, and it’s really different depending on what, I guess, epidemiology you’re focusing, are you doing local level, state level, or federal level? So I’ve seen that state and federal is a lot more of looking at the data and then also, seeing if it needs to be cleaned, seeing is there more stuff that needs to be gathered, but also, doing data analysis a lot. Then at a federal level, it’s almost purely data analysis and making those guidelines for every state to look at and then create their own. But at the local level, you’re really gathering all that information rather than doing it yourself. You have a little bit of stuff that you can do. You can make surveys or you can do some initiatives with infectious disease. You can look at the data and see if there’s any particular parts in your county, but it’s really small, so you can’t really post a lot of that information outside of internal use to be able to start these community health projects.

Steve Sonnier:

You talked a little bit about how vaccine planning is going and that’s obviously a big concern right now. What does that look like in your role? What kind of bit piece do you play in the whole vaccine planning, especially in Black Hawk County where there’s considerable concern about COVID-19 spread as there is everywhere in Iowa?

Aaron Reinke:

Yeah. So at first, I was really mainly focused on maintaining operations, so the COVID investigations stuff. Then, I slowly get pulled into when we need to have more people involved in the vaccine planning. So now, we have internal meetings before we really take what we’re going to do with the vaccine allocations that we’re getting. So everything’s really moving so fast, so we’re responding like you said. So then, what we were doing a month ago was very different than what we’re doing today and it feels like our process is so streamlined now compared to what it was back in the day that it’s almost impossible to think that we were doing that. That would just take so many man hours to finish. Essentially, what I get pulled into, the discussions internally, and then more now on our health partners that are producing the vaccines. Not producing, but giving the vaccine and then how we’re going to do that.

Aaron Reinke:

So we have the homebound population is a good example, is we can easily get all these individuals who are 64 and younger with underlying health conditions. We just open up these pods that say, “Just contact this person, schedule that,” and then you can get it scheduled. But the individuals who can’t come in or the individuals who don’t have access to the internet, so all these equity issues that we need to have in the front of our mind, those are those internal planning. Then, when we take those ideas, and then we see, “Is this possible in this clinic setting to do this? Are we still going to be able to get through our throughput of 80% of the vaccines in arms throughout the week?” So then it’s all these like different dynamics going back and forth, so just being part of those conversations is really where I’m at.

Alexis Clark:

You graduated in 2019, so that’s a fairly quick turnaround before COVID happened. Looking at moving directly from being a student to being immersed in combating this pandemic in Iowa, what was that like?

Aaron Reinke:

It was quite a transition. I think it was really when I first started, I had about three months where I didn’t really do COVID stuff. Those three months, I feel like now the grad school program really prepared me for what I should expect out of a local public health. But then when the pandemic came, it was really a lot of just response rather than planning and then using data to plan and then do those efforts, it was a lot of, “I have this data and now I have to figure out, within a day, how to use this data effectively, but also make sure that it’s clean, that it’s telling the story that we want to tell.” So it was a lot of immediate responses that I was more prepared for taking my time to look at and go through things and make sure everything was perfect before we started going. So now it’s like making sure it’s perfect immediately, so …

Steve Sonnier:

What does that transition look like when you’re trying to go from, we talk about evidence-based policymaking a lot of the time or evidence-based epidemiology too, and going into this novel situation, I’m thinking, number one, how does it affect you when you’re trying to figure this out as a young career professional? Then, number two, how does it affect how you interact with the public? That’s another key part of public health as the outfacing component that you do. How do those things overlay?

Aaron Reinke:

Really, in the beginning, I was a new professional, so I wanted to get my hands on everything. I wanted to do everything. I was excited, so I had all that energy. So then I was really, I guess, primed and ready to respond in that way. I feel like if I was in my career 10 years down the road, I might be a little bit more jaded. I don’t know if I would want to respond so quickly to things and do that, but then, I guess with the transition of communicating to the community, that was something that I never really did outside of my volunteer experience. I did work with crisis intervention at community there in Iowa City and that helped me talk to people, but to actually communicate the issues when there’s, I guess, all this disinformation going around, but also good information and then there’s information in between. There’s just information overload, essentially, so being able to communicate.

Aaron Reinke:

I’m usually not the best communicator. I like to talk about things and then my mind just wanders and then I have to rope it back in and then talk, so learning that on the fly was difficult. But there’s a lot of communication going on right now to make sure that when people are calling us that we’re able to tell them the same things or we’re able to tell them something that is understandable in a way and dissect the information that’s out there and lay it in front of them. So then they know what is actually happening instead of it being an issue that was posted maybe on Facebook and they’re saying, “Well, this person said this,” and having to be in tune with all the things that are happening in the community.

Aaron Reinke:

Say someone got the vaccine and now they’re a leader in the community and they said, “This is how it happened and it was awful and don’t do it,” and then just having to work with that leader, but also with the population that follows that leader, like how are we able to communicate with them, but also understand if someone like that was talking to me, if I was following a leader, I would feel that way too and giving that empathy piece and just understanding we’re all part of the community, but how do we make sure that everyone’s on the same page? So that was that outward mindset that was thrust upon us in this because we have to make sure that we’re communicating in a way that people understand us. So otherwise, we’re just talking to the wall and we’re not going to get anything done.

Alexis Clark:

Can you give some advice to other students who want to pursue a similar career to yours?

Aaron Reinke:

Yes. I would say, really, depending on what you want to do after school, try to intern or at least volunteer in places that you normally wouldn’t think for your major. So I did emergency preparedness and workforce development and those were two things that I didn’t typically think that epidemiology would do, but there’s still a lot of data. There’s a lot of, I guess, things that you can take from epidemiology and put it into those perspectives to give a different lens on what you’re doing. It’s really helpful to understand, also, people who are in preparedness who are thinking like this, “How can I take that and bring it back to epidemiology?” Really, don’t underestimate the volunteer experience that we have. I talked about the crisis intervention. That helped me dramatically, like de-escalating so many volatile conversations because when people are calling us, they’re very upset or something happened in the community that they are not trusting of the government.

Aaron Reinke:

Then, when you’re sitting there and you’re that representative, you want to make sure that you’re helping them, but you’re also want to make sure that you’re treating them as like a person. They’re very frustrated, but they, they want to talk about something, so that helped me. I didn’t think that was going to be something that I’d use on a daily basis, but I definitely use that a lot, but also, I guess the not really volunteer, but sitting in on lab meetings. So there’s a lot of lab meetings that are happening on campus, so I did a sit-down with Dr. Peterson’s lab, because I was really interested with infectious disease, but I didn’t really work there. I just sat in every morning on their lab meetings and just learned a lot about what immunology was happening on our campus, but also infectious disease. Really, I still take some of that stuff that I learned with that today.

Steve Sonnier:

Can you talk about more about the emergency preparedness aspect? That’s something that, in my head, I don’t think of epidemiology going there. I think of epidemiology as data, statistics, infectious disease modeling. When you’re talking about the emergency preparedness experience you had, what was that like? What did you gain from it?

Aaron Reinke:

It was very different than I was working with. I wasn’t working with data, like you’re saying. I wasn’t doing modeling, but it’s really heavily influenced by disease and epidemiology, but also, outside of disease, disasters, so just response. So when you’re at a local level, you’re going to be having your hands in everything and outside of infectious disease, preparedness is a huge piece of what epidemiologists would be expected to do. So having that experience at the State Hygienic Lab of going through the different exercises and seeing the tabletop exercise, it was actually for the pandemic influenza is what I did my capstone project on.

Aaron Reinke:

So I was like, “Oh, I’m ready for this.” Everything’s already laid out. There’s plans already and you’re taking some of that piece of that preparedness and then you can bring it to epidemiology. You know this is how reportable diseases come in. This is how the preparedness is going to respond. Do they mesh or are they conflicting? Then, you can see, and is that really congruent with what’s going on in the preparedness aspect? Because it seems like everything gets siloed, the more busy everyone gets, so then you can’t always communicate with the preparedness individuals who are doing the emergency management or the hospitals. So you have to understand what they’re doing on the backend, so then, that you can develop policies and things that will work with them as well.

Alexis Clark:

I think it’s ironic that your capstone was in regards to influenza planning and then you got thrust into COVID planning. Would you say pandemic planning is your favorite aspect of public health or public health issue or what gets you energized about coming into work every day?

Aaron Reinke:

Definitely the pandemic response was my number one reason why I wanted to go into public health in the first place and it got me really excited. I studied it in undergrad. I also studied it through grad school and then, my capstone project. So I thought going into this pandemic, “Oh, we have all these plans. We’re ready. It’s all laid out,” and then COVID just kind of threw all that out the window because everything that we planned is really for influenza and that’s a very different virus than COVID. So we know what we would do with influenza because it’s already in our areas. We get seasonal influenza all the time, but then a pandemic, influenza is just a little strain of that; whereas, a novel coronavirus is a completely new virus and we’re going to be testing it to see where it’s at pretty much at all times.

Aaron Reinke:

We want to know where it’s at. It has a very different incubation period, which was really stressful and a lot of people compared it to the influenza, which is only within a week rather than two weeks. So we really had all these plans set in place for influenza, but then, I don’t think we were really truly prepared for what COVID could do, which was very different. It also presented in all these different ways. You could be completely asymptomatic and you wouldn’t even know, and that’s kind of a different feel than when we think of flu. We think of, “Oh, you’re completely under the weather.” You know when you have the flu, especially like a pandemic flu. You’re not coming into work. Whereas, if your employer is like, “Well, we don’t know if you have it or not. You just have a sniffle,” and then you come in, then you’re potentially spreading COVID all over the place.

Steve Sonnier:

It’s a big whack-a-mole game, it seems like. It’s trying to figure out what intervention works past and having such a wide swath of the population you’re trying to take care of, there’s no one-size-fits-all solution, make it easy, let’s figure out a path forward. I imagine that’s incredibly hard.

Aaron Reinke:

That’s actually, I think, what’s energizing me now is these issues with equity, is that, I’d say, half my day is COVID planning, but in a sense, really there’s those super easy ways to get something done. You just say, “We’ll just schedule everyone online and then we’ll send everyone to these different places.” But then you start thinking, “Well, what if someone doesn’t have the internet access, or what if someone doesn’t even know how to use these scheduling platforms, or what if they don’t know how to speak English?” And all these different pieces that are coming together.

Aaron Reinke:

How do we reach these populations because COVID doesn’t just go after the people who use the internet and know how to schedule a clinic? So it’s going to be in our community everywhere, so how do we make sure that just because you don’t have these resources that you’re not getting the care you need? That’s a very large portion of vaccine planning is making sure that we’re not missing populations and if we are, who do we need at the table to make sure that they’re able to show us, “This is what you’re missing,” and that’s a big piece that makes me excited now. It’s like, how can we help everyone rather than a big portion of our population?

Steve Sonnier:

To round us out with that equity piece, one thing we always ask folks is, what’s one thing you thought you knew, but were later wrong about? When you’re going into those stages right now, where you’re at with the vaccine planning, and this is, again, still a novel situation, what do you think you went in expecting and it was just completely different?

Aaron Reinke:

I would say really when everything was coming through, COVID was over and the Asian area and then I started going to the European and then we were all looking at everything like, “How is it over there? What are the age groups and how is it spreading? What is the incubation period?” Learning all about this disease and then where it would affect people the most. Then we were spending a month-and-a-half, every day, we were out in the community doing education. I felt like I knew almost everything about COVID at that point. My day and night was just COVID. Even my social media posts were posting COVID information to me and it’s like, “I can’t get away from it.” I still feel like that, but in the beginning, it was just so much information. Then when it came and it finally hit, it was like we thought we had everything planned. We were setting everything in motion and then it just was so different.

Aaron Reinke:

Even if you look at how it spreads, like we thought we would go into it and then it would spike up and the May-June and then it would slowly go down in the summer. We thought we’d have a break through the summer and then it would just be a monster in the winter and there was no break at all. It was just constant doing everything. I feel like whenever you think, something about COVID and how it’s going to be next week, next month, next year, you don’t know. It just likes to switch everything up and I guess it really humbles me in that aspect, because that shows me that I have a lot left to learn, not just in pandemic response, but just how our community works and functions because we also are talking and there’s all these siloed approaches, but we’re also vaccine planning all the time. So I’m communicating with the community leaders all the time now, every day. I guess I was wrong about how COVID was going to happen.

Alexis Clark:

You were wrong, but I think the mass majority of people were wrong about COVID. [crosstalk 00:24:18] So I think it’s really awesome to hear from your perspective, as an early careerist, and especially as a college of public health alumni, we love having alumni on the show. So thank you again for taking the time out to talk with us today on From the Front Row.

Aaron Reinke:

Thank you. I appreciate you guys having me on.

Steve Sonnier:

That’s it for this episode of From the Front Row. Big thanks to Aaron Reinke for coming on with us today. This episode was hosted and written by Alexis Clark and Steve Sonnier. This episode was edited and produced by Stephen Sonnier. You can find more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts and SoundCloud. If you enjoyed this episode, please share it with your colleagues. Our team can be reached At cph-gradambassador@uiiowa.edu. This episode is brought to you by The University of Iowa College of Public Health. Keep on keeping on out there.