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Real-life Outbreaks: Sorrow and Statistics

Posted By Lauren Reeves, Friday, August 29, 2014

This week’s post is the second in our series of posts about Deadly Outbreaks, a book of real-life outbreak mystery stories. You can purchase a copy of Deadly Outbreaks by author Alexandra Levitt at

Epidemiologists who investigate outbreaks often use their findings not only to control disease but also to prevent future outbreaks once the immediate emergency is over. For example, in the aftermath of an outbreak that occurred at a Toronto hospital during the 1980s (described in Chapter 3 of Deadly Outbreaks), the investigators recommended extensive changes in how hospitals dispense drugs and how they use mortality data to monitor and improve hospital care. Although public health experts had been advocating these improvements for some time, the experience at the Toronto hospital—which involved drug overdoses and a long lag before a problem was recognized—demonstrated their importance in a dramatic and unequivocal way.

Here is what happened in the outbreak story entitled Sorrow and Statistics:

In 1981, thirty-four babies at the Hospital for Sick Children in Toronto died from apparent overdoses of the heart medication digoxin. Although a judge dismissed murder charges against a nurse who had been on duty during some (but not all) of the deaths, the police continued to claim that she was guilty, while the hospital’s doctors insisted the babies had died of natural causes.

With the hospital under a cloud of suspicion, the hospital authorities called in outside help, in the form of an Epidemic Intelligence Service (EIS) officer from CDC. On his arrival, officials from the Ontario Ministry of Health introduced the EIS officer —James Buehler—to two experienced Canadian colleagues who served as members of his investigative team.

Buehler understood from the start that there was uncertainty about what they might be able to accomplish. As recorded in Chapter 3 of Deadly Outbreaks [page 63]:

“What could the medical detectives do that the…doctors and police had not already done? The doctors had focused on the details of each baby’s illness, finding a natural reason for each death. The police, on the other hand, had focused on a particular suspect, seeking legal evidence to build a case against her. The epidemiologists viewed the evidence from a different angle. Unlike the police or the doctors, they looked at all of the deaths at once, as part of a single mission, trying to figure out what all the cases had in common—somewhat like an FBI analyst examining deaths linked to a single serial killer. However, unlike the police or FBI, they were not concerned with legal issues or with questions about human guilt and motivation, and unlike the hospital staff, they bore no personal responsibility for the babies’ welfare. They did not interview the nurses or meeting with the victims’ parents. Thus, they were emotionally removed from the tiny victims and perhaps better able to analyze the data in a dispassionate way, using graphs and statistics—“people with the tears wiped away” as the EIS saying goes. Another way to say it is that they ignored the horror behind the numbers and plunged on, wherever the data would take them.”

James Buehler and his team, working as unobtrusively as possible at the troubled hospital, used epidemiologic data to confirm that a significant rise in the infant death rate had actually occurred on the hospital’s cardiology ward. Then they proceeded to collect hypotheses and rule them out, one by one, until only one was left….

Tags:  Deadly Outbreaks  infectious disease  outbreak 

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