San Antonio's own Dr. Rohr-Allegrini whom headed up San Antonio's flu pandemic response for the H1N1 pandemic joins The Alamo Hour to discuss what is going on locally and globally. She gives us her insight into the virus, San Antonio's response and the unknowns, currently.

Transcript:

Justin Hill: Hello and bienvenido San Antonio. Welcome to the Alamo Hour, discussing the people, places, and passion that make our city. My name is Justin Hill, a local attorney, a proud San Antonian, and keeper of chickens and bees. On the Alamo Hour, you'll get to hear from the people that make San Antonio great and unique and the best-kept secret in Texas. We're glad that you're here. Okay, welcome to the Alamo Hour. Today's guest is Dr. Cherise Rohr-Allegrini. Did I say that right?

Dr. Cherise Rohr-Allegrini: You got it.

Justin: All right. I'm joined with her and my dog Winston, in case you hear him bark, I apologize. Our guest is an infectious disease epidemiologist and consultant, has a long list, a long resume. I think one of the more important things or what I thought was interesting was you were the pandemic flu coordinator for San Antonio Metro Health District, which I think probably has a lot of overlap to what's going on right now.

Dr. Rohr-Allegrini: Yes, that's right.

Justin: We're going to get to Covid, we're going to get to how people are responding and reacting, what San Antonians should be doing to make sure they're looking out for their neighbors. First, I want to go through just a few general questions with you and get to know you. This is the first time we've met. Jody Newman told me I should reach out to you and you were gracious enough to give me a little bit of your time. Do you have any pets?

Dr. Rohr-Allegrini: I do. I have a dog, Chico, and three cats.

Justin: All right. One thing I did notice, you and I both have been where I live for Rivard Report.

Dr. Rohr-Allegrini: Right. I actually did a lot of writing for Rivard Report.

Justin: I saw that too. [laughs]

Dr. Rohr-Allegrini: It's a great series.

Justin: Favorite place to eat right now?

Dr. Rohr-Allegrini: Right now? Thai Lucky. Or there's a Chinese place on the west side, whose name I always forget. It's on Ingram Road and we go there for takeout quite often.

Justin: Is it the one behind the mall?

Dr. Rohr-Allegrini: Yes.

Justin: Okay. Kind of a younger lady who runs the show?

Dr. Rohr-Allegrini: Yes, probably.

Justin: I think Jody and her husband took me there.

Dr. Rohr-Allegrini: They go there a lot. Yes.

Justin: It's fantastic.

Dr. Rohr-Allegrini: Awesome. Yes, it's our favorite place. My kids keep asking when we can go get takeout again.

Justin: Okay, so I think you'll probably have a good answer to this. Everybody that comes to San Antonio, I always say, "Okay, you've done that but you've got to go do this." What is your sort of hidden gem you tell everybody about?

Dr. Rohr-Allegrini: Usually, it's a friendly spot.

Justin: Okay, fair.

Dr. Rohr-Allegrini: It's not really hidden but it's one of my favorite places to hang out. I often just say, "Just take a stroll along the river, it's absolutely wonderful." I love walking downtown super early in the morning, 5:00 AM, 6:00 AM when nobody's out, it's really quiet and beautiful.

Justin: Japanese Tea Gardens is one of them.

Dr. Rohr-Allegrini: That's gorgeous. Yes.

Justin: I've had a guest say Esquire Downstairs. There are some hidden gems.

Dr. Rohr-Allegrini: Right.

Justin: Other than your job or your professional involvement, which we're going to talk about, are you involved in any outside nonprofits charities that you're all passionate about?

Dr. Rohr-Allegrini: I'm involved in a lot of things, I wear a lot of hats. For a long time, I was the president, I'm not anymore but friends of Bonham Academy which is our public school, we have a foundation that supports Friends of Bonham. I've been with them for eight years or so. It's a Title I SAISD School and we've done a lot to raise funds for their programs there.

I am also the president of my neighborhood association, the Lavaca Neighborhood Association. I have been doing that for a few years, so heavily involved in urban planning issues and community issues at that level.

Justin: Your neighborhood, it sounds like everything's kind of right there.

Dr. Rohr-Allegrini: Yes. Yes, absolutely.

Justin: Any odd hobbies?

Dr. Rohr-Allegrini: Odd hobbies.

Justin: You make birdhouses, you quilt, anything strange?

Dr. Rohr-Allegrini: No. I feel so boring. God. I do a lot of things. I'm usually so busy doing different things. I've got kids so that takes up a lot of my time. I love theater, mostly to watch and memorize all the songs, I don't actually perform. My kids are in theater, so I support that. I used to play soccer, I don't anymore. I used to be a diver and I'm not anymore, but I try to do a lot of little things here and there. I'd love to tell you I have one hobby and now I don't know. I'm usually supporting my family's hobbies. [laughs]

Justin: Yes, jack of all trades- [crosstalk]

Dr. Rohr-Allegrini: That's what happens when your mom too. [laughs]

Justin: This is one of my favorites. I had a mullet when I was a kid, what terrible trend did you follow?

Dr. Rohr-Allegrini: I'm so not a trendy person. I feel like I've had the same hairstyle since 1995.

Justin: Not when you were 14.

Dr. Rohr-Allegrini: No. I'm trying to think. When I look back at those photos, my God, they're not any different. I was, "Something's wrong with me." I was never that cool.

Justin: The first guest is [unintelligible 00:04:43] and his horrible trend was he had a picked out Afro which is just funny-- [crosstalk]

Dr. Rohr-Allegrini: All right. That's awesome.

Justin: How long have you lived in San Antonio?

Dr. Rohr-Allegrini: I moved here in 2001.

Justin: Favorite Fiesta event?

Dr. Rohr-Allegrini: King William Parade.

Justin: Okay. All right. That's I think the standard now among every guest has been the King William Parade.

Dr. Rohr-Allegrini: Really? That's great.

Justin: Yes.

Dr. Rohr-Allegrini: It's my neighborhood event. I would say the fair except usually we just do house parties during the fair. I don't really go into it anymore but it's like a big community party.

Justin: My law firm is the first aid station sponsor for King William Fair.

Dr. Rohr-Allegrini: Wonderful.

Justin: Yes, yearly.

Dr. Rohr-Allegrini: Awesome, that's great.

Justin: You're the only second epidemiologist I've ever met and the first had some sort of strange interest and I want to say crop funguses, would that be right? Would that be an area of epidemiology?

Dr. Rohr-Allegrini: Absolutely, that's an area. It's a disease of plants.

Justin: Do you have any weird specific interests among epidemiology? I saw your post today about armchair epidemiologists, apparently, that's an interest but any others?

Dr. Rohr-Allegrini: [laughs] I've worked on a lot of different things and most people know me now in relation to TB, STDs or flu or respiratory diseases, but I actually started in vector biology, so diseases transmitted by bugs of some sort: mosquitoes, ticks, fleas-- not fleas, not really, sand flies. I used to work on all of those, and that's really my first love is the mosquito-borne diseases.

Justin: Is that what vector means, is it travel species?

Dr. Rohr-Allegrini: The vector is what's transmitting the virus or the parasite or the bacteria from an animal to human usually, or between humans.

Justin: We have a real problem if a really bad one starts getting transmitted by mosquitoes here in San Antonio.

Dr. Rohr-Allegrini: Yes. Dengue exists in Central and South America. We've seen a few cases pop up, coming north but not anything transmitted locally. We were very worried about Zika virus for a while, that's definitely around but it hasn't been as bad as we were worried about but it's there. We used to have malaria in the US until 80 years ago or so. Then we drained swamps and a lot of places. Washington DC actually used to be full of malaria. It has existed here before, we've just been able to get rid of it.

Justin: DDT, was that a big part of it?

Dr. Rohr-Allegrini: DDT? No, I think for the malaria mosquitoes, it was really draining the swamps in a lot of places.

Justin: Different species.

Dr. Rohr-Allegrini: Different species of mosquito, yes. DDT has helped to get rid of mosquitoes in a lot of areas but now we see resistance so we see the mosquitoes coming back.

Justin: Got you. What is an epidemiologist?

Dr. Rohr-Allegrini: An epidemiologist is a jack of all trades, really. I say jack of all trades, master of some because you have to know a lot about a few different fields but you have your hands in a lot of different things. It was perfect for somebody like me who's interested in many things. I started college as a political science major in international relations. Then I went to biology and then I went back to political science then I went into epidemiology in graduate school.

I love it because you have to understand not just the science of the disease, not just the modeling. A lot of people think of epidemiologists are just modelers, they're working on data behind a computer. An epidemiologist is actually someone that has to understand the social dynamics and disease transmission. You have to understand the culture of the place, you have to sometimes understand the history and the politics of a place.

A lot of the work I did initially was in tropical diseases, so in a lot of countries in Africa or Southeast Asia, where you really have to understand the local community and what's their historical context. Have they had a disease like this before? Have western doctors come in and told them something and that's made them not trust us and so you have to be very conscientious and work with the folks there.

You really have to know anthropology and sociology as well as infectious disease and a bit of data modeling. Although, and frankly, I like to turn to the statisticians to do the data part and then I can explain it. I let them play with the number. I like playing with numbers too, a lot. [laughs] I would say that's a little bit of a hobby. Give me an Excel spreadsheet, I'm really excited. Really, the high-level statistics I ask the statistician to do it then I can explain it in terms of the context of the community that's impacted by it.

Justin: I guess from the same perspective of like a pharmacist, you can be a retail pharmacist or you can be a research pharmacist. From an epidemiological standpoint, it sounds like you have more involvement than probably some in the government role and or response to disease, would that be fair to say?

Dr. Rohr-Allegrini: Yes. I started in academics but the people I was trained by were usually physicians who were also epidemiologists and had worked in the field. They were the ones that were doing the outbreak investigation. Some of them had done the original Ebola investigation in 1976 or Lassa fever around that same time. Those were my early professors, which was just amazing to have that experience, the real-world experience. I think that's a lot different from when your experience is based on computer modeling. One of the advantages that I had was coming to work for San Antonio Metro Health District, I came in as a quasi-academic.

I had also done a lot of fieldwork because I'd worked in tropical diseases but I hadn't done on the ground EPI locally and working for San Antonio Metro Health, I was working with an epidemiologist who was not academically trained but was really a bootstrap EPI. We butted heads a lot at first because I was this young highly educated epidemiologist. I was going to show him what to do and he would get annoyed with me. In the end, I'm so grateful for the experience I had, the mentorship I had from somebody like that, who had so much real-world knowledge of what the diseases look like and how we had to investigate it. I had learned it but I hadn't actually seen it in practice.

Justin: And they knew how it looked in a community.

Dr. Rohr-Allegrini: Exactly. It was little things like this is how you talk to that community and I knew that academically because we did study it. You often come in with this idea and you expect people to follow it and then you realize, "Why aren't they listening to me?" Because you didn't talk to the right people. I knew that in the African situation but I didn't think of it locally. I remember going with him and he's chatting with somebody and like, "Ask them the question. Come on, we need to get the information." He's like, "Just wait," and then he eventually got all the information we needed because he knew how to work, ask about the family, ask about the kids, then they're more likely to talk to you.

That happens here as well as in Central Africa.

Justin: It's so strange to think that you've got to have those skills even when it's your own neighbors, as opposed to going into a different culture and country.

Dr. Rohr-Allegrini: You do because our work is so dependent upon trust. The folks have to trust us and if they see us as this outside force, even if it's just somebody in a tie, we have to get them to trust us and so that matters to have that link. I think I had that experience because I've worked at the local level and so a lot of government EPIs have but that's different from academic EPIs who-- Some of them might have worked in that area and some of them have not.

Justin: I think my biggest exposure to it was listening to a PBS show about how epidemiologists and anthropologists went into Africa during the most recent Ebola and got them to change burial practices. How much effort that took to convince people about hundreds of years of cultural changes, cultural significance needed to be changed. It's pretty interesting.

Dr. Rohr-Allegrini: It's fascinating stuff and I'm glad you bring up Ebola because, in the '76, original Ebola outbreak, that was one of the big issues. These Western scientists said, "Okay, you need to stop burying people like this." and they were like, "Get out of here. We're not going to listen to you."

It took a long time and they finally worked with the village elders to discuss why that needed to be done. Then the village elders went and told the people and got them to change the practices and so they had to do it again in the last Ebola outbreak.

Justin: Which is crazy that we're talking about that in terms of this and I still have people that want to meet up tomorrow for drinks. We're dealing with this right now culturally, whether we want to admit it or not and we look at our neighbors and our neighbors are almost foreign people in terms of following the rules and what we know is the safe practice. Talk to me a little bit about why Covid is such a unique danger to our community and why it needs to be taken differently than what you see on Facebook of, "Hey, it's a flu. It's close to the flu." Why is this different?

Dr. Rohr-Allegrini: Flu is pretty bad, to begin with. Seasonal flu kills a lot of people every year but it has a lower case fatality rate, so 0.1% versus what we're looking at 2% to 3% of people that get it die. So already a lot more people die from it. It also has a higher contagious rate, so you're going to give it to a few more people than you are with flu. It's a little bit higher and so it's going to spread faster and it's going to kill more people overall. We're still in the early stages of that. It's a completely different virus from flu. It