A Tropical Medicine Meeting in Lockdown

— Reflecting on the future of conferences while "Sleepless in Seattle"

MedpageToday
A photo of the Washington State Convention Center and the Seattle, Washington skyline

The event should have been glorious. Beginning on October 30, the American Society of Tropical Medicine and Hygiene (ASTMH) held its first, in-person meeting since 2019. As 4,200 attendees from 115 countries registered, waved, and even hugged while probably wondering (as did I) if we really needed to wear an N95 mask while fully vaccinated, I felt the same eager anticipation that marked my first ASTMH huddle roughly four decades earlier.

Back then, after I had returned from London with a degree in tropical medicine under my belt, my then-medical boss in Boston kindly gave me 3 days off to fly to New Orleans and drink my fill of breaking intel on parasites and plagues. Looking back, I can only marvel at the global scourges we've since battled, the lessons we've learned, and the challenges we still face. That said, back to the meeting this year in Seattle.

My first symptoms -- a mild sore throat and fatigue, nothing more -- began during the opening keynote. I fretted, despite being riveted by a talk by Mauricio Barreto, MD, PhD, MPH, entitled "Poverty, Inequalities, Social Justice, and Health: Notes from Brazil" (which thrillingly concluded with "just-in" news of who won Brazil's presidential election). Nonetheless, since my COVID-19 antigen test read negative, I attended three more stimulating symposia the next day. The first, covering different aspects of malaria, honored the late Colonel Alan Magill, MD, a colleague who served with distinction as a clinician, researcher, and military advisor, then led the malaria program at the Bill and Melinda Gates Foundation. The second session dealt with present and future threats from ticks and mosquito-borne viruses in a "warmer, wetter" world. My final pick was an earthy dissection of failing sanitation and intestinal parasites in impoverished pockets of the rural, southern U.S. I then went to one of my favorite fetes -- the London School of Hygiene and Tropical Medicine's annual reception for its mini-U.N. of alumni -- and polished off the evening with a dinner with friends.

What can I say? Our Halloween meal of apple salad and seafood paella on the rooftop deck of Terra Plata was delightful, as was the evening's conversation shared with a journalist and Lisa Frenkel, MD, a pediatric infectious diseases specialist whose dad famously discovered the life cycle of Toxoplasma gondii. But when fitful coughs interrupted that night's sleep, I could no longer blame my disease on the hotel's arid air. Instead, a bright magenta line on a second test kit from a biodegradable bag sporting ASTMH's motto -- "Advancing Global Health since 1903" -- told an all-too familiar tale. (Thankfully, I was later able to confirm none of my friends at dinner contracted it.)

I then entered COVID-19 lockdown for the rest of the conference.

Reflections From the 33rd Floor of the Sheraton Grand

As an ASTMH lifer, I have long cultivated ways to avoid the, "Stop the madness! My brain is full!" feeling that the annual meeting can trigger, whether attended in-person or online. I simply can't get enough of the content. As a result, this year in particular, I draw comfort from my year-long access to recorded coverage of all plenaries, symposia, and scientific sessions. In my future "Of Parasites and Plagues" columns in MedPage Today, I will no doubt draw on this content in addition to breaking medical news.

But do I rue having traveled from Los Angeles to Seattle only to spend 5 surreal days and nights in self-imposed incarceration? Hardly. Simply showing up and seeing long-time friends, even out of the corner of my eye -- then receiving caring inquiries about my health -- reinforced the joy of community in an era when healthcare professionals and "workers-in-the-field" often feel discouraged and alone. As one (admittedly biased) leader wrote of ASTMH on the day of my departure, "there is no better welcoming professional home!"

This leads me to something else. Yes, the culture of medicine has changed over time; to some, lifelong allegiance to a professional society now seems passé. But throughout my years as a doctor, teacher, and journalist, my engagement with ASTMH, an ever-growing global tribe, has been an incredible touchstone and anchor.

So, what awaits the next generation? I began to wonder in lockdown. Will it be a future in which other respiratory blights slam the door on large, in-person meetings? I surely hope not (plus, I didn't contract COVID-19 at this year's ASTMH but likely before leaving home, since my husband tested positive in California the same day my test turned pink). On the other hand, today, no international society can ignore the cost and carbon footprint of long-distance travel. So even though the decision is not mine to make, I anticipate more hybrid confabs and regional sub-meetings in ASTMH's future, which both inform and connect subsequent waves of devotees.

My final insight stemming from COVID-19 lockdown was far more personal.

A Closing Epiphany

In my mid-to-late 30s, I realized that certain friends and mentors were true "collectors." Some were drawn to exquisite pens, others to old medical instruments, others to antique books. Great! I thought, at the same time concluding that I didn't share their passion for acquiring one certain "thing."

But this year's first-ever "Story Slam" at ASTMH (which I was supposed to co-moderate) reminded me that I do collect something of inestimable value, as do most of us in medicine. Hand-picked from narrative essays published in the American Journal of Tropical Medicine and Hygiene, the tales presented wove together not just dramatic events but feelings forged in sadness and joy and intimate truths about the human condition the world over.

Authentic, heartfelt stories and feelings. What a fresh enhancement to any medical gathering, whether a beloved annual meeting or an ad hoc get-together of professionals back at home. And so, feeling fully restored after 5 days of rest and nirmatrelvir/ritonavir (Paxlovid), I finally left lockdown with a renewed appreciation for in-person medical meetings and the hope of enjoying them for years to come.

Claire Panosian Dunavan, MD, is a professor of medicine and infectious diseases at the David Geffen School of Medicine at UCLA and a past-president of the American Society of Tropical Medicine and Hygiene. You can read more of her writing in the "Of Parasites and Plagues" column.