Global Visitors, Local Preparedness: Dr. Laura Evans on World Cup Health Strategies

This episode of Transmission Interrupted was recorded April 24th, 2026.

Hello and welcome to Transmission Interrupted.

My name is Jill Morgan.

I'm a nurse here at Emory University Hospital in Atlanta.

For those of you not yet familiar with NETEC, our mission is to set the gold

standard for special pathogen preparedness and response across health systems

in the U.S. with the goals of driving best practices, closing knowledge gaps,

and developing innovative resources.

NETEC works alongside and in cooperation with the CDC and is

funded by ASPR, the Administration for Strategic Preparedness and Response.

So we are in World Cup prep and I am thrilled to have

with me today Dr. Laura Evans.

Dr. Evans has an illustrious history that many of you may be familiar with at

several facilities across the country.

But right now she is in this role as the Executive Director of the National

Special Pathogen System, which is just so exciting as we launch into

this idea of having Something like the trauma system for special pathogens.

And we're here today to talk about preparedness and World Cup and the

kind of pathogens we have to worry about with the World Cup visitors.

And I am thrilled to have Laura with me today.

So, welcome.

Thanks, Jill.

It's great to be here with you.

I think I'm as excited about the World Cup as anybody else, mostly to watch it.

Yes.

So, thinking about World Cup, right now we're still two months out from the first

games, but people will be coming in.

Teams and then games are scattered across the country so there's

a lot of moving parts to this.

But, we're here to talk about the parts that might impact healthcare systems.

And so what do you think emergency departments and urgent care should

be thinking about with this influx of visitors so that fans who are

coming, and of course I assume teams travel with their own like medical

teams, but who knows who's gonna be with them or who's gonna be, needing

medical care that goes beyond what their team doc may be able to provide.

Yeah, it's a great question, and I guess from my perspective as the

new Executive Director of the NSPS, and given my background with work in

a biocontainment unit back in Bellevue years ago, my lens is obviously drawn

to the infectious disease lens of it.

Although I'm not an infectious disease physician by training, but I think

anytime there is a large influx of tourism from very large geographic

areas across the world, there's probably a range of things that emergency

departments need to be concerned about.

Infectious diseases is one component of that, but anytime there's mass

gatherings, I think emergency departments go on prep for many things, right?

When you think about things that we consider like maybe a little

bit more mundane than infectious disease outbreaks, like is it gonna

be exceptionally hot in one of these areas where the games are happening?

I'm looking at the list, right?

And there's a lot of places that could be quite warm in late June

and early July in the U.S. right?

Dallas.

Houston, Atlanta, Miami.

There's lots of potential for a spectrum of things to present

to the emergency departments.

I know we're probably here mostly to talk about the infectious disease stuff,

but I think EDs are doing a ton of prep across the board for an influx

of people, with all types of potential illnesses that could present to the ED.

It's a good point that we don't wanna get so caught up on thinking

about, oh, we could get an Ebola patient, well the odds of that are super small.

But yes, people may not be familiar or acclimated to the temperature and

the humidity in some of these places, because Atlanta, I love the phrase,

which is actually stolen from a novel, Atlanta in the summertime can feel like

walking into the mouth of a panting dog.

Oh, that's very vivid, thank you for that.

It is, the moisture hits you in the face when you open the door

and you're like, ah, I can't imagine.

So I know that for instance, when we had the Olympics here many years

ago, they had these misters out.

And I was not thinking so much about infectious disease then, but now I

think, where's that water coming from?

Like, where are you misting people from?

But yes.

so we don't wanna forget the very common things.

And of course, as we mentioned, we had the opportunity to talk to Alex Isakov

about that it will be flu season for some of the people who are coming up.

So just the routine stuff is still certainly possible to see.

When we think about the countries that are coming are there pathogens

that you're concerned about?

And not just high-consequence infectious diseases, but the other things that

might be common in those countries or endemic in those countries that

people should be at least having in their list, in their mental list

On your radar so to speak.

Yes.

It's a great thing to think through, right?

Because you think about the Olympics, for example, as another

kind of correlate to this, right?

But where you're bringing people from every region of the globe you

really do have to think broadly about what are the potential things

I should be concerned about, right?

And so I look at a couple sources, right?

Because I don't think there's sort of like one single source of truth out

there for every outbreak across the globe that we should be worried about.

And so I, I look at a few different sources to try to get ideas

about where things are going on.

We have the resources of the CDC.

I'm also a big fan of the resource that Nahid Bhadelia's group at B.U.

has developed called Beacon, which is a nice conglomeration of many

news sources to look at potential infectious disease events globally.

There's a few things that come to my mind and I kind of separate them as you

do, I think, into endemic infections or things that we wouldn't necessarily

put in the bucket of a high-consequence infectious disease, but that can

cause disruption to the healthcare system and we need to be vigilant for.

Measles is an obvious one, right?

We have transmission here in the U.S. of measles, there's lots of sites

globally that have transmissions of measles, so I think measles for sure.

Not classically a high-consequence infectious disease, but boy is it

disruptive to your healthcare system if we don't have good processes in

place to identify, isolate, and inform.

I've been, I guess I'll call it the opportunity to have experienced

multiple kind of case tracing measles events through healthcare exposures,

and, I would prefer to avoid those.

They're not that fun.

So, measles for sure.

You already mentioned influenza, right?

We're gonna be out of our quote-unquote seasonal influenza season in the

U.S., but obviously regions of the world that experience different

seasonality than we do may have influenza transmission at that time.

And then I think about getting into that outside of our normal

spectrum, kind of the idea of other respiratory viruses, right?

We're certainly looking at novel influenzas and highly pathogenic avian

influenza and some areas of the world are seeing some human cases, not a lot of

human-to-human transmission, but I think it certainly should be on our differential

as we think about people presenting with respiratory illness and take a good

exposure history for where people have been, what have they been exposed to.

I think even several months ago now, where I am in Washington state had

a case of a novel influenza that took a quite a while to recognize.

Yeah.

Since you mentioned these sort of novel Influenzas, respiratory illnesses, and

thinking about people coming from other places, I know COVID we can't put in the

past tense, but when the outbreak was occurring, we were sort of all watching,

on an almost daily basis, the changes in the genome of what was circulating,

and it occurs to me now thinking about this, that we will have people traveling

with their own version of COVID perhaps.

And one that maybe we haven't seen here, or that my immune

system hasn't seen before.

So, do I also have to think about what to me has become sort of this

universal respiratory concern?

You hear somebody coughing, I mean, I know I do the mental math, right?

I'm walking down a hallway, somebody in front of me coughs, and I

hold my breath and do the math.

Can I walk through that cloud of dispersed aerosolization

before I have to breathe again?

Certainly COVID is always out there now, and it doesn't seem to have

the same waning that the flu does.

Yeah, it seems to have a little less of this very clear

seasonality pattern to it, right?

Fortunately, most of these events are outdoors.

Even probably a lot of the watch parties are outdoors, but we're gonna have

people in sort of concentrated areas.

So i think that we do have to be generally aware of our surroundings

and think about what your personal threshold is for putting on a mask

and wearing respiratory protection.

And I would certainly encourage people to do all the common sense

things, that if you feel ill don't go to the mass gathering.

Certainly wear a mask around other people.

Right.

Yes.

In the NETEC frame, right?

So of think about respiratory pathogens and I think about pathogens that may be

transmitted via contact like the viral hemorrhagic fevers, and I think there

aren't a ton of sort of current outbreaks.

Ebola is exceptionally low likelihood at this time.

There's no big outbreaks that we're aware of at this moment in time.

But there is certainly, like Lassa fever, for example, is an

endemic pathogen in West Africa.

Nigeria certainly has a multitude of cases every year.

They're unfortunately not one of the teams that is coming to the World Cup.

Certainly there are other teams from the West African region where Lassa

fever is not an unusual pathogen.

And that's why I think that that's something to bear in

mind as we're going through our preparations for the World Cup.

And I think when people in the United States think

about a viral hemorrhaging fever, or being sick with one, they

think of people being acutely ill.

And we saw terrible pictures, of course, of people dying

on the sidewalk or something.

But with Lassa fever, specifically, as you mentioned, there might be milder cases.

And you might have somebody who was feeling fine and then, by the time you

do all that traveling are eating weird food or you know, airport food and you

get somewhere you might not feel well.

And those people might have had a very mild case, unlike some of the

other viral hemorrhage fevers, Lassa seems to have, you know, some people

just have a much more mild case.

We still wanna protect healthcare workers, and we still need to think about it as

a potential, if they've been in these sort of, or come from an area where

there is, pretty constant circulation.

I know it has some seasonality as well..

Most people aren't gonna come in wearing a big sign saying "I have

a special pathogen infection", right?

And so, it really is being aware of what's out there.

It really is having good processes where people enter healthcare facilities,

to encourage patients to put on a mask if they're having illness, to ask them

the questions about where have you traveled, what have you been exposed to?

This is the stuff we learned in nursing school or in medical school, and we

just, it's harder to do in practicality than it is, in the learning environment,

but we really do need to do it.

Yeah.

The identify, isolate and form model, it sounds so easy, but in triage, you know,

it can get really busy and you're being pulled in a bunch of different directions.

I also wanted to ask you, with your NSPS hat on with this, I know that a

lot of people who use electronic medical records might have, screening built-in

for symptoms obviously, and then for travel, there might be some resources

that are built in, that help them identify where current outbreaks are occurring.

But I know that this has been an issue in the past where, in places where things

are endemic, it might not pop up as an alert, but if you've got these things

and you need to put them together in your head, even if the alert doesn't fire,

we need for you to be thinking about it.

But I'm wondering if there are other strategies for this?

Is there a list of where places are endemic or what's your best

advice on resources for that?

That's a tough one because I think you're right.

there's no great sort of single source of truth from it.

But I think, having really good adherence to infection prevention principles across

the board is probably our best protection.

Because people aren't gonna come in, saying I have Lassa

fever for the most part.

it may not flag in our travel screen, but just, being really diligent.

It's one of these things that is really hard to do in the

day-to-day grind of healthcare.

But I think it's also kind of one of the best things that we can

do, is just be really diligent overall to the sort of general

principles of infection prevention.

Wash your hands, wear a mask when indicated.

and those are probably the core way that we're gonna protect ourselves

because screening, I think, is an essential element, but screening is

probably not a perfect approach, right?

There's no way to screen with a hundred percent sensitivity and a

hundred percent specificity, right?

We're gonna miscategorize people.

Now, that's not to say it doesn't help.

I think we definitely should screen, we should use the tools that we

have at our disposal, and we should use all of our clinical training

and clinical judgment as well, and adhere rigorously to all Infection

prevention protocols and principles.

I agree because in the end, if somebody comes in with

a fever, and...if you have fever and cough, for instance, I don't

care whether it's MERS or COVID or influenza or whatever, I don't want it.

I want you to put on a mask.

I might put on a mask.

I'm gonna do some hand hygiene.

I might ask you to do some hand hygiene.

I'm gonna try to keep you from coughing all over other people.

And similarly, if somebody comes in with a fever and like nausea and

vomiting, vomiting and diarrhea, ah, I don't want that either.

Therefore, I'm going to say please, use hand hygiene.

Not only alcohol based hand sanitizer, but actually wash your hands.

And I'm not going to trust that your hand hygiene has been exceptional

if I just watched you come out of the waiting room bathroom.

Right?

I'm gonna make sure that we are taking care of those things, because

the fundamentals are still true.

If I can avoid contact with your blood and body fluids, I wanna do that.

Full stop.

Yeah, I think there's one core message that comes out of

this, right, is do what Jill would do.

That is not usually good advice.

Let me just say my mother would not agree with that at all.

In my world is very good advice.

Yes, I, can absolutely say please think about the basics.

And if you're a healthcare worker, my appeal to you is source control works.

Putting a mask on people really does help reduce what they spew out of them.

And, protect yourself.

Because the last thing we can afford to do at the 1st of June going into

World Cup events is to have a bunch of healthcare workers who are already sick

with, the new brand of whatever it is.

So, we do, not just because we want you to be at your job, we

want you to remain healthy, and that means protecting yourself.

Yep, 100% percent.

Along those lines, do you have any other advice for

people traveling around the country?

Because even if you're going to Miami for that game, which is so

important to you, you might stop in Orlando, you might go to Disney World.

If you're in Texas, you might go see all the other things

that there are to see in Texas.

Thinking about the level of alertness that other places outside of our host cities

need to bring to bear, and what advice you have for people who are traveling and what

they should do to help protect themselves.

I mean, we mentioned washing your hands.

Are there other things that you think that people should do?

That's a tough question too, right?

Because you want people to enjoy this amazing event and enjoy travel.

I mean, travel's an amazing thing to get to do and to see other places in

the country or other parts of the world.

And you want people to enjoy that and move about.

I think people in regions that don't have a World Cup event

should not necessarily feel like they're unaffected by this event.

So when we think about this from the NSPS standpoint, we have a

lot in the 10 federal regions.

Eight out of the 10 federal regions do have some World Cup event in

their region, but some of the regions are massive, geographically, right?

So it might still be hundreds of miles away from other sites within the region.

And then there are two federal regions that don't have a World Cup event in them.

And that doesn't necessarily mean that they're not going to have

impacts from this influx of visitors.

I don't wanna make this as like our only period that we should be considering

these things as the World Cup because people are always moving around, right?

Right.

Regardless.

It's not a crisis, right?

So I don't wanna use the, like, never let a good crisis go to waste adage.

But sort of the idea of using this as an opportunity to raise awareness.

Generally, the whole point of NSPS is to raise our level of preparedness

during blue skies as well, right?

That's right.

So using this as an opportunity to say, where are our gaps?

How do we do better?

We may not be around the context of a global mass gathering, like the World

Cup, it may just be through routine life that we have our next event, So,

I don't wanna focus solely on like, we just need to prepare and get through this

event, because I don't think that's the right message at, well, at all, right?

It really is about making this routine, day-to-day, getting our structure

and processes in place so that every healthcare facility across the U.S.

can do identify, isolate, and inform.

We know who to call.

We know how to get help.

We have a network in which we can hopefully move patients to

sites that have more capacity or capability for care for patients with

high-consequence infectious diseases.

And I'd love the side benefit of this to be that we have less transmission of

measles within our healthcare facility.

Right.

No, absolutely.

And I think that that's a great point because, we think about knowing what

your resources are, whether that's to help you identify what this might

be, and every small hospital across the country doesn't have to have an

infectious disease specialist necessarily on staff, and certainly not available

in your emergency room for a curbside.

But, we want you to know that there are places that you can

then say, look, you know, this is just not fitting together for me.

I'm concerned about this patient.

They might have something.

You know, knowing who you can use as a resource to say what do you think?

That can be public health, that can be your regional treatment center.

We want people to be on the lookout for these things and have a pathway

that they can then escalate that care, just as you would with something else.

If it's warranted.

And I've been telling people lately, just like you have to sort of get your

story straight and sell a neurotrauma patient, you don't just transfer

everybody who hit their head on something.

You transfer the people that are appropriate and need

that next level of care.

And so I think in this case, be on the lookout for something,

and then have it already in your head who you're gonna call.

Who's on your short list of people that you can rely on for this kind of help?

That's exactly it.

Know your team, know your resources.

Yep.

Know how to, ask for help if you need it.

Yes.

Yes.

I mean, good life skill in general.

It's absolutely true.

I mean, I think you and I had mentioned previously how important

this being prepared, even mentally, having your own list in your own head.

We'd like to think it's protocolized at your hospital.

We'd like to think there are algorithms, and who calls who.

And how do you do that?

But if you don't have that, and I get that there are an awful lot of people

interested in preparedness that may still feel like they're sort of yelling

into the void at their facility, but that doesn't mean you can't

have your own list in your own head.

I know what I'm gonna do when this situation happens.

I know what I'm gonna do when somebody calls and needs help.

I know where I will go to for assistance, and that alone can

make such a huge difference.

I think if I had to tell people one piece of advice, source control works,

yes, I want to make sure that people hear that over and over and over again.

The other thing is, I'm constantly amazed at watching people touch a lot of other

stuff in the environment and their face.

I mean, I'm grabbing a handrail and then I'm near, and then I'm grabbing the

handrail again, or I'm doing, you know; just be aware that there are cooties

everywhere and you don't wanna shove them into your eyes, nose, or mouth.

If you could just do one thing it would be like carry some hand sanitizer with you.

If you can't remember when you last used it, use it again.

Because that's the more likely route, right?

Is that I'm gonna touch something that I didn't realize was

contaminated and contaminate myself.

Yeah, and that's not related to the World Cup in any way,

shape, or form, but it's related to how do we do our jobs and how do

we establish safe work practices?

Yes, and even how we interact with our environment when

we're at these joyful events where we're seeing a lot of people and we're having

a lot of fun, but there are portalets, and crowds, and public transportation,

and all sorts of things that we're gonna be interacting with, and that

environment is gonna put us into contact with other people's natural cooties.

Gosh.

How interesting.

I am also looking forward to this.

I really hope that this ends up with a tremendous experience for the

people who come to the United States.

I hope that we are going to show out our hospitality and that people will have

safe visits and enjoy the entire time.

I hope everybody has a really wonderful time with this event.

It's one of my favorite sporting events ever, so I'm really excited

that it's local to us this year

Well, thank you Laura, so much for joining me today.

Dr. Evans joins us from the opposite coast, Washington.

She is the Executive Director for the National Special Pathogen System.

And, we really hope that you will look for the resources in your area, in

your region, with your public health.

And we will put into the show notes, the resource that Laura mentioned,

Beacon out of Boston University.

So thank you very much Dr. Evans for joining me today.

Always fun see you, Jill.

For those of you listening at home, thank you for joining us for

this episode on World Cup preparation.

We hope you'll join us for future episodes of all sorts of topics,

healthcare workers safety, and personal protective equipment, infectious diseases.

If you have questions for NETEC or ideas for future shows, please feel

free to contact us at info@netec.org.

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So thank you guys, and we'll see you next time on Transmission Interrupted.