Dr. Angela Campbell is a Medical Officer at the Centers for Disease Control and Prevention and lead of the Multisystem Inflammatory Syndrome (MIS) Unit of the COVID-19 Epidemiology Task Force in the Respiratory Viruses Branch of the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases. Dr. Campbell completed her medical degree at Vanderbilt University. She trained in pediatrics and pediatric infectious diseases, and completed an MPH, at Seattle Children’s and the University of Washington. Dr. Campbell first worked at CDC as an EIS officer, followed by several years in academic medicine in Seattle, before rejoining CDC in 2013. She is also an Adjunct Associate Professor of Pediatrics at Emory University School of Medicine and has a Professional Staff appointment at Children’s Healthcare of Atlanta where she cares for patients as a hospitalist and infectious disease attending.
Dr. Kris Bryant recently had the opportunity to speak with Dr. Campbell about her career path and her current work at CDC. This interview has been edited for length.
Why did you choose a career in Pediatric Infectious Diseases?
I’ve always loved science and I attribute that in part to really excellent teachers and mentors, even going back to high school where one amazing woman taught me biology, chemistry and physics. I actually chose my undergraduate college because it had great programs in science and music, and I knew I wanted to do both. I did a summer research program at Vanderbilt University between my junior and senior year of college and really enjoyed it.
I have had remarkable mentors all along the way, and that’s what led me back to Nashville, initially for graduate school at Vanderbilt University and then ultimately to medical school there. So as a grad student and as a med student, my inspirations for my career in pediatric ID were the role models I had, including Mark Denison, Peter Wright, Terry Dermody, and Kathy Edwards.
I’ve also always been fascinated by respiratory virus infections. This is an example of a crazy circle of life thing because I worked on coronavirus polyprotein processing in Mark Denison’s lab before medical school. Then I did pediatric residency and after that, EIS (Epidemic Intelligence Service) at CDC where I was in the Respiratory and Enteric Viruses Branch during the first SARS pandemic. We wrote all sorts of protocols evaluating transmission among family members and healthcare workers. Now here I am back at CDC in the COVID-19 response for SARS-CoV-2 and the COVID-19 pandemic. So, it’s full circle.
Before we move on to talk more about your career, you said you chose your college because you wanted to study both science and music. Are you a musician?
I played clarinet in Concert Band all through college, and I sang in the Collegiate Chorale. I was in a women’s acapella group in medical school – the Biorhythms – and now I sometimes sing in the worship band and choir at church.
Do you still play clarinet?
When we moved from Seattle I took the clarinet to a music store and donated it because I thought it was unlikely I would ever pick it up again. Sometimes I wish I still had it. Maybe I can live vicariously through my rising 6th grader who is about to start band.
You did two years in the Epidemic Intelligence Service at CDC between your pediatric residency and your pediatric ID fellowship. Why did you do it and what would you say to someone who is considering that?
I was really influenced by great people during my residency. I thought about an ID fellowship and I thought about EIS, but I had some great mentors in Seattle who had done EIS and, at that time, no clear pediatric mentor in ID. For me, it seemed like the best next step to get exposure to the larger world of public health. It also seemed that it would close no doors if I wanted to do an ID fellowship afterwards. For me, that was the right direction.
Ultimately, you were lured back to Seattle to do that ID fellowship. Can you talk about how that happened?
A love of respiratory viruses and the right mentors! While I was in Atlanta, Janet Englund moved to Seattle and that gave me a pediatric ID respiratory virus mentor. Michael Boeckh was also there – he’s an adult transplant ID physician who works on respiratory virus infections in immunocompromised patients. As a resident at the University of Washington, I had done a research project with him on respiratory syncytial virus infection before hematopoietic stem cell transplantation. When Jan moved to Seattle, I had this perfect combination of mentors from the adult and the pediatric worlds who studied respiratory viruses.
After fellowship, you were on a traditional academic career path as a faculty member in Seattle. What prompted you to make that change and come back to CDC?
It was a combination of life and circumstances, both personal and professional. By then, I had a family, and the Southeast was always a place we thought would be a great place to settle and got us closer to family. The other reason was that I had an opportunity to come back and bring my training and preparation to the Influenza Division where I got to work on really clinically relevant questions related to influenza antiviral treatment and effectiveness and also influenza vaccine effectiveness. So, it was a combination for me of timing and my background being a good fit for the right opportunity.
At CDC, part of your job was pandemic preparedness. Did that prepare you for 2020? What did you find surprising about this pandemic relative to what you had planned for prior to the emergence of SARS-CoV-2?
I think it probably prepared me to stay calm and to know what to expect in the larger pandemic response structure at CDC. When I was an EIS officer for the first SARS pandemic, the Emergency Operations Center activated. After I came back to CDC, it was activated for H7N9 influenza, and then again for MERS (Middle Eastern Respiratory Syndrome). I had been involved a little bit with each one of those responses. We had specific pandemic exercises all along the way. I think the preparedness helped me to know what to expect.
But there were also a number of surprises. In our influenza scenarios, I don’t think we ever reached all the challenges at once that we have in the past year. In the flu scenarios, we never had to deal with having no specific antiviral medications, no candidate vaccines initially, the mask shortages, the presentation of severe clinical illness, particularly in adults, and then transmission driven less among children and more among adults.There are many things about this pandemic that were and are challenging.
I still think the preparation helped us to expect curveballs—and there have been so many along the way. I do think if I had thought about it, I wouldn’t have been surprised that a coronavirus might do this because SARS and MERS showed us the potential for emergence of a new virus. The preparations for a flu pandemic were typically agency-wide and involved people from all different centers and divisions, just as this response has. It did make us well suited to pull in experts across the agency to work together.
Tell me about your current role at CDC.
The last year has brought some changes to my role. Last summer I was asked to lead a team of physicians and epidemiologists focusing on multisystem inflammatory syndrome, a complication associated with COVID-19 seen largely in children, but now also recognized in adults. I think it’s probably best to call it an MIS unit rather than MIS-C unit.
Early in the pandemic, the entire flu division was deployed and is still mostly deployed to the response, so it was sort of a natural transition for me. I have a core group of incredible people working with me on questions related to MIS-C and MIS-A. We oversee national MIS-C surveillance and MIS-C and COVID-19 surveillance through a multisite hospital network called Overcoming COVID-19.
From your perspective, what is the biggest unanswered question about MIS-C?
There are many, so I don’t think I could say there is just one big, unanswered question. MIS-C appears to be caused by a dysregulated immune response among people with SARS-CoV-2 infection, even if that was an unrealized, asymptomatic infection. But we really don’t know what antigen triggers this immune response or what drives the immune response the most. We also don’t know what additional factor in addition to SARS-CoV-2 infection, such as genetic predisposition or environmental exposure, leads to a person developing MIS-C. So, we’re actually working to answer these questions right now with some of our studies.
There also appear to be different phenotypes of children that meet the MIS-C case definition and so we’re looking to better understand those. Another important question relates to the long-term outcomes of children not only with MIS-C, but also those who have recovered from acute COVID-19. There is such a big interest right now in post-COVID conditions, and that’s largely centered on adults, but we’re also studying long term implications of COVID-19 and MIS-C in children.
What advice do you have for others who may be uncertain about their future direction in pediatric ID?
I’ve talked to a lot of people about that very question in the last couple of years. I’m a person who likes predictability and stability in life, but I think that perhaps the route to where I am now would best be described as “prepared unpredictability.” I feel like the best advice is to prepare yourself by learning about things you’re passionate about, because you never know where that might lead you. I think the mentors who cared about me and taught me along the way have been very intentional, and I would encourage people to find mentors like that in their lives. Whatever it is that you love about those people and want to emulate tells you a lot about your own strengths, passions, and aptitudes.
I’ve realized two things lately. One, I’m learning new things over this past year and I want to continue to learn and grow because it’s never too late to do that. Second, I’m also realizing that for myself and those who are my peers in training and age, we are now “those people” that I used to look up to …we’re in that level of our careers where we should be the mentors for the students and residents and fellows and junior colleagues we work with. That’s now our responsibility. I hope that I can play a part in helping guide those amazing junior people to best understand what motivates them and how to use their talents to make a difference in public health or clinical medicine (or both!).